Sample records for inappropriate focus cues

  1. Optical methods for enabling focus cues in head-mounted displays for virtual and augmented reality (United States)

    Hua, Hong


    Developing head-mounted displays (HMD) that offer uncompromised optical pathways to both digital and physical worlds without encumbrance and discomfort confronts many grand challenges, both from technological perspectives and human factors. Among the many challenges, minimizing visual discomfort is one of the key obstacles. One of the key contributing factors to visual discomfort is the lack of the ability to render proper focus cues in HMDs to stimulate natural eye accommodation responses, which leads to the well-known accommodation-convergence cue discrepancy problem. In this paper, I will provide a summary on the various optical methods approaches toward enabling focus cues in HMDs for both virtual reality (VR) and augmented reality (AR).

  2. Child-directed and nutrition-focused marketing cues on food packaging: links to nutritional content. (United States)

    Lapierre, Matthew A; Brown, Autumn M; Houtzer, Hunter V; Thomas, Tyler J


    We tested whether the presence of both child-targeted and nutrition-focused (i.e. parent-targeted) marketing cues on food packaging was associated with the nutritional content of these products. We conducted a quantitative content analysis of 403 food packages chosen randomly from the supermarket's online portal along with all products (n 312) from the cereal aisle in a supermarket from the Southeastern USA. We examined main and interaction effects for cues on nutritional content (e.g. energy density, sugar, sodium, fibre). A regional supermarket chain in the Southeastern USA. Tests of main effects indicated that increased presence of nutritional cues was linked to more nutritious content (e.g. less sugar, less saturated fat, more fibre) while the increased presence of child-targeted cues was uniformly associated with less nutritious content (e.g. more sugar, less protein, less fibre). Among the interaction effects, results revealed that products with increased nutrition-focused and child-targeted cues were likely to contain significantly more sugar and less protein than other products. Products that seek to engage children with their packaging in the supermarket are significantly less nutritious than foods that do not, while product packages that suggest nutritional benefits have more nutritious content. More importantly, the study provides evidence that those products which try to engage both child and parent consumers are significantly less healthy in crucial ways (e.g. more sugar, less fibre) than products that do not.

  3. Motivational cues predict the defensive system in team handball: A model based on regulatory focus theory. (United States)

    Debanne, T; Laffaye, G


    This study was based on the naturalistic decision-making paradigm and regulatory focus theory. Its aim was to model coaches' decision-making processes for handball teams' defensive systems based on relevant cues of the reward structure, and to determine the weight of each of these cues. We collected raw data by video-recording 41 games that were selected using a simple random method. We considered the defensive strategy (DEF: aligned or staged) to be the dependent variable, and the three independent variables were (a) numerical difference between the teams; (b) score difference between the teams; and (c) game periods. We used a logistic regression design (logit model) and a multivariate logistic model to explain the link between DEF and the three category independent variables. Each factor was weighted differently during the decision-making process to select the defensive system, and combining these variables increased the impact on this process; for instance, a staged defense is 43 times more likely to be chosen during the final period in an unfavorable situation and in a man advantage. Finally, this shows that the coach's decision-making process could be based on a simple match or could require a diagnosis of the situation based on the relevant cues. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Optical mapping near-eye three-dimensional display with correct focus cues (United States)

    Cui, Wei; Gao, Liang


    We present an optical mapping near-eye (OMNI) three-dimensional display method for wearable devices. By dividing a display screen into different sub-panels and optically mapping them to various depths, we create a multiplane volumetric image with correct focus cues for depth perception. The resultant system can drive the eye's accommodation to the distance that is consistent with binocular stereopsis, thereby alleviating the vergence-accommodation conflict, the primary cause for eye fatigue and discomfort. Compared with the previous methods, the OMNI display offers prominent advantages in adaptability, image dynamic range, and refresh rate.

  5. Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups. (United States)

    Yap, Tracey L; Kennerly, Susan; Corazzini, Kirsten; Porter, Kristie; Toles, Mark; Anderson, Ruth A


    The purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours. The Diffusion of Innovation (DOI) model guided staff interviews about their perceptions of the intervention's characteristics, outcomes, and sustainability. This was a qualitative, observational study of staff perceptions of the PrU prevention intervention conducted in Midwestern U.S. LTC facilities (N = 45 staff members). One focus group was held in each of eight intervention facilities using a semi-structured interview protocol. Transcripts were analyzed using thematic content analysis, and summaries for each category were compared across groups. The a priori codes (observability, trialability, compatibility, relative advantage and complexity) described the innovation characteristics, and the sixth code, sustainability, was identified in the data. Within each code, two themes emerged as a positive or negative response regarding characteristics of the innovation. Moreover, within the sustainability code, a third theme emerged that was labeled "brainstormed ideas", focusing on strategies for improving the innovation. Cueing LTC staff using music offers a sustainable potential to improve PrU prevention practices, to increase resident movement, which can subsequently lead to a reduction in PrUs.

  6. Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups

    Directory of Open Access Journals (Sweden)

    Tracey L. Yap


    Full Text Available The purpose of the manuscript is to describe long-term care (LTC staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours. The Diffusion of Innovation (DOI model guided staff interviews about their perceptions of the intervention’s characteristics, outcomes, and sustainability. Methods: This was a qualitative, observational study of staff perceptions of the PrU prevention intervention conducted in Midwestern U.S. LTC facilities (N = 45 staff members. One focus group was held in each of eight intervention facilities using a semi-structured interview protocol. Transcripts were analyzed using thematic content analysis, and summaries for each category were compared across groups. Results: The a priori codes (observability, trialability, compatibility, relative advantage and complexity described the innovation characteristics, and the sixth code, sustainability, was identified in the data. Within each code, two themes emerged as a positive or negative response regarding characteristics of the innovation. Moreover, within the sustainability code, a third theme emerged that was labeled “brainstormed ideas”, focusing on strategies for improving the innovation. Implications: Cueing LTC staff using music offers a sustainable potential to improve PrU prevention practices, to increase resident movement, which can subsequently lead to a reduction in PrUs.

  7. Textures shape the attentional focus: evidence from exogenous and endogenous cueing. (United States)

    Feldmann-Wüstefeld, Tobias; Schubö, Anna


    The spatial cueing paradigm (Posner Quarterly Journal of Experimental Psychology 32:3-25, 1980) has often been used to investigate the time course of the deployment of visual attention in space. In a series of eight experiments we investigated whether spatial cues would not only enhance processing of stimuli presented at cued locations, but also enhance processing of the entire texture in which the stimuli were presented. Results showed highest accuracy for responses to stimuli presented at cued locations, a replication of the traditional cueing effect (Posner 1980). Additionally, stimuli presented at uncued locations were responded to with higher accuracy when they were presented inside the same texture as the cued location, as compared with stimuli presented outside the texture with the cued location. To investigate this texture advantage for both automatic and voluntary attention deployment, exogenous and endogenous cues were used. The texture advantage was observed for short interstimulus intervals (ISIs) of 50 and 100 ms for exogenous cues and for a longer ISI of 200 ms for endogenous cues. These findings indicate that the arrangement of task-irrelevant visual stimuli also can have a large impact on the cueing effect. This suggests that visual spatial attention spreads texture-wise across the visual field. Control experiments revealed that the homogeneity within texture elements contributes most to the effect but that the texture advantage is a function of both orientation contrast at the texture border and homogeneity within texture elements.

  8. Discontinuing Inappropriate Medication Use in Nursing Home Residents : A Cluster Randomized Controlled Trial

    NARCIS (Netherlands)

    Wouters, Hans; Scheper, Jessica; Koning, Hedi; Brouwer, Chris; Twisk, Jos W.; van der Meer, Helene; Boersma, Froukje; Zuidema, Sytse U.; Taxis, Katja


    Background: Inappropriate prescribing is a well-known clinical problem in nursing home residents, but few interventions have focused on reducing inappropriate medication use. Objective: To examine successful discontinuation of inappropriate medication use and to improve prescribing in nursing home

  9. Connecting Cues: Overlapping Regularities Support Cue Discovery in Infancy (United States)

    Sahni, Sarah D.; Seidenberg, Mark S.; Saffran, Jenny R.


    The present work examined the discovery of linguistic cues during a word segmentation task. Whereas previous studies have focused on sensitivity to individual cues, this study addresses how individual cues may be used to discover additional, correlated cues. Twenty-four 9-month-old infants were familiarized with a speech stream in which…

  10. Bullying and Inappropriate Behaviour among Faculty Personnel (United States)

    Meriläinen, Matti; Sinkkonen, Hanna-Maija; Puhakka, Helena; Käyhkö, Katinka


    This study focuses on the degree, nature and consequences of bullying or inappropriate behaviour among faculty personnel (n = 303) in a Finnish university. A total of 114 (38%) faculty members answered the email questionnaire. According to the results, 15% of the respondents had experienced bullying; in addition, 45% had experienced inappropriate…

  11. Relying on satiety cues in food consumption : studies on the role of social context, appearance focus, and mindfulness

    NARCIS (Netherlands)

    Veer, van de E.


    Consumers eat at various sequential occasions throughout the day. The current thesis addresses the question of how one consumption episode can affect the amount of consumption at a subsequent episode. The thesis focuses specifically on how the social context during a consumption episode affects

  12. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    Gallagher, P


    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  13. Inappropriate prescribing in geriatric patients.

    LENUS (Irish Health Repository)

    Barry, Patrick J


    Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.

  14. [Inappropriate test methods in allergy]. (United States)

    Kleine-Tebbe, J; Herold, D A


    Inappropriate test methods are increasingly utilized to diagnose allergy. They fall into two categories: I. Tests with obscure theoretical basis, missing validity and lacking reproducibility, such as bioresonance, electroacupuncture, applied kinesiology and the ALCAT-test. These methods lack both the technical and clinical validation needed to justify their use. II. Tests with real data, but misleading interpretation: Detection of IgG or IgG4-antibodies or lymphocyte proliferation tests to foods do not allow to separate healthy from diseased subjects, neither in case of food intolerance, allergy or other diagnoses. The absence of diagnostic specificity induces many false positive findings in healthy subjects. As a result unjustified diets might limit quality of life and lead to malnutrition. Proliferation of lymphocytes in response to foods can show elevated rates in patients with allergies. These values do not allow individual diagnosis of hypersensitivity due to their broad variation. Successful internet marketing, infiltration of academic programs and superficial reporting by the media promote the popularity of unqualified diagnostic tests; also in allergy. Therefore, critical observation and quick analysis of and clear comments to unqualified methods by the scientific medical societies are more important than ever.

  15. A focus on polarity: Investigating the role of orientation cues in mediating student performance on mRNA synthesis tasks in an introductory cell and molecular biology course. (United States)

    Olimpo, Jeffrey T; Quijas, Daniel A; Quintana, Anita M


    The central dogma has served as a foundational model for information flow, exchange, and storage in the biological sciences for several decades. Despite its continued importance, however, recent research suggests that novices in the domain possess several misconceptions regarding the aforementioned processes, including those pertaining specifically to the formation of messenger ribonucleic acid (mRNA) transcripts. In the present study, we sought to expand upon these observations through exploration of the influence of orientation cues on students' aptitude at synthesizing mRNAs from provided deoxyribonucleic acid (DNA) template strands. Data indicated that participants (n = 45) were proficient at solving tasks of this nature when the DNA template strand and the mRNA molecule were represented in an antiparallel orientation. In contrast, participants' performance decreased significantly on items in which the mRNA was depicted in a parallel orientation relative to the DNA template strand. Furthermore, participants' Grade Point Average, self-reported confidence in understanding the transcriptional process, and spatial ability were found to mediate their performance on the mRNA synthesis tasks. Collectively, these data reaffirm the need for future research and pedagogical interventions designed to enhance students' comprehension of the central dogma in a manner that makes transparent its relevance to real-world scientific phenomena. © 2017 by The International Union of Biochemistry and Molecular Biology, 45(6):501-508, 2017. © 2017 The International Union of Biochemistry and Molecular Biology.

  16. Three Cases With Inappropriate TSH Syndrome

    Directory of Open Access Journals (Sweden)

    Hatice Sebila Dökmetaş


    Full Text Available Inappropriate thyroid-stimulating hormone (TSH syndrome or central hyperthyroidism is a rare disorder characterized by inappropriately normal or elevated levels of TSH and elevated levels of T3 and T4. The syndrome is associated with TSH-secreting pituitary adenoma (TSHoma or thyroid hormone resistance (THR. Thyroid-releasing hormone stimulation test and T3 suppression test can be useful for the differential diagnosis of central hyperthyroidism. In the present study, we report three cases of inappropriate TSH syndrome diagnosed after TRH stimulation and T3 suppression tests. Turk Jem 2012; 16: 105-8

  17. Primary Sjogren's syndrome associated with inappropriate ...

    African Journals Online (AJOL)

    A patient in whom primary Sjogren's syndrome and inappropriate antiduretic hormone secretion were associated is reported. This is the first report of such an association. The possible pathophysiological mechanisms are discussed and vasculitis proposed as the underlying pathogenetic mechanism.

  18. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    O'Connor, Marie N


    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  19. Drug Utilization and Inappropriate Prescribing in Centenarians. (United States)

    Hazra, Nisha C; Dregan, Alex; Jackson, Stephen; Gulliford, Martin C


    To use primary care electronic health records (EHRs) to evaluate prescriptions and inappropriate prescribing in men and women at age 100. Population-based cohort study. Primary care database in the United Kingdom, 1990 to 2013. Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084; n = 8,982 women, n = 2,102 men). Main drug classes prescribed and potentially inappropriate prescribing according to the 2012 American Geriatrics Society Beers Criteria. At the age of 100, 73% of individuals (79% of women, 54% of men) had received one or more prescription drugs, with a median of 7 (interquartile range 0-12) prescription items. The most frequently prescribed drug classes were cardiovascular (53%), central nervous system (CNS) (53%), and gastrointestinal (47%). Overall, 32% of participants (28% of men, 32% of women) who received drug prescriptions may have received one or more potentially inappropriate prescriptions, with temazepam and amitriptyline being the most frequent. CNS prescriptions were potentially inappropriate in 23% of individuals, and anticholinergic prescriptions were potentially inappropriate in 18% of individuals. The majority of centenarians are prescribed one or more drug therapies, and the prescription may be inappropriate for up to one-third of these individuals. Research using EHRs offers opportunities to understand prescribing trends and improve pharmacological care of the oldest adults. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  20. Inappropriate shocks in the subcutaneous ICD

    DEFF Research Database (Denmark)

    Olde Nordkamp, Louise R A; Brouwer, Tom F; Barr, Craig


    shocks have been reported. METHODS: We analyzed the incidence, predictors and management of inappropriate shocks in the EFFORTLESS S-ICD Registry, which collects S-ICD implantation information and follow-up data from clinical centers in Europe and New Zealand. RESULTS: During a follow-up of 21 ± 13...... months, 48 out of 581 S-ICD patients (71% male, age 49 ± 18 years) experienced 101 inappropriate shocks (8.3%). The most common cause was cardiac signal oversensing (73%), such as T-wave oversensing. Eighteen shocks (18%) were due to supraventricular tachycardias (SVT), of which 15 occurred in the shock......-only zone. Cox-proportional hazard modeling using time-dependent covariates demonstrated that patients with a history of atrial fibrillation (HR 2.4) and patients with hypertrophic cardiomyopathy (HR 4.6) had an increased risk for inappropriate shocks, while programming the primary vector for sensing (from...

  1. Optimal assessment of multiple cues

    NARCIS (Netherlands)

    Fawcett, Tim W; Johnstone, Rufus A


    In a wide range of contexts from mate choice to foraging, animals are required to discriminate between alternative options on the basis of multiple cues. How should they best assess such complex multicomponent stimuli? Here, we construct a model to investigate this problem, focusing on a simple case

  2. Inappropriate Intensive Care Unit admissions: Nigerian doctors ...

    African Journals Online (AJOL)


    Dec 4, 2015 ... Conclusion: Inappropriate ICU admissions were perceived as a common event and were mainly attributed to pressure from seniors, referring clinicians, and hospital management. Further work is ..... Financial support and sponsorship. Nil. Conflicts of interest. There are no conflicts of interest. References. 1.

  3. Prevalence and Predictors of Inappropriate Medications Prescribing ...

    African Journals Online (AJOL)

    Data analysis involved use of World Health Organization (WHO) prescribing indicators, Updated 2002 Beer's criteria and DRUG-REAX® system software package of MICROMEDEX (R) Healthcare Series to assess the prescribing pattern, identify potentially inappropriate medications and potential drug-drug interactions, ...

  4. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt


    OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...

  5. Missed opportunities and inappropriately given vaccines reduce ...

    African Journals Online (AJOL)

    Coverage would have increased by 10% for diphtheria pertusistetanus (DPT) doses DPTI and DPT2, and 7% for DPT3. Measles immunisation coverage would have increased by 19% had missed immunisation opportunities and inappropriately administered vaccinations been avoided. The overall missed opportunities rate ...

  6. The Association between Inappropriate Weight Control Behaviors and Suicide Ideation and Attempt among Korean Adolescents. (United States)

    Lee, Sang Ah; Jang, Suk Yong; Shin, Jaeyong; Ju, Yeong Jun; Nam, Jin Young; Park, Eun Cheol


    Suicide is a leading cause of death among adolescents globally, and body weight is also a recognized reason for adolescent suicide. Therefore, we investigated the association between weight control behaviors (WCB) and suicide ideation and attempt, focusing on inappropriate weight control measures. We used data from the 2014 Korea Youth Risk Behavior Web-based Survey, representing a total of 35,224 boys and 34,361 girls aged 12 to 18 years. Adolescents were classified into groups based on WCB: appropriate WCB, inappropriate WCB, and no WCB. We performed logistic regression models to examine associations between WCB and suicide ideation and attempt, controlling for covariates. Both boys and girls with inappropriate WCB were more likely to report suicide ideation and attempt. Underweight and normal weight boys with inappropriate WCB were more likely to think or attempt suicide, and underweight girls with inappropriate WCB were also more likely to attempt suicide. Among five common WCB combinations, the combination of "regular exercise, fasting, eating less" was highly associated with suicide ideation and attempt. We confirmed that inappropriate WCB is associated with suicide ideation and attempt among Korean adolescents. Given the high incidence rate of suicide among adolescents and the adverse effect of inappropriate WCB, encouraging adolescents to control their weight in healthy ways is imperative.

  7. Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital. (United States)

    Fernández-Ruiz, Mario; Calvo, Beatriz; Vara, Rebeca; Villar, Rocío N; Aguado, José María


    The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. Further educational efforts should be focused on improving catheterization prescribing practices by physicians. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  8. POPI (Pediatrics: Omission of Prescriptions and Inappropriate prescriptions: development of a tool to identify inappropriate prescribing.

    Directory of Open Access Journals (Sweden)

    Sonia Prot-Labarthe

    Full Text Available INTRODUCTION: Rational prescribing for children is an issue for all countries and has been inadequately studied. Inappropriate prescriptions, including drug omissions, are one of the main causes of medication errors in this population. Our aim is to develop a screening tool to identify omissions and inappropriate prescriptions in pediatrics based on French and international guidelines. METHODS: A selection of diseases was included in the tool using data from social security and hospital statistics. A literature review was done to obtain criteria which could be included in the tool called POPI. A 2-round-Delphi consensus technique was used to establish the content validity of POPI; panelists were asked to rate their level of agreement with each proposition on a 9-point Likert scale and add suggestions if necessary. RESULTS: 108 explicit criteria (80 inappropriate prescriptions and 28 omissions were obtained and submitted to a 16-member expert panel (8 pharmacists, 8 pediatricians hospital-based -50%- or working in community -50%-. Criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology and miscellaneous. Each criterion was accompanied by a concise explanation as to why the practice is potentially inappropriate in pediatrics (including references. Two round of Delphi process were completed via an online questionnaire. 104 out of the 108 criteria submitted to experts were selected after 2 Delphi rounds (79 inappropriate prescriptions and 25 omissions. DISCUSSION CONCLUSION: POPI is the first screening-tool develop to detect inappropriate prescriptions and omissions in pediatrics based on explicit criteria. Inter-user reliability study is necessary before using the tool, and prospective study to assess the effectiveness of POPI is also necessary.

  9. Occlusion edge blur: A cue to relative visual depth


    Marshall, J.A.; Burbeck, C.A.; Ariely, D.; Rolland, J.P.; Martin, K.E.


    We studied whether the blur/sharpness of an occlusion boundary between a sharply focused surface and a blurred surface is used as a relative depth cue. Observers judged relative depth in pairs of images that differed only in the blurriness of the common boundary between two adjoining texture regions, one blurred and one sharply focused. Two experiments were conducted; in both, observers consistently used the blur of the boundary as a cue to relative depth. However, the strength of the cue, re...

  10. Inappropriate colonoscopic surveillance of hyperplastic polyps.

    LENUS (Irish Health Repository)

    Keane, R A


    Colonoscopic surveillance of hyperplastic polyps alone is controversial and may be inappropriate. The colonoscopy surveillance register at a university teaching hospital was audited to determine the extent of such hyperplastic polyp surveillance. The surveillance endoscopy records were reviewed, those patients with hyperplastic polyps were identified, their clinical records were examined and contact was made with each patient. Of the 483 patients undergoing surveillance for colonic polyps 113 (23%) had hyperplastic polyps alone on last colonoscopy. 104 patients remained after exclusion of those under appropriate surveillance. 87 of the 104 patients (84%) were successfully contacted. 37 patients (8%) were under appropriate colonoscopic surveillance for a significant family history of colorectal carcinoma. 50 (10%) patients with hyperplastic polyps alone and no other clinical indication for colonoscopic surveillance were booked for follow up colonoscopy. This represents not only a budgetary but more importantly a clinical opportunity cost the removal of which could liberate valuable colonoscopy time for more appropriate indications.

  11. [Patients with hyperlipidemia: inappropriate nutritional intake]. (United States)

    Lecerf, Jean-Michel; Hottin, Delphine Mastin


    Gather knowledge on nutritional supplementation in patients with hyperlipidemia. In an observational study on patients with hyperlipidemia, nutritional intake was assessed using a 7-day dietary questionnaire, provided on the first visit to a lipid clinic. 291 patients (201 men and 90 women) were studied. Calorie intake and proportion of energetic nutrients revealed low carbohydrate intake, low intake of dietary fibres, and excessive lipid and saturated fatty acid intakes. Patients with isolated hypercholesterolemia had nutritional intake very similar to the daily allowances recommended in France. Men with type III hyperlipidemia had the highest calorie intake and those with type IV dyslipidemia had the highest alcohol intake. Triglycerides increased with total energy intake and with fat intake (%). Body mass index was inversely correlated to carbohydrate intake. The duration of dyslipidemia was related to low vitamin C and B9 intake. The existence of risk factors (type 2 diabetes, hypertension, smoking or inactivity) was associated with less well-balanced diet and low protective micronutrient status. In the case of atherosclerosis, vitamin B9, C, E and beta-carotene intake was insufficient. Interactions existed between nutrient intake with correlations between fibres, vitamin B9, C and beta-carotene, suggesting that nutritional education should favour foodstuffs that provide them simultaneously. Nutritional intake in patients with hyperlipidemia is often far from that recommended and does not greatly differ from that in large non-selected populations. It can be considered as inappropriate because of the metabolic and cardiovascular risks in these patients. Adapted nutritional management is crucial.

  12. Accommodating Presuppositions Is Inappropriate in Implausible Contexts. (United States)

    Singh, Raj; Fedorenko, Evelina; Mahowald, Kyle; Gibson, Edward


    According to one view of linguistic information (Karttunen, 1974; Stalnaker, 1974), a speaker can convey contextually new information in one of two ways: (a) by asserting the content as new information; or (b) by presupposing the content as given information which would then have to be accommodated. This distinction predicts that it is conversationally more appropriate to assert implausible information rather than presuppose it (e.g., von Fintel, 2008; Heim, 1992; Stalnaker, 2002). A second view rejects the assumption that presuppositions are accommodated; instead, presuppositions are assimilated into asserted content and both are correspondingly open to challenge (e.g., Gazdar, 1979; van der Sandt, 1992). Under this view, we should not expect to find a difference in conversational appropriateness between asserting implausible information and presupposing it. To distinguish between these two views of linguistic information, we performed two self-paced reading experiments with an on-line stops-making-sense judgment. The results of the two experiments-using the presupposition triggers the and too-show that accommodation is inappropriate (makes less sense) relative to non-presuppositional controls when the presupposed information is implausible but not when it is plausible. These results provide support for the first view of linguistic information: the contrast in implausible contexts can only be explained if there is a presupposition-assertion distinction and accommodation is a mechanism dedicated to reasoning about presuppositions. Copyright © 2015 Cognitive Science Society, Inc.

  13. Cue conflicts in context

    DEFF Research Database (Denmark)

    Boeg Thomsen, Ditte; Poulsen, Mads


    When learning their first language, children develop strategies for assigning semantic roles to sentence structures, depending on morphosyntactic cues such as case and word order. Traditionally, comprehension experiments have presented transitive clauses in isolation, and crosslinguistically...... in discourse-pragmatically felicitous contexts. Our results extend previous findings of preschoolers’ sensitivity to discourse-contextual cues in sentence comprehension (Hurewitz, 2001; Song & Fisher, 2005) to the basic task of assigning agent and patient roles....

  14. Role of Speaker Cues in Attention Inference

    Directory of Open Access Journals (Sweden)

    Jin Joo Lee


    Full Text Available Current state-of-the-art approaches to emotion recognition primarily focus on modeling the nonverbal expressions of the sole individual without reference to contextual elements such as the co-presence of the partner. In this paper, we demonstrate that the accurate inference of listeners’ social-emotional state of attention depends on accounting for the nonverbal behaviors of their storytelling partner, namely their speaker cues. To gain a deeper understanding of the role of speaker cues in attention inference, we conduct investigations into real-world interactions of children (5–6 years old storytelling with their peers. Through in-depth analysis of human–human interaction data, we first identify nonverbal speaker cues (i.e., backchannel-inviting cues and listener responses (i.e., backchannel feedback. We then demonstrate how speaker cues can modify the interpretation of attention-related backchannels as well as serve as a means to regulate the responsiveness of listeners. We discuss the design implications of our findings toward our primary goal of developing attention recognition models for storytelling robots, and we argue that social robots can proactively use speaker cues to form more accurate inferences about the attentive state of their human partners.

  15. Inappropriate treatments for patients with cognitive decline. (United States)

    Robles Bayón, A; Gude Sampedro, F


    Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol<40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases. Polypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population. Copyright © 2012 Sociedad Española de Neurolog

  16. Functional Analysis and Treatment of Multiply Controlled Inappropriate Mealtime Behavior (United States)

    Bachmeyer, Melanie H.; Piazza, Cathleen C.; Fredrick, Laura D.; Reed, Gregory K.; Rivas, Kristi D.; Kadey, Heather J.


    Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function-based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast,…

  17. Prescribing Patterns and Inappropriate Use of Medications in Elderly ...

    African Journals Online (AJOL)

    Prescribing Patterns and Inappropriate Use of Medications in Elderly Outpatients in a Tertiary Hospital in Nigeria. ... Tropical Journal of Pharmaceutical Research ... Purpose: To determine the prescribing patterns and occurrence of potentially inappropriate medications (PIM) among elderly outpatients visiting a tertiary ...

  18. Cross-modal cueing in audiovisual spatial attention

    DEFF Research Database (Denmark)

    Blurton, Steven Paul; Greenlee, Mark W.; Gondan, Matthias


    Visual processing is most effective at the location of our attentional focus. It has long been known that various spatial cues can direct visuospatial attention and influence the detection of auditory targets. Cross-modal cueing, however, seems to depend on the type of the visual cue: facilitation...... that the perception of multisensory signals is modulated by a single, supramodal system operating in a top-down manner (Experiment 1). In contrast, bottom-up control of attention, as observed in the exogenous cueing task of Experiment 2, mainly exerts its influence through modality-specific subsystems. Experiment 3...

  19. Aggressive Cue Prominence and Gender Participation in MTV. (United States)

    Kalis, Pamela; Neuendorf, Kimberly A.


    Explores the content and structure of music videos, focusing on the pervasiveness of aggressive cues (objects or events representing physical harm or the threat of harm), gender portrayals within a context of aggression, and the pacing of music videos. Finds that aggressive cues in music videos are less prominent than critics indicate. (MM)

  20. Inappropriate urinary catheter reinsertion in hospitalized older patients. (United States)

    Hu, Fang-Wen; Tsai, Chuan-Hsiu; Lin, Huey-Shyan; Chen, Ching-Huey; Chang, Chia-Ming


    We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes. A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge. A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  1. Inappropriate behaviors and hypersexuality in individuals with dementia: An overview of a neglected issue. (United States)

    Torrisi, Michele; Cacciola, Alberto; Marra, Angela; De Luca, Rosaria; Bramanti, Placido; Calabrò, Rocco Salvatore


    Behavioral and psychological symptoms of dementia are very common in patients affected by dementia, and are associated with high rates of institutionalization. Behavioral and psychological symptoms of dementia consist of aggressive behavior, delusions, hallucinations, depression, apathy, wandering, stereotyped and inappropriate sexual behavior. Interestingly, the latter has been reported to be relatively uncommon, but causing immense distress to patients and their caregivers. The genesis of inappropriate behavior is considered a combination of neurological, psychological and social factors. Although assessment is mainly carried out by clinical observation and interviews with caregivers, the most appropriate management of behavioral and psychological symptoms of dementia, including hypersexuality, is a combination of pharmacological and non-pharmacological interventions, according to specific symptoms, degree of cognitive dysfunction and subtype of dementia. The present narrative review will mainly focus on aggressiveness, disinhibition, aberrant motor, and sexually inappropriate behavior diagnostic work-up and treatment, in an attempt to provide both the patients and their caregivers with useful information to better manage these symptoms and improve their quality of life. Space is particularly dedicated to inappropriate sexual behavior, which is still considered a neglected issue. Geriatr Gerontol Int 2017; 17: 865-874. © 2016 Japan Geriatrics Society.

