On qualitative differences in learning: IV -- effects of intrinsic motivation and extrinsic test anxiety on process and outcome.
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Anxiety↗
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By carrot or by stick: cognitive reinforcement learning in parkinsonism.
To what extent do we learn from the positive versus negative outcomes of our decisions? The neuromodulator dopamine plays a key role in these reinforcement learning processes. Patients with Parkinson's disease, who have depleted dopamine in the basal ganglia, are impaired in tasks that require learning from trial and error. Here, we show, using two cognitive procedural learning tasks, that Parkinson's patients off medication are better at learning to avoid choices that lead to negative outcomes than they are at learning from positive outcomes. Dopamine medication reverses this bias, making patients more sensitive to positive than negative outcomes. This pattern was predicted by our biologically based computational model of basal ganglia-dopamine interactions in cognition, which has separate pathways for "Go" and "NoGo" responses that are differentially modulated by positive and negative reinforcement.
Aged↗
Lipid-lowering therapy and the patient with multiple risk factors: what have we learned from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)?
The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) was the first trial of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) to assess the benefits of lipid lowering in the primary prevention of coronary heart disease (CHD) in patients with hypertension who were not deemed to have dyslipidemia by conventional measures. A total of 19,342 patients with hypertension and > or =3 cardiovascular risk factors, but without CHD, were enrolled in ASCOT. Of these, 10,305 patients with a serum cholesterol level of < or =250 mg/dL (< or =6.5 mmol/L) were randomized to either atorvastatin (10 mg/day) or placebo in the ASCOT lipid-lowering arm (ASCOT-LLA). Follow-up was planned for an average of 5 years. The ASCOT-LLA was stopped after 3.3 years owing to the superiority of atorvastatin 10 mg over placebo in reducing the primary end point of nonfatal myocardial infarction (MI) and fatal CHD. Patients receiving atorvastatin experienced a significant reduction in total cholesterol (50 mg/dL [1.3 mmol/L]) and low-density lipoprotein cholesterol (46 mg/dL [1.2 mmol/L]) levels after 1 year compared with those who received placebo. Cholesterol lowering with atorvastatin was associated with a highly significant reduction in the primary end point of nonfatal MI and fatal CHD (36%, P = 0.0005). The observed benefit was consistent across the secondary end points and the 18 prespecified subgroups. The ASCOT-LLA findings have influenced lipid-lowering guidelines and support the concept that treatment strategies to reduce cardiovascular disease should be based on the assessment of all cardiovascular risk factors, rather than on numerical thresholds of individual risk factors, to determine treatment strategies.
Adult↗
Ruptured intracranial aneurysms--learning from experience.
The outcome of treatment of 400 consecutive patients with ruptured intracranial aneurysms was assessed at 1 year. The patients were treated by a single surgeon over a period of 13 years. Data sheets completed as each patient was treated included a contemporary analysis of the reasons for any unsatisfactory outcome. Surgery was usually delayed for over 10 days from the last haemorrhage. Over the four successive 100-patient cohorts, in which the composition of the patient population remained unaltered, 1 year overall management mortality fell steadily from 38 to 24%. One year surgical mortality fell from 19 to 3%. The population of those operated on who were in Glasgow Outcome Score 5 at 1 year rose from 73 to 90% (from 51 to 71% for all patients). Of the 123 deaths, 89 occurred prior to operation, 24 after it. Thirty-five patients died from rebleeding prior to operation, but only eight of these occurred in patients judged fit for surgery at the time. All but one of the postoperative deaths resulted from technical problems related to the surgery. Over the successive cohorts, several factors indicated an improvement in operative efficiency, notably a fall in the proportion of cases with technical problems from 15 to 1%. We have demonstrated a steady improvement in management results, resulting largely from increasing operative experience. We do not believe that changes in overall management strategy, such as early surgery, would have any effect on overall outcome.
Adult↗
Correlated coding of motivation and outcome of decision by dopamine neurons.
