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PubMedDate not supplied

Evaluation of an autotutorial-simulator program for instruction of hollow organ closure.

Forty students were randomly assigned into two study groups (traditional, T; and simulator, S) of 20 students each for a core operative practice laboratory. Students were randomly paired and their group assignment and identity remained anonymous to the evaluators throughout the study. Questionnaires were distributed to students to evaluate prior surgical experience and obtain learning resource use information. Before the evaluation sessions, both groups were given identical learning resource opportunities except students in Group S received hollow organ simulators and practice materials for gastrotomy closure. All students were forewarned that surgical instruction would not be available during the evaluation sessions. In the first live animal evaluation session, all student pairs were videotaped after which stomachs were harvested for gross evaluation of the surgical site. Group T performed an additional gastrotomy for video and gross evaluation 2 weeks later. Questionnaire, and gross and video evaluation results were compared statistically between groups and sessions. The hollow organ model did not suitably simulate live stomach tissue; the material was more fragile and stiff and suture cut-out was a problem even with appropriate suture tension and technique. The model was effective for teaching needle placement, instrument usage, creating proper tissue inversion, and methods to minimize instrument handling of tissue during gastrotomy closure. Prior practice with models did not boost student confidence during their live gastrotomy session. The autotutorials (ATs) were well received by students but did not sufficiently address how to manage mucosal eversion, suture tension, and bleeding encountered during live gastrotomy. AT viewing time positively correlated with mean total video score for Group T during both sessions. None of the students had prior experience performing hollow organ closure and no significant difference in experience level was evident between groups. Mean closure time was not significantly different between groups for session one (Group T, mean, 31.5 minutes, range, 18.4 to 53.4; Group S, mean, 28.2 minutes, range, 16.8 to 36), but was significantly reduced for session two (Group T, mean, 21.3 minutes, range, 13.9 to 31). This AT/simulator program does not significantly influence students' overall gastrotomy closure technique; gross and video evaluation scores were not significantly different between groups. Without instructor supervision, an additional gastrotomy experience did not improve surgical technique appreciably for Group T; however, these students performed the second procedure with more confidence and speed.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2003

[Current status in drug addiction and addiction memory research].

The central feature of drug addiction is compulsive drug use--loss of control over apparently voluntary acts of drug seeking and drug taking. Drug addiction, as a chronic brain disease, may result from abnormal engagement of long-term associative memory. Addiction and memory are likely to share much in common in the aspects of neural adaptations, synaptic plasticity, and related molecular mechanisms. This paper reviews the possible roles of learning mechanisms in the development of relapse, sensitization, and drug addiction, abnormal associative learning and compulsive behavior, addiction memory and addiction, multiple memory systems and the development of addiction, and emphasize the importance of synaptic plasticity and addiction memory in drug addiction. Addiction is characterized by the involvement of specific learning patterns of information. Addiction is closely related to the disorder of associate learning that depends on dopamine. Hippocampus may play a key role in addiction. At last, we put forward the future directions for research.

Adaptation, Physiological↗
PubMed1998

Association learning in the acute confusional state.

The usefulness of cognitive rehabilitative treatment in the acute stages after brain injury seems questionable because patients in severe acute confusional state early after coma clinically seem unable to learn and store new information. Therefore, the capability of patients in acute confusional state to learn and retain associative information was assessed. On two occasions pairs of simple nouns were presented to six patients in severe acute confusional state. Stimuli were presented repeatedly either in written form only or with additional pictorial representations. Immediate and 20 minutes delayed recall was measured. Patients in acute confusional state were able to learn progressively more word pairs across several presentations. They retained some information over an interval of 20 minutes. In addition, they learned and remembered pictorially supported associations better than pure verbal associations. Patients in severe acute confusional state may retain some explicit information and may profit from an imagery mnemonic aid. These results were not expected on the basis of clinical findings alone and they have potential implications for the care of patients in acute confusional state.

Adult↗
PubMed1998

Talker-specific learning in speech perception.