  2. Multisensor image cueing (MUSIC) (United States)

    Rodvold, David; Patterson, Tim J.


    There have been many years of research and development in the Automatic Target Recognition (ATR) community. This development has resulted in numerous algorithms to perform target detection automatically. The morphing of the ATR acronym to Aided Target Recognition provides a succinct commentary regarding the success of the automatic target recognition research. Now that the goal is aided recognition, many of the algorithms which were not able to provide autonomous recognition may now provide valuable assistance in cueing a human analyst where to look in the images under consideration. This paper describes the MUSIC system being developed for the US Air Force to provide multisensor image cueing. The tool works across multiple image phenomenologies and fuses the evidence across the set of available imagery. MUSIC is designed to work with a wide variety of sensors and platforms, and provide cueing to an image analyst in an information-rich environment. The paper concentrates on the current integration of algorithms into an extensible infrastructure to allow cueing in multiple image types.

  3. Composition: Cue Wheel

    DEFF Research Database (Denmark)

    Bergstrøm-Nielsen, Carl


    Cue Rondo is an open composition to be realised by improvising musicians. See more about my composition practise in the entry "Composition - General Introduction". This work is licensed under a Creative Commons "by-nc" License. You may for non-commercial purposes use and distribute it, performanc...

  4. Reacting to Neighborhood Cues?

    DEFF Research Database (Denmark)

    Danckert, Bolette; Dinesen, Peter Thisted; Sønderskov, Kim Mannemar


    is founded on politically sophisticated individuals having a greater comprehension of news and other mass-mediated sources, which makes them less likely to rely on neighborhood cues as sources of information relevant for political attitudes. Based on a unique panel data set with fine-grained information...

  5. Individual Sensitivity to Spectral and Temporal Cues in Listeners with Hearing Impairment (United States)

    Souza, Pamela E.; Wright, Richard A.; Blackburn, Michael C.; Tatman, Rachael; Gallun, Frederick J.


    Purpose: The present study was designed to evaluate use of spectral and temporal cues under conditions in which both types of cues were available. Method: Participants included adults with normal hearing and hearing loss. We focused on 3 categories of speech cues: static spectral (spectral shape), dynamic spectral (formant change), and temporal…

  6. Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study. (United States)

    Márquez, Paola H Ponte; Torres, Olga H; San-José, Anonio; Vidal, Xavier; Agustí, Antonia; Formiga, Francesc; López-Soto, Alfonso; Ramírez-Duque, Nieves; Fernández-Moyano, Antonio; Garcia-Moreno, Juana; Arroyo, Juan A; Ruiz, Domingo


    Previous studies of antihypertensive treatment of older patients have focused on blood pressure control, cardiovascular risk or adherence, whereas data on inappropriate antihypertensive prescriptions to older patients are scarce. The aim of the study was to assess inappropriate antihypertensive prescriptions to older patients. An observational, prospective multicentric study was conducted to assess potentially inappropriate prescription of antihypertensive drugs, in patients aged 75 years and older with arterial hypertension (HTN), in the month prior to hospital admission, using four instruments: Beers, Screening Tool of Older Person's Prescriptions (STOPP), Screening Tool to Alert Doctors to the Right Treatment (START) and Assessing Care of Vulnerable Elders 3 (ACOVE-3). Primary care and hospital electronic records were reviewed for HTN diagnoses, antihypertensive treatment and blood pressure readings. Of 672 patients, 532 (median age 85 years, 56% female) had HTN. 21.6% received antihypertensive monotherapy, 4.7% received no hypertensive treatment, and the remainder received a combination of antihypertensive therapies. The most frequently prescribed antihypertensive drugs were diuretics (53.5%), angiotensin-converting enzyme inhibitors (ACEIs) (41%), calcium antagonists (32.2%), angiotensin receptor blockers (29.7%) and beta-blockers (29.7%). Potentially inappropriate prescription was observed in 51.3% of patients (27.8% overprescription and 35% underprescription). The most frequent inappropriately prescribed drugs were calcium antagonists (overprescribed), ACEIs and beta-blockers (underprescribed). ACEI and beta-blocker underprescriptions were independently associated with heart failure admissions [beta-blockers odds ratio (OR) 0.53, 95% confidence interval (CI) 0.39-0.71, p treatment. Underprescription was more frequent than overprescription. ACEIs and beta-blockers were frequently underprescribed and were associated with heart failure admissions.

  7. Discontinuing Inappropriate Medication in Nursing Home Residents (DIM-NHR study): A cluster randomized controlled trial

    NARCIS (Netherlands)

    Wouters, H.; Scheper, J.; Koning, H.; Brouwer, C.; Twisk, J.; Van Der Meer, H.; Boersma, F.; Zuidema, S.; Taxis, K.


    Introduction: Inappropriate prescribing is a prevalent problem in nursing home residents that is associated with cognitive and physical impairment. Few interventions have been shown to reduce inappropriate prescribing. The aim was therefore to examine successful discontinuation of inappropriate

  8. Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

    Directory of Open Access Journals (Sweden)

    Lott Alison


    able to identify which variables have the greatest effect on physician judgments, and whether judgments are affected by inappropriate cues or incorrect weighting of appropriate cues. We will send antibiotics surveys to family physicians (300 per survey, and warfarin surveys to both family physicians and internal medicine specialists (300 per group per survey, for a total of 1,800 physicians. Each Type 1 survey will be two to four pages in length and take about fifteen minutes to complete, while each Type 2 survey will be eight to ten pages in length and take about thirty minutes to complete. Discussion This work will provide insight into the extent to which clinicians' judgments about the likelihood of important treatment outcomes explain inappropriate treatment decisions. This work will also provide information necessary for the development of an individualized feedback tool designed to improve treatment decisions. The techniques developed here have the potential to be applicable to a wide range of clinical areas where inappropriate utilization stems from biased judgments.

  9. Inappropriate oophorectomy at time of benign premenopausal hysterectomy. (United States)

    Mahal, Amandeep S; Rhoads, Kim F; Elliott, Christopher S; Sokol, Eric R


    We assessed rates of oophorectomy during benign hysterectomy around the release of the American College of Obstetricians and Gynecologists 2008 practice bulletin on prophylactic oophorectomy, and evaluated predictors of inappropriate premenopausal oophorectomy. A cross-sectional administrative database analysis was performed utilizing the California Office of Statewide Health Planning Development Patient Discharge Database for years 2005 to 2011. After identifying all premenopausal women undergoing hysterectomy for benign conditions, International Classification of Diseases (ICD)-9 diagnosis codes were reviewed to create a master list of indications for oophorectomy. We defined appropriate oophorectomy as cases with concomitant coding for ovarian cyst, breast cancer susceptibility gene carrier status, and other diagnoses. Using patient demographics and hospital characteristics to predict inappropriate oophorectomy, a logistic regression model was created. We identified 57,776 benign premenopausal hysterectomies with oophorectomies during the period studied. Of the premenopausal oophorectomies, 37.7% (21,783) were deemed "inappropriate" with no documented reason for removal. The total number of premenopausal inpatient hysterectomies with oophorectomy decreased yearly (12,227/y in 2005 to 5,930/y in 2011). However, the percentage of inappropriate oophorectomies remained stable. In multivariate analysis, Hispanic and African American ethnicity/race associated with increased odds of inappropriate oophorectomy (P Urban and at low Medi-Cal utilization hospitals showed increased odds of inappropriate oophorectomy. In premenopausal women undergoing benign hysterectomy, over one-third undergo oophorectomy without an appropriate indication documented. The rate of inappropriate oophorectomy in California has not changed since the 2008 American College of Obstetricians and Gynecologists guidelines. Whereas the absolute number of inpatient hysterectomies for benign

  10. Prevalence and correlates of inappropriate use of benzodiazepines in Kosovo. (United States)

    Tahiri, Zejdush; Kellici, Suela; Mone, Iris; Shabani, Driton; Qazimi, Musa; Burazeri, Genc


    In post-war Kosovo, the magnitude of inappropriate use of benzodiazepines is unknown to date. The aim of this study was to assess the prevalence and correlates of continuation of intake of benzodiazepines beyond prescription (referred to as "inappropriate use") in the adult population of Gjilan region in Kosovo. A cross-sectional study was conducted in Gjilan region in 2015 including a representative sample of 780 individuals attending different pharmacies and reporting use of benzodiazepines (385 men and 395 women; age range 18-87 years; response rate: 90%). A structured questionnaire was administered to all participants inquiring about the use of benzodiazepines and socio-demographic characteristics. Overall, the prevalence of inappropriate use of benzodiazepines was 58%. In multivariable-adjusted models, inappropriate use of benzodiazepines was significantly associated with older age (OR 1.7, 95% CI 1.1-2.7), middle education (OR 1.8, 95% CI 1.2-2.7), daily use (OR 1.4, 95% CI 1.1-2.0) and addiction awareness (OR 2.7, 95% CI 2.0-3.8). Furthermore, there was evidence of a borderline relationship with rural residence (OR 1.2, 95% CI 0.9-1.7). Our study provides novel evidence about the prevalence and selected correlates of inappropriate use of benzodiazepines in Gjilan region of Kosovo. Health professionals and policymakers in Kosovo should be aware of the magnitude and determinants of drug misuse in this transitional society.

  11. Group Contingencies, Randomization of Reinforcers, and Criteria for Reinforcement, Self-Monitoring, and Peer Feedback on Reducing Inappropriate Classroom Behavior (United States)

    Coogan, Brenda Anne; Kehle, Thomas J.; Bray, Melissa A.; Chafouleas, Sandra M.


    Considerable research has demonstrated the effectiveness of interdependent and unknown dependent group contingencies on reducing inappropriate classroom behavior. Several investigators have focused on the addition of self-monitoring and peer feedback to these interdependent and unknown dependent group contingencies in order to further improve…

  12. Hypercalcemia, inappropriate calcitriol levels, and tuberculosis on hemodialysis. (United States)

    Peces, R; Pobes, A; Díaz-Corte, C; Gago, E


    We describe a female patient undergoing hemodialysis who developed tuberculosis, hypercalcemia, and inappropriately elevated calcitriol levels. These findings suggest ectopic production of calcitriol by tuberculous granulomas. Successful treatment of tuberculosis led to a substantial decrease in the levels of calcium and calcitriol.

  13. Inappropriate prescribing of proton pump inhibitors among patients ...

    African Journals Online (AJOL)

    updating physicians on the practice guidelines, participation of a clinical pharmacist in making therapeutic decisions and modifying hospital ... inappropriate overuse of PPIs include physician type, practice setting, formulary status and ... Well-trained assistants, using a structured questionnaire, recruited the study sample.

  14. [Inappropriate prescription in older patients: the STOPP/START criteria].

    LENUS (Irish Health Repository)

    Delgado Silveira, Eva


    Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers\\' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person\\'s Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers\\' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP\\/START criteria could become a useful screening tool to improve prescription in older people.

  15. Inappropriate Practices in Fitness Testing and Reporting: Alternative Strategies (United States)

    Zhu, Xihe; Davis, Summer; Kirk, T. Nicole; Haegele, Justin A.; Knott, Stephen E.


    Fitness education is becoming an integrated component for many physical education programs. As such, many physical educators conduct health-related fitness tests on a regular basis. Some states even mandate certain types of physical fitness tests to be administered and reported annually or by semester. Yet, inappropriate practices have been…

  16. Impact of oncology-related direct-to-consumer advertising: association with appropriate and inappropriate prescriptions. (United States)

    Abel, Gregory A; Chen, Kun; Taback, Nathan; Hassett, Michael J; Schrag, Deborah; Weeks, Jane C


    Little is known about the impact of direct-to-consumer advertising (DTCA) on appropriate versus inappropriate prescribing. Aromatase inhibitor (AI) therapy for breast cancer provides an ideal paradigm for studying this issue, because AIs have been the focus of substantial DTCA, and because they should only be used in postmenopausal women, age can serve as a simple surrogate marker of appropriateness. Data regarding national DTCA spending for the AIs were obtained from TNS Multimedia; hormonal therapy prescription data were obtained from IMS Health. Time series analyses were performed to characterize the association between monthly changes in DTCA spending for the AIs and monthly changes in the proportion of all new hormonal therapy prescriptions represented by the AIs from October 2005 to September 2007. Analyses were stratified by age, considering prescriptions for women ≤ 40 (likely premenopausal) to be inappropriate and those for women > 60 (likely postmenopausal) to be appropriate. Monthly dollars spent on AI-associated DTCA varied considerably ($118,600 to $22,019,660). Time series analysis revealed that for every million dollars spent on DTCA for the AIs, there was an associated increase 3 months later in the new AI prescription proportion of 0.15% for all ages (P 60 years (P < .0001), but no significant change for those ≤ 40 at any time from 0 to 6 months. DTCA for the AIs was associated with increases in appropriate prescriptions with no significant effect on inappropriate prescriptions, suggesting that DTCA may not foster inappropriate medication use for certain drug classes. Copyright © 2012 American Cancer Society.

  17. Inappropriate prescribing in the older population: need for new criteria.

    LENUS (Irish Health Repository)

    O'Mahony, Denis


    Inappropriate prescribing (IP) is a common and serious global healthcare problem in elderly people, leading to increased risk of adverse drug reactions (ADRs), polypharmacy being the main risk factor for both IP and ADRs. IP in older people is highly prevalent but preventable; hence screening tools for IP have been devised, principally Beers\\' Criteria and the Inappropriate Prescribing in the Elderly Tool (IPET). Although Beers\\' Criteria have become the most widely cited IP criteria in the literature, nevertheless, they have serious deficiencies, including several drugs that are rarely prescribed nowadays, a lack of structure in the presentation of the criteria and omission of several important and common IP instances. New, more up-to-date, systems-based and easily applicable criteria are needed that can be applied in the routine clinical setting.

  18. Factors associated with inappropriate utilisation of emergency department services. (United States)

    Selasawati, H G; Naing, L; Wan Aasim, W A; Winn, T; Rusli, B N


    This study was carried out to determine the associated factors and the reasons for inappropriate utilisation of Emergency Department (ED) services at Universiti Sains Malaysia Hospital. A case-control study was conducted with 170 cases from ED and 170 controls from the Outpatient Department (OPD). A self-administered questionnaire was designed and used to obtain sociodemographic data, knowledge on the functions of ED and OPD, health seeking attitude and behaviour, and reasons for seeking treatment at ED. The study found that gender, marital status, family size, shift work, perceived illness, and knowledge on the role and functions of ED and OPD were significant associated factors. The three most common reasons for inappropriate utilisation of ED were as follows: "due to severity of illness" (85%), "can't go to OPD during office hours" (42%), and "ED near my house" (27%).

  19. The syndrome of inappropriate antidiuretic hormone: prevalence, causes and consequences.

    LENUS (Irish Health Repository)

    Hannon, M J


    Hyponatraemia is the commonest electrolyte abnormality found in hospital inpatients, and is associated with a greatly increased morbidity and mortality. The syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent cause of hyponatraemia in hospital inpatients. SIADH is the clinical and biochemical manifestation of a wide range of disease processes, and every case warrants investigation of the underlying cause. In this review, we will examine the prevalence, pathophysiology, clinical characteristics and clinical consequences of hyponatraemia due to SIADH.

  20. Requests for "inappropriate" treatment based on religious beliefs. (United States)

    Orr, R D; Genesen, L B


    Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured.

  1. A qualitative examination of inappropriate hospital admissions and lengths of stay

    Directory of Open Access Journals (Sweden)

    Hammond Christina L


    Full Text Available Abstract Background Research has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions. We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group. Methods Two focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach. Results The participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS, including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations. Conclusion Clinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed.

  2. Potentially inappropriate medications among older adults in Pelotas, Southern Brazil. (United States)

    Lutz, Bárbara Heather; Miranda, Vanessa Irribarem Avena; Bertoldi, Andréa Dâmaso


    To assess the use of potentially inappropriate medications among older adults. This is a population-based cross-sectional study with 1,451 older individuals aged 60 years or more in the city of Pelotas, State of Rio Grande do Sul, Brazil, in 2014. We have investigated the use of medications in the last 15 days. Using the Beers criteria (2012), we have verified the use of potentially inappropriate medications and their relationship with socioeconomic and demographic variables, polypharmacy, self-medication, and burden of disease. Among the 5,700 medications used, 5,651 could be assessed as to being inappropriate. Of these, 937 were potentially inappropriate for the older adults according to the 2012 Beers criteria (16.6%). Approximately 42.4% of the older adults studied used at least one medication considered as potentially inappropriate. The group of medications for the nervous system accounted for 48.9% of the total of the potentially inappropriate medications. In the adjusted analysis, the variables female, advanced age, white race, low educational level, polypharmacy, self-medication, and burden of disease were associated with the use of potentially inappropriate medications. It is important to known the possible consequences of the use of medication among older adults. Special attention should be given to the older adults who use polypharmacy. Specific lists should be created with more appropriate medications for the older population in the National Essential Medicine List. Avaliar o uso de medicamentos potencialmente inadequados entre idosos. Estudo transversal de base populacional com 1.451 idosos com 60 anos ou mais em Pelotas, RS, em 2014. Investigou-se o uso de medicamentos nos últimos 15 dias. Utilizando os critérios de Beers (2012), verificou-se a potencial inadequação dos medicamentos e sua relação com variáveis socioeconômicas e demográficas, polifarmácia, automedicação e carga de doença. Dentre os 5.700 medicamentos utilizados, 5

  3. Surveillance cues enhance moral condemnation. (United States)

    Bourrat, Pierrick; Baumard, Nicolas; McKay, Ryan


    Humans pay close attention to the reputational consequences of their actions. Recent experiments indicate that even very subtle cues that one is being observed can affect cooperative behaviors. Expressing our opinions about the morality of certain acts is a key means of advertising our cooperative dispositions. Here, we investigated how subtle cues of being watched would affect moral judgments. We predicted that participants exposed to such cues would affirm their endorsement of prevailing moral norms by expressing greater disapproval of moral transgressions. Participants read brief accounts of two moral violations and rated the moral acceptability of each violation. Violations were more strongly condemned in a condition where participants were exposed to surveillance cues (an image of eyes interposed between the description of the violation and the associated rating scale) than in a control condition (in which the interposed image was of flowers). We discuss the role that public declarations play in the interpersonal evaluation of cooperative dispositions.

  4. Surveillance Cues Enhance Moral Condemnation

    Directory of Open Access Journals (Sweden)

    Pierrick Bourrat


    Full Text Available Humans pay close attention to the reputational consequences of their actions. Recent experiments indicate that even very subtle cues that one is being observed can affect cooperative behaviors. Expressing our opinions about the morality of certain acts is a key means of advertising our cooperative dispositions. Here, we investigated how subtle cues of being watched would affect moral judgments. We predicted that participants exposed to such cues would affirm their endorsement of prevailing moral norms by expressing greater disapproval of moral transgressions. Participants read brief accounts of two moral violations and rated the moral acceptability of each violation. Violations were more strongly condemned in a condition where participants were exposed to surveillance cues (an image of eyes interposed between the description of the violation and the associated rating scale than in a control condition (in which the interposed image was of flowers. We discuss the role that public declarations play in the interpersonal evaluation of cooperative dispositions.

  5. Visual form Cues, Biological Motions, Auditory Cues, and Even Olfactory Cues Interact to Affect Visual Sex Discriminations


    Rick Van Der Zwan; Anna Brooks; Duncan Blair; Coralia Machatch; Graeme Hacker


    Johnson and Tassinary (2005) proposed that visually perceived sex is signalled by structural or form cues. They suggested also that biological motion cues signal sex, but do so indirectly. We previously have shown that auditory cues can mediate visual sex perceptions (van der Zwan et al., 2009). Here we demonstrate that structural cues to body shape are alone sufficient for visual sex discriminations but that biological motion cues alone are not. Interestingly, biological motions can resolve ...

  6. Different cue weights at the same place

    NARCIS (Netherlands)

    Muller, C. M P; Brenner, E.; Smeets, J. B J


    The visual system uses multiple cues to estimate properties of interest. Since the errors in the estimates from different cues for the same property are generally different, a weighted average of the cues provides a better overall estimate. The most precise estimate is found when each cue's weight

  7. Combining cues while avoiding perceptual conflicts

    NARCIS (Netherlands)

    Hogervorst, M.A.; Brenner, E.


    A common assumption in cue combination models is that small discrepancies between cues are due to the limited resolution of the individual cues. Whenever this assumption holds, information from the separate cues can best be combined to give a single, more accurate estimate of the property of

  8. Cost analysis of inappropriate treatments for suspected dermatomycoses

    Directory of Open Access Journals (Sweden)

    Emanuela Fiammenghi


    Full Text Available Superficial mycoses are estimated to affect more than 20-25% of the world’s population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1 to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2 to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital “ Federico II” in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination were defined as inappropriate: (1 cortisone in a patient with at least one positive site; (2 antifungals in (a patients with all negative sites or (b ineffective antifungal treatment (in terms of drug chosen, dose or duration in those with all positive sites; or (3 antibiotics; (4 antivirals or (5 antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease

  9. Medically Inappropriate or Futile Treatment: Deliberation and Justification 1 (United States)

    Misak, Cheryl J.; White, Douglas B.; Truog, Robert D.


    This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with (1) a clear justification of why it is important to take best standards, norms, and physician judgment seriously and (2) a clear justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. PMID:26681796

  10. Mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy

    DEFF Research Database (Denmark)

    Suppli, M.; Aabenhus, R.; Harboe, Z.B.


    Enterococcus species are common in nosocomial bloodstream infections and their incidence is rising. Although well recognized in several serious bacterial infections, the influence of appropriate antimicrobial therapy in enterococcal bacteraemia has not been fully settled. The aim of the study.......7-10), thrombocytopenia (3.9, 1.6-9.3), chronic liver failure (3.3, 1.1-10) and age >/=60 years (2.2, 0.99-5.0). Antibiotics not appropriately covering enterococci are frequently administered empirically in suspected bloodstream infections. Inappropriate antibiotic therapy was an independent risk factor for mortality...

  11. Quetiapine-Induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone

    Directory of Open Access Journals (Sweden)

    Theocharis Koufakis


    Full Text Available The syndrome of inappropriate secretion of antidiuretic hormone (SIADH can be induced by various conditions, including malignant neoplasms, infections, central nervous system disorders, and numerous drugs. We here report a case of a 65-year-old female patient, treated with quetiapine for schizophrenia, who presented with generalized tonic-clonic seizures and was finally diagnosed with quetiapine-induced SIADH. Quetiapine-associated hyponatremia is extremely uncommon and only a few, relevant reports can be found in the literature. This case underlines the fact that patients on antipsychotic medication and more specifically on quetiapine should be closely monitored and routinely tested for electrolyte disorders.

  12. Diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone

    DEFF Research Database (Denmark)

    Holm, Ellen Astrid; Bie, Peter; Ottesen, Michael


    BACKGROUND: Hyponatremia is a frequent condition in elderly patients. In diagnostic workup, a 24-hour urine sample is used to measure urinary osmolality and urinary sodium concentration necessary to confirm the diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH...... peptide (P = 0.007), elevated mean arterial blood pressure (P = 0.03), and lower plasma levels of creatinine (P = 0.002) compared to the controls. CONCLUSION: A spot urine sample seems to be sufficient to confirm the diagnosis of SIADH....

  13. Using virtual human technology to provide immediate feedback about participants' use of demographic cues and knowledge of their cue use. (United States)

    Wandner, Laura D; Letzen, Janelle E; Torres, Calia A; Lok, Benjamin; Robinson, Michael E


    Demographic characteristics have been found to influence pain management decisions, but limited focus has been placed on participants' reactions to feedback about their use of sex, race, or age to make these decisions. The present study aimed to examine the effects of providing feedback about the use of demographic cues to participants making pain management decisions. Participants (N = 107) viewed 32 virtual human patients with standardized levels of pain and provided ratings for virtual humans' pain intensity and their treatment decisions. Real-time lens model idiographic analyses determined participants' decision policies based on cues used. Participants were subsequently informed about cue use and completed feedback questions. Frequency analyses were conducted on responses to these questions. Between 7.4 and 89.4% of participants indicated awareness of their use of demographic or pain expression cues. Of those individuals, 26.9 to 55.5% believed this awareness would change their future clinical decisions, and 66.6 to 75.9% endorsed that their attitudes affect their imagined clinical practice. Between 66.6 and 79.1% of participants who used cues reported willingness to complete an online tutorial about pain across demographic groups. This study was novel because it provided participants feedback about their cue use. Most participants who used cues indicated willingness to participate in an online intervention, suggesting this technology's utility for modifying biases. This is the first study to make individuals aware of whether a virtual human's sex, race, or age influences their decision making. Findings suggest that a majority of the individuals who were made aware of their use of demographic cues would be willing to participate in an online intervention. Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

  14. Sex differences in associations between cannabis craving and neural responses to cannabis cues: Implications for treatment. (United States)

    Wetherill, Reagan R; Jagannathan, Kanchana; Hager, Nathan; Childress, Anna Rose; Franklin, Teresa R


    Preclinical and clinical research indicates that there are sex differences in how men and women initiate, progress, respond to, and withdraw from cannabis use; however, neurophysiological differences, such as neural responses to cannabis cues, are not well understood. Using functional MRI and an event-related blood oxygen level-dependent backward-masking task, we compared neural responses to backward-masked cannabis cues to neutral cues in treatment-seeking, cannabis-dependent adults (N = 44; 27 males) and examined whether sex differences exist. In addition, functional MRI findings were correlated with cannabis craving. Backward-masked cannabis cues elicited greater neural responses than neutral cues in reward-related brain regions, including the striatum, hippocampus/amygdala, insula, anterior cingulate cortex, and lateral orbitofrontal cortex, p 121 voxels. Although no significant sex differences in neural responses to cannabis cues emerged, women showed a positive correlation between neural responses to cannabis cues in the bilateral insula and cannabis craving and an inverse correlation between neural responses to cannabis cues in the left lateral orbitofrontal cortex and cannabis craving. Men, however, showed a positive correlation between neural responses to cannabis cues in the striatum and cannabis craving. Given that cues and craving are important triggers and the focus on many behavioral treatment approaches, these findings suggest that treatment-seeking, cannabis-dependent men and women may benefit from sex-specific and tailored cannabis use disorder treatments. (c) 2015 APA, all rights reserved).

  15. Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit. (United States)

    Swan, Joshua T


    The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for diagnosing delirium in the ICU and yields 1 of 3 ratings: positive, negative, and unable to assess (UTA). It was hypothesized that an educational campaign focused on establishing patients' arousal as comatose versus noncomatose before initiating the CAM-ICU would decrease the incidence of inappropriate UTA ratings. To compare the incidence of inappropriate UTA ratings before and after an educational campaign. An interventional, quasi-experimental study was conducted in a surgical ICU at a tertiary academic medical center. A nursing educational campaign was conducted from March 1 to March 7, 2012. Patients admitted to the surgical ICU from December 25, 2011 through January 25, 2012 were included in the baseline cohort, and patients admitted from March 9 through April 9, 2012 were included in the posteducation cohort. Inclusion criteria were admission to the surgical ICU for at least 24 hours and at least 1 CAM-ICU assessment. The baseline cohort included 93 patients and the posteducation cohort included 96 patients. Patients were 41% less likely to receive an inappropriate UTA rating after the educational campaign (32% [30 of 93] baseline vs 19% [18 of 96], P = .03). Patients with concurrent mechanical ventilation were more likely to receive an inappropriate UTA rating in the baseline cohort (odds ratio, 30.7; 95% CI, 8.9-105.9; P < .001) and the posteducation cohort (odds ratio, 15.5; 95% CI, 4.1-59.5; P < .001). The educational campaign decreased the incidence of inappropriate UTA ratings.