We recorded the activity of midbrain dopamine neurons in an instrumental conditioning task in which monkeys made a series of behavioral decisions on the basis of distinct reward expectations. Dopamine neurons responded to the first visual cue that appeared in each trial [conditioned stimulus (CS)] through which monkeys initiated trial for decision while expecting trial-specific reward probability and volume. The magnitude of neuronal responses to the CS was approximately proportional to reward expectations but with considerable discrepancy. In contrast, CS responses appear to represent motivational properties, because their magnitude at trials with identical reward expectation had significant negative correlation with reaction times of the animal after the CS. Dopamine neurons also responded to reinforcers that occurred after behavioral decisions, and the responses precisely encoded positive and negative reward expectation errors (REEs). The gain of coding REEs by spike frequency increased during learning act-outcome contingencies through a few months of task training, whereas coding of motivational properties remained consistent during the learning. We found that the magnitude of CS responses was positively correlated with that of reinforcers, suggesting a modulation of the effectiveness of REEs as a teaching signal by motivation. For instance, rate of learning could be faster when animals are motivated, whereas it could be slower when less motivated, even at identical REEs. Therefore, the dual correlated coding of motivation and REEs suggested the involvement of the dopamine system, both in reinforcement in more elaborate ways than currently proposed and in motivational function in reward-based decision-making and learning.
Action Potentials↗
The development of a questionnaire to assess the readiness of health care students for interprofessional learning (RIPLS).
OBJECTIVES: Although shared learning activities are gradually being introduced to health care undergraduates, it has not been possible to measure the effects of educational interventions on students' attitudes. The main objective of this study was to develop a rating scale using items based on the desired outcomes of shared learning, to assess the 'readiness' of health care students for shared learning activities. DESIGN AND PARTICIPANTS: A questionnaire study of 120 undergraduate students in 8 health care professions. RESULTS: Principal components analysis resulted a 3-factor scale with 19 items and having an internal consistency of 0.9. The factors have been initially named 'team-working and collaboration', 'professional-identity' and 'professional roles'. CONCLUSIONS: The new scale may be used to explore differences in students' perception and attitudes towards multi-professional learning. Further work is necessary to validate the scale amongst a larger population.
Female↗
[Follow-up results and learning curve in laparoscopic gastrofundoplications].
AIM OF THE STUDY: To analyze the postoperative results and the learning curve of laparoscopic gastrofundoplications by postoperative clinical monitoring of consequences and self-evaluation of complaints 12 months after surgery. METHODS: One hundred patients (58 female and 42 male) were operated at the Department of Surgery, Hospital of Kaunas University of Medicine, from April 1998 to January 2001 because of hiatal hernias, complicated with gastroesophageal reflux (in 59 cases sliding axial non-fixed, in 38 cases sliding axial fixed, and in 3 cases paraesophageal hernias were found). 89 Nissen and 11 Toupet fundoplications were performed. Patients were distributed into five groups (20 patients in each). Operation time, number of postoperative complications, postoperative hospital stay were analyzed. RESULTS: The mean operation time was 198 min in the 1 st group, 105 min in the 2 nd group, 110 min in the 3 rd group, 124 min in the 4 th group and 120 min in the 5 th group. Conversion to laparotomy was necessary in two cases (the 1 st and the 2 nd groups). The number of postoperative complications decreased from 5 in the 1 st group to 2 in the 2 nd group, and to 1 in the 3 rd and 4 th groups; no complications were noted in the 5 th group. According patient's opinion, successful results were received in 87 %. CONCLUSIONS: Laparoscopy is a good approach for surgical management of hiatal hernias complicated with gastroesophageal reflux, but laparoscopic gastrofundoplication needs advanced skills to be performed safely. The learning curve in terms of operation time covered initial 20 procedures and remained stable afterwards, the number of postoperative complications decreased after initial 20 operations, but dangerous complications occurred until the 60 th procedure. Other conventional elective surgical procedures of medium extent can be successfully performed simultaneously with laparoscopic fundoplication without affecting the outcome. The true learning curve of laparoscopic fundoplication can be drawn by careful follow-up and analysis of long-term postoperative results; this enables to improve operative techniques.
Adult↗
Speech and language in Wolf-Hirschhorn syndrome: a case-study.