The effects of perceptual learning of talker identity on the recognition of spoken words and sentences were investigated in three experiments. In each experiment, listeners were trained to learn a set of 10 talkers' voices and were then given an intelligibility test to assess the influence of learning the voices on the processing of the linguistic content of speech. In the first experiment, listeners learned voices from isolated words and were then tested with novel isolated words mixed in noise. The results showed that listeners who were given words produced by familiar talkers at test showed better identification performance than did listeners who were given words produced by unfamiliar talkers. In the second experiment, listeners learned novel voices from sentence-length utterances and were then presented with isolated words. The results showed that learning a talker's voice from sentences did not generalize well to identification of novel isolated words. In the third experiment, listeners learned voices from sentence-length utterances and were then given sentence-length utterances produced by familiar and unfamiliar talkers at test. We found that perceptual learning of novel voices from sentence-length utterances improved speech intelligibility for words in sentences. Generalization and transfer from voice learning to linguistic processing was found to be sensitive to the talker-specific information available during learning and test. These findings demonstrate that increased sensitivity to talker-specific information affects the perception of the linguistic properties of speech in isolated words and sentences.

Humans↗
PubMed2004

Audiovisual speech facilitates voice learning.

In this research, we investigated the effects of voice and face information on the perceptual learning of talkers and on long-term memory for spoken words. In the first phase, listeners were trained over several days to identify voices from words presented auditorily or audiovisually. The training data showed that visual information about speakers enhanced voice learning, revealing cross-modal connections in talker processing akin to those observed in speech processing. In the second phase, the listeners completed an auditory or audiovisual word recognition memory test in which equal numbers of words were spoken by familiar and unfamiliar talkers. The data showed that words presented by familiar talkers were more likely to be retrieved from episodic memory, regardless of modality. Together, these findings provide new information about the representational code underlying familiar talker recognition and the role of stimulus familiarity in episodic word recognition.

Auditory Perception↗
PubMedDate not supplied

Implementing a Web-based information resource at an inner-city community church: lessons learned.

The objective of this project was to develop and implement electronic access to HIV/AIDS information resources at Glide Memorial Church in San Francisco, CA. This involved developing tailored Web-based access to the relevant information for the Glide Clinic patients. In addition, the project deployed workstations in 2 clinic areas and provided support to clinic patients as they learned to access the information resources. This article describes the experience with information retrieval in a clinic setting for underserved patients, including lessons learned, effective strategies, and anecdotes of effect on patients. Required nursing informatics competencies in this particular area are also addressed.

Attitude to Health↗
PubMed1996

Artificial grammar learning depends on implicit acquisition of both abstract and exemplar-specific information.

The contributions of exemplar-specific and abstract knowledge to artificial grammar learning were examined in amnesic patients and controls. In Experiment 1, grammatical rule adherence and chunk strength exerted separate effects on grammaticality judgments. Amnesic patients exhibited intact classification performance, demonstrating the same pattern of results as controls. In Experiment 2, amnesic patients exhibited impaired declarative memory for chunks. In Experiment 3, both amnesic patients and controls exhibited transfer when tested with a letter set different than the one used for training, although performance was better when the same letter sets were used at training and test. The results suggest that individuals learn both abstract information about training items and exemplar-specific information about chunk strength and that both types of learning occur independently of declarative memory.

Age Factors↗
PubMed2001

Assessing Medicare beneficiaries' readiness to make informed health plan choices.

The Transtheoretical Model (TTM, the "stage model") can guide development of programs to increase Medicare beneficiaries' readiness to make informed health plan choices. In this study, TTM staging algorithms were developed to assess readiness to engage in three types of informed choice: (1) learning about the Medicare program; (2) learning about Medicare health maintenance organizations (HMOs); and (3) reviewing different plan options. Stage of change based on all three algorithms is related to knowledge about the Medicare program and information-seeking. Findings provide evidence for the construct validity of the stage measures and for the applicability of the TTM to informed choice among beneficiaries.