  16. Real-Time Clinical Decision Support Decreases Inappropriate Plasma Transfusion. (United States)

    Shah, Neil; Baker, Steven A; Spain, David; Shieh, Lisa; Shepard, John; Hadhazy, Eric; Maggio, Paul; Goodnough, Lawrence T


    To curtail inappropriate plasma transfusions, we instituted clinical decision support as an alert upon order entry if the patient's recent international normalized ratio (INR) was 1.7 or less. The alert was suppressed for massive transfusion and within operative or apheresis settings. The plasma order was automatically removed upon alert acceptance while clinical exception reasons allowed for continued transfusion. Alert impact was studied comparing a 7-month control period with a 4-month intervention period. Monthly plasma utilization decreased 17.4%, from a mean ± SD of 3.40 ± 0.48 to 2.82 ± 0.6 plasma units per hundred patient days (95% confidence interval [CI] of difference, -0.1 to 1.3). Plasma transfused below an INR of 1.7 or less decreased from 47.6% to 41.6% (P = .0002; odds ratio, 0.78; 95% CI, 0.69-0.89). The alert recommendation was accepted 33% of the time while clinical exceptions were chosen in the remaining cases (active bleeding, 31%; other clinical indication, 33%; and apheresis, 2%). Alert acceptance rate varied significantly among different provider specialties. Clinical decision support can help curtail inappropriate plasma use but needs to be part of a comprehensive strategy including audit and feedback for comprehensive, long-term changes. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail:

  17. [Prevalence of potentially inappropriate drug prescription in the elderly]. (United States)

    Fajreldines, A; Insua, J; Schnitzler, E


    One of the causes of preventable adverse drug events (ADES) in older patients constitutes inappropriate prescription of drugs (PIM). The PIM is where risks exceed the clinical benefit. Several instruments can be use to measure this problem, the most used are: a) Beers criteria; b) Screening tool to Older People Potentially inappropriate Prescription (STOPP); c) Screening tool to Alert Doctors to Right Appropriate indicated Treatments (START); d) The Medication Appropriateness Index (MAI). This study aims to assess the prevalence of PIM, in a population of older adults in three clinical scopes of university hospital. cross sectional study of 300 cases from a random sample of fields: hospitalization (n=100), ambulatory (n=100) and emergency (n=100), all patients over 65 years old or more who where treated at our hospital. 1355 prescription drugs were analized, finding patients hospitalized (PIM) of 57.7%, 55%, 26%, and 80% according to Beers, in ambulatory 36%, 36.5%, 5% and 52% with the same tools and in emergency 35%, 35%, 6% y 52% with the same tools. Was found significant association the PIM with polipharmacy with Beers, STOPP and MAI. results can be compare to world literature (26-80% vs 11-73.1%). The STOPP-START used in an integrated manner would be best estimating the problem of PIM. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Getting more from visual working memory: Retro-cues enhance retrieval and protect from visual interference. (United States)

    Souza, Alessandra S; Rerko, Laura; Oberauer, Klaus


    Visual working memory (VWM) has a limited capacity. This limitation can be mitigated by the use of focused attention: if attention is drawn to the relevant working memory content before test, performance improves (the so-called retro-cue benefit). This study tests 2 explanations of the retro-cue benefit: (a) Focused attention protects memory representations from interference by visual input at test, and (b) focusing attention enhances retrieval. Across 6 experiments using color recognition and color reproduction tasks, we varied the amount of color interference at test, and the delay between a retrieval cue (i.e., the retro-cue) and the memory test. Retro-cue benefits were larger when the memory test introduced interfering visual stimuli, showing that the retro-cue effect is in part because of protection from visual interference. However, when visual interference was held constant, retro-cue benefits were still obtained whenever the retro-cue enabled retrieval of an object from VWM but delayed response selection. Our results show that accessible information in VWM might be lost in the processes of testing memory because of visual interference and incomplete retrieval. This is not an inevitable state of affairs, though: Focused attention can be used to get the most out of VWM. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  19. Rates of inappropriate antiretroviral prescription among injection drug users

    Directory of Open Access Journals (Sweden)

    Bonner Simon


    Full Text Available Abstract Background Although the survival benefits of antiretroviral therapy (ART for the treatment of HIV infection are well established, the clinical management of HIV disease continues to present major challenges. There are particular concerns regarding access to appropriate HIV treatment among HIV-infected injection drug users (IDU. Methods In a prospective cohort study of HIV-infected IDU in Vancouver, Canada, we examined initial ART regimens vis-à-vis the provincial government's therapeutic guidelines at the time ART was initiated. Briefly, there have been four sets of guidelines: Era 1 (1992 to November 1995; double-drug (dual NRTIs ART for patients with a CD4 cell count of 350 or less; Era 2 (December 1995 to May 1996; double-drug therapy for patients with a CD4+ cell count of 500 or less; Era 3 (June 1996 to June 1997; triple-drug therapy (dual NRTIs with a PI or NNRTI for patients who had a plasma viral load of > 100,000 HIV-1 RNA copies/mL; dual therapy with two NRTIs for those with a plasma viral load of 5,000 to 100,000 HIV-1 RNA copies/mL; Era 4 (since July 1997; universal use of triple drug therapy as first-line treatment. Results Between May 1996 and May 2003, 431 HIV-infected individuals were enrolled into the cohort. By May 31, 2003, 291 (67.5% individuals had initiated ART. We noted instances of inappropriate antiretroviral prescription in each guideline era, with 9 (53% in Era 1, 3 (12% in Era 2, 22 (28% in Era 3, and 23 (15% in Era 4. Of the 57 subjects who received an inappropriate ART regimen initially, 14 never received the appropriate therapy; among the remaining 43, the median time to the initiation of a guideline-appropriate ART regimen was 12 months (inter-quartile range 5 – 20. Conclusion The present study identified measurable rates of guideline-inappropriate ART prescription for patients who were injection drug users. Rates were highest in the era of dual therapy, although high rates persisted into the triple

  20. Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital

    DEFF Research Database (Denmark)

    Soerensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt


    Background Very little is known about the general appropriateness of prescribing for psychiatric patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of psychotropic and somatic medications, to assess the severity of potential clinical consequences...... and to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish...... the most frequent PIP. Predictive factors for PIP were polypharmacy (>5 prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic illness were associated...

  1. Inappropriate sexual behaviour experienced by speech-language therapists. (United States)

    Williams, T H; de Seriere, J; Boddington, L


    Inappropriate sexual behaviour by clients or patients of health professionals has been noted as a considerable problem in a number of professions. Similarly, sexual harassment by colleagues or employers has been identified as causing stress and harm. The primary objective of this study was to investigate the experience of speech-language therapists in New Zealand of inappropriate sexual behaviour (ISB) by colleagues, clients, and care givers of clients. A questionnaire developed by McComas and colleagues to investigate ISB directed by patients at physical therapists in Canada was adapted to meet the broader requirements of this study. This questionnaire was sent to all members of the New Zealand Speech-Language Therapists' Association and to current third- and fourth-year students in the Bachelor of Speech and Language Therapy degree programme in 1994. The overall return rate was 70%. A large number of respondents (81%) reported experiencing some level of ISB. The number of incidents of ISB from clients and colleagues was identified with equal frequency; care givers less frequently. Fewer students than qualified therapists reported ISB as sexual harassment. ISB affects work performance (e.g. absenteeism) and causes psychological reactions (e.g. stress). A majority of respondents reported being satisfied with how they handled ISB but considered there would be value in having training for both qualified and student therapists in managing such behaviour. Conclusions drawn from the study are that colleagues as well as clients are a serious source of ISB for qualified and student speech-language therapists; that negative effects in this group are similar to those in other professions; that speech-language therapists experience less ISB from clients than some other professions; and that, despite legal steps to curb sexual harassment, it continues to be an issue that requires local administrative and educative attention.

  2. Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH). (United States)

    Hamilton, Mark G; Price, Angel V


    Most patients with acute hydrocephalus have ventriculomegaly and high intracranial pressure (ICP). However, there is a subset of patients who are symptomatic with acute ventriculomegaly and inappropriately low ICP. Two patient groups were defined. Each patient presented with clinical deterioration that included a significant decrease in level of consciousness with new and significant ventriculomegaly. Patients in group 1 (n = 10) were managed without endoscopic third ventriculostomy (ETV). Group 2 was a series of patients (n = 10) managed with ETV. Treatment for both groups involved insertion of an external ventricular drain (EVD) with ICP <5 cmH(2)O. Further treatment consisted of either neck wrapping with a tensor bandage and/or lowering the EVD to negative levels to facilitate drainage of cerebrospinal fluid (CSF), which resulted in clinical improvement and resolution of ventriculomegaly. All 20 patients had anatomical obstruction to CSF flow into the subarachnoid space (SAS) confirmed by magnetic resonance imaging (MRI) with cine MRI studies. Group 1 patients were treated until shunt revision/insertion was possible (n = 7), ICP normalized, and the EVD could be removed (n = 2), or death (n = 1) occurred. Patients in group 2 all underwent ETV, and ICP patterns normalized in all. Group 2 patients were managed with an EVD until shunt revision/insertion was required (n = 2), ICP normalized and the EVD could be removed (n = 7), or death (n = 1) occurred. The syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH) is an important entity in both children and adults. A possible hypothesis invokes loss of an effective SAS. ETV reestablishes communication between the SAS and ventricles, producing a rapid return of normal ICP dynamics and a significant decrease in the number of shunt-dependent patients.

  3. Evaluation of multimodal ground cues

    DEFF Research Database (Denmark)

    Nordahl, Rolf; Lecuyer, Anatole; Serafin, Stefania


    This chapter presents an array of results on the perception of ground surfaces via multiple sensory modalities,with special attention to non visual perceptual cues, notably those arising from audition and haptics, as well as interactions between them. It also reviews approaches to combining synth...

  4. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. (United States)

    Tommelein, Eline; Mehuys, Els; Petrovic, Mirko; Somers, Annemie; Colin, Pieter; Boussery, Koen


    Potentially inappropriate prescribing (PIP) is one of the main risk factors for adverse drug events (ADEs) in older people. This systematic literature review aims to determine prevalence and type of PIP in community-dwelling older people across Europe, as well as identifying risk factors for PIP. The PubMed and Web of Science database were searched systematically for relevant manuscripts (January 1, 2000-December 31, 2014). Manuscripts were included if the study design was observational, the study participants were community-dwelling older patients in Europe, and if a published screening method for PIP was used. Studies that focused on specific pathologies or that focused on merely one inappropriate prescribing issue were excluded. Data analysis was performed using R statistics. Fifty-two manuscripts were included, describing 82 different sample screenings with an estimated overall PIP prevalence of 22.6 % (CI 19.2-26.7 %; range 0.0-98.0 %). Ten of the sample screenings were based on the Beers 1997 criteria, 19 on the Beers 2003 criteria, 14 on STOPP criteria (2008 version), 8 on START-criteria (2008 version), and 7 on the PRISCUS list. The 24 remaining sample screenings were carried out using compilations of screening methods or used country-specific lists such as the Laroche criteria. It appears that only PIP prevalence calculated from insurance data significantly differs from the other data collection method categories. Furthermore, risk factors most often positively associated with PIP prevalence were polypharmacy, poor functional status, and depression. Drug groups most often involved in PIP were anxiolytics (ATC-code: N05B), antidepressants (N06A), and nonsteroidal anti-inflammatory and anti-rheumatic products (M01A). PIP prevalence in European community-dwelling older adults is high and depends partially on the data collection method used. Polypharmacy, poor functional status, and depression were identified as the most common risk factors for PIP.

  5. Cue for quality. (United States)

    Manning, C; Lund, G C


    Continuous improvement or CI is an approach to improving quality in an organization's processes on an ongoing basis. Three key components contribute to CI success: (1) draw on the knowledge and abilities of employees at all levels; (2) focus on customer needs; and (3) use data in a scientific approach to decision making. A long-term effort, not a short-term fix, the classic CI cycle is Plan, Do, Study, Act. Health care organizations are finding a good fit for CI in clinical applications. Improved patient care through efficient, consistent processes is one of the immediate, obvious benefits of CI. The data collected can also validate decisions from a financial standpoint and provide necessary information to regulatory agencies. Over the longer term, applying CI data and understanding customer needs can help to develop efficient, user-oriented facilities. The chief payback, however, is an organization that is flourishing because it meets the needs and expectations of customers--patients, physicians, employees, and the community.

  6. Visual cues to female physical attractiveness. (United States)

    Tovée, M J; Maisey, D S; Emery, J L; Cornelissen, P L


    Evolutionary psychology suggests that a woman's sexual attractiveness is based on cues of health and reproductive potential. In recent years, research has focused on the ratio of the width of the waist to the width of the hips (the waist-to-hip ratio (WHR). A low WHR (i.e. a curvaceous body) is believed to correspond to the optimal fat distribution for high fertility, and so this shape should be highly attractive. In this paper we present evidence that weight scaled for height (the body mass index (BMI)) is the primary determinant of sexual attractiveness rather than WHR. BMI is also strongly linked to health and reproductive potential. Furthermore, we show how covariation of apparent BMI and WHR in previous studies led to the overestimation of the importance of WHR in the perception of female attractiveness. Finally, we show how visual cues, such as the perimeter-area ratio (PAR), can provide an accurate and reliable index of an individual's BMI and could be used by an observer to differentiate between potential partners.

  7. Endogenous cueing attenuates object substitution masking. (United States)

    Germeys, Filip; Pomianowska, I; De Graef, P; Zaenen, P; Verfaillie, K


    Object substitution masking (OSM) is a form of visual masking in which a briefly presented target surrounded by four small dots is masked by the continuing presence of the four dots after target offset. A major parameter in the prediction of OSM is the time required for attention to be directed to the target following its onset. Object substitution theory (Di Lollo et al. in J Exp Psychol Gen 129:481-507, 2000) predicts that the sooner attention can be focused at the target's location, the less masking will ensue. However, recently Luiga and Bachmann (Psychol Res 71:634-640, 2007) presented evidence that precueing of attention to the target location prior to target-plus-mask onset by means of a central (endogenous) arrow cue does not reduce OSM. When attention was cued exogenously, OSM was attenuated. Based on these results, Luiga and Bachmann argued that object substitution theory should be adapted by differentiating the ways of directing attention to the target location. The goal of the present study was to further examine the dissociation between the effects of endogenous and exogenous precueing on OSM. Contrary to Luiga and Bachmann, our results show that prior shifts of attention to the target location initiated by both exogenous and endogenous cues reduce OSM as predicted by object substitution theory and its computational model CMOS.

  8. [Cues and pseudocues in surgical multiple choice questions from the German state examination]. (United States)

    de Laffolie, J; Visser, D; Hirschburger, M; Turial, S


    Multiple choice questions (MCQs) are the most common written test item in medical examinations. Writing MCQs is difficult and cues can decrease test validity. The aim of this article is to describe the prevalence and pattern of cues in surgical MCQs in the central German medical examination questions from 2000-2011. All surgical questions were entered into a database. The questions were reviewed for cues and pseudocues independently by three students of different academic background and one clinical physician. Initially, 1014 questions were included, 22 questions were not rated uniformly by the reviewers and 3 questions were excluded because no consensus could be reached. Overall 15.2 % of the questions analyzed contained some type of cue or pseudocue. Of the total questions 0.2 % contained type A cues (i.e. disruption of grammatical flow), 6.5 % contained type B cues (i.e. heterogeneous length or differentiation), 4.0 % contained type C cues (two or more answers described closely related topics, serving to focus attention), 0.6 % contained type D convergence cues (i.e. answers with the most items in common with distractors are correct), 0.7 % contained type E verbal association cues (i.e. connection in the use of words leading to the correct answer) and 1.0 % contained type F cues (i.e. answers with absolute terms). Pseudocues were found in 3.7 % of the questions. The proportion of questions that contained cues or pseudocues should lead to further efforts to avoid such factors compromising test reliability by specific attention in the process of question design and review. Cues are still an important consideration in designing MCQs and are present in considerable numbers in medical state examination questions. Pseudocues should be explicitly avoided so as not to compromise validity and reliability.

  9. When Symbolic Spatial Cues Go before Numbers (United States)

    Herrera, Amparo; Macizo, Pedro


    This work explores the effect of spatial cueing on number processing. Participants performed a parity judgment task. However, shortly before the target number, a cue (arrow pointing to left, arrow pointing to right or a cross) was centrally presented. In Experiment 1, in which responses were lateralized, the cue direction modulated the interaction…

  10. Linguistic Cues Enhance the Learning of Perceptual Cues


    Yoshida, Hanako; Smith, Linda B.


    When language is correlated with regularities in the world, does it enhance the learning of these regularities? This question lies at the core of both notions of linguistic bootstrapping in children and the Whorfian hypothesis. Support for an affirmative answer is provided in an artificial-noun-learning task in which 2-year-old children were taught to distinguish categories of solid and nonsolid things with and without supporting correlated linguistic cues.

  11. Potentially inappropriate medication use in a city of Southeast Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Cunha Xavier Pinto


    Full Text Available Potentially inappropriate medication use by the Diamantina (Minas Gerais State population was investigated by analyzing medicine consumption, self-medication, polypharmacy and drug interactions of medicines prescribed among those interviewed. Level of knowledge about rational drug use and its relationship to socio-economic variables was also evaluated using a semi-structured questionnaire. This survey was based on stratified sampling of 423 individuals selected randomly. The prevalence of prescription drug consumption was 42.32% (n=179 and cardiovascular drugs were the most prescribed. Drug interactions were found in 45.81% (n=82 of prescriptions and 92.68% (n=76 of these interactions were moderate, with co-administration of cardiovascular drugs occurring in more than half of the cases. The inappropriate use of medication, according to Beers criteria, occurred in 44.73% of prescriptions to the elderly. The prevalence of self-medication was 63.34% (n=268 while 21.99% (n=91 of individuals administered medications to their children without formal prescriptions, where this practice was associated to analgesic/antipyretic consumption. The population showed a high prevalence of inappropriate use of drugs across all strata of society, representing an issue requiring effective actions to promote rational use of medicines.O consumo inapropriado de medicamentos pela população de Diamantina-MG foi investigado através da análise do consumo de medicamentos, automedicação, polifarmácia e interações medicamentosas prescritas aos entrevistados. Também foi avaliado o nível de conhecimento sobre uso racional de medicamentos e sua relação com variáveis sócio-econômicas através de um questionário semi-estruturado. Este estudo transversal foi baseado em amostragem estratificada e contou com a participação de 423 indivíduos selecionados aleatoriamente. A prevalência do consumo de medicamentos prescritos foi de 42,32% (n=179, sendo os

  12. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use


    Lee, Chun-Hsien; Chang, Fong-Ching; Hsu, Sheng-Der; Chi, Hsueh-Yun; Huang, Li-Jung; Yeh, Ming-Kung


    Background While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication. Method In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factor...

  13. Stop identity cue as a cue to language identity (United States)

    Castonguay, Paula Lisa

    The purpose of the present study was to determine whether language membership could potentially be cued by the acoustic-phonetic detail of word-initial stops and retained all the way through the process of lexical access to aid in language identification. Of particular interest were language-specific differences in CE and CF word-initial stops. Experiment 1 consisted of an interlingual homophone production task. The purpose of this study was to examine how word-initial stop consonants differ in terms of acoustic properties in Canadian English (CE) and Canadian French (CF) interlingual homophones. The analyses from the bilingual speakers in Experiment 1 indicate that bilinguals do produce language-specific differences in CE and CF word-initial stops, and that closure duration, voice onset time, and burst spectral SD may provide cues to language identity in CE and CF stops. Experiment 2 consisted of a Phoneme and Language Categorization task. The purpose of this study was to examine how stop identity cues, such as VOT and closure duration, influence a listener to identify word-initial stop consonants as belonging to Canadian English (CE) or Canadian French (CF). The RTs from the bilingual listeners in this study indicate that bilinguals do perceive language-specific differences in CE and CF word-initial stops, and that voice onset time may provide cues to phoneme and language membership in CE and CF stops. Experiment 3 consisted of a Phonological-Semantic priming task. The purpose of this study was to examine how subphonetic variations, such as changes in the VOT, affect lexical access. The results of Experiment 3 suggest that language-specific cues, such as VOT, affects the composition of the bilingual cohort and that the extent to which English and/or French words are activated is dependent on the language-specific cues present in a word. The findings of this study enhanced our theoretical understanding of lexical structure and lexical access in bilingual speakers

  14. Visual cues for data mining (United States)

    Rogowitz, Bernice E.; Rabenhorst, David A.; Gerth, John A.; Kalin, Edward B.


    This paper describes a set of visual techniques, based on principles of human perception and cognition, which can help users analyze and develop intuitions about tabular data. Collections of tabular data are widely available, including, for example, multivariate time series data, customer satisfaction data, stock market performance data, multivariate profiles of companies and individuals, and scientific measurements. In our approach, we show how visual cues can help users perform a number of data mining tasks, including identifying correlations and interaction effects, finding clusters and understanding the semantics of cluster membership, identifying anomalies and outliers, and discovering multivariate relationships among variables. These cues are derived from psychological studies on perceptual organization, visual search, perceptual scaling, and color perception. These visual techniques are presented as a complement to the statistical and algorithmic methods more commonly associated with these tasks, and provide an interactive interface for the human analyst.

  15. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    Ryan, Cristín


    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  16. Between two beds: inappropriately delayed discharges from hospitals. (United States)

    Holmås, Tor Helge; Islam, Mohammad Kamrul; Kjerstad, Egil


    Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care.

  17. An inappropriate tool: criminal law and HIV in Asia. (United States)

    Csete, Joanne; Dube, Siddharth


    Asian countries have applied criminal sanctions widely in areas directly relevant to national HIV programmes and policies, including criminalization of HIV transmission, sex work, homosexuality and drug injection. This criminalization may impede universal access to HIV prevention and treatment services in Asia and undermine vulnerable people's ability to be part of the HIV response. To review the status of application of criminal law in key HIV-related areas in Asia and analyze its impact. Review of literature and application of human rights norms to analysis of criminal law measures. Criminal laws in the areas considered here and their enforcement, while intended to reduce HIV transmission, are inappropriate and counterproductive with respect to health and human rights. Governments should remove punitive laws that impede the HIV response and should ensure meaningful participation of people living with HIV, people who use illicit drugs, sex workers and men who have sex with men in combating stigma and discrimination and developing rights-centered approaches to HIV.

  18. Inappropriate eating behavior: a longitudinal study with female adolescents

    Directory of Open Access Journals (Sweden)

    Leonardo de Sousa Fortes


    Full Text Available Objective: To evaluate the inappropriate eating behaviors (IEB of female adolescents over a one-year period. Methods: 290 adolescents aged between 11 and 14 years old participated in the three research stages (T1: first four months, T2: second four months and T3: third four months. The Eating Attitudes Test (EAT-26 was applied to assess the IEB. Weight and height were measured to calculate body mass index (BMI in the three study periods. Analysis of variance for repeated measures was used to analyze the data, adjusted for the scores of the Body Shape Questionnaire and the Brazil Economic Classification Criteria. Results: Girls at T1 showed a higher frequency of IEB compared to T2 (p=0.001 and T3 (p=0.001. The findings also indicated higher values for BMI in T3 in relation to T1 (p=0.04. The other comparisons did not show statistically significant differences. Conclusions: IEB scores of female adolescents declined over one year.

  19. Colour cues or spatial cues? Context-dependent preferences in the European greenfinch (Carduelis chloris). (United States)

    Herborn, Katherine; Alexander, Lucille; Arnold, Kathryn E


    Using featural cues such as colour to identify ephemeral food can increase foraging efficiency. Featural cues may change over time however; therefore, animals should use spatial cues to relocate food that occurs in a temporally stable position. We tested this hypothesis by measuring the cue preferences of captive greenfinches Carduelis chloris when relocating food hidden in a foraging tray. In these standardised associative learning trials, greenfinches favoured colour cues when returning to a foraging context that they had encountered before only once ("one-trial test") but switched to spatial cues when they had encountered that scenario on ten previous occasions ("repeated-trial test"). We suggest that repeated encounters generated a context in which individuals had a prior expectation of temporal stability, and hence context-dependent cue selection. Next, we trained birds to find food in the absence of colour cues but tested them in the presence of visual distracters. Birds were able to learn spatial cues after one encounter, but only when visual distracters were identical in colouration. When a colourful distracter was present in the test phase, cue selection was random. Unlike the first one-trial test, birds were not biased towards this colourful visual distracter. Together, these results suggest that greenfinches are able to learn both cue types, colour cue biases represent learning, not simply distraction, and spatial cues are favoured over colour cues only in temporally stable contexts. © Springer-Verlag 2010

  20. Inappropriate prescribing and adverse drug events in older people.

    LENUS (Irish Health Repository)

    Hamilton, Hilary J


    Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  1. Inappropriate prescribing and adverse drug events in older people

    Directory of Open Access Journals (Sweden)

    Gallagher Paul F


    Full Text Available Abstract Inappropriate prescribing (IP in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs, morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  2. The Inappropriate Symmetries of Multivariate Statistical Analysis in Geometric Morphometrics. (United States)

    Bookstein, Fred L

    In today's geometric morphometrics the commonest multivariate statistical procedures, such as principal component analysis or regressions of Procrustes shape coordinates on Centroid Size, embody a tacit roster of symmetries -axioms concerning the homogeneity of the multiple spatial domains or descriptor vectors involved-that do not correspond to actual biological fact. These techniques are hence inappropriate for any application regarding which we have a-priori biological knowledge to the contrary (e.g., genetic/morphogenetic processes common to multiple landmarks, the range of normal in anatomy atlases, the consequences of growth or function for form). But nearly every morphometric investigation is motivated by prior insights of this sort. We therefore need new tools that explicitly incorporate these elements of knowledge, should they be quantitative, to break the symmetries of the classic morphometric approaches. Some of these are already available in our literature but deserve to be known more widely: deflated (spatially adaptive) reference distributions of Procrustes coordinates, Sewall Wright's century-old variant of factor analysis, the geometric algebra of importing explicit biomechanical formulas into Procrustes space. Other methods, not yet fully formulated, might involve parameterized models for strain in idealized forms under load, principled approaches to the separation of functional from Brownian aspects of shape variation over time, and, in general, a better understanding of how the formalism of landmarks interacts with the many other approaches to quantification of anatomy. To more powerfully organize inferences from the high-dimensional measurements that characterize so much of today's organismal biology, tomorrow's toolkit must rely neither on principal component analysis nor on the Procrustes distance formula, but instead on sound prior biological knowledge as expressed in formulas whose coefficients are not all the same. I describe the problems

  3. Inappropriate shock: a failure of SVT discriminators in a dual chamber ICD? (United States)

    Al-Ahmad, Amin; Tsiperfal, Angela; Hsia, Henry H; Wang, Paul J


    Inappropriate shock remains a major issue in patients with implantable cardioverter defibrillators. We examine an inappropriate shock delivered in a patient with atrial tachycardia that conducted 1:1. We reconstruct the device algorithms that led to therapy delivery and discuss programming changes that could be considered.

  4. Functional Analysis of Inappropriate Social Interactions in Students with Asperger's Syndrome (United States)

    Roantree, Christina F.; Kennedy, Craig H.


    We analyzed the inappropriate social interactions of 3 students with Asperger's syndrome whose behavior was maintained by social positive reinforcement. We tested whether inappropriate social behavior was sensitive to social positive reinforcement contingencies and whether such contingencies could be reversed to increase the probability of…

  5. [Management of inappropriate shocks/T-wave-oversensing in S-ICD®-patients]. (United States)

    Larbig, Robert; Bettin, Markus; Motloch, Lukas J; Fischer, Alicia; Bode, Niklas; Frommeyer, Gerrit; Reinke, Florian; Loeher, Andreas; Eckardt, Lars; Köbe, Julia


    Inappropriate shocks are a feared complication after implantable cardioverter-defibrillator (ICD) implantation and have a tremendous impact on quality of life. Inappropriate shocks in patients with subcutaneous ICD (S-ICD®, Boston Scientific, Marlborough, MA, USA) have various underlying causes. This review summarizes the current literature on this topic and lists possible treatment options.

  6. What is inappropriate hospital use for elderly people near the end of life?

    DEFF Research Database (Denmark)

    Cardona-Morrell, Magnolia; Kim, James C H; Brabrand, Mikkel


    independently by two authors. RESULTS: The definition of 'Inappropriate admissions' near the end of life incorporated system factors, social and family factors. The prevalence of inappropriate admissions ranged widely depending largely on non-clinical reasons: poor availability of alternative sites of care...

  7. Auditory rhythmic cueing in movement rehabilitation: findings and possible mechanisms. (United States)

    Schaefer, Rebecca S


    Moving to music is intuitive and spontaneous, and music is widely used to support movement, most commonly during exercise. Auditory cues are increasingly also used in the rehabilitation of disordered movement, by aligning actions to sounds such as a metronome or music. Here, the effect of rhythmic auditory cueing on movement is discussed and representative findings of cued movement rehabilitation are considered for several movement disorders, specifically post-stroke motor impairment, Parkinson's disease and Huntington's disease. There are multiple explanations for the efficacy of cued movement practice. Potentially relevant, non-mutually exclusive mechanisms include the acceleration of learning; qualitatively different motor learning owing to an auditory context; effects of increased temporal skills through rhythmic practices and motivational aspects of musical rhythm. Further considerations of rehabilitation paradigm efficacy focus on specific movement disorders, intervention methods and complexity of the auditory cues. Although clinical interventions using rhythmic auditory cueing do not show consistently positive results, it is argued that internal mechanisms of temporal prediction and tracking are crucial, and further research may inform rehabilitation practice to increase intervention efficacy. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  8. Cues for localization in the horizontal plane

    DEFF Research Database (Denmark)

    Jeppesen, Jakob; Møller, Henrik


    Spatial localization of sound is often described as unconscious evaluation of cues given by the interaural time difference (ITD) and the spectral information of the sound that reaches the two ears. Our present knowledge suggests the hypothesis that the ITD roughly determines the cone of the perce...... to be necessary for localization in the sense that sources are localized well when the two types of cues are correct. When the cues are severely conflicting the localization performance is highly degraded....... manipulated in HRTFs used for binaural synthesis of sound in the horizontal plane. The manipulation of cues resulted in HRTFs with cues ranging from correct combinations of spectral information and ITDs to combinations with severely conflicting cues. Both the ITD and the spectral information seem...