UNLABELLED: Wolf-Hirschhorn syndrome (WHS), a condition resulting from a distal deletion of the short arm of chromosome 4, is usually associated with a severe phenotypic expression including multiple malformations, delayed psychomotor development, and profound learning disabilities. As far as communicative development is concerned, speech is usually absent and comprehension is limited to simple orders or to a specific context. There is some suggestion, however, that the developmental outcome in WHS depends on deletion size. This paper reports on an individual with WHS illustrating that a smaller deletion may result in a milder phenotype with respect to communicative abilities. This 10-year-old girl developed speech and language to a considerable degree. Although most children with this syndrome are severely limited in communicative abilities, the school-based speech-language pathologist working with a special education caseload may encounter WHS children with smaller deletions (and thus less severe phenotypes) who may profit from speech language pathology services. LEARNING OUTCOMES: The reader will learn about the genetics, incidence, and clinical characteristics of Wolf-Hirschhorn syndrome, and about the communicative abilities and genotype/phenotype correlations in children with this syndrome.
Carrier Proteins↗
Outcome-specific conditioned inhibition in Pavlovian backward conditioning.
In the present experiments, the outcome specificity of learning was explored in an appetitive Pavlovian backward conditioning procedure with rats. The rats initially were administered Pavlovian backward training with two qualitatively different unconditioned stimulus conditioned-stimulus (US-CS) pairs of stimuli (e.g., pellet --> noise or sucrose --> light), and then the effects of this training were assessed in Pavlovian-to-instrumental transfer (Experiment 1) and retardation-of-learning (Experiment 2) tests. In the transfer test, it was shown that during the last 10-sec interval, the CSs selectively reduced the rate of the instrumental responses with which they shared a US, relative to the instrumental responses with which they did not share a US. The opposite result was obtained when the USs (in the absence of the CSs) were presented noncontingently. In the retardation test, conditioned magazine approach, responding to the CSs was acquired more slowly when the stimulus-outcome combinations in the backward and the forward conditioning phases were the same, as compared with when they were reversed. These results are collectively in accord with the view that Pavlovian backward conditioning can result in the formation of outcome-specific inhibitory associations. Alternative views of backward conditioning are also examined.
Animals↗
Functional outcomes in self-care, mobility, communication, and learning in extremely low-birth weight infants.
Gaps have existed in specifying degrees of severity of cerebral palsy assessment of self-care and communicative competencies, and specifying age-appropriate preschool educational and behavioral competencies. Imbedded in the concept of measuring functional status is the interaction between health and neurologic impairments, developmental challenges and competencies, family resources and disadvantages, and the child's current status. In reviewing historic outcomes of severe ROP over the past 40 years, it was noted that severe ROP caused blindness in 2% to 11% of survivors. There was a constant observation that approximately 50% of severe ROP survivors with blindness had multiple functional and developmental challenges beyond blindness alone. Similarly, in reviewing outcomes of cerebral palsy, it is imperative to describe the severity of cerebral palsy and functional consequences in motor, selfcare, communication, and learning. The reason to measure the functional status of children with neurodevelopmental impairments before first grade is that the degrees of severity of these disorders can be specified before attending school with peers. Subtler aspects of neurodevelopmental impairments need to assess impact on literacy, information learning, written language, social competencies with peers, and recreational and community participation. In this way, we can understand the vulnerabilities and resiliences of children and families of VLBW and ELBW status. This is a critical step in understanding long-term quality of life and independent living issues. In addition, our efforts can address those factors and pathways whereby multiple disabilities and multiple functional limitations cluster. Our biomedical intervention can prioritize strategies that lessen severe multiple disabilities and simultaneously support families, when despite our best efforts functional challenges are life long.
Activities of Daily Living↗
Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial.