Aged↗
PubMed1985

Remediation of memory disorders: experimental evaluation of the spaced-retrieval technique.

Research concerning remediation of memory disorders has frequently been concerned with mnemonic techniques that demand a great deal of elaborative and effortful processing. The present study examines a relatively simple technique, known as spaced retrieval, in which patients are taught to retrieve information at increasingly long temporal intervals after initial presentation. Results indicated that the spaced-retrieval technique aided patients' learning of new information. There was also evidence of learning to learn: Two of the four patients who were studied learned to use the technique in the absence of explicit cues from the experimenter. Issues pertaining to the possible usefulness of spaced retrieval in everyday life are discussed.

Adult↗
PubMed1992

Learning and retention of melodic and verbal information after unilateral temporal lobectomy.

The role of the temporal lobes in auditory memory was tested in two analogous tasks assessing learning and 24-hr delayed recognition of unfamiliar melodies and nonsense words. The performance of patients with either anterior right (RT) or left (LT) temporal lobectomy was impaired in learning and delayed recognition of both melodies and words, as compared to normal control subjects, although some preserved learning over successive trials was observed. These results suggest a bilateral temporal-lobe contribution to the learning of these auditory patterns. However, melodies and nonsense words were not recognized in the same way by the two patient groups after 24 hr: subjects in the LT group tended to improve on melodies but drop on words, whereas subjects with RT lesions displayed the reverse pattern, suggesting a differential role for each temporal lobe in long-term memory, according to the nature of the cues inherent to a given type of stimulus.

Adult↗
PubMed1994

Implicit learning.

Implicit learning is nonepisodic learning of complex information in an incidental manner, without awareness of what has been learned. Implicit learning experiments use 3 different stimulus structures (visual, sequence, and function) and 3 different dependent measures or response modalities (conceptual fluency, efficiency, and prediction and control). Implicit learning may require a certain minimal amount of attention and may depend on attentional and working memory mechanisms. The result of implicit learning is implicit knowledge in the form of abstract (but possibly instantiated) representations rather than verbatim or aggregate representations. Implicit learning shows biases and dissociations in learning different stimulus structures. The dependence of implicit learning on particular brain areas is discussed, some conclusions are drawn for modeling implicit learning, and the interaction of implicit and explicit learning is considered.

Concept Formation↗
PubMedDate not supplied

Indicators of success in distance education.

Distance education offers many advantages to students, faculty, and educational institutions. Despite these advantages, distance education classes historically have higher dropout rates than do the courses taught in the traditional, face-to-face setting. Current research includes information related to technology, teaching tips, and resources for these extended learning opportunities. However, information related to student success in distance education is limited and success indicators are poorly defined. Current studies on success indicators often lack a defining framework that provides an opportunity for study replication and strengthens the credibility of study findings. An empirical model developed by Powell et al divides potential determinants of success into three categories. This literature review identifies indicators in each category and indicates a need to revise the current framework to include technology as a fourth category. The revised framework should provide a basis for additional research in this rapidly growing area.

Attitude of Health Personnel↗
PubMed2006

The effects of distributional learning on rats' sensitivity to phonetic information.

During the first year of life, infants show decreased sensitivity to phonetic differences not used in their native language and increased sensitivity to the differences that are used. It has been shown that this change in speech perception is a function of the distributional properties of the input. The present study explores whether the mechanism responsible for the developmental changes regarding the organization of phonetic categories is a general mechanism shared with other animals. The results demonstrate that the distributional exposure to a phonetic continuum affects the subsequent discrimination of these phonemes in rats, indicating that the ability to use distributional cues to change the phonetic category structure extends beyond humans.

Animals↗
PubMed2006

Learning words: children disregard some pragmatic information that conflicts with mutual exclusivity.

