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At least 1,135 records · Page 63Linked to original sources
PubMed2002

Born to fear: non-associative vs associative factors in the etiology of phobias.

Poulton and Menzies (Behaviour Research & Therapy 40 (2001) 127-149) review two lines of evidence as supporting a non-associative pathway to the origins of "evolutionary relevant phobias". First, in retrospective studies of mode of onset some recall they have always had this fear. We review here solid evidence that retrospective recall is notoriously unreliable. Second, they note as many nonphobics recall relevant associative learning experiences as do phobics. We argue such studies are very inconclusive because they fail to consider many experiential and personality vulnerability (and invulnerability) factors that strongly impact the outcome of any putative learning experience. Their argument also does not explain the transition from developmental fears to phobias that is central to their thesis. Overall, we call for major methodological improvements in this area, in the context of theoretical developments pointing to interacting vulnerability and invulnerability factors.

Conditioning, Psychological↗
PubMed2005

Robotic radical prostatectomy in the community setting--the learning curve and beyond: initial 200 cases.

PURPOSE: The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. We report on our experience with robotic radical prostatectomy in the community setting. MATERIALS AND METHODS: A total of 200 patients underwent robotic radical prostatectomy during 18 months. Prospective data collection included a quality of life (Expanded Prostate Cancer Index Composite) questionnaire, basic demographics, prostate specific antigen (PSA), clinical stage and Gleason grade. Operative outcome measures included operative time, estimated blood loss and complications. Postoperative outcome measures included hospital stay, catheter time, pathology, PSA and return of continence. RESULTS: Average operative time was 141 minutes with an estimated blood loss of 75 cc. The intraoperative complication rate was 1% with no mortality, reexploration or transfusion. Of the patients 95% were discharged home on postoperative day 1 (1 to 3) with hematocrit averaging 34.5 (range 25 to 45). The average difference in preoperative and postoperative hematocrit was 3 points (range -2 to 15). Average catheter time was 7.2 days (range 5 to 15). The positive margin rate was 10.5% for the entire series, 5.7% for T2 tumors, 28.5% (T3a), 20% (T3b) and 33% (T4a). Of the patients 95% had undetectable PSA (less than 0.1 ng/ml) at average followup of 9.7 months. Continence at 1, 3, 6, 9 and 12 months was 47%, 78%, 89%, 92% and 98%, respectively. CONCLUSIONS: Our initial experience with robotic radical prostatectomy is promising. The learning curve was approximately 20 to 25 cases. With a structured methodical approach we were able to implement robotics safely and effectively into our community practice with minimal patient morbidity, and good oncological and functional outcomes.

Adult↗
PubMed2004

The role of the lateral frontal cortex in causal associative learning: exploring preventative and super-learning.

Prediction error--a mismatch between expected and actual outcome--is critical to associative accounts of inferential learning. However, it has proven difficult to explore the effects of prediction error using functional magnetic resonance imaging (fMRI) while excluding the confounding effects of stimulus novelty and incorrect responses. In this event-related fMRI study we used a three-stage experiment generating preventative- and super-learning conditions. In both cases, it was possible to generate prediction error within a causal associative learning experiment while subtracting the effects of novelty and error. We show that right lateral prefrontal cortex (PFC) activation is sensitive to the magnitude of prediction error. Furthermore, super-learning activation in this region of PFC correlates, across subjects, with the amount learned. We thus provide direct evidence for a brain correlate of the surprise-dependent mechanisms proposed by associative accounts of causal learning. We show that activity in right lateral PFC is sensitive to the magnitude, though not the direction, of the prediction error. Furthermore, its activity is not directly explicable in terms of novelty or response errors and appears directly related to the learning that arises out of prediction error.

Adult↗
PubMedDate not supplied

Maintaining the relationship between science and special education.

Science has been an important partner of the field of learning disabilities since its inception. Special educators have used science to confirm or reject approaches to identifying and teaching students with disabilities. Current research and practice is using science to find better approaches to preventing learning difficulties and reducing the number of students referred for special education. However, I caution that if we want science to have the desired impact on the educational and social outcomes of students with learning disabilities, we must take care not to misuse it.

Education, Special↗
PubMedDate not supplied

Group therapy in the treatment of diabetes.

The psychological burden imposed by diabetes is large but is often ignored by health care professionals who concentrate on its technical aspects. In this article we review the need for psychosocial support in the treatment of diabetes. Group psychotherapy, although most widely used in psychiatry, was in fact started by a physician almost 80 yr ago and has been used as an adjunct to the management of many medical conditions. Limited experience of group psychotherapy among diabetic patients has given encouraging results. Issues remain, however, as to which groups of patients might benefit most, who should act as group leader, and how one can best assess outcome.

Adolescent↗
PubMedDate not supplied

Pittsburgh Regional Healthcare Initiative: a systems approach for achieving perfect patient care.