OBJECTIVE: To assess neurological sequelae in patients with all grades of carbon monoxide (CO) poisoning after treatment with hyperbaric oxygen (HBO) and normobaric oxygen (NBO). DESIGN: Randomised controlled double-blind trial, including an extended series of neuropsychological tests and sham treatments in a multiplace hyperbaric chamber for patients treated with NBO. SETTING: The multiplace hyperbaric chamber at the Alfred Hospital, a university-attached quarternary referral centre in Melbourne providing the only hyperbaric service in the State of Victoria. PATIENTS: All patients referred with CO poisoning between 1 September 1993 and 30 December 1995, irrespective of severity of poisoning. Pregnant women, children, burns victims and those refusing consent were excluded. INTERVENTION: Daily 100-minute treatments with 100% oxygen in a hyperbaric chamber--60 minutes at 2.8 atmospheres absolute for the HBO group and at 1.0 atmosphere absolute for the NBO group--for three days (or for six days for patients who were clinically abnormal or had poor neuropsychological outcome after three treatments). Both groups received continuous high flow oxygen between treatments. MAIN OUTCOME MEASURES: Neuropsychological performance at completion of treatment, and at one month where possible. RESULTS: More patients in the HBO group required additional treatments (28% v. 15%, P = 0.01 for all patients; 35% v. 13%, P = 0.001 for severely poisoned patients). HBO patients had a worse outcome in the learning test at completion of treatment (P = 0.01 for all patients; P = 0.005 for severely poisoned patients) and a greater number of abnormal test results at completion of treatment (P = 0.02 for all patients; P = 0.008 for severely poisoned patients). A greater percentage of severely poisoned patients in the HBO group had a poor outcome at completion of treatment (P = 0.03). Delayed neurological sequelae were restricted to HBO patients (P = 0.03). No outcome measure was worse in the NBO group. CONCLUSION: In this trial, in which both groups received high doses of oxygen, HBO therapy did not benefit, and may have worsened, the outcome. We cannot recommend its use in CO poisoning.
Adult↗
Design of future acute-stroke treatment trials.
Very few trials of acute stroke treatments show efficacy of a tested agent on the prespecified primary outcome. We can learn many lessons from the studies that achieve only neutral results. Preclinical studies have been flawed by use of models of transient not permanent brain ischaemia, treatments that aim to protect cerebral grey matter independently of white matter, delivery of the study drug within too short a time window after ischaemic insult, use of surrogate outcome measures in the short term instead of function in the long-term, and small sample sizes. Clinical trials have been hampered by heterogeneity in causes of stroke and inability to classify subtypes of cause; the short time available to rescue ischaemic brain tissue; the haemorrhagic transformation that can cause severe functional consequences seen frequently in infarcted brain tissue; the lack of valid, reliable, sensitive, and simple tools for assessment of functional outcome; and, above all, small treatment effects that are difficult to detect or refute. In this review, we look at the designs and results of all controlled trials of treatments for ischaemic stroke, and try to identify opportunities to improve future treatment assessment.
Clinical Trials as Topic↗
Naloxone ameliorates the learning deficit induced by pentylenetetrazol kindling in rats.
Endogenous opioid peptides modulate and regulate processes of central excitability. Furthermore, opioids are thought to interfere with processes of learning and memory storage. In order to study the effects of endogenous opioids on both processes we injected in the course of development of pentylenetetrazol kindling the opiate receptor antagonist naloxone, and tested the animals afterwards in a shuttle-box task. It was found that naloxone pretreatment had dissociative effects. There was no effect on seizure outcome, whereas the learning deficit was ameliorated in the kindled group. The data suggest that endogenous opioid peptides contribute to the learning deficit found in pentylenetetrazol-kindled rats.
Animals↗
Assessing Australian undergraduate clinical learning.
Determining the clinical preparedness of undergraduate nursing students is vital in developing graduates who are ready to assume the roles of registered nurses. This paper reports findings relating to clinical assessment in Australian undergraduate nursing programs. Using data collected in a national survey and selected case studies, current assessment practices are described. Although students were increasingly exposed to a narrower range of clinical experiences, claims to comprehensive preparation of nurses remain prominent. Issues in the congruity between assessment methods and purported outcomes of clinical learning programs are discussed.
Australia↗
Pre-registration midwifery programmes: a case study evaluation of the non-midwifery placements.