  9. Utilising wearable sensor technology to provide effective memory cues


    Doherty, Aiden R.; Smeaton, Alan F.


    We describe a wearable sensor technology that passively records "lifelog" images and sensor readings of a wearer's daily life. The focus of our work is not on aggregating, collecting or networking data as in the usual application of sensors in the Sensor Web, but rather on detecting events of interest to the wearer from a multi-sensor standalone device. These events of interest provide effective cues to allow people to more easily access their autobiographical memories. Early research indicat...

  10. Anemonefishes rely on visual and chemical cues to correctly identify conspecifics (United States)

    Johnston, Nicole K.; Dixson, Danielle L.


    Organisms rely on sensory cues to interpret their environment and make important life-history decisions. Accurate recognition is of particular importance in diverse reef environments. Most evidence on the use of sensory cues focuses on those used in predator avoidance or habitat recognition, with little information on their role in conspecific recognition. Yet conspecific recognition is essential for life-history decisions including settlement, mate choice, and dominance interactions. Using a sensory manipulated tank and a two-chamber choice flume, anemonefish conspecific response was measured in the presence and absence of chemical and/or visual cues. Experiments were then repeated in the presence or absence of two heterospecific species to evaluate whether a heterospecific fish altered the conspecific response. Anemonefishes responded to both the visual and chemical cues of conspecifics, but relied on the combination of the two cues to recognize conspecifics inside the sensory manipulated tank. These results contrast previous studies focusing on predator detection where anemonefishes were found to compensate for the loss of one sensory cue (chemical) by utilizing a second cue (visual). This lack of sensory compensation may impact the ability of anemonefishes to acclimate to changing reef environments in the future.

  11. Effective integration of serially presented stochastic cues (United States)

    Juni, Mordechai Z.; Gureckis, Todd M.; Maloney, Laurence T.


    This study examines how people deal with inherently stochastic cues when estimating a latent environmental property. Seven cues to a hidden location were presented one at a time in rapid succession. The seven cues were sampled from seven different Gaussian distributions that shared a common mean but differed in precision (the reciprocal of variance). The experimental task was to estimate the common mean of the Gaussians from which the cues were drawn. Observers ran in two conditions on separate days. In the “decreasing precision” condition the seven cues were ordered from most precise to least precise. In the “increasing precision” condition this ordering was reversed. For each condition, we estimated the weight that each cue in the sequence had on observers' estimates and compared human performance to that of an ideal observer who maximizes expected gain. We found that observers integrated information from more than one cue, and that they adaptively gave more weight to more precise cues and less weight to less precise cues. However, they did not assign weights that would maximize their expected gain, even over the course of several hundred trials with corrective feedback. The cost to observers of their suboptimal performance was on average 16% of their maximum possible winnings. PMID:22911906

  12. Extracellular matrix elasticity and topography: material-based cues that affect cell function via conserved mechanisms (United States)

    Janson, Isaac A.; Putnam, Andrew J.


    Chemical, mechanical, and topographic extracellular matrix (ECM) cues have been extensively studied for their influence on cell behavior. These ECM cues alter cell adhesion, cell shape, and cell migration, and activate signal transduction pathways to influence gene expression, proliferation, and differentiation. ECM elasticity and topography, in particular, have emerged as material properties of intense focus based on strong evidence these physical cue can partially dictate stem cell differentiation. Cells generate forces to pull on their adhesive contacts, and these tractional forces appear to be a common element of cells’ responses to both elasticity and topography. This review focuses on recently published work that links ECM topography and mechanics and their influence on differentiation and other cell behaviors, We also highlight signaling pathways typically implicated in mechanotransduction that are (or may be) shared by cells subjected to topographic cues. Finally, we conclude with a brief discussion of the potential implications of these commonalities for cell based therapies and biomaterial design. PMID:24910444

  13. Post-cueing deficits with maintained cueing benefits in patients with Parkinson's disease dementia

    Directory of Open Access Journals (Sweden)

    Susanne eGräber


    Full Text Available In Parkinson’s disease (PD internal cueing mechanisms are impaired leading to symptoms such as like hypokinesia. However external cues can improve movement execution by using cortical resources. These cortical processes can be affected by cognitive decline in dementia.It is still unclear how dementia in PD influences external cueing. We investigated a group of 25 PD patients with dementia (PDD and 25 non-demented PD patients (PDnD matched by age, sex and disease duration in a simple reaction time (SRT task using an additional acoustic cue. PDD patients benefited from the additional cue in similar magnitude as did PDnD patients. However, withdrawal of the cue led to a significantly increased reaction time in the PDD group compared to the PDnD patients. Our results indicate that even PDD patients can benefit from strategies using external cue presentation but the process of cognitive worsening can reduce the effect when cues are withdrawn.

  14. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use. (United States)

    Lee, Chun-Hsien; Chang, Fong-Ching; Hsu, Sheng-Der; Chi, Hsueh-Yun; Huang, Li-Jung; Yeh, Ming-Kung


    While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication. In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication. The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%), cold or cough medicines (prevalence = 21.6%), analgesics (prevalence = 19.3%), and antacids (prevalence = 17.3%). Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%), using excessive dosages (21.6%), and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy) (30.3%). The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication. Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

  15. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use.

    Directory of Open Access Journals (Sweden)

    Chun-Hsien Lee

    Full Text Available While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication.In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication.The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%, cold or cough medicines (prevalence = 21.6%, analgesics (prevalence = 19.3%, and antacids (prevalence = 17.3%. Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%, using excessive dosages (21.6%, and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy (30.3%. The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication.Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

  16. Retrieval of bilingual autobiographical memories: effects of cue language and cue imageability. (United States)

    Mortensen, Linda; Berntsen, Dorthe; Bohn, Ocke-Schwen


    An important issue in theories of bilingual autobiographical memory is whether linguistically encoded memories are represented in language-specific stores or in a common language-independent store. Previous research has found that autobiographical memory retrieval is facilitated when the language of the cue is the same as the language of encoding, consistent with language-specific memory stores. The present study examined whether this language congruency effect is influenced by cue imageability. Danish-English bilinguals retrieved autobiographical memories in response to Danish and English high- or low-imageability cues. Retrieval latencies were shorter to Danish than English cues and shorter to high- than low-imageability cues. Importantly, the cue language effect was stronger for low-than high-imageability cues. To examine the relationship between cue language and the language of internal retrieval, participants identified the language in which the memories were internally retrieved. More memories were retrieved when the cue language was the same as the internal language than when the cue was in the other language, and more memories were identified as being internally retrieved in Danish than English, regardless of the cue language. These results provide further evidence for language congruency effects in bilingual memory and suggest that this effect is influenced by cue imageability.

  17. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    Directory of Open Access Journals (Sweden)

    Yamada Yukari


    Full Text Available Abstract Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified on the basis of the 2003 Beers criteria. Results The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1% of the patients were treated with potentially inappropriate medication independent of disease or condition. The most commonly inappropriately prescribed medication was ticlopidine, which had been prescribed for 107 patients (6.3%. There were 300 (18.0% patients treated with at least 1 inappropriate medication dependent on the disease or condition. The highest prevalence of inappropriate medication use dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511, medication cost of per day (OR = 1.173, number of medications (OR = 1.140, and age (OR = 0.981 as factors related to inappropriate medication use independent of disease or condition. Neither patient characteristics nor facility characteristics emerged as predictors of inappropriate prescription. Conclusion The prevalence and predictors of inappropriate medication use in Japanese LTC facilities were similar to those in other countries.

  18. Impact of a warning CPOE system on the inappropriate pill splitting of prescribed medications in outpatients.

    Directory of Open Access Journals (Sweden)

    Chia-Chen Hsu

    Full Text Available Prescribing inappropriate pill splitting is not rare in clinical practice. To reduce inappropriate pill splitting, we developed an automatic warning system linked to a computerized physician order entry (CPOE system for special oral formulation drugs in outpatient settings. We examined the impact of the warning system on inappropriate prescribing of pill splitting and assess prescribers' responses to the warnings.Drugs with extended-release or enteric-coated formulations that were not originally intended to be split were recognized as "special oral formulations". A hard-stop system which could examine non-integer doses of drugs with special oral formulations, provide warnings to interrupt inappropriate prescriptions was integrated in CPOE in a medical center since June 2010. We designed an intervention study to compare the inappropriate splitting before and after the implementation of the warning system (baseline period 2010 January to May vs. intervention period 2010 June to 2011 August. During the intervention period, prescription changes in response to a warning were logged and analyzed.A total of 470,611 prescribed drug items with 34 different drugs with special oral formulations were prescribed in the study period. During the 15-month intervention period, 909 warnings for 26 different drugs were triggered among 354,523 prescribed drug items with special oral formulations. The warning rate of inappropriate splitting in the late intervention period was lower than those in baseline period (0.16% vs. 0.61%, incidence rate ratio 0.27, 95% CI 0.23-0.31, P<0.001. In respond to warnings, physicians had to make adjustments, of which the majority was changing to an unsplit pill (72.9%.The interruptive warning system could avoid the prescriptions with inappropriate pill splitting. Accordingly, physicians changed their behavior of prescribing special oral formulations regarding inappropriate pill splitting. We suggest the establishment of such system

  19. Individual and hospital-related determinants of potentially inappropriate admissions emerging from administrative records. (United States)

    Fusco, Marco; Buja, Alessandra; Piergentili, Paolo; Golfetto, Maria Teresa; Serafin, Gianni; Gallo, Silvia; Dalla Barba, Livio; Baldo, Vincenzo


    The appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. Medical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients' medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. Inappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards' specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients' higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. Some individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate

  20. Understanding Factors Contributing to Inappropriate Critical Care: A Mixed-Methods Analysis of Medical Record Documentation. (United States)

    Neville, Thanh H; Tarn, Derjung M; Yamamoto, Myrtle; Garber, Bryan J; Wenger, Neil S


    Factors leading to inappropriate critical care, that is treatment that should not be provided because it does not offer the patient meaningful benefit, have not been rigorously characterized. We explored medical record documentation about patients who received inappropriate critical care and those who received appropriate critical care to examine factors associated with the provision of inappropriate treatment. Medical records were abstracted from 123 patients who were assessed as receiving inappropriate treatment and 66 patients who were assessed as receiving appropriate treatment but died within six months of intensive care unit (ICU) admission. We used mixed methods combining qualitative analysis of medical record documentation with multivariable analysis to examine the relationship between patient and communication factors and the receipt of inappropriate treatment, and present these within a conceptual model. One academic health system. Medical records revealed 21 themes pertaining to prognosis and factors influencing treatment aggressiveness. Four themes were independently associated with patients receiving inappropriate treatment according to physicians. When decision making was not guided by physicians (odds ratio [OR] 3.76, confidence interval [95% CI] 1.21-11.70) or was delayed by patient/family (OR 4.52, 95% CI 1.69-12.04), patients were more likely to receive inappropriate treatment. Documented communication about goals of care (OR 0.29, 95% CI 0.10-0.84) and patient's preferences driving decision making (OR 0.02, 95% CI 0.00-0.27) were associated with lower odds of receiving inappropriate treatment. Medical record documentation suggests that inappropriate treatment occurs in the setting of communication and decision-making patterns that may be amenable to intervention.

  1. Cueing Animations: Dynamic Signaling Aids Information Extraction and Comprehension (United States)

    Boucheix, Jean-Michel; Lowe, Richard K.; Putri, Dian K.; Groff, Jonathan


    The effectiveness of animations containing two novel forms of animation cueing that target relations between event units rather than individual entities was compared with that of animations containing conventional entity-based cueing or no cues. These relational event unit cues ("progressive path" and "local coordinated" cues) were specifically…

  2. Knudsen-Like Scaling May Be Inappropriate for Gas Shales

    KAUST Repository

    Patzek, Tadeusz


    Summary We assert that a classification of gas flow regimes in shales that is widely accepted in the petroleum industry, may be inconsistent with the physics of high-pressure gas flow in capillaries. This classification follows from the 1946 work by Brown et al. (1946) that deals with the flow of gases in large industrial metal pipes, elbows and orifices under vacuum, with gas pressures of the order of 1 mm Hg or less. In another pioneering paper that year, Tsien (1946) analyzed the hypersonic flight of rockets in the thermosphere (above 50 miles of altitude), and established the widely accepted Knudsen flow regimes for the high-Reynolds, high-Mach flow of rarified gases. We show why both these papers are not quite applicable to flow of compressed gas in the hot, high-pressure shale pores with rough surfaces. In addition, it may be inappropriate to use the capillary tube metaphor to describe shale micropores or microcracks, simply because each is fed with gas by dozens or hundreds of intricately connected nanopores, which themselves may be slits rather than circular cylinders, and are charged with the dense, liquid-like gas. In the small-scale, low-velocity flows of gases, failure of the standard Navier-Stokes description (the standard Darcy law in petroleum engineering) can be quantified by the Knudsen number, ratio of the mean free path, λ, of gas molecules at the reservoir pressure and temperature to the characteristic pore radius, R. We carefully enumerate the multiple restrictive conditions that must hold for the slip-flow boundary condition to emerge. We also describe the dependence of the slip correction factor on the gas pressure and temperature, as well as the median pore size and rock roughness. In the derivation, we revisit the original approaches of Helmholtz and von Piotrowski (1860) and Maxwell, Niven (1890), which were somehow lost in the multiple translations from physics to petroleum engineering. For example, in Barnett mudrocks, naturally

  3. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem (United States)

    Parsons, Carole


    Multimorbidity and polypharmacy are increasingly prevalent across healthcare systems and settings as global demographic trends shift towards increased proportions of older people in populations. Numerous studies have demonstrated an association between polypharmacy and potentially inappropriate prescribing (PIP), and have reported high prevalence of PIP across settings of care in Europe and North America and, as a consequence, increased risk of adverse drug reactions, healthcare utilization, morbidity and mortality. These studies have not focused specifically on people with dementia, despite the high risk of adverse drug reactions and PIP in this patient cohort. This narrative review considers the evidence currently available in the area, including studies examining prevalence of PIP in older people with dementia, how appropriateness of prescribing is assessed, the medications most commonly implicated, the clinical consequences, and research priorities to optimize prescribing for this vulnerable patient group. Although there has been a considerable research effort to develop criteria to assess medication appropriateness in older people in recent years, the majority of tools do not focus on people with dementia. Of the limited number of tools available, most focus on the advanced stages of dementia in which life expectancy is limited. The development of tools to assess medication appropriateness in people with mild to moderate dementia or across the full spectrum of disease severity represents an important gap in the research literature and is beginning to attract research interest, with recent studies considering the medication regimen as a whole, or misprescribing, overprescribing or underprescribing of certain medications/medication classes, including anticholinergics, psychotropics, antibiotics and analgesics. Further work is required in development and validation of criteria to assess prescribing appropriateness in this vulnerable patient population, to

  4. Gaze in Visual Search Is Guided More Efficiently by Positive Cues than by Negative Cues. (United States)

    Kugler, Günter; 't Hart, Bernard Marius; Kohlbecher, Stefan; Einhäuser, Wolfgang; Schneider, Erich


    Visual search can be accelerated when properties of the target are known. Such knowledge allows the searcher to direct attention to items sharing these properties. Recent work indicates that information about properties of non-targets (i.e., negative cues) can also guide search. In the present study, we examine whether negative cues lead to different search behavior compared to positive cues. We asked observers to search for a target defined by a certain shape singleton (broken line among solid lines). Each line was embedded in a colored disk. In "positive cue" blocks, participants were informed about possible colors of the target item. In "negative cue" blocks, the participants were informed about colors that could not contain the target. Search displays were designed such that with both the positive and negative cues, the same number of items could potentially contain the broken line ("relevant items"). Thus, both cues were equally informative. We measured response times and eye movements. Participants exhibited longer response times when provided with negative cues compared to positive cues. Although negative cues did guide the eyes to relevant items, there were marked differences in eye movements. Negative cues resulted in smaller proportions of fixations on relevant items, longer duration of fixations and in higher rates of fixations per item as compared to positive cues. The effectiveness of both cue types, as measured by fixations on relevant items, increased over the course of each search. In sum, a negative color cue can guide attention to relevant items, but it is less efficient than a positive cue of the same informational value.

  5. Cue Reliance in L2 Written Production (United States)

    Wiechmann, Daniel; Kerz, Elma


    Second language learners reach expert levels in relative cue weighting only gradually. On the basis of ensemble machine learning models fit to naturalistic written productions of German advanced learners of English and expert writers, we set out to reverse engineer differences in the weighting of multiple cues in a clause linearization problem. We…

  6. How rats combine temporal cues. (United States)

    Guilhardi, Paulo; Keen, Richard; MacInnis, Mika L M; Church, Russell M


    The procedures for classical and operant conditioning, and for many timing procedures, involve the delivery of reinforcers that may be related to the time of previous reinforcers and responses, and to the time of onsets and terminations of stimuli. The behavior resulting from such procedures can be described as bouts of responding that occur in some pattern at some rate. A packet theory of timing and conditioning is described that accounts for such behavior under a wide range of procedures. Applications include the food searching by rats in Skinner boxes under conditions of fixed and random reinforcement, brief and sustained stimuli, and several response-food contingencies. The approach is used to describe how multiple cues from reinforcers and stimuli combine to determine the rate and pattern of response bouts.

  7. Factors underlying students’ appropriate or inappropriate use of scholarly sources in academic writing, and instructors’ responses

    Directory of Open Access Journals (Sweden)

    John Sivell


    Full Text Available At first glance it is surprising that – in remarkable contrast to grammatical or lexical failings which, while certainly not viewed as insignificant, are rarely greeted with outright anger or hostility – inappropriate documentation of scholarly sources so frequently provokes very harsh penalties. Rather than the constructively pedagogical approach that one would expect with regard to other defects in writing, why do we so often witness a rush to negative evaluation of what may, after all, be evidence of nothing more culpable than misinformation, confusion, or oversight? Much has of course been written about possible remedies for ineffective use of scholarly sources and, on the other hand, about available monitoring and punishment for deliberate plagiarism; so, in a sense, the alternatives appear quite simple. However, decisions about when to adopt a more pedagogical or a more disciplinary viewpoint are complicated by difficult and potentially emotional factors that can disrupt calm, confident and well-reasoned judgment. Thus, this paper will focus not on pedagogical or disciplinary strategies, whichever may be considered suitable in a given case, but on a framework for thorough reflection earlier in the thinking process. It will explore multiple perspectives on possible origins for the innocent if maladroit mishandling of scholarly sources, with a view to highlighting a number of informative but potentially neglected reference points – a cognitive psychological perspective on human error and error management, plausible ambiguities in determining what actually constitutes plagiarism, and communication challenges – that may enter into the instructor’s final determination.

  8. Kin-informative recognition cues in ants

    DEFF Research Database (Denmark)

    Nehring, Volker; Evison, Sophie E F; Santorelli, Lorenzo A


    behaviour is thought to be rare in one of the classic examples of cooperation--social insect colonies--because the colony-level costs of individual selfishness select against cues that would allow workers to recognize their closest relatives. In accord with this, previous studies of wasps and ants have...... found little or no kin information in recognition cues. Here, we test the hypothesis that social insects do not have kin-informative recognition cues by investigating the recognition cues and relatedness of workers from four colonies of the ant Acromyrmex octospinosus. Contrary to the theoretical...... prediction, we show that the cuticular hydrocarbons of ant workers in all four colonies are informative enough to allow full-sisters to be distinguished from half-sisters with a high accuracy. These results contradict the hypothesis of non-heritable recognition cues and suggest that there is more potential...

  9. Attentional bias to food-related visual cues: is there a role in obesity? (United States)

    Doolan, K J; Breslin, G; Hanna, D; Gallagher, A M


    The incentive sensitisation model of obesity suggests that modification of the dopaminergic associated reward systems in the brain may result in increased awareness of food-related visual cues present in the current food environment. Having a heightened awareness of these visual food cues may impact on food choices and eating behaviours with those being most aware of or demonstrating greater attention to food-related stimuli potentially being at greater risk of overeating and subsequent weight gain. To date, research related to attentional responses to visual food cues has been both limited and conflicting. Such inconsistent findings may in part be explained by the use of different methodological approaches to measure attentional bias and the impact of other factors such as hunger levels, energy density of visual food cues and individual eating style traits that may influence visual attention to food-related cues outside of weight status alone. This review examines the various methodologies employed to measure attentional bias with a particular focus on the role that attentional processing of food-related visual cues may have in obesity. Based on the findings of this review, it appears that it may be too early to clarify the role visual attention to food-related cues may have in obesity. Results however highlight the importance of considering the most appropriate methodology to use when measuring attentional bias and the characteristics of the study populations targeted while interpreting results to date and in designing future studies.

  10. Lonely adolescents exhibit heightened sensitivity for facial cues of emotion. (United States)

    Vanhalst, Janne; Gibb, Brandon E; Prinstein, Mitchell J


    Contradicting evidence exists regarding the link between loneliness and sensitivity to facial cues of emotion, as loneliness has been related to better but also to worse performance on facial emotion recognition tasks. This study aims to contribute to this debate and extends previous work by (a) focusing on both accuracy and sensitivity to detecting positive and negative expressions, (b) controlling for depressive symptoms and social anxiety, and (c) using an advanced emotion recognition task with videos of neutral adolescent faces gradually morphing into full-intensity expressions. Participants were 170 adolescents (49% boys; M age  = 13.65 years) from rural, low-income schools. Results showed that loneliness was associated with increased sensitivity to happy, sad, and fear faces. When controlling for depressive symptoms and social anxiety, loneliness remained significantly associated with sensitivity to sad and fear faces. Together, these results suggest that lonely adolescents are vigilant to negative facial cues of emotion.

  11. Inappropriate antibiotic prescription for respiratory tract indications : most prominent in adult patients

    NARCIS (Netherlands)

    Dekker, Anne R. J.; Verheij, Theo J. M.; van der Velden, Alike W.

    Background. Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient

  12. Effects of Personality on Social Network Disclosure: Do Emotionally Intelligent Individuals Post Inappropriate Content?

    Directory of Open Access Journals (Sweden)

    Chockalingam Viswesvaran


    Full Text Available The prevalence of individuals using social networking sites to stay connected has increased considerably in only a few years and the information posted is now being used by organizations for employee selection. The purpose of the current study was to investigating how differences on the Big Five Personality traits, honesty-integrity, and emotional intelligence influence whether individuals post inappropriate social network content. Participants were 506 college students from a large metropolitan state university in the Southeastern United States. Results suggest individuals scoring high on emotional intelligence and honesty/integrity disclosed less inappropriate social network content. Emotional intelligence was not, however, predictive of inappropriate disclosure above and beyond the Big Five Personality traits. Honest and emotionally intelligent individuals seem to understand the negative implications of disclosing inappropriate social network content. Future research should examine how social network information is being used in employee selection and the predictive validity of this method.

  13. The frequency of agitation due to inappropriate use of naltrexone in addicts

    Directory of Open Access Journals (Sweden)

    Sima Siadat


    Conclusion: Considering the high prevalence of agitation in the poisoning emergency department due to inappropriate use of naltrexone, more accurate planning for administration of naltrexone in addicts seems necessary.

  14. Correlates of (inappropriate) benzodiazepine use : the Netherlands Study of Depression and Anxiety (NESDA)

    NARCIS (Netherlands)

    Manthey, Leonie; van Veen, Tineke; Giltay, Erik J.; Stoop, Jose E.; Neven, Arie Knuistingh; Penninx, Brenda W. J. H.; Zitman, Frans G.

    AIM Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. METHODS We

  15. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA)

    NARCIS (Netherlands)

    Manthey, L.; van Veen, T.; Giltay, E.J.; Stoop, J.E.; Neven, A.K.; Penninx, B.W.J.H.; Zitman, F.G.


    AIM Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model.METHODS We

  16. Cue-induced craving among inhalant users: Development and preliminary validation of a visual cue paradigm. (United States)

    Jain, Shobhit; Dhawan, Anju; Kumaran, S Senthil; Pattanayak, Raman Deep; Jain, Raka


    Cue-induced craving is known to be associated with a higher risk of relapse, wherein drug-specific cues become conditioned stimuli, eliciting conditioned responses. Cue-reactivity paradigm are important tools to study psychological responses and functional neuroimaging changes. However, till date, there has been no specific study or a validated paradigm for inhalant cue-induced craving research. The study aimed to develop and validate visual cue stimulus for inhalant cue-associated craving. The first step (picture selection) involved screening and careful selection of 30 cue- and 30 neutral-pictures based on their relevance for naturalistic settings. In the second step (time optimization), a random selection of ten cue-pictures each was presented for 4s, 6s, and 8s to seven adolescent male inhalant users, and pre-post craving response was compared using a Visual Analogue Scale(VAS) for each of the picture and time. In the third step (validation), craving response for each of 30 cue- and 30 neutral-pictures were analysed among 20 adolescent inhalant users. Findings revealed a significant difference in before and after craving response for the cue-pictures, but not neutral-pictures. Using ROC-curve, pictures were arranged in order of craving intensity. Finally, 20 best cue- and 20 neutral-pictures were used for the development of a 480s visual cue paradigm. This is the first study to systematically develop an inhalant cue picture paradigm which can be used as a tool to examine cue induced craving in neurobiological studies. Further research, including its further validation in larger study and diverse samples, is required. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Impact of carvedilol and metoprolol on inappropriate implantable cardioverter-defibrillator therapy

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Abu-Zeitone, Abeer; Jons, Christian


    The goal of this study was to evaluate the effects of carvedilol and metoprolol on the endpoint of inappropriate implantable cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy) study.......The goal of this study was to evaluate the effects of carvedilol and metoprolol on the endpoint of inappropriate implantable cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy) study....

  18. Inappropriate Detection of a Supraventricular Tachycardia as Dual Tachycardia by the PR Logic™ Algorithm

    Directory of Open Access Journals (Sweden)

    Ajit Thachil, MD, DM, CCDS


    Full Text Available Tachycardia detection and therapy algorithms in Implantable Cardioverter-Defibrillators (ICD reduce, but do not eliminate inappropriate ICD shocks. Awareness of the pros and cons of a particular algorithm helps to predict its utility in specific situations. We report a case where PR logic™, an algorithm commonly used in currently implanted ICDs to differentiate supraventricular tachycardia (SVT from ventricular tachycardia resulted in inappropriate detection and shock for an SVT, and discuss several solutions to the problem.

  19. Correlation analysis between team communication characteristics and frequency of inappropriate communications

    International Nuclear Information System (INIS)

    Kim, Ar Ryum; Lee, Seung Woo; Park, Jinkyun; Kang, Hyun Gook; Seong, Poong Hyun


    Highlights: • We proposed a method to evaluate team communication characteristics based on social network analysis. • We compare team communication characteristics with the frequency of inappropriate communications. • Frequency of inappropriate communications were decreased when more operators perform the same types of role as others. • Frequency of inappropriate communications were decreased for teams who provide more number of acknowledgment. - Abstract: The characteristics of team communications are important since large process systems such as nuclear power plants, airline, and railways are operated by operating teams. In such situation, inappropriate communications can cause a lack of situational information and lead to serious consequences for the systems. As a result, the communication characteristics of operating teams should be understood in order to extract meaningful insights to address the nature of inappropriate communications. The purpose of this study was to develop a method to evaluate the characteristics of team communications based on social network analysis and compare them with the frequency of inappropriate communications. In order to perform the analysis, verbal protocol data, which were audio-visual recorded under training sessions by operating teams, were used and interfacing system loss of coolant accident scenarios were selected. As a result of the study, it was found that the frequency of inappropriate communications decreased when more operators perform the same types of role as other operators, since they can easily and effectively back up each other. Also, the frequency of inappropriate communication is decreased for teams which provide a relatively large communication content that acknowledge or confirm another communication content

  20. Reduction in inappropriate hospital use based on analysis of the causes

    Directory of Open Access Journals (Sweden)

    Soria-Aledo Víctor


    Full Text Available Abstract Background To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement. Methods Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain. Results Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease. Conclusions It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital.

  1. Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study.

    Directory of Open Access Journals (Sweden)

    Giuseppe Colloca

    Full Text Available BACKGROUND: It has been estimated that Nursing Home (NH residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe. METHODS: Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008. RESULTS: Mean age of participating residents was 84.2±8.9 years, 1087 (75.0% were women. Inappropriate drug use was observed in 643 (44.9% residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%, antiplatelet agents (excluding Acetylsalicylic Acid - ASA - (9.9%, acetylcholinesterase, inhibitors (7.2% and antispasmodics (6.9%. Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24, heart failure (OR 1.48; 95% CI 1.04-2.09, stroke (OR 1.43; 95% CI 1.06-1.93, and recent hospitalization (OR 1.69; 95% CI 1.20-2.39. An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77. CONCLUSION: Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.