The Pittsburgh Regional Healthcare Initiative (PRHI) is an innovative model for health system change based on regionwide shared learning. By linking patient outcomes data with processes of care and sharing that information widely, PRHI supports measurable improvements in regionwide clinical practice and patient safety. In addition, through the redesign of problem solving at the front lines of care, PRHI helps health care organizations to evolve toward becoming sustainable systems of perfect patient care. This paper describes PRHI's design for change, reviews the progress and limitations of the shared learning model, and offers a set of broader policy considerations.

Humans↗
PubMed2004

Interactive computer-assisted instruction vs. lecture format in dental education.

PURPOSE: The purpose of this study was to compare computer-assisted instruction (CAI) with lecture format using recent hardware and software advances. A pre- and post-test was used to determine student performance and instructional preference. In addition, a post-instruction survey was used to determine student learning preferences. METHODS: Seventy-five first-year University of North Carolina (UNC) dental students who were registered for the introductory radiology course were asked to participate. All agreed and were randomly placed in one of three groups: interactive CD only, interactive CD and lecture, and lecture only. The content of the multimedia instruction focused on intraoral radiography. A pre- and post-test was administered to determine if there was a significant difference between interactive CD and lecture formats, and an evaluation instrument was used to determine if there was a student learning preference between CAI and lecture format. Analysis of covariance and the sign test were used to determine significance (p<.05). RESULTS: There was no significant difference between pre- and post-test outcomes, indicating that similar learning took place using the interactive CD and/or lecture format. However, students preferred CAI to lecture format.

Analysis of Variance↗
PubMed2006

Aging, working memory, and discrimination learning.

Older adults easily learn probabilistic relationships between cues and outcomes when the predictive event is the occurrence of a cue, but have greater difficulty when the predictive event is the nonoccurrence of a cue (Mutter & Pliske, 1996; Mutter & Plumlee, 2004; Mutter & Williams, 2004). This study explored whether this age-related deficit occurs in a simpler learning context and whether it might be related to working memory (WM) decline. We gave younger and older adults simultaneous discrimination tasks that allowed us to compare their ability to learn deterministic relationships when either the occurrence (feature positive; FP) or the nonoccurrence (feature negative; FN) of a distinctive feature predicted reinforcement. We also included a group of younger adults who performed the discrimination tasks under a concurrent WM load. Both age and WM load had a detrimental effect on initial FP and FN discrimination; however, these effects persisted only in FN discrimination after additional learning experience. Learning predictive relationships requires inductive reasoning processes that apparently do not operate as efficiently in individuals with reduced WM capacity. The impact of WM decline may ultimately be greater for negative cue-outcome relationships because learning these relationships requires more difficult inductive reasoning processes, which place greater demands on WM.

Adult↗
PubMed2004

Sexual and nonsexual offenders with intellectual and learning disabilities: a comparison of characteristics, referral patterns, and outcome.

This article reports an evaluation of a community intellectual disability offender service over the period from 1990 to 2001. Men who committed sex offenses or sexually abusive incidents (n = 106) and men who committed other types of offenses and serious incidents (n = 78) are compared on personal characteristics, referral sources, forensic details, and outcome up to 7 years after referral. The cohorts are older than one would expect from the criminology literature, and, at about 33%, the incidence of mental illness is consistent with some previous studies. A greater proportion of sex offenders had criminal justice involvement and a formal disposal from court. Fire raising was not overly represented as an offense. There was a higher rate of reoffending in the nonsexual cohort, which persisted up to 7 years. Investigating only reoffenders, there was a considerable amount of harm reduction recorded up to 7 years, statistically significant up to 5 years following initial referral.

Adult↗
PubMed1998

A comparison of multimedia and standard advanced cardiac life support learning.

OBJECTIVES: To compare student performance after Multimedia ACLS Learning System (MM) education compared with that after standard (ST) ACLS education. METHODS: Final-year medical students were divided into 2 groups based on convenience scheduling and given ACLS instruction either in a standard format or with the MM course. The sizes of the small groups and the times in small-group instruction were identical. All students were evaluated with the same 50-item multiple-choice written examination, a structured evaluation immediately after the management of a mock cardiac arrest, and a second structured evaluation of the same mock arrest (videotaped) by an instructor blinded to the education method. Students were assigned a mark from 1 to 5 in each of 4 domains: assessment, immediate priorities, continual assessment, and leadership. RESULTS: 75 students took the MM and 38 took the ST course. The mean +/- SD mark for the multiple-choice test was 89.3 +/- 4.9% (MM) vs 89.3 +/- 4.8% (ST); the on-site mock arrest evaluation mark (20 maximum) was 14.1 +/- 2.5 (MM) vs 14.1 +/- 2.0 (ST); and the blinded mock arrest evaluation was 13.1 +/- 2.9 (MM) vs 14.4 +/- 2.9 (ST) (p = 0.024). 1/75 (MM) vs 0/38 (ST) did not successfully complete the on-site mock arrest evaluation. More students in the MM group (46% vs 25%) required multiple attempts to successfully complete the mock arrest evaluation (p < 0.02). CONCLUSION: In medical students with no previous ACLS training, structured access to the multimedia ACLS Learning System provides immediate educational outcomes similar to those of a standard ACLS course. Multimedia computer-interactive learning should be enhanced with a short period of hands-on practice.