Children tend to infer that when a speaker uses a new label, the label refers to an unlabeled object rather than one they already know the label for. Does this inference reflect a default assumption that words are mutually exclusive? Or does it instead reflect the result of a pragmatic reasoning process about what the speaker intended? In two studies, we distinguish between these possibilities. Preschoolers watched as a speaker pointed toward (Study 1) or looked at (Study 2) a familiar object while requesting the referent for a new word (e.g. 'Can you give me the blicket?'). In both studies, despite the speaker's unambiguous behavioral cue indicating an intent to refer to a familiar object, children inferred that the novel label referred to an unfamiliar object. These results suggest that children expect words to be mutually exclusive even when a speaker provides some kinds of pragmatic evidence to the contrary.

Child, Preschool↗
PubMed1992

Learning, retention and recall of clinical information.

A representative group of 33 medical students who were entering the junior year clerkships was tested for retention and recall of clinical information 3 months after taking an examination on the same subject. The students were not given an opportunity to review the subject. On 39 identical multiple choice test questions, the students' mean score declined 10 percentile points (P < 0.05) from that on the original examination. On 40 comparable but previously unseen questions, the mean score fell 19 percentile points from that attained 3 months earlier. On open-ended questions of clinical reasoning, a third component of the assessment, the students performed at a level similar to those on the two multiple choice tests, but with greater variability. These assessments give data on retention and recall that have not previously been reported in the literature. Correlations among individual test components were moderate (r = 0.52-0.63). There was inconsistency of individual students in scores on the component tests, and, thus, variability in performance by students was marked. Retention and recall were weakly predicted by results on an initial multiple choice examination. In addition, on a subsequent assessment of knowledge, results from different types of tests were inconsistent, suggesting that these tests evaluate different forms of competence.

Clinical Clerkship↗
PubMed2004

A new criterion using information gain for action selection strategy in reinforcement learning.

In this paper, we regard the sequence of returns as outputs from a parametric compound source. Utilizing the fact that the coding rate of the source shows the amount of information about the return, we describe l-learning algorithms based on the predictive coding idea for estimating an expected information gain concerning future information and give a convergence proof of the information gain. Using the information gain, we propose the ratio w of return loss to information gain as a new criterion to be used in probabilistic action-selection strategies. In experimental results, we found that our w-based strategy performs well compared with the conventional Q-based strategy.

Algorithms↗
PubMed1998

Early experience and learning curve associated with laparoscopic Nissen fundoplication.

BACKGROUND: Laparoscopic approach for hiatal hernia repair is relatively new. Information on the learning curve is limited. METHODS: From January 1994 to September 1996, 280 patients underwent antireflux surgery at our institution. A laparoscopic repair was attempted in 60 patients (21.4%). There were 38 men and 22 women. Median age was 49 years (range 21 to 78 years). Indications for operation were gastroesophageal reflux in 59 patients and a large paraesophageal hernia in one. A Nissen fundoplication was performed in all patients; 53 (88.3%) had concomitant hiatal hernia repair. RESULTS: In eight patients (13.3%) the operation was converted to an open procedure. Median operative time for the 52 patients who had laparoscopic repair was 215 minutes (range 104 to 320 minutes). There were no deaths. Complications occurred in five patients (9.6%). Median hospitalization was 2 days (range 1 to 5 days). Median operative time and median hospitalization were significantly longer in the first 26 patients than in the subsequent 25 patients (248 vs 203 minutes and 2 days vs 1 day, respectively; p = 0.03). Seven of the first 30 patients (23.3%) required laparotomy as compared with two of the second 30 (6.7%) (p = 0.07). Follow-up in the 51 patients who had laparoscopic fundoplication for reflux was complete in 50 (98.0%) and ranged from 7 to 38 months (median 13 months). Functional results were classified as excellent in 34 patients (68.0%), good in 6 (12.0%), fair in 7 (14.0%), and poor in 3 (6.0%). Three patients were reoperated on for recurrent reflux symptoms at 5, 5, and 11 months. CONCLUSIONS: We conclude that laparoscopic Nissen fundoplication can be performed safely. The operative time, hospitalization, and conversion rate to laparotomy are higher during the early part of the experience, but all are reduced after the learning curve.

Adult↗