  2. Contour identification with pitch and loudness cues using cochlear implants


    Luo, Xin; Masterson, Megan E.; Wu, Ching-Chih


    Different from speech, pitch and loudness cues may or may not co-vary in music. Cochlear implant (CI) users with poor pitch perception may use loudness contour cues more than normal-hearing (NH) listeners. Contour identification was tested in CI users and NH listeners; the five-note contours contained either pitch cues alone, loudness cues alone, or both. Results showed that NH listeners' contour identification was better with pitch cues than with loudness cues; CI users performed similarly w...

  3. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Binit N Jhaveri


    Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

  4. Heart failure severity, inappropriate ICD therapy, and novel ICD programming: a MADIT-RIT substudy. (United States)

    Daimee, Usama A; Vermilye, Katherine; Rosero, Spencer; Schuger, Claudio D; Daubert, James P; Zareba, Wojciech; McNitt, Scott; Polonsky, Bronislava; Moss, Arthur J; Kutyifa, Valentina


    The effects of heart failure (HF) severity on risk of inappropriate implantable cardioverter-defibrillator (ICD) therapy have not been thoroughly investigated. We aimed to study the association between HF severity and inappropriate ICD therapy in MADIT-RIT. MADIT-RIT randomized 1,500 patients to three ICD programming arms: conventional (Arm A), high-rate cut-off (Arm B: ≥200 beats/min), and delayed therapy (Arm C: 60-second delay for ≥170 beats/min). We evaluated the association between New York Heart Association (NYHA) class III (n = 256) versus class I-II (n = 251) and inappropriate ICD therapy in Arm A patients with ICD-only and cardiac resynchronization therapy with defibrillator (CRT-D). We additionally assessed benefit of novel ICD programming in Arms B and C versus Arm A by NYHA classification. In Arm A, the risk of inappropriate therapy was significantly higher in those with NYHA III versus NYHA I-II for both ICD (hazard ratio [HR] = 2.55, confidence interval [CI]: 1.51-4.30, P programming significantly reduced inappropriate therapy in patients with both NYHA III (Arm B vs Arm A: HR = 0.08, P programming with high-rate cut-off or delayed detection reduces inappropriate ICD therapies in both mild and moderate HF. © 2017 Wiley Periodicals, Inc.

  5. The Use of Prosodic Cues in Sentence Processing by Prelingually Deaf Users of Cochlear Implants. (United States)

    Holt, Colleen M; Demuth, Katherine; Yuen, Ivan


    The purpose of this study is to assess the use of prosodic and contextual cues to focus by prelingually deaf adolescent users of cochlear implants (CIs) when identifying target phonemes. We predict that CI users will have slower reaction times to target phonemes compared with a group of normally-hearing (NH) peers. We also predict that reaction times will be faster when both prosodic and contextual (semantic) cues are provided. Eight prelingually deaf adolescent users of CIs and 8 adolescents with NH completed 2 phoneme-monitoring experiments. Participants were aged between 13 and 18 years. The mean age at implantation for the CI group was 1.8 years (SD: 1.0). In the prosodic condition, reaction times to a target phoneme in a linguistically focused (i.e., stressed) word were compared between the two groups. The semantic condition compared reaction time with target phonemes when contextual cues to focus were provided in addition to prosodic cues. Reaction times of the CI group were slower than those of the NH group in both the prosodic and semantic conditions. A linear mixed model was used to compare reaction times using Group as a fixed factor and Phoneme and Subject as random factors. When only prosodic cues (prosodic condition) to focus location were provided, the mean reaction time of the CI group was 512 msec compared with 317 msec for the NH group, and this difference was significant (p cues speeded reaction times for both groups (semantic condition), indicating that top-down processing aided both groups in their search for a focused item. However, even with both prosodic and contextual cues, the CI users' processing times remained slower, compared with the NH group, with mean reaction times of 385 msec for the CI users but 232 msec for the NH listeners (p cues is less efficient than that of their NH peers, as evidenced by slower reaction times to targets in phoneme monitoring. The provision of contextual cues speeded reaction times for both NH and CI groups

  6. The influence of imagery vividness on cognitive and perceptual cues in circular auditorily-induced vection

    Directory of Open Access Journals (Sweden)

    Aleksander eVäljamäe


    Full Text Available In the absence of other congruent multisensory motion cues, sound contribution to illusions of self-motion (vection is relatively weak and often attributed to purely cognitive, top-down processes. The present study addressed the influence of cognitive and perceptual factors in the experience of circular, yaw auditorily-induced vection (AIV, focusing on participants’ imagery vividness scores. We used different rotating sound sources (acoustic landmark vs. movable types and their filtered versions that provided different binaural cues (interaural time or level differences, ITD vs. ILD when delivering via loudspeaker array. The significant differences in circular vection intensity showed that 1 AIV was stronger for rotating sound fields containing auditory landmarks as compared to movable sound objects; 2 ITD based acoustic cues were more instrumental than ILD based ones for horizontal AIV; and 3 individual differences in imagery vividness significantly influenced the effects of contextual and perceptual cues. While participants with high scores of kinesthetic and visual imagery were helped by vection ``rich cues, i.e. acoustic landmarks and ITD cues, the participants from the low-vivid imagery group did not benefit from these cues automatically. Only when specifically asked to use their imagination intentionally did these external cues start influencing vection sensation in similar way to high-vivid imagers. These findings are in line with the recent fMRI work which suggested that high-vivid imagers employ automatic, almost unconscious mechanisms in imagery generation, while low-vivid imagers rely on more schematic and conscious framework. Consequently, our results provide an additional insight into the interaction between perceptual and contextual cues when experiencing purely auditorily or multisensorily induced vection.

  7. Are olfactory cues involved in nest recognition in two social species of estrildid finches?

    Directory of Open Access Journals (Sweden)

    E Tobias Krause

    Full Text Available Reliably recognizing their own nest provides parents with a necessary skill to invest time and resources efficiently in raising their offspring and thereby maximising their own reproductive success. Studies investigating nest recognition in adult birds have focused mainly on visual cues of the nest or the nest site and acoustic cues of the nestlings. To determine whether adult songbirds also use olfaction for nest recognition, we investigated the use of olfactory nest cues for two estrildid finch species, zebra finches (Taeniopygia guttata and Bengalese finches (Lonchura striata var. domestica during the nestling and fledgling phase of their offspring. We found similar behavioural responses to nest odours in both songbird species. Females preferred the odour of their own nest over a control and avoided the foreign conspecific nest scent over a control during the nestling phase of their offspring, but when given the own odour and the foreign conspecific odour simultaneously we did not find a preference for the own nest odour. Males of both species did not show any preferences at all. The behavioural reaction to any nest odour decreased after fledging of the offspring. Our results show that only females show a behavioural response to olfactory nest cues, indicating that the use of olfactory cues for nest recognition seems to be sex-specific and dependent on the developmental stage of the offspring. Although estrildid finches are known to use visual and acoustic cues for nest recognition, the similar behavioural pattern of both species indicates that at least females gain additional information by olfactory nest cues during the nestling phase of their offspring. Thus olfactory cues might be important in general, even in situations in which visual and acoustic cues are known to be sufficient.

  8. Action experience changes attention to kinematic cues

    Directory of Open Access Journals (Sweden)

    Courtney eFilippi


    Full Text Available The current study used remote corneal reflection eye-tracking to examine the relationship between motor experience and action anticipation in 13-month-old infants. To measure online anticipation of actions infants watched videos where the actor’s hand provided kinematic information (in its orientation about the type of object that the actor was going to reach for. The actor’s hand orientation either matched the orientation of a rod (congruent cue or did not match the orientation of the rod (incongruent cue. To examine relations between motor experience and action anticipation, we used a 2 (reach first vs. observe first x 2 (congruent kinematic cue vs. incongruent kinematic cue between-subjects design. We show that 13-month-old infants in the observe first condition spontaneously generate rapid online visual predictions to congruent hand orientation cues and do not visually anticipate when presented incongruent cues. We further demonstrate that the speed that these infants generate predictions to congruent motor cues is correlated with their own ability to pre-shape their hands. Finally, we demonstrate that following reaching experience, infants generate rapid predictions to both congruent and incongruent hand shape cues—suggesting that short-term experience changes attention to kinematics.

  9. Cues of Maternal Condition Influence Offspring Selfishness (United States)

    Wong, Janine W. Y.; Lucas, Christophe; Kölliker, Mathias


    The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia) if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism) and extracted and analyzed the females’ cuticular hydrocarbons (CHC). Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons. PMID:24498046

  10. Does laboratory cue reactivity correlate with real-world craving and smoking responses to cues? (United States)

    Shiffman, Saul; Li, Xiaoxue; Dunbar, Michael S; Tindle, Hilary A; Scholl, Sarah M; Ferguson, Stuart G


    Laboratory cue reactivity (CR) assessments are used to assess smokers' responses to cues. Likewise, EMA recording is used to characterize real-world response to cues. Understanding the relationship between CR and EMA responses addresses the ecological validity of CR. In 190 daily smokers not currently quitting, craving and smoking responses to cues were assessed in laboratory CR and by real-world EMA recording. Separate CR sessions involved 5 smoking-relevant cues (smoking, alcohol, negative affect, positive affect, smoking prohibitions), and a neutral cue. Subjects used EMA to monitor smoking situations for 3 weeks, completing parallel situational assessments (presence of others smoking, alcohol consumption, negative affect, positive affect, and smoking prohibitions, plus current craving) in smoking and non-smoking occasions (averaging 70 and 60 occasions each). Analyses correlated CR craving and smoking cue responses with EMA craving and smoking correlations with similar cues. Although some cues did not show main effects on average craving or smoking, a wide range of individual differences in response to cues was apparent in both CR and EMA data, providing the necessary context to assess their relationship. Laboratory CR measures of cue response were not correlated with real-world cue responses assessed by EMA. The average correlation was 0.03; none exceeded 0.32. One of 40 correlations examined was significantly greater than 0. Laboratory CR measures do not correlate with EMA-assessed craving or smoking in response to cues, suggesting that CR measures are not accurate predictors of how smokers react to relevant stimuli in the real world. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Inappropriate and cloned clinical histories on radiology request forms for sick children. (United States)

    Shah, Chetan Chandulal; Linam, Leann; Greenberg, S Bruce


    An appropriate clinical history improves the perception and interpretation of radiographic examinations in children and adults. However, clinical history provided on radiology request has not been studied for its appropriateness and frequency of cloned clinical history. The purpose of this study was to determine the frequency of inappropriate histories and cloned histories at a tertiary-care children's hospital. We analyzed radiology request forms of 388 outpatient and inpatient radiographic examinations obtained on 3 days during the same month at a tertiary-care children's hospital. Appropriateness of the clinical history was judged by its relevance to the examination ordered and appropriate associated billable ICD-9 code. Cloning was defined as identical clinical histories appearing on the radiology request on three consecutive days. Cloned histories were further subdivided as being appropriate or inappropriate. A total of 18% (70/388) of the requests for clinical history were either inappropriate, cloned or both. Neonatal intensive care unit (NICU) referrals constituted the majority (82%, 9/11) of combined inappropriate history and cloning. NICU referrals accounted for 52% (28/54) of all inappropriate clinical histories, a significantly higher percentage than other inpatient locations (P = 0.006). The cardiovascular intensive care unit (CVICU) was the second most common patient location for inappropriate clinical histories (11%, 6/54). About one-third of the radiographic requests from the NICU had inappropriate histories (35%, 28/79). Among the outpatient referrals, 50% (4/8) of the inappropriate histories were from the emergency department. The most common cloned histories included "hypoplastic left heart syndrome" (15%, 4/27), "endotracheal tube placement" (11%, 3/27) and "evaluate lung fields and bowel" (11%, 3/27). The most commonly cloned clinical history was seen on referrals from the NICU at 63% (17/27), a significantly higher percentage than other

  12. Potentially inappropriate medication use: the Beers' Criteria used among older adults with depressive symptoms

    Directory of Open Access Journals (Sweden)

    Lee D


    Full Text Available INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3 years and 59% were women. The median number of medications used was 6 (range 1-21 medications. The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49% of the participants were prescribed at least one potentially inappropriate medication; 29% were considered to suffer significant depressive symptoms (Geriatric Depression Scale ≥5 and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54. DISCUSSION: Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed.

  13. Using a social story intervention to decrease inappropriate behavior of preschool children with autism

    Directory of Open Access Journals (Sweden)

    Angkhana Khantreejitranon


    Full Text Available This research investigated the inappropriate behavior of preschool children with autism in a classroom and examined the effectiveness of the use of social stories to decrease inappropriate autistic behavior. An A-B-A-B single subject design was used across the five participants selected for the study. Investigating the problematic social skills and developing a social story intervention for the preschool autistic children was completed, followed by an examination of the effectiveness of the social story intervention. Ten common problematic social skills among the autistic children in preschool were identified—walking around, making loud noises, not sharing their toys with others, showing frustration when feeling unsatisfied, having no patience, not putting toys away when finished, taking other people's belongings without permission, not knowing how to greet others, destroying things when feeling frustrated, and giving a hug to other people at inappropriate times. It was found that the social story intervention helped to decrease inappropriate behavior in children with autism. The social story intervention consisted of five social story books and five e-books (one story per child using a single subject design with an A-B-A-B pattern. The autistic children preferred social stories from the hardcopy books compared with stories from the e-books. A fourth stage time trial was used over 6 weeks, five times per week, for a total of 30 times. The findings suggested that the use of properly constructed social stories can be effective in decreasing the inappropriate behavior of children with autism. However, each story intervention should be applied with caution because of individual differences between children. The social story intervention should be designed only for autistic children who exhibit specific inappropriate social behavior. Keywords: autistic child, inappropriate behavior, social skills, social story

  14. Potentially inappropriate prescriptions for older patients in long-term care

    Directory of Open Access Journals (Sweden)

    Laurin Danielle


    Full Text Available Abstract Background Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs in long-term care in metropolitan Quebec. Methods A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs. Results Almost all residents (94.0% were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7% of treated patients had a potentially inappropriate prescription (PIP. Most common PIPs were drug interactions (33.9% of treated patients, followed by potentially inappropriate duration (23.6%, potentially inappropriate medication (14.7% and potentially inappropriate dosage (9.6%. PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication. The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33 – 1.43 and with the length of stay (OR: 1.78, CI: 1.43 – 2.20. On the other hand, the risk of receiving a PIP decreased with age. Conclusion Potentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.

  15. Inappropriate implantable cardioverter defibrillator shocks-incidence, effect, and implications for driver licensing. (United States)

    Watanabe, Eiichi; Okajima, Katsunori; Shimane, Akira; Ozawa, Tomoya; Manaka, Tetsuyuki; Morishima, Itsuro; Asai, Toru; Takagi, Masahiko; Honda, Toshihiro; Kasai, Atsunobu; Fujii, Eitaro; Yamashiro, Kohei; Kohno, Ritsuko; Abe, Haruhiko; Noda, Takashi; Kurita, Takashi; Watanabe, Shigeyuki; Ohmori, Hiroya; Nitta, Takashi; Aizawa, Yoshifusa; Kiyono, Ken; Okumura, Ken


    Patients with implantable cardioverter defibrillators (ICDs) have an ongoing risk of sudden incapacitation that may cause traffic accidents. However, there are limited data on the magnitude of this risk after inappropriate ICD therapies. We studied the rate of syncope associated with inappropriate ICD therapies to provide a scientific basis for formulating driving restrictions. Inappropriate ICD therapy event data between 1997 and 2014 from 50 Japanese institutions were analyzed retrospectively. The annual risk of harm (RH) to others posed by a driver with an ICD was calculated for private driving habits. We used a commonly employed annual RH to others of 5 in 100,000 (0.005%) as an acceptable risk threshold. Of the 4089 patients, 772 inappropriate ICD therapies occurred in 417 patients (age 61 ± 15 years, 74% male, and 65% secondary prevention). Patients experiencing inappropriate therapies had a mean number of 1.8 ± 1.5 therapy episodes during a median follow-up period of 3.9 years. No significant differences were found in the age, sex, or number of inappropriate therapies between patients receiving ICDs for primary or secondary prevention. Only three patients (0.7%) experienced syncope associated with inappropriate therapies. The maximum annual RH to others after the first therapy in primary and secondary prevention patients was calculated to be 0.11 in 100,000 and 0.12 in 100,000, respectively. We found that the annual RH from driving was far below the commonly cited acceptable risk threshold. Our data provide useful information to supplement current recommendations on driving restrictions in ICD patients with private driving habits.

  16. Speech cues contribute to audiovisual spatial integration.

    Directory of Open Access Journals (Sweden)

    Christopher W Bishop

    Full Text Available Speech is the most important form of human communication but ambient sounds and competing talkers often degrade its acoustics. Fortunately the brain can use visual information, especially its highly precise spatial information, to improve speech comprehension in noisy environments. Previous studies have demonstrated that audiovisual integration depends strongly on spatiotemporal factors. However, some integrative phenomena such as McGurk interference persist even with gross spatial disparities, suggesting that spatial alignment is not necessary for robust integration of audiovisual place-of-articulation cues. It is therefore unclear how speech-cues interact with audiovisual spatial integration mechanisms. Here, we combine two well established psychophysical phenomena, the McGurk effect and the ventriloquist's illusion, to explore this dependency. Our results demonstrate that conflicting spatial cues may not interfere with audiovisual integration of speech, but conflicting speech-cues can impede integration in space. This suggests a direct but asymmetrical influence between ventral 'what' and dorsal 'where' pathways.

  17. Decreasing Inappropriate Use of Mobile Devices in Urban High School Classrooms: Comparing an Antecedent Intervention With and Without the Good Behavior Game. (United States)

    Hernan, Colleen J; Collins, Tai A; Morrison, Julie Q; Kroeger, Stephen D


    As the capabilities of portable technology continue to advance and become more accessible, educators express concern about the impact of the inappropriate use of mobile devices on academic engagement and learning. An alternating treatments design was used to compare the effectiveness of an antecedent (Clear Box) intervention and an interdependent group contingency (Clear Box + Good Behavior Game [GBG]) intervention to typical classroom management techniques (Control) in increasing the academic engagement and decreasing mobile device use of high school students during instruction. The results indicate an increase in academic engagement and a decrease in the inappropriate presence of mobile devices in both classrooms with the implementation of the Clear Box + GBG, as compared with the Clear Box and Control conditions. In addition, teacher and student social validity data suggested that teachers and students viewed the Clear Box + GBG intervention favorably. Discussion focuses on contributions to the current literature, implications for practice, and suggestions for future areas of research.

  18. Spontaneous Hedonic Reactions to Social Media Cues. (United States)

    van Koningsbruggen, Guido M; Hartmann, Tilo; Eden, Allison; Veling, Harm


    Why is it so difficult to resist the desire to use social media? One possibility is that frequent social media users possess strong and spontaneous hedonic reactions to social media cues, which, in turn, makes it difficult to resist social media temptations. In two studies (total N = 200), we investigated less-frequent and frequent social media users' spontaneous hedonic reactions to social media cues using the Affect Misattribution Procedure-an implicit measure of affective reactions. Results demonstrated that frequent social media users showed more favorable affective reactions in response to social media (vs. control) cues, whereas less-frequent social media users' affective reactions did not differ between social media and control cues (Studies 1 and 2). Moreover, the spontaneous hedonic reactions to social media (vs. control) cues were related to self-reported cravings to use social media and partially accounted for the link between social media use and social media cravings (Study 2). These findings suggest that frequent social media users' spontaneous hedonic reactions in response to social media cues might contribute to their difficulties in resisting desires to use social media.

  19. Perception of health from facial cues. (United States)

    Henderson, Audrey J; Holzleitner, Iris J; Talamas, Sean N; Perrett, David I


    Impressions of health are integral to social interactions, yet poorly understood. A review of the literature reveals multiple facial characteristics that potentially act as cues to health judgements. The cues vary in their stability across time: structural shape cues including symmetry and sexual dimorphism alter slowly across the lifespan and have been found to have weak links to actual health, but show inconsistent effects on perceived health. Facial adiposity changes over a medium time course and is associated with both perceived and actual health. Skin colour alters over a short time and has strong effects on perceived health, yet links to health outcomes have barely been evaluated. Reviewing suggested an additional influence of demeanour as a perceptual cue to health. We, therefore, investigated the association of health judgements with multiple facial cues measured objectively from two-dimensional and three-dimensional facial images. We found evidence for independent contributions of face shape and skin colour cues to perceived health. Our empirical findings: (i) reinforce the role of skin yellowness; (ii) demonstrate the utility of global face shape measures of adiposity; and (iii) emphasize the role of affect in facial images with nominally neutral expression in impressions of health. © 2016 The Author(s).

  20. Addressing the Issue of Chronic, Inappropriate Benzodiazepine Use: How Can Pharmacists Play a Role?

    Directory of Open Access Journals (Sweden)

    Helen C. Gallagher


    Full Text Available Prescribing guidelines do not recommend the long-term use of benzodiazepines since their effectiveness with chronic use is out-weighed by risks including dependence, memory and cognitive impairment, hip fractures and traffic accidents. Despite these guidelines, historical data points to an increasing proportion of inappropriate, repeat prescribing of benzodiazepines in Ireland and elsewhere, with up to 33% of patients who use these drugs doing so long-term. The typical long-term benzodiazepine user is an older, socio-economically disadvantaged patient who has been prescribed these medicines by their general practitioner (GP and dispensed them by their community pharmacist. Misuse of benzodiazepines in nursing homes and psychiatric institutions is also of concern, with one Irish study indicating that almost half of all admissions to a psychiatric hospital were prescribed these drugs, usually despite a lack of clear clinical need. Discontinuation of benzodiazepines has proven to be of benefit, as it is followed by improvements in cognitive and psychomotor function, particularly in elderly patients. It is obvious that an inter-professional effort, focusing on the primary care setting, is required to address benzodiazepine misuse and to ensure appropriate pharmaceutical care. Pharmacists must be an integral part of this inter-professional effort, not least because they are uniquely positioned as the health professional with most frequent patient contact. There is already some supporting evidence that pharmacists’ involvement in interventions to reduce benzodiazepine use can have positive effects on patient outcomes. Here, this evidence is reviewed and the potential for pharmacists to play an expanded role in ensuring the appropriate use of benzodiazepines is discussed.

  1. Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery

    Directory of Open Access Journals (Sweden)

    Paolo Bifulco


    Full Text Available Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs. A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences. As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients.

  2. Healthcare providers attitudes and perceptions of 'inappropriate attendance' in the Emergency Department. (United States)

    Breen, Bernadette M; McCann, Margaret


    Emergency Departments (EDs) worldwide are facing a crisis from overcrowding and a common perception exists that inappropriate use of the ED is a major contributing factor. Patients, who attend the ED with non-urgent problems, could be dealt with by a General Practitioner; such patients use time and resources that would otherwise be used for patients with more appropriate needs. To explore attitudes and perceptions of healthcare providers regarding 'inappropriate attendance' in the ED. Using a survey questionnaire, this descriptive quantitative study included ED nurses, doctors and paramedics from three regional hospitals in the Republic of Ireland. A total of 163 surveys were returned (59% response rate). There was an overwhelming agreement among respondents that inappropriate attendance in Irish ED exists and poses a considerable challenge for healthcare providers. Results suggest differences of opinion on what represents inappropriate ED use. Potential solutions to address the issue of inappropriate ED attendance include General Practitioners and Advanced Nurse Practitioners practicing within the ED setting; education and greater public awareness and faster access to a specialist opinion in the Out Patient Department. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Inappropriate sexual behaviour in adolescents with autism spectrum disorder: what education is recommended and why. (United States)

    Beddows, Nicola; Brooks, Rachel


    Autism spectrum disorder (ASD) is a neurodevelopmental disorder impairing social skills and communication. Adolescents with ASD have sexual needs, but may not understand their physical and emotional development resulting in inappropriate sexual behaviour. The aim of this review is to describe the type of inappropriate behaviour that presents in these adolescents, explain why such behaviours occur, suggest what education is suitable and identify current gaps in research. The databases EMBASE, OVID MEDLINE and PSYCINFO were searched for relevant articles. In total, 5241 articles were found, with an additional 15 sources found via soft searches, of which 42 met inclusion criteria and were subsequently reviewed. Sexual behaviours that occur in these adolescents with ASD include hypermasturbation, public masturbation, inappropriate romantic gestures, inappropriate arousal and exhibitionism. Such behaviours are thought to be caused via a lack of understanding of normal puberty, the absence of appropriate sex education, the severity of their ASD and other associated problems. It is suggested that individualized, repetitive education should be started from an early age in an accessible form. Social skills development is also important before more technical aspects of sex education are taught. Despite being such a common problem for schools, institutions and families to manage, it is surprising how sparse literature is particularly regarding why inappropriate behaviour occurs and what education is effective. © 2015 Wiley Publishing Asia Pty Ltd.

  4. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Vivatkusol Y


    Full Text Available Yada Vivatkusol, Thaovalai Thavaramara, Chadakarn Phaloprakarn Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand Objective: To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG among teenage pregnant women.Methods: A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG.Results: Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m2. The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P<0.001. The rates of gestational diabetes mellitus among women who were underweight, overweight, or appropriate weight were not significantly different.Conclusion: More than 60% of teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes. Keywords: prevalence, pregnancy outcome, inappropriate gestational weight gain, teenage pregnancy

  5. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul F


    INTRODUCTION: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers\\' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation. METHODS: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers\\' Criteria applied. RESULTS: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking < or =5 medications (OR 3.34: 95%, CI 2.37-4.79; P<0.001). Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications. Sixteen per cent of all admissions were associated with such adverse effects. CONCLUSION: IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation. However, Beers\\' Criteria cannot be used as a gold standard as they do not comprehensively address all aspects of IP in older people.

  6. Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

    Directory of Open Access Journals (Sweden)

    Ajit Kumar Sah


    Full Text Available Background & Objectives: Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM prescribing in older Nepalese patients in a medicine outpatient department.Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM in elderly patients was analysed using Beer’s Criteria updated to 2013. Results: In the 869 patients included, the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%, amlodipine (23.16%, paracetamol (17.6%, salbutamol (15.72% and vitamin B complex (13.26%. The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  7. Early perceptual interactions shape the time course of cueing

    NARCIS (Netherlands)

    Wilschut, A.M.; Theeuwes, J.; Olivers, C.N.L.


    Performance in spatial cueing tasks is characterized by a rapid attentional enhancement with increasing cue-target SOA. We recently found that this enhancement function also applies when the cue and the target are presented invariably at a single central location, suggesting a universal cueing time

  8. Direct and Indirect Cues to Knowledge States during Word Learning (United States)

    Saylor, Megan M.; Carroll, C. Brooke


    The present study investigated three-year-olds' sensitivity to direct and indirect cues to others' knowledge states for word learning purposes. Children were given either direct, physical cues to knowledge or indirect, verbal cues to knowledge. Preschoolers revealed a better ability to learn words from a speaker following direct, physical cues to…

  9. Toward understanding social cues and signals in human–robot interaction: effects of robot gaze and proxemic behavior (United States)

    Fiore, Stephen M.; Wiltshire, Travis J.; Lobato, Emilio J. C.; Jentsch, Florian G.; Huang, Wesley H.; Axelrod, Benjamin


    As robots are increasingly deployed in settings requiring social interaction, research is needed to examine the social signals perceived by humans when robots display certain social cues. In this paper, we report a study designed to examine how humans interpret social cues exhibited by robots. We first provide a brief overview of perspectives from social cognition in humans and how these processes are applicable to human–robot interaction (HRI). We then discuss the need to examine the relationship between social cues and signals as a function of the degree to which a robot is perceived as a socially present agent. We describe an experiment in which social cues were manipulated on an iRobot AvaTM mobile robotics platform in a hallway navigation scenario. Cues associated with the robot’s proxemic behavior were found to significantly affect participant perceptions of the robot’s social presence and emotional state while cues associated with the robot’s gaze behavior were not found to be significant. Further, regardless of the proxemic behavior, participants attributed more social presence and emotional states to the robot over repeated interactions than when they first interacted with it. Generally, these results indicate the importance for HRI research to consider how social cues expressed by a robot can differentially affect perceptions of the robot’s mental states and intentions. The discussion focuses on implications for the design of robotic systems and future directions for research on the relationship between social cues and signals. PMID:24348434

  10. Statin therapy reduces inappropriate shock in non-ischemic patients with mild heart failure

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine H.; Zareba, Wojciech; Jons, Christian


    BACKGROUND: The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy...... tachycardia zone of 170 to 199 bpm (arm A), high-rate cutoff with a ventricular tachycardia zone ≥200 bpm (arm B), or 60-second-delayed therapy (arm C). The end points of inappropriate therapy, appropriate therapy, and death were assessed among 485 patients with and 998 without diabetes mellitus. Innovative...... (hazard ratio, 4.17; 95% confidence interval, 1.52-11.40; P=0.005) and appropriate therapy (hazard ratio, 2.49; 95% confidence interval, 1.06-5.87; P=0.037) compared with those who did not. CONCLUSIONS: Innovative high-rate cutoff or delayed ICD programming was associated with a reduction in inappropriate...