British Columbia↗
PubMed2006

Forward blocking in human learning sometimes reflects the failure to encode a cue-outcome relationship.

In two "allergist" causal judgement experiments, participants were trained with a blocking design (A+|AB+). The procedure allowed different food cues to be paired with different fictitious allergic reactions. On test, participants were asked to rate the causal efficacy of the target cues and to recall the particular allergic reaction (outcome) that had followed each cue during training. Forward blocking was observed on the causal judgement measure and on the outcome recall measure in both Experiment 1 and Experiment 2. A backward blocking contingency was also trained in Experiment 2 (AB+|A+). Backward blocking was not observed either on the causal judgement or on the outcome recall measure. The evidence from the recall measure suggests that forward blocking in this task results from a failure to encode the B-outcome relationship during training. Associative and nonassociative mechanisms of forward blocking are discussed.

Association↗
PubMed1991

Rehabilitation in spinal cord disorders. 4. Outcomes and issues of aging after spinal cord injury.

This self-directed learning module highlights current concepts in outcomes and issues of aging in spinal cord injury. It is part of the chapter on rehabilitation in spinal cord disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This article includes discussion of the measurement of impairment, disability, and handicap, and outcomes with respect to employment, long-term adjustment, aging, life expectancy, and causes of death in spinal cord injury.

Adaptation, Psychological↗
PubMed2006

Web-based learning versus standardized patients for teaching clinical diagnosis: a randomized, controlled, crossover trial.

BACKGROUND: Little evidence exists to guide the selection of methods for teaching clinical diagnosis. PURPOSE: To compare the efficacy, student preference, and cost of a Web-based (WB) program versus a standardized patient (SP) encounter for teaching clinical diagnosis skills to 2nd-year medical students. METHODS: Randomized, controlled, crossover study comparing WB versus SP-based teaching for the clinical diagnosis of abdominal pain and headache. Outcome measures were performance on a 2-case SP examination (scored on the basis of a checklist completed by a faculty observer and an objective score on a postencounter subjective-objective assessment plan [SOAP] note), format preferences as assessed by end-of-course evaluations, and cost. RESULTS: Thirty students consented to participate. WB and SP training produced similar scores on both the Abdominal Pain checklist (66% vs. 62%; p = .17) and Headache checklist (56% vs. 63%; p = .07). WB training produced a higher score on the Abdominal Pain SOAP note (69% vs. 47%; p = .006), but not the Headache SOAP note (69% vs. 67%; p = .85). Students rated the SP format higher than the WB format on all 7 preference measures. Start-up costs were estimated at 2,190 dollars for the SP format and 2,250 dollars for the WB format. Ongoing costs per case per student were estimated to be 45 dollars for the SP format and 30 dollars for the WB format. CONCLUSIONS: WB and SP learning outcomes were comparable, but students preferred the SP format. Start-up costs were comparable, but the ongoing costs of the WB format were less expensive, suggesting that WB teaching may be a viable strategy.

Algorithms↗
PubMed2002

Tracking process and outcome results of BSW students' preparation for public child welfare practice: lessons learned.

A Texas university/agency partnership program to prepare social work students for public child welfare conducted an exploratory study of the process and outcome results of the program's efforts from 1989-99 and offers recommendations to other university/agency programs. The evaluation plan was multi-faceted, and the evaluation included both process and outcome components from the perspectives of each stakeholder-the agency, the university, the students, the clients, and the taxpayers. The paper concludes with recommendations for the future. The partnership acknowledges that these evaluation results have limitations and are not generalizable beyond this specific partnership. The lessons learned in this university/agency partnership are first steps in developing better partnerships to prepare students for public child welfare practice.

Child↗
PubMed2006

Facilitating the acquisition of UNDER by means of IN and ON--a training study in Polish.

Forty Polish children aged between 1;8 and 2;3 were trained over two training sessions in the comprehension of the preposition POD [UNDER]. In the experiment, two variables were manipulated: a within subjects variable of SITUATION and a between subjects variable of LINGUISTIC INPUT. The effect of situation could be found in all trained groups, showing that children's understanding in familiar and transfer situations differed significantly from the performance of the control group in the post-test. The results further suggest that depending on the type of a situation, the linguistic task requires different word learning abilities from a child.

Case-Control Studies↗
PubMed2005

Patient-specific models for predicting the outcomes of patients with community acquired pneumonia.

We investigated two patient-specific and four population-wide machine learning methods for predicting dire outcomes in community acquired pneumonia (CAP) patients. Predicting dire outcomes in CAP patients can significantly influence the decision about whether to admit the patient to the hospital or to treat the patient at home. Population-wide methods induce models that are trained to perform well on average on all future cases. In contrast, patient-specific methods specifically induce a model for a particular patient case. We trained the models on a set of 1601 patient cases and evaluated them on a separate set of 686 cases. One patient-specific method performed better than the population-wide methods when evaluated within a clinically relevant range of the ROC curve. Our study provides support for patient-specific methods being a promising approach for making clinical predictions.

Algorithms↗