OBJECTIVE: to evaluate the effectiveness of non-midwifery placements in enabling pre-registration (direct entry) student midwives to learn about caring for childbearing women with medical, surgical or mental health problems and needs. DESIGN: case study. SETTING: a large midwifery education department and three acute general hospitals in England. PARTICIPANTS: 15 student midwives in the first intake of one college's three-year diploma programme in midwifery plus the practitioners involved in their education. MAIN OUTCOME MEASURES: the learning needs of student midwives, who have no previous health-care experience, to enable them to care effectively for women with medical/surgical/mental health problems; the teaching processes and learning opportunities related to these aspects of care; how the views of teachers and practice placement staff compare with those of the students; the factors that influence the teaching and learning processes and experiences for pre-registration student midwives. FINDINGS: the broad range of experiences in medical/surgical/metal health placements enabled students to increase in maturity, and confidence and develop their communication skills. The variety of placements enhanced student understanding of the multi-disciplinary team's contribution to health care, students learned new practical skills which were transferable to maternity care contexts and all students had opportunities to care for adults with most of the medical/surgical/mental health problems seen in childbearing women. CONCLUSION: this action research project provided data for curriculum development and helped to avoid premature reaction to individual staff and student response. The value of the medical/surgical/mental health placements and the importance of staff and student preparation for effective learning was established. Whilst it might be essential to identify what and where student midwives should learn, it would appear that developing each student must be an equal, if not greater, priority for curriculum designers.
Adult↗
Service-learning, personal development, and social commitment: a case study of university students in Hong Kong.
Service-learning, which combines academic study with community service, is becoming increasingly popular throughout the world. It is ideally suited to achieving both the personal and academic goals of students and the broader goals of civic responsibility and social justice. This paper describes the design of a local service-learning program the author implemented at a university in Hong Kong. Based on survey data collected from 93 university student participants in the program, it illustrates the impact of service-learning on student outcomes. Results show that the majority of the students benefitted as follows: (1) By developing personal autonomy through real world experiences, students develop a recognition of and faith in their potential. It enhances self-assurance, assumption of new responsibilities, and achievement of individual growth. (2) Students move toward becoming responsible citizens and agents of social change. By learning to care for deprived groups in the community, they are assuming meaningful roles and responding to real issues in ways that have a long-lasting impact on their own lives. Recommendations, based on the shortcomings we have witnessed and the changes we have implemented, are also made.
Achievement↗
From teaching to learning in a mobile, wireless world.
What research evidence justifies this shift from teaching to learning in the mobile, wireless world? We do not need evidence to answer questions such as, "Will the mobile, wireless device technology support teaching and learning?" (we already know it will), or "Will distance learning with mobile, wireless devices be as effective as that in the classroom?" (abundant evidence indicates there will be no significant differences). However, we do need to know, "How can we use these learning technologies to improve student learning and the outcomes of our academic programs?" Answers to this question will ultimately help educators prepare students to deliver safe and competent patient care in the mobile, wireless world.
Cell Phone↗
Avoidance performance, cue and response-choice discrimination after neuroleptic treatment.
The effects of pimozide on discriminated avoidance performance in a Y-maze were evaluated in mice. Relatively low doses of pimozide (0.4 mg/kg) retarded acquisition of an active avoidance response. The avoidance deficit induced by this dosage was largely eliminated among mice that had received either 1 or 2 previous avoidance training sessions, but was still evident in mice treated with a higher drug dosage (0.8 mg/kg). If mice were initially trained in the drug condition, the disruptive effects were still evident in a later test conducted in the absence of the drug treatment. In contrast to the avoidance deficits, pimozide did not disrupt the acquisition or the performance of a cue- or response-choice discrimination. That is, once a running response was initiated (on avoidance trials) pimozide treated animals appeared capable of appropriately directing the response. It is suggested that at the dosages used pimozide did not affect S-S learning or learning response-outcome contingencies, but rather hindered performance owing to deficits in response initiation processes. Moreover, within a task involving aversive motivation pimozide did not appear to reduce the reinforcement derived for correct responding.
Animals↗