  11. The Effect of ICD Programming on Inappropriate and Appropriate ICD Therapies in Ischemic and Nonischemic Cardiomyopathy

    DEFF Research Database (Denmark)

    Sedláček, Kamil; Ruwald, Anne-Christine; Kutyifa, Valentina


    INTRODUCTION: The MADIT-RIT trial demonstrated reduction of inappropriate and appropriate ICD therapies and mortality by high-rate cut-off and 60-second-delayed VT therapy ICD programming in patients with a primary prophylactic ICD indication. The aim of this analysis was to study effects of MADIT......-RIT ICD programming in patients with ischemic and nonischemic cardiomyopathy. METHODS AND RESULTS: First and total occurrences of both inappropriate and appropriate ICD therapies were analyzed by multivariate Cox models in 791 (53%) patients with ischemic and 707 (47%) patients with nonischemic......-rate cut-off (arm B) and delayed VT therapy ICD programming (arm C) compared with conventional (arm A) ICD programming were associated with a significant risk reduction of first inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy (HR range 0.11-0.34, P

  12. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    DEFF Research Database (Denmark)

    Niwata, Satoko; Yamada, Yukari; Ikegami, Naoki


    Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We...... conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC) facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified...... on the basis of the 2003 Beers criteria. Results The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1%) of the patients were treated with potentially inappropriate medication independent of disease or condition...

  13. Dementia and inappropriate sexual behavior (ISB: What we know and what we need to know

    Directory of Open Access Journals (Sweden)

    Josep Fabà


    Full Text Available Traditionally, there has been no place for sexuality in older age. However, research has shown that sexuality plays an important role in older people’s life, even in situations such as dementia. The goal of the article is to review the scientific literature regarding the inappropriate sexual behavior that these kind of patients might present. In order to do so, we will firstly address the definition of inappropriate sexual behavior or, more precisely, its multiple definitions. After that, we will deal with other issues such as its prevalence, factors that can cause its appearance, its consequences and some of the available therapeutic options. Finally, in the last section some recommendations for future research will be provided, such as the need to clarify the concept of inappropriate sexual behavior, to find more efficient ways to address this problem, and the desirability of considering sexuality as a human dimension with a high adaptive potential in old age.

  14. Dementia and inappropriate sexual behavior: What we know and what we need to know

    Directory of Open Access Journals (Sweden)

    Josep Fabà


    Full Text Available Traditionally, there has been no place for sexuality in older age. However, research has shown that sexuality plays an important role in older people’s life, even in situations such as dementia. The goal of the article is to review the scientific literature regarding the inappropriate sexual behavior that these kind of patients might present. In order to do so, we will firstly address the definition of inappropriate sexual behavior or, more precisely, its multiple definitions. After that, we will deal with other issues such as its prevalence, factors that can cause its appearance, its consequences and some of the available therapeutic options. Finally, in the last section some recommendations for future research will be provided, such as the need to clarify the concept of inappropriate sexual behavior, to find more efficient ways to address this problem, and the desirability of considering sexuality as a human dimension with a high potential for adaptation in old age.

  15. Inappropriate shock for myopotential over-sensing in a patient with subcutaneous ICD

    Directory of Open Access Journals (Sweden)

    Alessandro Corzani


    Full Text Available Inappropriate ICD shocks are common adverse events; they are mainly due to supraventricular arrhythmias and secondly are related to noise, undersensing, oversensing, device malfunctions. We present a case of inappropriate device therapy due to myopotential oversensing in a patient with a subcutaneous ICD (s-ICD. A 58 years old male with an s-ICD during the device interrogation showed a previous episode of suspected sustained ventricular tachycardia at 210 bpm, which was effectively treated with ICD shock. The patient experienced the electrical shock while holding a big gas-cylinder in his arms. The EGM analysis revealed many irregular ventricular signals of low amplitude lasting for 24 s and interrupted by the shock. The device showed no malfunctions. This is the first case report of inappropriate S-ICD shock related to myopotential over-sensing. By recording intracardiac EGM, we demonstrated that the noise was created by the activity of the pectorals muscles.

  16. Elevator talk: observational study of inappropriate comments in a public space. (United States)

    Ubel, P A; Zell, M M; Miller, D J; Fischer, G S; Peters-Stefani, D; Arnold, R M


    We conducted a study to determine the type and frequency of inappropriate comments made by hospital employees while riding hospital elevators. Four observers rode in elevators at five hospitals, listening for any comments made by hospital employees that might be deemed inappropriate. All potentially inappropriate comments were reviewed by the research team and were classified as inappropriate if they met at least one of the following criteria: violated patient confidentiality, raised concerns about the speaker's ability or desire to provide high-quality patient care, raised concerns about poor quality of care in the hospital (by persons other than the speaker), or contained derogatory remarks about patients or their families. We observed 259 one-way elevator trips offering opportunity for conversation. We overheard a total of 39 inappropriate comments, which took place on 36 rides (13.9% of the trips). The most frequent comments (18) were violations of patients confidentiality. Next most frequent (10 comments) were unprofessional remarks in which clinicians talked about themselves in ways that raised questions about their ability or desire to provide high-quality patient care. Other comments included derogatory statements about the general quality of hospital care (8) and derogatory remarks about patients (5). Physicians were involved in 15 of the comments, nurses in 10, and other hospital employees in the remainder. Inappropriate comments took place with disturbing frequency in the elevator rides we sampled. These comments did not exclusively involve violations of patient confidentiality, but encompassed a range of discussions that health care employees must be careful to avoid.

  17. The inappropriate use of lumbar magnetic resonance imaging in a health service area

    International Nuclear Information System (INIS)

    Rodriguez Recio, F. J.; Sanz, J. C.; Vera, S.; Peiro, S.


    To identify the percentage of inappropriate lumbar spine magnetic resonance imaging in the Soria Health Service, to quantify the costs and the possible association between inadequate use, the characteristics of the patient and the services requested. A descriptive study of the inappropriate use of MRI of the lumbar spine, taken from the retrospective examination, carried out by a radiologist, of the 233 MRI's requested between 1995 and 1998. For the valuation, the criteria of the American College of Radiology (ACR) and the Basque Agency for the Evaluation of Technologies (OSTEBA) were used. All the MRI's were carried out at an approved centre, the costs were calculated taken form the expenses paid by the Insalud, including the transport costs, calculated at prices applicable for the year in question. 11.7% of the studies were values as inappropriate, 2.1% debatable and the remainder adequate according to the ACR criteria, concentrating the inadequacy on studies for lumbago, that reached 80% of the inappropriate requests. The ACR and OSTEBA criteria coincided to a high degree (kappa statistics: 0.87). The expense related to the unnecessary studies was a litter higher than a million pesetas. No differences were found in the proportion of inappropriate studies according to the characteristics of the patient or the service requested, except the one already mentioned for the supposition diagnosis. Although the results of the study cannot be generalised to other environments, they suggest the possibility of a significant proportion of inappropriate use of lumbar spine MRI that could have an important repercussion on health care expenses. (Author) 11 refs

  18. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA). (United States)

    Manthey, Leonie; van Veen, Tineke; Giltay, Erik J; Stoop, José E; Neven, Arie Knuistingh; Penninx, Brenda W J H; Zitman, Frans G


    Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. We included 429 BZD users and 2423 non-users from the Netherlands Study of Depression and Anxiety (NESDA) in order to investigate sociodemographic, psychological and physical determinants of BZD use and inappropriate use by logistic and linear regression analyses. BZDs were used by a considerable proportion of the 2852 NESDA participants (15.0%). BZD use was independently associated with older age, singleness, unemployment, treatment in secondary care, higher medical consumption (more severe) anxiety, depression (OR [95% CI]=1.95 [1.29, 2.93]), comorbidity, insomnia, SSRI (OR [95% CI]=2.05 [1.55, 2.70]), TCA and other antidepressant (OR [95% CI]=2.44 [1.64, 3.62]) use. Overall, BZD use was rarely in accordance with all guidelines, mainly because most users (82.5%) exceeded the recommended duration of safe use. Inappropriate use was independently associated with older age (β=0.130) and chronic illnesses (β=0.120). Higher scores on agreeableness were associated with less inappropriate use. Mentally or physically vulnerable subjects were most likely to use BZDs. The most vulnerable (i.e. the old and physically ill) BZD users were at highest risk of inappropriate BZD use. Without further evidence of the effectiveness of BZDs in long-term use, caution in initiating BZD prescriptions is recommended, particularly when patients are chronically ill and old, as those are most likely to display inappropriate use. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

  19. Reducing inappropriate testing in the diagnosis of the menopause and peri-menopause. (United States)

    Williams, Jac; Currie, Heather; Foster, Adele; Anderson, Julia


    The menopause should be diagnosed based on age, menstrual history and clinical symptoms, and as such, follicle stimulating hormone testing may be considered inappropriate when diagnosing the menopause or peri-menopause in women aged 45 and over. As part of a demand optimisation programme, the number of follicle stimulating hormone tests requested to diagnose the menopause in this age group was quantified and educational interventions were implemented to reduce inappropriate testing. The number of follicle stimulating hormone tests requested to diagnose the menopause in women aged 45 and over was successfully and sustainably reduced. © The Author(s) 2016.

  20. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    DEFF Research Database (Denmark)

    Niwata, Satoko; Yamada, Yukari; Ikegami, Naoki


    Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We...... dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511), medication cost of per day (OR = 1.173), number of medications (OR = 1.140), and age (OR = 0.981) as factors related to inappropriate...

  1. Without 'Focus'


    Aldo Sevi; Nirit Kadmon


    It is widely accepted that a notion of 'focus', more or less as conceived of in Jackendoff (1972), must be incorporated into our theory of grammar, as a means of accounting for certain observed correlations between prosodic facts and semantic/pragmatic facts. In this paper, we put forth the somewhat radical idea that the time has come to give up this customary view, and eliminate 'focus' from our theory of grammar. We argue that such a move is both economical and fruitful.Research over the ye...

  2. Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

    Directory of Open Access Journals (Sweden)

    Opondo Charles


    Full Text Available Abstract Background There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial. Methods Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention. Results 9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7% were diagnosed with diarrhoea, with 130 of these being bloody (dysentery therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7% of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02. Conclusion We found some evidence that the multi-faceted, sustained intervention described in this

  3. What Does a Cue Do? Comparing Phonological and Semantic Cues for Picture Naming in Aphasia (United States)

    Meteyard, Lotte; Bose, Arpita


    Purpose: Impaired naming is one of the most common symptoms in aphasia, often treated with cued picture naming paradigms. It has been argued that semantic cues facilitate the reliable categorization of the picture, and phonological cues facilitate the retrieval of target phonology. To test these hypotheses, we compared the effectiveness of…

  4. Cues for Better Writing: Empirical Assessment of a Word Counter and Cueing Application's Effectiveness (United States)

    Vijayasarathy, Leo R.; Gould, Susan Martin; Gould, Michael


    Written clarity and conciseness are desired by employers and emphasized in business communication courses. We developed and tested the efficacy of a cueing tool--Scribe Bene--to help students reduce their use of imprecise and ambiguous words and wordy phrases. Effectiveness was measured by comparing cue word usage between a treatment group given…

  5. Colliding Cues in Word Segmentation: The Role of Cue Strength and General Cognitive Processes (United States)

    Weiss, Daniel J.; Gerfen, Chip; Mitchel, Aaron D.


    The process of word segmentation is flexible, with many strategies potentially available to learners. This experiment explores how segmentation cues interact, and whether successful resolution of cue competition is related to general executive functioning. Participants listened to artificial speech streams that contained both statistical and…

  6. Without 'Focus'

    Directory of Open Access Journals (Sweden)

    Aldo Sevi


    Full Text Available It is widely accepted that a notion of 'focus', more or less as conceived of in Jackendoff (1972, must be incorporated into our theory of grammar, as a means of accounting for certain observed correlations between prosodic facts and semantic/pragmatic facts. In this paper, we put forth the somewhat radical idea that the time has come to give up this customary view, and eliminate 'focus' from our theory of grammar. We argue that such a move is both economical and fruitful.Research over the years has revealed that the correlations between prosody, 'focus', and the alleged semantic/pragmatic effects of focus are much less clear and systematic than we may have initially hoped. First we argue that this state of affairs detracts significantly from the utility of our notion of 'focus', to the point of calling into question the very motivation for including it in the grammar. Then we look at some of the central data, and show how they might be analyzed without recourse to a notion of 'focus'. We concentrate on (i the effect of pitch accent placement on discourse congruence, and (ii the choice of 'associate' for the so-called 'focus sensitive' adverb only. We argue that our focus-free approach to the data improves empirical coverage, and begins to reveal patterns that have previously been obscured by preconceptions about 'focus'.ReferencesBeaver, D. & Clark, B. 2008. Sense and Sensitivity: How Focus Determines Meaning. Blackwell.Beaver, D., Clark, B., Flemming, E., Jaeger, T. F. & Wolters, M. 2007. ‘When semantics meets phonetics: Acoustical studies of second occurrence focus’. Language 83.2: 245–76., M. & Hirschberg, J. 1994. ‘The ToBI Annotation Conventions’. Ms.,, D. 1972. ‘Accent is predictable (if you are a mind-reader’. Language 48.3: 633–44.üring, D. 2006. ‘Focus projection and default

  7. Focus: Digital

    DEFF Research Database (Denmark)

    Technology has been an all-important and defining element within the arts throughout the 20th century, and it has fundamentally changed the ways in which we produce and consume music. With this Focus we investigate the latest developments in the digital domain – and their pervasiveness and rapid...... production and reception of contemporary music and sound art. With ‘Digital’ we present four composers' very different answers to how technology impact their work. To Juliana Hodkinson it has become an integral part of her sonic writing. Rudiger Meyer analyses the relationships between art and design and how...... technology affects our habits of consumption. Risto Holopainen presents a notion of autonomous instruments and automated composition that, in the end, cannot escape the human while Jøren Rudi reflects on aesthetic elements and artistic approaches to sound in computer games. This focus is edited by Sanne...

  8. Material focus

    DEFF Research Database (Denmark)

    Sokoler, Tomas; Vallgårda, Anna K. A.


    In this paper we build on the notion of computational composites, which hold a material perspective on computational technology. We argue that a focus on the material aspects of the technology could be a fruitful approach to achieve new expressions and to gain a new view on the technology's role...... in design. We study two of the computer's material properties: computed causality and connectability and through developing two computational composites that utilize these properties we begin to explore their potential expressions....

  9. Development of new taxonomy of inappropriate communication and its application to operating teams in nuclear power plants

    International Nuclear Information System (INIS)

    Kim, Ar Ryum; Lee, Seung Woo; Jang, In Seok; Kang, Hyun Gook; Seong, Poong Hyun; Park, Jin Kyun


    Inappropriate communications can cause a lack of necessary information exchange between operators and lead to serious consequences in large process systems such as nuclear power plants (NPPs). In this regard, various kinds of taxonomies of inappropriate communications have been developed to prevent inappropriate communications. However, there seems to be difficult to identify inappropriate communications from verbal protocol data between operators. Because the existing taxonomies were developed for use in report analysis, there is a problem of 'uncertainty'. In consequence, this paper proposes a new taxonomy of inappropriate communications and provides some insights to prevent inappropriate communications. In order to develop the taxonomy, existing taxonomies for four industries from 1980 to 2010 were collected and a new taxonomy is developed based on the simplified one-way communication model. In addition, the ratio of inappropriate communications from 8 samples of audio-visual format verbal protocol data recorded during emergency training sessions by operating teams is compared with performance scores calculated based on the task analysis. As a result, inappropriate communications can be easily identified from the verbal protocol data using the suggested taxonomy, and teams with a higher ratio of inappropriate communications tend to have a lower performance score.

  10. Using an Electronic Highlighter to Eliminate the Negative Effects of Pre-Existing, Inappropriate Highlighting (United States)

    Gier, Vicki; Kreiner, David; Hudnell, Jason; Montoya, Jodi; Herring, Daniel


    The purpose of the present experiment was to determine whether using an active learning technique, electronic highlighting, can eliminate the negative effects of pre-existing, poor highlighting on reading comprehension. Participants read passages containing no highlighting, appropriate highlighting, or inappropriate highlighting. We hypothesized…

  11. [Characteristics of potentially inappropriate prescribing of drugs in elderly polypathological patients]. (United States)

    Rivas-Cobas, Paula Carlota; Ramírez-Duque, Nieves; Gómez Hernández, Mercedes; García, Juana; Agustí, Antonia; Vidal, Xavier; Formiga, Francesc; López-Soto, Alfonso; Torres, Olga H; San-José, Antonio

    To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Inappropriate implantable cardioverter-defibrillator shocks in Brugada syndrome: Pattern in primary and secondary prevention

    Directory of Open Access Journals (Sweden)

    Aimé Bonny


    Conclusion: Inappropriate shock is common in Brugada syndrome during the early periods after an ICD implantation, and seems to be more likely in asymptomatic patients. This finding may warrant a review of the indications for ICD implantation, especially in the young and apparently healthy population of patients with Brugada syndrome.

  13. Potentially Inappropriate Medication Use Among Elderly Home Care Patients in Europe

    Czech Academy of Sciences Publication Activity Database

    Fialová, D.; Topinková, E.; Gambassi, G.; Finne-Soveri, H.; Jónsson, P.; Carpenter, I.; Schroll, M.; Onder, G.; Sorbye, L.W.; Wagner, C.; Reissigová, Jindra; Bernabei, R.


    Roč. 293, č. 11 (2005), s. 1348-1358 ISSN 0098-7484 Institutional research plan: CEZ:AV0Z10300504 Keywords : potentially inappropriate medication * prevalence * independent correlates Subject RIV: FQ - Public Health Care, Social Medicine Impact factor: 23.332, year: 2005

  14. Unveiling common responses of Medicago truncatula to appropriate and inappropriate rust species

    Directory of Open Access Journals (Sweden)

    Maria Carlota eVaz Patto


    Full Text Available Little is known about the nature of effective defense mechanisms in legumes to pathogens of remotely related plant species. Some rust species are among pathogens with broad host range causing dramatic losses in various crop plants. To understand and compare the different host and nonhost resistance responses of legume species against rusts, we characterized the reaction of the model legume Medicago truncatula to one appropriate (Uromyces striatus and two inappropriate (U. viciae-fabae and U. lupinicolus rusts. We found that similar pre and post-haustorial mechanisms of resistance appear to be operative in M. truncatula against appropriate and inappropriate rust fungus. The appropriate U. striatus germinated better on M. truncatula accessions then the inappropriate U. viciae-fabae and U. lupinicolus, but once germinated, germ tubes of the three rusts had a similar level of success in finding stomata and forming an appressoria over a stoma. However responses to different inappropriate rust species also showed some specificity, suggesting a combination of non specific and specific responses underlying this legume nonhost resistance to rust fungi. Further genetic and expression analysis studies will contribute to the development of the necessary molecular tools to use the present information on host and nonhost resistance mechanisms to breed for broad-spectrum resistance to rust in legume species.

  15. Inappropriate use of urinary catheters and its common complications in different hospital wards

    Directory of Open Access Journals (Sweden)

    Parivash Davoodian


    Full Text Available Inappropriate use of indwelling urinary catheters (IUCs and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6% had IUCs used appropriately while 42 of them (20.6% were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%, 16 (19.0% and 14 patients (24.6%, respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2% and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

  16. Potentially inappropriate medication use among institutionalized elderly individuals in southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Cunha Xavier Pinto


    Full Text Available In recent decades, the elderly population in Brazil has grown rapidly, as has concern for the health of this population. Institutionalization in nursing homes has appeared as an alternative form of health care for frail elderly that live alone. The present study evaluated the pharmacotherapy and inappropriate drug prescriptions for institutionalized elderly patients living in long-term institutions in southeastern Brazil. This research was conducted at five institutions with a total sample of 151 individuals aged at least 60 years. Databases were used to identify drug interactions, defined daily dose and inappropriate prescriptions. The prevalence of drug intake among the elderly was 95.36%, and there were an average of 3.31 ± 1.80 drug prescriptions per individual. Based on Beers criteria, the prevalence of inappropriate prescriptions was 25.83%. In addition, 70.2% of prescriptions were prescribed at a higher dosage than the defined daily dose (ATC/WHO. Potential drug interactions were identified for 54.11% of prescriptions; 81.42% of these were of moderate severity. The main inappropriate drugs were prescribed for cardiovascular and nervous system problems. Institutionalized elderly individuals presented a high consumption and misuse of medications, requiring professional intervention to monitor prescriptions and improve the quality of service for this population.

  17. College Student Perceptions of the (In)Appropriateness and Functions of Teacher Disclosure (United States)

    Hosek, Angela M.; Presley, Rachel


    This study investigated college student perceptions of the (in)appropriateness of instructor disclosures and perceived functions of instructor disclosures. An interpretive analysis of 35 college students identified that family relationships, life experiences and background, and everyday talk and activities were forms of appropriate disclosures;…

  18. Inappropriate Care in European ICUs Confronting Views From Nurses and Junior and Senior Physicians

    NARCIS (Netherlands)

    Piers, Ruth D.; Azoulay, Elie; Ricou, Bara; Ganz, Freda DeKeyser; Max, Adeline; Michalsen, Andrej; Maia, Paulo Azevedo; Owczuk, Radoslaw; Rubulotta, Francesca; Meert, Anne-Pascale; Reyners, Anna K.; Decruyenaere, Johan; Benoit, Dominique D.

    BACKGROUND: ICU care providers oft en feel that the care given to a patient may be inconsistent with their professional knowledge or beliefs. This study aimed to assess differences in, and reasons for, perceived inappropriate care (PIC) across ICU care providers with varying levels of

  19. Electromagnetic Interference from Swimming Pool Generator Current Causing Inappropriate ICD Discharges

    Directory of Open Access Journals (Sweden)

    Edward Samuel Roberto


    Full Text Available Electromagnetic interference (EMI includes any electromagnetic field signal that can be detected by device circuitry, with potentially serious consequences: incorrect sensing, pacing, device mode switching, and defibrillation. This is a unique case of extracardiac EMI by alternating current leakage from a submerged motor used to recycle chlorinated water, resulting in false rhythm detection and inappropriate ICD discharge. A 31-year-old female with arrhythmogenic right ventricular cardiomyopathy and Medtronic dual-chamber ICD placement presented after several inappropriate ICD shocks at the public swimming pool. Patient had never received prior shocks and device was appropriate at all regular follow-ups. Intracardiac electrograms revealed unique, high-frequency signals at exactly 120 msec suggestive of EMI from a strong external source of alternating current. Electrical artifact was incorrectly sensed as a ventricular arrhythmia which resulted in discharge. ICD parameters including sensing, pacing thresholds, and impedance were all normal suggesting against device malfunction. With device failure and intracardiac sources excluded, EMI was therefore strongly suspected. Avoidance of EMI source brought complete resolution with no further inappropriate shocks. After exclusion of intracardiac interference, device malfunction, and abnormal settings, extracardiac etiologies such as EMI must be thoughtfully considered and excluded. Elimination of inappropriate shocks is to “first, do no harm.”

  20. Improving Inappropriate Social Behavior of Autistic Students Using the LISTEN Intervention Strategy (United States)

    Al-Shammari, Zaid; Daniel, Cathy; Faulkner, Paula; Yawkey, Thomas D.


    A case study was conducted on the development of the LISTEN intervention strategy for use with autistic students to improve inappropriate social behaviors. The study was conducted in a special education classroom in an autism school in Kuwait. Examination of LISTEN Intervention Strategy applications included: duration of targeted behavior; methods…

  1. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes. (United States)

    Vivatkusol, Yada; Thavaramara, Thaovalai; Phaloprakarn, Chadakarn


    To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG) among teenage pregnant women. A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG. Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m 2 . The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes.

  2. Age-Related Differences in Judgments of Inappropriate Behavior are Related to Humor Style Preferences (United States)

    Stanley, Jennifer Tehan; Lohani, Monika; Isaacowitz, Derek M.


    Identifying social gaffes is important for maintaining relationships. Older adults are less able than young to discriminate between socially appropriate and inappropriate behavior in video clips. One open question is how these social appropriateness ratings relate to potential age differences in the perception of what is actually funny or not. In the present study, young, middle-aged, and older adults were equally able to discriminate between appropriate and inappropriate social behavior in a diverse set of clips relevant to both age groups. However, young and middle-aged adults rated the gaffe clips as funnier than control clips and young adults smiled more during the inappropriate clips than the control clips. Older adults did not show this pattern, suggesting that they did not find the inappropriate clips funny. Additionally, young adults endorsed a more aggressive humor style than middle-aged and older adults and aggressive humor style endorsement mediated age differences in social appropriateness ratings. Results are discussed in terms of possible mechanisms such as cohort differences in humor and developmental prioritization of certain humor styles, as well as the importance of investigating age differences in both abilities and preferences. PMID:25244473

  3. Performance Costs when Emotion Tunes Inappropriate Cognitive Abilities: Implications for Mental Resources and Behavior (United States)

    Storbeck, Justin


    Emotion tunes cognition, such that approach-motivated positive states promote verbal cognition, whereas withdrawal-motivated negative states promote spatial cognition (Gray, 2001). The current research examined whether self-control resources become depleted and influence subsequent behavior when emotion tunes an inappropriate cognitive tendency.…

  4. Attention to health cues on product packages

    DEFF Research Database (Denmark)

    Orquin, Jacob Lund; Scholderer, Joachim


    attention was measured by means of eye-tracking. Task (free viewing, product healthfulness evaluation, and purchase likelihood evaluation) and product (five different yoghurt products) were varied in a mixed within-between subjects design. The free viewing condition served as a baseline against which...... increases or decreases in attention during product healthfulness evaluation and purchase likelihood evaluation were assessed. The analysis revealed that the only element operating as a health cue during product healthfulness evaluation was the nutrition label. The information cues used during purchase...... likelihood evaluation were the name of the product category and the nutrition label. Taken together, the results suggest that the only information element that consumers consistently utilize as a health cue is the nutrition label and that only a limited amount of attention is devoted to read nutrition labels...

  5. Perceptions of Sexual Orientation From Minimal Cues. (United States)

    Rule, Nicholas O


    People derive considerable amounts of information about each other from minimal nonverbal cues. Apart from characteristics typically regarded as obvious when encountering another person (e.g., age, race, and sex), perceivers can identify many other qualities about a person that are typically rather subtle. One such feature is sexual orientation. Here, I review the literature documenting the accurate perception of sexual orientation from nonverbal cues related to one's adornment, acoustics, actions, and appearance. In addition to chronicling studies that have demonstrated how people express and extract sexual orientation in each of these domains, I discuss some of the basic cognitive and perceptual processes that support these judgments, including how cues to sexual orientation manifest in behavioral (e.g., clothing choices) and structural (e.g., facial morphology) signals. Finally, I attend to boundary conditions in the accurate perception of sexual orientation, such as the states, traits, and group memberships that moderate individuals' ability to reliably decipher others' sexual orientation.

  6. Cues for localization in the horizontal plane

    DEFF Research Database (Denmark)

    Jeppesen, Jakob; Møller, Henrik


    Spatial localization of sound is often described as unconscious evaluation of cues given by the interaural time difference (ITD) and the spectral information of the sound that reaches the two ears. Our present knowledge suggests the hypothesis that the ITD roughly determines the cone of the perce......Spatial localization of sound is often described as unconscious evaluation of cues given by the interaural time difference (ITD) and the spectral information of the sound that reaches the two ears. Our present knowledge suggests the hypothesis that the ITD roughly determines the cone...... of the perceived position (i.e. the azimuth in a polar coordinate system with left-right poles), whereas the spectral information determines the position on the cone (i.e. the elevation in the same coordinate system). This hypothesis was evaluated in a series of listening tests, where the two cues were manipulated...

  7. Investigating the effects of consumption-associated cues on disappointment, regret and post-consumption behaviours


    Hossain, Muhammad Ismail


    Consumers invariably encounter both positive and negative consumption experiences in their lives. Prior research finds that negative consumption experiences result in particular affective and behavioural reactions. This research focuses on how consumers respond to consumption-associated cues, in particular, causal attributions, expectations, and perceived information search, in terms of feelings of disappointment and regret, and how these emotions subsequently influence consumers’ post consum...

  8. Can Children with Autistic Spectrum Disorders Extract Emotions out of Contextual Cues? (United States)

    Da Fonseca, David; Santos, Andreia; Bastard-Rosset, Delphine; Rondan, Cecilie; Poinso, Francois; Deruelle, Christine


    The aim of the present study was to determine whether children with autism spectrum disorders (ASD) are able to recognize facial expressions of emotion and objects missing on the basis of contextual cues. While most of these studies focused on facial emotion recognition, here we examined the ability to extract emotional information on the basis…

  9. Competition between auditory and visual spatial cues during visual task performance

    NARCIS (Netherlands)

    Koelewijn, T.; Bronkhorst, A.; Theeuwes, J.


    There is debate in the crossmodal cueing literature as to whether capture of visual attention by means of sound is a fully automatic process. Recent studies show that when visual attention is endogenously focused sound still captures attention. The current study investigated whether there is

  10. The Use of Voice Cues for Speaker Gender Recognition in Cochlear Implant Recipients (United States)

    Meister, Hartmut; Fürsen, Katrin; Streicher, Barbara; Lang-Roth, Ruth; Walger, Martin


    Purpose: The focus of this study was to examine the influence of fundamental frequency (F0) and vocal tract length (VTL) modifications on speaker gender recognition in cochlear implant (CI) recipients for different stimulus types. Method: Single words and sentences were manipulated using isolated or combined F0 and VTL cues. Using an 11-point…

  11. Meninges-derived cues control axon guidance. (United States)

    Suter, Tracey A C S; DeLoughery, Zachary J; Jaworski, Alexander


    The axons of developing neurons travel long distances along stereotyped pathways under the direction of extracellular cues sensed by the axonal growth cone. Guidance cues are either secreted proteins that diffuse freely or bind the extracellular matrix, or membrane-anchored proteins. Different populations of axons express distinct sets of receptors for guidance cues, which results in differential responses to specific ligands. The full repertoire of axon guidance cues and receptors and the identity of the tissues producing these cues remain to be elucidated. The meninges are connective tissue layers enveloping the vertebrate brain and spinal cord that serve to protect the central nervous system (CNS). The meninges also instruct nervous system development by regulating the generation and migration of neural progenitors, but it has not been determined whether they help guide axons to their targets. Here, we investigate a possible role for the meninges in neuronal wiring. Using mouse neural tissue explants, we show that developing spinal cord meninges produce secreted attractive and repulsive cues that can guide multiple types of axons in vitro. We find that motor and sensory neurons, which project axons across the CNS-peripheral nervous system (PNS) boundary, are attracted by meninges. Conversely, axons of both ipsi- and contralaterally projecting dorsal spinal cord interneurons are repelled by meninges. The responses of these axonal populations to the meninges are consistent with their trajectories relative to meninges in vivo, suggesting that meningeal guidance factors contribute to nervous system wiring and control which axons are able to traverse the CNS-PNS boundary. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Consumer attention to product health cues

    DEFF Research Database (Denmark)

    Orquin, Jacob Lund

    healthfulness and purchase likelihood. Study 2 used a 3x2x2 group mixed design manipulating product images (control images, health-related images, exercise-related images), brand (control brand, health association brand), and color scheme (control color scheme, green health-association color scheme). Study 3...... of all labels). Results The only elements operating as health cues were the nutrition label and the organic label. The information cues used during purchase evaluation were the product category name and the nutrition label. Results also revealed that the probability a consumer will read the nutrition...

  13. Healthcare Utilization and Expenditures Associated With Appropriate and Inappropriate Implantable Defibrillator Shocks. (United States)

    Turakhia, Mintu P; Zweibel, Steven; Swain, Andrea L; Mollenkopf, Sarah A; Reynolds, Matthew R


    In patients with implantable cardioverter-defibrillators, healthcare utilization (HCU) and expenditures related to shocks have not been quantified. We performed a retrospective cohort study of patients with implantable cardioverter-defibrillators identified from commercial and Medicare supplemental claims databases linked to adjudicated shock events from remote monitoring data. A shock event was defined as ≥1 spontaneous shocks delivered by an implanted device. Shock-related HCU was ascertained from inpatient and outpatient claims within 7 days following a shock event. Shock events were adjudicated and classified as inappropriate or appropriate, and HCU and expenditures, stratified by shock type, were quantified. Of 10 266 linked patients, 963 (9.4%) patients (61.3±13.6 years; 81% male) had 1885 shock events (56% appropriate, 38% inappropriate, and 6% indeterminate). Of these events, 867 (46%) had shock-related HCU (14% inpatient and 32% outpatient). After shocks, inpatient cardiovascular procedures were common, including echocardiography (59%), electrophysiology study or ablation (34%), stress testing (16%), and lead revision (11%). Cardiac catheterization was common (71% and 51%), but percutaneous coronary intervention was low (6.5% and 5.0%) after appropriate and inappropriate shocks. Expenditures related to appropriate and inappropriate shocks were not significantly different. After implantable cardioverter-defibrillator shock, related HCU was common, with 1 in 3 shock events followed by outpatient HCU and 1 in 7 followed by hospitalization. Use of invasive cardiovascular procedures was substantial, even after inappropriate shocks, which comprised 38% of all shocks. Implantable cardioverter-defibrillator shocks seem to trigger a cascade of health care. Strategies to reduce shocks could result in cost savings. © 2017 American Heart Association, Inc.

  14. [Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital]. (United States)

    Ruvinsky, Silvina; Mónaco, Andrea; Pérez, Guadalupe; Taicz, Moira; Inda, Laura; Kijko, Ivana; Constanzo, Patricia; Bologna, Rosa


    Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

  15. Echocardiographic assessment of inappropriate left ventricular mass and left ventricular hypertrophy in patients with diastolic dysfunction

    Directory of Open Access Journals (Sweden)

    Hasan Shemirani


    Full Text Available Background: early diagnosis of left ventricular mass (LVM inappropriateness and left ventricular hypertrophy (LVH can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM. Materials and Methods: one hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E/late diastolic peak velocity (A, deceleration time (DT, and E/early mitral annulus velocity (E′ were measured. Results: the mean systolic and diastolic blood pressure at the patients′ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (P 0.05. Spearman′s Rank test was used to test the correlation between diastolic dysfunction and LV mass (P = 0.025. Conclusion: LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.

  16. Vowel identification by cochlear implant users: Contributions of duration cues and dynamic spectral cues. (United States)

    Donaldson, Gail S; Rogers, Catherine L; Johnson, Lindsay B; Oh, Soo Hee


    A recent study from our laboratory assessed vowel identification in cochlear implant (CI) users, using full /dVd/ syllables and partial (center- and edges-only) syllables with duration cues neutralized [Donaldson, Rogers, Cardenas, Russell, and Hanna (2013). J. Acoust. Soc. Am. 134, 3021-3028]. CI users' poorer performance for partial syllables as compared to full syllables, and for edges-only syllables as compared to center-only syllables, led to the hypotheses (1) that CI users may rely strongly on vowel duration cues; and (2) that CI users have more limited access to dynamic spectral cues than steady-state spectral cues. The present study tested those hypotheses. Ten CI users and ten young normal hearing (YNH) listeners heard full /dVd/ syllables and modified (center- and edges-only) syllables in which vowel duration cues were either preserved or eliminated. The presence of duration cues significantly improved vowel identification scores in four CI users, suggesting a strong reliance on duration cues. Duration effects were absent for the other CI users and the YNH listeners. On average, CI users and YNH listeners demonstrated similar performance for center-only stimuli and edges-only stimuli having the same total duration of vowel information. However, three CI users demonstrated significantly poorer performance for the edges-only stimuli, indicating apparent deficits of dynamic spectral processing.

  17. Plasma Focus

    International Nuclear Information System (INIS)

    Bernard, Alain; Jolas, Alain; Garconnet, J.-P.; Mascureau, J. de; Nazet, Christian; Coudeville, Alain; Bekiarian, Andre.


    The present report is the edition of the lectures given in a conference on the Focus experiment held at the Centre d'etudes de Limeil, on Oct. 1975. After a survey of the early laboratories one will find the main results obtained in Limeil concerning interferometry, laser scattering, electric and magnetic-measurements, X-ray and neutron emission and also the possible use of explosive current generators instead of capacitor banks at high energy levels. The principal lines of future research are given in the conclusion [fr

  18. Cue-responding during simulated routine nursing care: a mixed method study. (United States)

    Chan, Engle A


    Failure of nurses to recognize, acknowledge, and/or explore patient cues/concerns may result in patients' unrecognized psychosocial and information needs that could have untoward consequences. With the continuous evidence of the need for nurses to improve their communication, a greater emphasis is needed in the undergraduate nursing curriculum on training students in such skills. This study is to explore the cue-responding behaviors of nursing students during their routine care of patients in a simulated setting. A mixed methods approach. Senior year students. Data was collected by video-taping the students' cue-responding behavior performance, through individual debriefing interviews, and from the student-patient actors' written comments and the focus group. Of the 110 cues in the conversation, 47% were acknowledged, only 12% were explored, and 53% were responded to with distancing behavior. Students' cue-responding behavior was a negative 21.8% with more cues being responded to through distancing behaviors than were acknowledged. Their pattern of communication was characterized by a focus on task completion, the use of predominately close-ended questions, and the giving of explanations and information based on unchecked assumptions. Learning from their individual video-taped performance and debriefing with facilitators helped the students to not only develop a deeper level of self-awareness and reflection but also caused them to think more about time, the culture of nursing, and the tension between task-focused and patient-centered care. They came to value cue-responding in communication as one way of learning about communicating with patients. Focusing on cue-responding in communication also provided us with insights on the students' understanding of communication and the need for educators to re-emphasize person-centered communication and to deal with issues that go beyond technical skills. Future research is critical to examine its transferability to practice

  19. Daytime Water Detection by Fusing Multiple Cues for Autonomous Off-Road Navigation (United States)

    Rankin, A. L.; Matthies, L. H.; Huertas, A.


    Detecting water hazards is a significant challenge to unmanned ground vehicle autonomous off-road navigation. This paper focuses on detecting the presence of water during the daytime using color cameras. A multi-cue approach is taken. Evidence of the presence of water is generated from color, texture, and the detection of reflections in stereo range data. A rule base for fusing water cues was developed by evaluating detection results from an extensive archive of data collection imagery containing water. This software has been implemented into a run-time passive perception subsystem and tested thus far under Linux on a Pentium based processor.

  20. Focusing horn

    CERN Multimedia


    This was the first magnetic horn developed by Simon Van der Meer to collect antiprotons in the AD complex. It was used for the AA (antiproton accumulator). Making an antiproton beam took a lot of time and effort. Firstly, protons were accelerated to an energy of 26 GeV/c (protons at 26GeV/c, antiprotons at 3.6GeV/c) in the PS and ejected onto a metal target. From the spray of emerging particles, a magnetic horn picked out 3.6 GeV antiprotons for injection into the AA through a wide-aperture focusing quadrupole magnet. For a million protons hitting the target, just one antiproton was captured, 'cooled' and accumulated. It took 3 days to make a beam of 3 x 10^11 -, three hundred thousand million - antiprotons. The development of this technology was a key step to the functioning of CERN's Super Proton Synchrotron as a proton - antiproton collider.

  1. Effects of similarity on environmental context cueing. (United States)

    Smith, Steven M; Handy, Justin D; Angello, Genna; Manzano, Isabel


    Three experiments examined the prediction that context cues which are similar to study contexts can facilitate episodic recall, even if those cues are never seen before the recall test. Environmental context cueing effects have typically produced such small effect sizes that influences of moderating factors, such as the similarity between encoding and retrieval contexts, would be difficult to observe experimentally. Videos of environmental contexts, however, can be used to produce powerful context-dependent memory effects, particularly when only one memory target is associated with each video context, intentional item-context encoding is encouraged, and free recall tests are used. Experiment 1 showed that a not previously viewed video of the study context provided an effective recall cue, although it was not as effective as the originally viewed video context. Experiments 2 and 3 showed that videos of environments that were conceptually similar to encoding contexts (e.g., both were videos of ball field games) also cued recall, but not as well if the encoding contexts were given specific labels (e.g., "home run") incompatible with test contexts (e.g., a soccer scene). A fourth experiment that used incidental item-context encoding showed that video context reinstatement has a robust effect on paired associate memory, indicating that the video context reinstatement effect does not depend on interactive item-context encoding or free recall testing.

  2. Probabilistic Cue Combination: Less Is More (United States)

    Yurovsky, Daniel; Boyer, Ty W.; Smith, Linda B.; Yu, Chen


    Learning about the structure of the world requires learning probabilistic relationships: rules in which cues do not predict outcomes with certainty. However, in some cases, the ability to track probabilistic relationships is a handicap, leading adults to perform non-normatively in prediction tasks. For example, in the "dilution effect,"…

  3. Spontaneous hedonic reactions to social media cues

    NARCIS (Netherlands)

    Koningsbruggen, G.M. van; Hartmann, T.; Eden, A.; Veling, H.P.


    Why is it so difficult to resist the desire to use social media? One possibility is that frequent social media users possess strong and spontaneous hedonic reactions to social media cues, which, in turn, makes it difficult to resist social media temptations. In two studies (total N = 200), we

  4. Preschoolers Benefit from Visually Salient Speech Cues (United States)

    Lalonde, Kaylah; Holt, Rachael Frush


    Purpose: This study explored visual speech influence in preschoolers using 3 developmentally appropriate tasks that vary in perceptual difficulty and task demands. They also examined developmental differences in the ability to use visually salient speech cues and visual phonological knowledge. Method: Twelve adults and 27 typically developing 3-…

  5. Transsituational relations between personality cues and judgements

    NARCIS (Netherlands)


    In this dissertation the transsituational consistency of the two kinds of personality measures was compared: (1) judgments, i.e., inferential judgements in terms of global traits; (2) cues, i.e., behavioral observation data and other characteristics of stimulus persons, that can be measured

  6. Do taste expectations mediate the impact of quality cues on consumers’ choice of chicken?

    DEFF Research Database (Denmark)

    Marian, Livia; Thøgersen, John; Krystallis Krontalis, Athanasios

    The hypothesis of this research is that the impact of quality dimensions on consumers’ willingness to buy organic vs. conventional or free-range chicken is partly mediated through taste expectations. The study comprises two exploratory focus group studies, followed by a questionnaire containing...... for the choice of chicken, and that taste is one of the most important quality dimensions in consumers’ overall evaluation of chicken. In the next step, the four quality cues were included in a conjoint design, where nine different profiles of whole fresh chickens were created using a fractional factorial design...... analyses, in order to determine the impact of the quality cues on buying intention on the one hand, and on the expected taste on the other hand. In these models, quality cues are initial variables, while expected taste and willingness to buy are both outcome variables. The two models are then integrated...

  7. Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria. (United States)

    Nyborg, Gunhild; Brekke, Mette; Straand, Jørund; Gjelstad, Svein; Romøren, Maria


    Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. Cross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009-11 included residents' demographic and clinical status and all medications, regular and on demand. 881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009). Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially

  8. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients.

    LENUS (Irish Health Repository)

    Hamilton, Hilary


    Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness.

  9. Amplitude rise time does not cue the /ba/-/wa/ contrast for adults or children. (United States)

    Nittrouer, Susan; Lowenstein, Joanna H; Tarr, Eric


    Previous research has demonstrated that children weight the acoustic cues to many phonemic decisions differently than do adults and gradually shift those strategies as they gain language experience. However, that research has focused on spectral and duration cues rather than on amplitude cues. In the current study, the authors examined amplitude rise time (ART; an amplitude cue) and formant rise time (FRT; a spectral cue) in the /b/-/w/ manner contrast for adults and children, and related those speech decisions to outcomes of nonspeech discrimination tasks. Twenty adults and 30 children (ages 4-5 years) labeled natural and synthetic speech stimuli manipulated to vary ARTs and FRTs, and discriminated nonspeech analogs that varied only by ART in an AX paradigm. Three primary results were obtained. First, listeners in both age groups based speech labeling judgments on FRT, not on ART. Second, the fundamental frequency of the natural speech samples did not influence labeling judgments. Third, discrimination performance for the nonspeech stimuli did not predict how listeners would perform with the speech stimuli. Even though both adults and children are sensitive to ART, it was not weighted in phonemic judgments by these typical listeners.

  10. The (unclear effects of invalid retro-cues.

    Directory of Open Access Journals (Sweden)

    Marcel eGressmann


    Full Text Available Studies with the retro-cue paradigm have shown that validly cueing objects in visual working memory long after encoding can still benefit performance on subsequent change detection tasks. With regard to the effects of invalid cues, the literature is less clear. Some studies reported costs, others did not. We here revisit two recent studies that made interesting suggestions concerning invalid retro-cues: One study suggested that costs only occur for larger set sizes, and another study suggested that inclusion of invalid retro-cues diminishes the retro-cue benefit. New data from one experiment and a reanalysis of published data are provided to address these conclusions. The new data clearly show costs (and benefits that were independent of set size, and the reanalysis suggests no influence of the inclusion of invalid retro-cues on the retro-cue benefit. Thus, previous interpretations may be taken with some caution at present.

  11. Cue-induced craving in patients with cocaine use disorder predicts cognitive control deficits toward cocaine cues. (United States)

    DiGirolamo, Gregory J; Smelson, David; Guevremont, Nathan


    Cue-induced craving is a clinically important aspect of cocaine addiction influencing ongoing use and sobriety. However, little is known about the relationship between cue-induced craving and cognitive control toward cocaine cues. While studies suggest that cocaine users have an attentional bias toward cocaine cues, the present study extends this research by testing if cocaine use disorder patients (CDPs) can control their eye movements toward cocaine cues and whether their response varied by cue-induced craving intensity. Thirty CDPs underwent a cue exposure procedure to dichotomize them into high and low craving groups followed by a modified antisaccade task in which subjects were asked to control their eye movements toward either a cocaine or neutral drug cue by looking away from the suddenly presented cue. The relationship between breakdowns in cognitive control (as measured by eye errors) and cue-induced craving (changes in self-reported craving following cocaine cue exposure) was investigated. CDPs overall made significantly more errors toward cocaine cues compared to neutral cues, with higher cravers making significantly more errors than lower cravers even though they did not differ significantly in addiction severity, impulsivity, anxiety, or depression levels. Cue-induced craving was the only specific and significant predictor of subsequent errors toward cocaine cues. Cue-induced craving directly and specifically relates to breakdowns of cognitive control toward cocaine cues in CDPs, with higher cravers being more susceptible. Hence, it may be useful identifying high cravers and target treatment toward curbing craving to decrease the likelihood of a subsequent breakdown in control. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Facial age cues and emotional expression interact asymmetrically: age cues moderate emotion categorisation. (United States)

    Craig, Belinda M; Lipp, Ottmar V


    Facial attributes such as race, sex, and age can interact with emotional expressions; however, only a couple of studies have investigated the nature of the interaction between facial age cues and emotional expressions and these have produced inconsistent results. Additionally, these studies have not addressed the mechanism/s driving the influence of facial age cues on emotional expression or vice versa. In the current study, participants categorised young and older adult faces expressing happiness and anger (Experiment 1) or sadness (Experiment 2) by their age and their emotional expression. Age cues moderated categorisation of happiness vs. anger and sadness in the absence of an influence of emotional expression on age categorisation times. This asymmetrical interaction suggests that facial age cues are obligatorily processed prior to emotional expressions. Finding a categorisation advantage for happiness expressed on young faces relative to both anger and sadness which are negative in valence but different in their congruence with old age stereotypes or structural overlap with age cues suggests that the observed influence of facial age cues on emotion perception is due to the congruence between relatively positive evaluations of young faces and happy expressions.

  13. What's in a cue? The role of cue orientation in object displacement tasks. (United States)

    Mangalindan, Diane Marie J; Schmuckler, Mark A


    The current study looked at two theoretical proposals explaining toddlers' abilities to use cue information for recovering a hidden object that had rolled down a ramp behind an occluded screen. These two approaches, the theory of object directed attention and a landmark-based account, make different predictions regarding the efficacy of an obliquely aligned cue to object position. Accordingly, the search by forty 24-month olds, forty-two 30-month olds, and forty-one 36-month olds for a hidden toy that was cued using either a short versus a long cue, or a vertically aligned versus an obliquely aligned cue, were compared. Analyses of search accuracy revealed that children were more successful when faced with short as opposed to long cues, and when using vertical as opposed to oblique cues. These findings support a landmark-based approach, as opposed to an object-directed attention account, and are discussed with reference to their implications for spatial orientation more generally. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Beyond naïve cue combination: salience and social cues in early word learning. (United States)

    Yurovsky, Daniel; Frank, Michael C


    Children learn their earliest words through social interaction, but it is unknown how much they rely on social information. Some theories argue that word learning is fundamentally social from its outset, with even the youngest infants understanding intentions and using them to infer a social partner's target of reference. In contrast, other theories argue that early word learning is largely a perceptual process in which young children map words onto salient objects. One way of unifying these accounts is to model word learning as weighted cue combination, in which children attend to many potential cues to reference, but only gradually learn the correct weight to assign each cue. We tested four predictions of this kind of naïve cue combination account, using an eye-tracking paradigm that combines social word teaching and two-alternative forced-choice testing. None of the predictions were supported. We thus propose an alternative unifying account: children are sensitive to social information early, but their ability to gather and deploy this information is constrained by domain-general cognitive processes. Developmental changes in children's use of social cues emerge not from learning the predictive power of social cues, but from the gradual development of attention, memory, and speed of information processing. © 2015 John Wiley & Sons Ltd.

  15. Clinical analysis of asthenopia caused by wearing inappropriate glasses in college students

    Directory of Open Access Journals (Sweden)

    Li Wang


    Full Text Available AIM: To proposed control measures by exploring visual fatigue caused by college students wearing inappropriate glasses.METHODS: A total of 124 cases of asthenopia patients underwent optometry students audition, checked the original spectacles; TOPCON-CL100 computer center was used to checked the original mirror glasses(glasses, the distance between the optical center; with near vision as the standard examination table nearly with vergence and regulation near point, and checked the visual function. RESULTS: All 124 cases(248 eyeshad refractive errors, 77% were spherical mirror and 69% column mirror with error ≥±0.50D, and the pupil center distance from the lens had significant difference(U=5.27, PCONCLUSION: Students wearing inappropriate spectacle asthenopia is caused by one of the main scientific wearing glasses can effectively control asthenopia.

  16. Collecting duct renal cell carcinoma with the syndrome of inappropriate antidiuresis: An autopsy case report

    Directory of Open Access Journals (Sweden)

    Emi Yasuda


    Full Text Available A 57-year-old Japanese man visited our hospital with a moist cough. Chest radiographic imaging showed a left hilar shadow. Adenocarcinoma cells were found on cytologic screening of fresh sputum. Although multiple metastases including brain were detected, no tumor was observed in the kidneys. The patient underwent whole-brain irradiation and chemotherapy for advanced-stage lung cancer. One month before his death, carcinomatous meningitis was detected. Hyponatremia, hypo-osmolality, and hypertonic urine suggested the syndrome of inappropriate antidiuresis. Restricting water intake improved the hyponatremia; however, he developed fever and hematuria. Despite systemic administration of an antibacterial drug, he died. Primary tumor in the lung was absent, but adenocarcinoma of the right kidney was evident on autopsy. Lectin histochemical analysis of the carcinoma revealed its distal nephron origin, confirming collecting duct carcinoma. Severe carcinomatous meningitis, which is possibly caused the syndrome of inappropriate antidiuresis, was observed, with no cancer involvement of the pituitary gland and hypothalamus.

  17. Testing a counter-intuitive prediction of optimal cue combination

    NARCIS (Netherlands)

    Muller, C.M.P.; Brenner, E.; Smeets, J.B.J.


    Weighted averaging is said to be optimal when the weights assigned to the cues minimize the variance of the final estimate. Since the variance of this optimal percept only depends on the variances of the individual cues, irrespective of their values, judgments about a cue conflict stimulus should

  18. Perceptual and Conceptual Priming of Cue Encoding in Task Switching (United States)

    Schneider, Darryl W.


    Transition effects in task-cuing experiments can be partitioned into task switching and cue repetition effects by using multiple cues per task. In the present study, the author shows that cue repetition effects can be partitioned into perceptual and conceptual priming effects. In 2 experiments, letters or numbers in their uppercase/lowercase or…

  19. Mental Effort in Binary Categorization Aided by Binary Cues (United States)

    Botzer, Assaf; Meyer, Joachim; Parmet, Yisrael


    Binary cueing systems assist in many tasks, often alerting people about potential hazards (such as alarms and alerts). We investigate whether cues, besides possibly improving decision accuracy, also affect the effort users invest in tasks and whether the required effort in tasks affects the responses to cues. We developed a novel experimental tool…

  20. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as clinical presentation of acute intermittent porphyria. (United States)

    Valle Feijóo, M L; Bermúdez Sanjurjo, J R; González Vázquez, L; Rey Martínez, M; de la Fuente Aguado, J


    Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  1. A case of appropriate inappropriate device therapy: Hyperkalemia-induced ventricular oversensing


    Oudit, Gavin Y; Cameron, Doug; Harris, Louise


    The present case describes a patient who received inappropriate, but potentially life-saving, therapy from her implantable cardioverter defibrillator (ICD) in the setting of acute hyperkalemia (plasma potassium concentration = 8 mM). Hyperkalemia was associated with the development of a slow sinusoidal ventricular tachycardia, at a rate of 100 beats/min to 125 beats/min (610 ms to 480 ms) in a patient who is pacemaker-dependent. There was associated fractionation of the ICD electrogram and T ...

  2. Potentially inappropriate prescribing and cost outcomes for older people: a national population study.

    LENUS (Irish Health Repository)

    Cahir, Caitriona


    Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP.

  3. An automated technique to identify potential inappropriate traditional Chinese medicine (TCM) prescriptions. (United States)

    Yang, Hsuan-Chia; Iqbal, Usman; Nguyen, Phung Anh; Lin, Shen-Hsien; Huang, Chih-Wei; Jian, Wen-Shan; Li, Yu-Chuan


    Medication errors such as potential inappropriate prescriptions would induce serious adverse drug events to patients. Information technology has the ability to prevent medication errors; however, the pharmacology of traditional Chinese medicine (TCM) is not as clear as in western medicine. The aim of this study was to apply the appropriateness of prescription (AOP) model to identify potential inappropriate TCM prescriptions. We used the association rule of mining techniques to analyze 14.5 million prescriptions from the Taiwan National Health Insurance Research Database. The disease and TCM (DTCM) and traditional Chinese medicine-traditional Chinese medicine (TCMM) associations are computed by their co-occurrence, and the associations' strength was measured as Q-values, which often referred to as interestingness or life values. By considering the number of Q-values, the AOP model was applied to identify the inappropriate prescriptions. Afterwards, three traditional Chinese physicians evaluated 1920 prescriptions and validated the detected outcomes from the AOP model. Out of 1920 prescriptions, 97.1% of positive predictive value and 19.5% of negative predictive value were shown by the system as compared with those by experts. The sensitivity analysis indicated that the negative predictive value could improve up to 27.5% when the model's threshold changed to 0.4. We successfully applied the AOP model to automatically identify potential inappropriate TCM prescriptions. This model could be a potential TCM clinical decision support system in order to improve drug safety and quality of care. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Beers Criteria as a Proxy for Inappropriate Prescribing of Other Medications Among Older Adults (United States)

    Lund, Brian C; Steinman, Michael A; Chrischilles, Elizabeth A; Kaboli, Peter J


    BACKGROUND The Beers criteria are a compilation of medications deemed potentially inappropriate for older adults, and widely used a prescribing quality indicator. OBJECTIVE To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescribing, as measured by comprehensive implicit review. METHODS Data for patients 65 years and older were obtained from the VA Enhanced Pharmacy Outpatient Clinic (EPOC) and the Iowa Medicaid Pharmaceutical Case Management (PCM) studies. Comprehensive measurement of prescribing quality was conducted using expert clinician review of medical records according to the Medication Appropriateness Index (MAI). MAI scores attributable to non-Beers medications (non-Beers MAI) were contrasted between patients who did and did not receive a Beers criteria medication. RESULTS Beers criteria medications accounted for 12.9% and 14.0% of total MAI scores in the two studies. Importantly, non-Beers MAI scores were significantly higher in patients receiving a Beers criteria medication in both studies (EPOC: 15.1 vs. 12.4, p = 0.02; PCM: 11.1 vs. 8.7, p = 0.04), after adjusting for important confounding factors. CONCLUSIONS Beers criteria utility extended beyond direct measurement of a limited set of inappropriate prescribing practices by serving as a clinically meaningful proxy for other inappropriate practices. Using prescribing quality indicators to guide interventions should thus identify patients for comprehensive medication review, rather than identifying specific targets for discontinuation. Future research should explore both the quality measurement and the intervention targeting applications of the Beers criteria, particularly when integrated with other indicators. PMID:21972251

  5. Syndrome of inappropriate antidiuretic hormone caused by continuous lumbar spinal fluid drainage after transphenoidal surgery. (United States)

    Norlela, S; Azmi, K N; Khalid, B A K


    A 53-year-old acromegalic woman had cerebrospinal fluid rhinorrhoea following transphenoidal surgery for a pituitary microadenoma. A continuous lumbar spinal fluid drainage catheter was inserted and on the sixth postoperative day, she developed hyponatremia with features of syndrome of inappropriate antidiuretic hormone (SIADH) requiring hypertonic saline administration. Over-drainage is potentially hazardous and close biochemical monitoring is required. To our knowledge, this is the first reported case of SIADH caused by continuous lumbar drainage in an adult.

  6. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes


    Vivatkusol, Yada; Thavaramara, Thaovalai; Phaloprakarn, Chadakarn


    Yada Vivatkusol, Thaovalai Thavaramara, Chadakarn Phaloprakarn Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand Objective: To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG) among teenage pregnant women.Methods: A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse preg...

  7. Short notes and reviews Simplifying hydrozoan classification: inappropriateness of the group Hydroidomedusae in a phylogenetic context


    Marques, Antonio C.


    The systematics of Hydrozoa is considered from the viewpoint of logical consistency between phylogeny and classification. The validity of the nominal taxon Hydroidomedusae (including all groups of Hydrozoa except the Siphonophorae) is discussed with regard to its distinctness and inclusive relationships. In general, phylogenetic systematic evidence suggest that the use of the term Hydroidomedusae is inappropriate given our current level of understanding. It is concluded that no new, or resurr...

  8. Evaluation of potentially inappropriate medications among older residents of Malaysian nursing homes. (United States)

    Chen, Li Li; Tangiisuran, Balamurugan; Shafie, Asrul Akmal; Hassali, Mohamed Azmi Ahmad


    There is an increasing evidence of medicines related issues such as inappropriate prescribing among older people. Inappropriate prescribing is an important risk factor for adverse drug reactions and hospitalizations in the older people. To assess and characterize the prevalence of Potentially Inappropriate Medications (PIMs) in nursing home care in Malaysia as defined by Screening Tool of Older Peoples Prescriptions (STOPP) and Beers criteria. Four Nursing Homes situated in Penang, Malaysia. A multicenter and cross-sectional study was conducted over 2 months period at four large non-governmental organizations nursing homes in Penang, Malaysia. The study population included older residents (≥65 years old) taking at least one medication. Residents who had been diagnosed with dementia or taking anti dementia drugs, delirium, too frail or refused to give consent were excluded. Demographic, clinical data and concurrent medications were collected through direct interview and also by reviewing medical records. STOPP and Beers criteria were applied in the medical review to screen for PIMs. Potentially Inappropriate Medication using STOPP and Beers criteria. Two hundred eleven residents were included in the study with the median age of 77 (inter quartile range (IQR) 72-82) years. Median number of prescription medicines was 4 (IQR 1-14). STOPP identified less residents (50 residents, 23.7 %) being prescribed on PIMs compared with Beers criteria (69 residents, 32.7 %) (p older residents living in the nursing homes and are associated with number of medications and longer nursing home stay. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  9. Reduction of the inappropriate ICD therapies by implementing a new fuzzy logic-based diagnostic algorithm. (United States)

    Lewandowski, Michał; Przybylski, Andrzej; Kuźmicz, Wiesław; Szwed, Hanna


    The aim of the study was to analyze the value of a completely new fuzzy logic-based detection algorithm (FA) in comparison with arrhythmia classification algorithms used in existing ICDs in order to demonstrate whether the rate of inappropriate therapies can be reduced. On the basis of the RR intervals database containing arrhythmia events and controls recordings from the ICD memory a diagnostic algorithm was developed and tested by a computer program. This algorithm uses the same input signals as existing ICDs: RR interval as the primary input variable and two variables derived from it, onset and stability. However, it uses 15 fuzzy rules instead of fixed thresholds used in existing devices. The algorithm considers 6 diagnostic categories: (1) VF (ventricular fibrillation), (2) VT (ventricular tachycardia), (3) ST (sinus tachycardia), (4) DAI (artifacts and heart rhythm irregularities including extrasystoles and T-wave oversensing-TWOS), (5) ATF (atrial and supraventricular tachycardia or fibrillation), and 96) NT (sinus rhythm). This algorithm was tested on 172 RR recordings from different ICDs in the follow-up of 135 patients. All diagnostic categories of the algorithm were present in the analyzed recordings: VF (n = 35), VT (n = 48), ST (n = 14), DAI (n = 32), ATF (n = 18), NT (n = 25). Thirty-eight patients (31.4%) in the studied group received inappropriate ICD therapies. In all these cases the final diagnosis of the algorithm was correct (19 cases of artifacts, 11 of atrial fibrillation and 8 of ST) and fuzzy rules algorithm implementation would have withheld unnecessary therapies. Incidence of inappropriate therapies: 3 vs. 38 (the proposed algorithm vs. ICD diagnosis, respectively) differed significantly (p fuzzy logic based algorithm seems to be promising and its implementation could diminish ICDs inappropriate therapies. We found FA usefulness in correct diagnosis of sinus tachycardia, atrial fibrillation and artifacts in comparison with tested ICDs.

  10. Congenital short QT syndrome and implantable cardioverter defibrillator treatment: inherent risk for inappropriate shock delivery. (United States)

    Schimpf, Rainer; Wolpert, Christian; Bianchi, Francesca; Giustetto, Carla; Gaita, Florenzo; Bauersfeld, Urs; Borggrefe, Martin


    A congenital short QT interval constitutes a new primary electrical abnormality associated with syncope and/or sudden cardiac death. We report on the initial use of implantable cardioverter defibrillator (ICD) therapy in patients with inherited short QT interval and discuss sensing abnormalities and detection issues. In five consecutive patients from two unrelated European families who had structurally normal hearts, excessively shortened QT intervals, and a strong positive family history of sudden cardiac death, ICDs were placed for primary and secondary prevention. Mean QT intervals were 252 +/- 13 ms (QTc 287 +/- 13 ms). Despite normal sensing behavior during intraoperative and postoperative device testing, 3 of 5 patients experienced inappropriate shock therapies for T wave oversensing 30 +/- 26 days after implantation. Programming lower sensitivities and decay delays prevented further inappropriate discharges. The congenital short QT syndrome constitutes a new clinical entity with an increased risk for sudden cardiac death. Currently, ICD treatment is the only therapeutic option. In patients with short QT interval and implanted ICD, increased risk for inappropriate therapy is inherent due to the detection of short-coupled and prominent T waves. Careful testing of ICD function and adaptation of sensing levels and decay delays without sacrificing correct arrhythmia detection are essential.

  11. Inappropriate Dexamethasone Use by a Trekker in Nepal: A Case Report. (United States)

    Haslam, Nicholas R; Garth, Rachel; Kelly, Nicola


    We present a case of inappropriate dexamethasone use in a trekker in the Everest region of Nepal. We aim to increase awareness among health professionals of the possible use of this medication by trekkers and promote knowledge of potential complications. In this case, a previously altitude-naive trekker was prescribed prophylactic dexamethasone by physicians in a Western travel clinic before high-altitude trekking in Nepal. There were no indications for prophylactic medication nor for the use of dexamethasone. The trekker reported that no discussion regarding risks and benefits, alternatives, side effects, contraindications, or dose tapering on completion of the course had occurred before travel. Side effects were temporary, but serious complications may have ensued if it not for timely interventions by doctors at the International Porter Protection Group rescue post. The events leading to inappropriate dexamethasone use in this case cannot be known for certain. However, it is clear that the trekker lacked the knowledge to use the medication safely. Although the efficacy of dexamethasone in the prevention of acute mountain sickness is undisputed, associated side effects and other limitations make acetazolamide the prophylactic drug of choice. Inappropriate use of dexamethasone can lead to severe complications, and such a case has been reported from Mount Everest. Clinicians prescribing dexamethasone must understand the indications and risks, and health professionals at altitude should be aware of its use by trekkers and the potential complications. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  12. Phantom movements from physiologically inappropriate muscles: A case study with a high transhumeral amputee. (United States)

    Gade, Julie; Hugosdottir, Rosa; Kamavuako, Ernest N


    Individuals with high-level amputation have a great need for functional prostheses because of their vast functional deficits. Conventional techniques are considered inappropriate for high-level amputees due to the lack of physiologically appropriate muscles. This study investigates how accurate phantom movements (PMs) can be classified from physiologically inappropriate muscles. The study involves a case study of a 42-year-old transhumeral amputee. Suitable PMs and best electrode configuration were identified using the sequential forward selection method and brute-force technique. Using linear discriminant analysis, the best PMs (elbow extension/flexion, wrist supination/pronation) and rest were classified with error ranging from 3% to 0.18% when using 3 to 8 EMG channels respectively. A completion rate of 93 % was obtained during a targeted achievement control test in a virtual reality environment. This case indicates that a proximal transhumeral amputee can generate muscle activation patterns related to distinct PMs; and these PMs can be decoded from physiologically inappropriate muscles.

  13. Amusia results in abnormal brain activity following inappropriate intonation during speech comprehension. (United States)

    Jiang, Cunmei; Hamm, Jeff P; Lim, Vanessa K; Kirk, Ian J; Chen, Xuhai; Yang, Yufang


    Pitch processing is a critical ability on which humans' tonal musical experience depends, and which is also of paramount importance for decoding prosody in speech. Congenital amusia refers to deficits in the ability to properly process musical pitch, and recent evidence has suggested that this musical pitch disorder may impact upon the processing of speech sounds. Here we present the first electrophysiological evidence demonstrating that individuals with amusia who speak Mandarin Chinese are impaired in classifying prosody as appropriate or inappropriate during a speech comprehension task. When presented with inappropriate prosody stimuli, control participants elicited a larger P600 and smaller N100 relative to the appropriate condition. In contrast, amusics did not show significant differences between the appropriate and inappropriate conditions in either the N100 or the P600 component. This provides further evidence that the pitch perception deficits associated with amusia may also affect intonation processing during speech comprehension in those who speak a tonal language such as Mandarin, and suggests music and language share some cognitive and neural resources.

  14. Amusia results in abnormal brain activity following inappropriate intonation during speech comprehension.

    Directory of Open Access Journals (Sweden)

    Cunmei Jiang

    Full Text Available Pitch processing is a critical ability on which humans' tonal musical experience depends, and which is also of paramount importance for decoding prosody in speech. Congenital amusia refers to deficits in the ability to properly process musical pitch, and recent evidence has suggested that this musical pitch disorder may impact upon the processing of speech sounds. Here we present the first electrophysiological evidence demonstrating that individuals with amusia who speak Mandarin Chinese are impaired in classifying prosody as appropriate or inappropriate during a speech comprehension task. When presented with inappropriate prosody stimuli, control participants elicited a larger P600 and smaller N100 relative to the appropriate condition. In contrast, amusics did not show significant differences between the appropriate and inappropriate conditions in either the N100 or the P600 component. This provides further evidence that the pitch perception deficits associated with amusia may also affect intonation processing during speech comprehension in those who speak a tonal language such as Mandarin, and suggests music and language share some cognitive and neural resources.

  15. The Impact of a Computerized Clinical Decision Support Tool on Inappropriate Clostridium difficile Testing. (United States)

    White, Duncan R; Hamilton, Keith W; Pegues, David A; Hanish, Asaf; Umscheid, Craig A


    OBJECTIVE To evaluate the effectiveness of a computerized clinical decision support intervention aimed at reducing inappropriate Clostridium difficile testing DESIGN Retrospective cohort study SETTING University of Pennsylvania Health System, comprised of 3 large tertiary-care hospitals PATIENTS All adult patients admitted over a 2-year period INTERVENTION Providers were required to use an order set integrated into a commercial electronic health record to order C. difficile toxin testing. The order set identified patients who had received laxatives within the previous 36 hours and displayed a message asking providers to consider stopping laxatives and reassessing in 24 hours prior to ordering C. difficile testing. Providers had the option to continue or discontinue laxatives and to proceed with or forgo testing. The primary endpoint was the change in inappropriate C. difficile testing, as measured by the number of patients who had C. difficile testing ordered while receiving laxatives. RESULTS Compared to the 1-year baseline period, the intervention resulted in a decrease in the proportion of inappropriate C. difficile testing (29.6% vs 27.3%; P=.02). The intervention was associated with an increase in the number of patients who had laxatives discontinued and did not undergo C. difficile testing (5.8% vs 46.4%; Ptesting (5.4% vs 35.2%; Ptesting and improving the timely discontinuation of laxatives. Infect Control Hosp Epidemiol 2017;38:1204-1208.

  16. Spatial and Identity Cues Differentially Affect Implicit Contextual Cueing in Adolescents and Adults with Autism Spectrum Disorder (United States)

    Travers, Brittany G.; Powell, Patrick S.; Mussey, Joanna L.; Klinger, Laura G.; Crisler, Megan E.; Klinger, Mark R.


    The present studies examined implicit contextual cueing in adolescents and adults with Autism Spectrum Disorder (ASD). In Study 1, 16 individuals with ASD and 20 matched individuals with typical development completed a contextual cueing task using stimulus-identity cues. In Study 2, 12 individuals with ASD and 16 individuals with typical…

  17. Social traits modulate attention to affiliative cues

    Directory of Open Access Journals (Sweden)

    Sarah R. Moore


    Full Text Available Neurobehavioral models of personality suggest that the salience assigned to particular classes of stimuli vary as a function of traits that reflect both the activity of neurobiological encoding and relevant social experience. In turn, this joint influence modulates the extent that salience influences attentional processes, and hence learning about and responding to those stimuli. Applying this model to the domain of social valuation, we assessed the differential effects on attentional guidance by affiliative cues of (i a higher-order temperament trait (Social Closeness, and (ii attachment style in a sample of 57 women. Attention to affiliative pictures paired with either incentive or neutral pictures was assessed using camera eye-tracking. Trait social closeness and attachment avoidance interacted to modulate fixation frequency on affiliative but not on incentive pictures, suggesting that both traits influence the salience assigned to affiliative cues specifically.

  18. Early perceptual interactions shape the time course of cueing. (United States)

    Wilschut, Anna; Theeuwes, Jan; Olivers, Christian N L


    Performance in spatial cueing tasks is characterized by a rapid attentional enhancement with increasing cue-target SOA. We recently found that this enhancement function also applies when the cue and the target are presented invariably at a single central location, suggesting a universal cueing time course [Wilschut et al., 2011, PLoS ONE, 6, e27661]. However, using a very similar cueing task, Nieuwenstein et al. [2009, JoV, 9, 1-14] have found a rather different pattern, namely a U-shaped deficit in performance after a cue-like stimulus. The present study varied the properties of the cue and the target in order to investigate the mechanisms underlying the different time functions. In four experiments, cueing was found to either improve or decrease performance with increasing SOA, depending on the type of target that was used. In addition, the level of performance at the shortest cue-target intervals (33-83ms) was dependent on the relative strength of the cue and the target, akin to what has been found in visual masking studies. The results suggest that cueing shapes performance via two mechanisms, one sensory-related and one attention-related, the combination of which results in either U-shaped or monotonic patterns. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. Moving to Music: Effects of Heard and Imagined Musical Cues on Movement-Related Brain Activity (United States)

    Schaefer, Rebecca S.; Morcom, Alexa M.; Roberts, Neil; Overy, Katie


    Music is commonly used to facilitate or support movement, and increasingly used in movement rehabilitation. Additionally, there is some evidence to suggest that music imagery, which is reported to lead to brain signatures similar to music perception, may also assist movement. However, it is not yet known whether either imagined or musical cueing changes the way in which the motor system of the human brain is activated during simple movements. Here, functional magnetic resonance imaging was used to compare neural activity during wrist flexions performed to either heard or imagined music with self-pacing of the same movement without any cueing. Focusing specifically on the motor network of the brain, analyses were performed within a mask of BA4, BA6, the basal ganglia (putamen, caudate, and pallidum), the motor nuclei of the thalamus, and the whole cerebellum. Results revealed that moving to music compared with self-paced movement resulted in significantly increased activation in left cerebellum VI. Moving to imagined music led to significantly more activation in pre-supplementary motor area (pre-SMA) and right globus pallidus, relative to self-paced movement. When the music and imagery cueing conditions were contrasted directly, movements in the music condition showed significantly more activity in left hemisphere cerebellum VII and right hemisphere and vermis of cerebellum IX, while the imagery condition revealed more significant activity in pre-SMA. These results suggest that cueing movement with actual or imagined music impacts upon engagement of motor network regions during the movement, and suggest that heard and imagined cues can modulate movement in subtly different ways. These results may have implications for the applicability of auditory cueing in movement rehabilitation for different patient populations. PMID:25309407

  20. Acoustic Constraints and Musical Consequences: Exploring Composers' Use of Cues for Musical Emotion (United States)

    Schutz, Michael


    Emotional communication in music is based in part on the use of pitch and timing, two cues effective in emotional speech. Corpus analyses of natural speech illustrate that happy utterances tend to be higher and faster than sad. Although manipulations altering melodies show that passages changed to be higher and faster sound happier, corpus analyses of unaltered music paralleling those of natural speech have proven challenging. This partly reflects the importance of modality (i.e., major/minor), a powerful musical cue whose use is decidedly imbalanced in Western music. This imbalance poses challenges for creating musical corpora analogous to existing speech corpora for purposes of analyzing emotion. However, a novel examination of music by Bach and Chopin balanced in modality illustrates that, consistent with predictions from speech, their major key (nominally “happy”) pieces are approximately a major second higher and 29% faster than their minor key pieces (Poon and Schutz, 2015). Although this provides useful evidence for parallels in use of emotional cues between these domains, it raises questions about how composers “trade off” cue differentiation in music, suggesting interesting new potential research directions. This Focused Review places those results in a broader context, highlighting their connections with previous work on the natural use of cues for musical emotion. Together, these observational findings based on unaltered music—widely recognized for its artistic significance—complement previous experimental work systematically manipulating specific parameters. In doing so, they also provide a useful musical counterpart to fruitful studies of the acoustic cues for emotion found in natural speech. PMID:29249997

  1. Moving to music: Effects of heard and imagined musical cues on movement-related brain activity

    Directory of Open Access Journals (Sweden)

    Rebecca S Schaefer


    Full Text Available Music is commonly used to facilitate or support movement, and increasingly used in movement rehabilitation. Additionally, there is some evidence to suggest that music imagery, which is reported to lead to brain signatures similar to music perception, may also assist movement. However, it is not yet known whether either imagined or musical cueing changes the way in which the motor system of the human brain is activated during simple movements. Here, functional Magnetic Resonance Imaging (fMRI was used to compare neural activity during wrist flexions performed to either heard or imagined music with self-pacing of the same movement without any cueing. Focusing specifically on the motor network of the brain, analyses were performed within a mask of BA4, BA6, the basal ganglia (putamen, caudate and pallidum, the motor nuclei of the thalamus and the whole cerebellum. Results revealed that moving to music compared with self-paced movement resulted in significantly increased activation in left cerebellum VI. Moving to imagined music led to significantly more activation in pre-supplementary motor area (pre-SMA and right globus pallidus, relative to self-paced movement. When the music and imagery cueing conditions were contrasted directly, movements in the music condition showed significantly more activity in left hemisphere cerebellum VII and right hemisphere and vermis of cerebellum IX, while the imagery condition revealed more significant activity in pre-SMA. These results suggest that cueing movement with actual or imagined music impacts upon engagement of motor network regions during the movement, and suggest that heard and imagined cues can modulate movement in subtly different ways. These results may have implications for the applicability of auditory cueing in movement rehabilitation for different patient populations.

  2. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours.

    Directory of Open Access Journals (Sweden)

    Valerie Voon

    Full Text Available Although compulsive sexual behaviour (CSB has been conceptualized as a "behavioural" addiction and common or overlapping neural circuits may govern the processing of natural and drug rewards, little is known regarding the responses to sexually explicit materials in individuals with and without CSB. Here, the processing of cues of varying sexual content was assessed in individuals with and without CSB, focusing on neural regions identified in prior studies of drug-cue reactivity. 19 CSB subjects and 19 healthy volunteers were assessed using functional MRI comparing sexually explicit videos with non-sexual exciting videos. Ratings of sexual desire and liking were obtained. Relative to healthy volunteers, CSB subjects had greater desire but similar liking scores in response to the sexually explicit videos. Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala. Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire (but not liking to a greater degree in CSB relative to non-CSB subjects. The dissociation between desire or wanting and liking is consistent with theories of incentive motivation underlying CSB as in drug addictions. Neural differences in the processing of sexual-cue reactivity were identified in CSB subjects in regions previously implicated in drug-cue reactivity studies. The greater engagement of corticostriatal limbic circuitry in CSB following exposure to sexual cues suggests neural mechanisms underlying CSB and potential biological targets for interventions.

  3. Neural substrates of cue reactivity and craving in gambling disorder (United States)

    Limbrick-Oldfield, E H; Mick, I; Cocks, R E; McGonigle, J; Sharman, S P; Goldstone, A P; Stokes, P R A; Waldman, A; Erritzoe, D; Bowden-Jones, H; Nutt, D; Lingford-Hughes, A; Clark, L


    Cue reactivity is an established procedure in addictions research for examining the subjective experience and neural basis of craving. This experiment sought to quantify cue-related brain responses in gambling disorder using personally tailored cues in conjunction with subjective craving, as well as a comparison with appetitive non-gambling stimuli. Participants with gambling disorder (n=19) attending treatment and 19 controls viewed personally tailored blocks of gambling-related cues, as well as neutral cues and highly appetitive (food) images during a functional magnetic resonance imaging (fMRI) scan performed ~2–3 h after a usual meal. fMRI analysis examined cue-related brain activity, cue-related changes in connectivity and associations with block-by-block craving ratings. Craving ratings in the participants with gambling disorder increased following gambling cues compared with non-gambling cues. fMRI analysis revealed group differences in left insula and anterior cingulate cortex, with the gambling disorder group showing greater reactivity to the gambling cues, but no differences to the food cues. In participants with gambling disorder, craving to gamble correlated positively with gambling cue-related activity in the bilateral insula and ventral striatum, and negatively with functional connectivity between the ventral striatum and the medial prefrontal cortex. Gambling cues, but not food cues, elicit increased brain responses in reward-related circuitry in individuals with gambling disorder (compared with controls), providing support for the incentive sensitization theory of addiction. Activity in the insula co-varied with craving intensity, and may be a target for interventions. PMID:28045460

  4. Influence of diabetes mellitus on inappropriate and appropriate implantable cardioverter-defibrillator therapy and mortality in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) Trial

    DEFF Research Database (Denmark)

    Ruwald, Martin H.; Zareba, Wojciech; Jons, Christian


    The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy delivery...

  5. Perception of Verbal and Nonverbal Emotional Signals in Women With Borderline Personality Disorder: Evidence of a Negative Bias and an Increased Reliance on Nonverbal Cues. (United States)

    Brück, Carolin; Derstroff, Stephanie; Jacob, Heike; Wolf-Arehult, Martina; Wekenmann, Stefanie; Wildgruber, Dirk


    Studies conducted in patients diagnosed with borderline personality disorder (BPD) have documented a variety of anomalies concerning patients' abilities to interpret emotional signals. Attempting to clarify the bases of these anomalies, the current literature draws attention to a possible role of dysfunctional expectations, such as the expectation of social rejection. Dysfunctional expectations, however, may not only bias social interpretations, but may also focus attention on social cues most important in conveying emotional messages, such as nonverbal signals. To explore these assumptions, 30 female BPD patients were tasked to judge the valence of emotional states conveyed by combinations of verbal and nonverbal emotional cues. Compared to controls, BPD patients exhibited a negative bias in their interpretations and relied more on available nonverbal cues. Shifts in the relative importance of nonverbal cues appeared to be rooted mainly in a reduced reliance on positive verbal cues presumably deemed less credible by BPD patients.

  6. Why does cue polarity information provide benefits in inference problems? The role of strategy selection and knowledge of cue importance. (United States)

    von Helversen, Bettina; Karlsson, Linnea; Mata, Rui; Wilke, Andreas


    Knowledge about cue polarity (i.e., the sign of a cue-criterion relation) seems to boost performance in a wide range of inference tasks. Knowledge about cue polarity information may enhance performance by increasing (1) the reliance on rule- relative to similarity-based strategies, and (2) explicit knowledge about the relative importance of cues. We investigated the relative contribution of these two mechanisms in a multiple-cue judgment task and a categorization task, which typically differ in the inference strategies they elicit and potentially the explicit task knowledge available to participants. In both tasks participants preferred rule-based relative to similarity-based strategies and had more knowledge about cue importance when cue polarity information was provided. Strategy selection was not related to increases in performance in the categorization task and could only partly explain increases in performance in the judgment task. In contrast, explicit knowledge about the importance of cues was related to better performance in both categorization and judgment independently of the strategy used. In sum, our results suggest that the benefits of receiving cue polarity information may span across tasks, such multiple-cue judgment and categorization, primarily by enhancing knowledge of relative cue importance. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Does cue context matter? Examining the specificity of cue-related activation of positive and negative alcohol expectancies. (United States)

    Wardell, Jeffrey D; Read, Jennifer P


    Consistent with the Encoding Specificity principle, positive alcohol expectancies may be activated by cues in drinking contexts because they are more closely associated with these cues in memory than are negative expectancies. However, there is little research examining the specificity of cue-induced alcohol expectancy activation. This study investigated the relative activation of positive and negative expectancies in response to positive and negative cue contexts. We also examined whether these effects were stronger for heavier and more problematic drinkers. College student drinkers were randomly assigned to listen to vignettes describing either positive or negative drinking scenarios (cue exposure). Participants also completed an implicit measure of alcohol expectancy activation (modified Stroop task) both before and after the cue exposure, as well as self-report measures of alcohol use and alcohol-related problems. We found that alcohol-related problems moderated the effects of cue condition on expectancy activation, such that specific activation of positive relative to negative expectancies in response to positive cues was observed only for drinkers with higher levels of alcohol problems. No differences in activation of positive versus negative expectancies were observed for more problematic drinkers in the negative cue condition or for less problematic drinkers in either cue condition. The results are partially consistent with the Encoding Specificity principle, showing that positive contextual cues can selectively activate positive alcohol expectancies for more problematic drinkers. Findings may have implications for interventions that target automatic expectancy processes, suggesting potential utility in targeting specific expectancies in specific contexts.

  8. Inappropriate pharmacological treatment in older adults affected by cardiovascular disease and other chronic comorbidities: a systematic literature review to identify potentially inappropriate prescription indicators

    Directory of Open Access Journals (Sweden)

    Lucenteforte E


    Full Text Available Ersilia Lucenteforte,1 Niccolò Lombardi,1,* Davide Liborio Vetrano,2,* Domenico La Carpia,2,* Zuzana Mitrova,3 Ursula Kirchmayer,3 Giovanni Corrao,4 Francesco Lapi,5 Alessandro Mugelli,1 Alfredo Vannacci1 On behalf of the Italian Group for Appropriate Drug prescription in the Elderly (I-GrADE 1Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA, University of Florence, Florence, Italy; 2Department of Geriatrics Catholic University, Rome, Italy; 3Department of Epidemiology, ASL 1 Rome, Italy; 4Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; 5Epidemiology Unit, ARS Toscana, Florence, Italy *These authors contributed equally to this work Abstract: Avoiding medications in which the risks outweigh the benefits in the elderly patient is a challenge for physicians, and different criteria to identify inappropriate prescription (IP exist to aid prescribers. Definition of IP indicators in the Italian geriatric population affected by cardiovascular disease and chronic comorbidities could be extremely useful for prescribers and could offer advantages from a public health perspective. The purpose of the present study was to identify IP indicators by means of a systematic literature review coupled with consensus criteria. A systematic search of PubMed, EMBASE, and CENTRAL databases was conducted, with the search structured around four themes and combining each with the Boolean operator “and”. The first regarded “prescriptions”, the second “adverse events”, the third “cardiovascular conditions”, and the last was planned to identify studies on “older people”. Two investigators independently reviewed titles, abstracts, full texts, and selected articles addressing IP in the elderly affected by cardiovascular condition using the following inclusion criteria: studies on people aged ≥65 years; studies on patients with no restriction on age but with data on subjects

  9. Charlson Comorbidity Index, inappropriate medication use and cognitive impairment : Bermuda Triangle. (United States)

    Silay, Kamile; Yalcin, Ahmet; Akinci, Sema; Gursoy, Fatma Gul; Sener Dede, Didem


    The aim is to evaluate the association between the Charlson Comorbidity Index (CCI), polypharmacy, inappropriate medication use and cognitive impairment in long-term care facility patients. A cross-sectional study including 105 long-term care facility residents was performed. The Charlson Comorbidity Index (CCI) was used. Inappropriate drug use (IDU) was defined according to the STOPP (Screening Tool of Older People's Prescriptions) criteria. Univariate analysis to identify variables associated with patient outcome related with cognitive impairment was investigated with χ 2 , Pearson correlation, Fisher exact, and Mann-Whitney U test where appropriate. For the multivariate analysis, the possible factors identified with univariate analysis were further entered into logistic regression analysis. A significant difference was found between gender, CCI and cognitive impairment (p = 0.038, p = 0.01). While every one point increment in the CCI increases the risk of cognitive impairment 3.1 fold (95% CI = 1.8-5.4, p < 0.001), hypertension increases the risk 12 fold (95% CI = 2.5-67.8, p = 0.002). While the correlation between Mini-Mental Status Examination (MMSE) score and polypharmacy is significant (p = 0.015), the correlation between MMSE and IDU was insignificant (p = 0.739). The association of urogenital system drugs and dementia was significant (p = 0.044). Comorbidities, especially hypertension and old age, are risk factors for cognitive impairment. Polypharmacy correlates with MMSE and is considered a risk factor for cognitive impairment. Inappropriate medication use is high among long-term care facility residents. More studies on large cohorts are needed regarding optimal drug prescription and detection of specific drugs that may have an impact on cognitive performance.

  10. Failed Attempts to Reduce Inappropriate Laboratory Utilization in an Emergency Department Setting in Cyprus: Lessons Learned. (United States)

    Petrou, Panagiotis


    Laboratory test ordering is a significant part of the diagnosis definition and disease treatment monitoring process. Inappropriate laboratory test ordering wastes scarce resources, places unnecessary burden on the health care delivery system, and exposes patients to unnecessary discomfort. Inappropriate ordering is caused by many factors, such as lack of guidelines, defensive medicine, thoughtless ordering, and lack of awareness of costs incurred to the system. The purpose of this study is to assess two successive measures, which were introduced in a Cyprus emergency department (ED) for the purpose of synergistically reducing inappropriate laboratory ordering: the introduction of a copayment fee to reduce nonemergent visits, and the development of a Web-based protocol defining the tests emergency physicians could order. An autoregressive integrated moving average model for interrupted time series analysis was constructed. Data include number and type of tests ordered, along with number of visits for a period of 4 years from an ED in Cyprus. Copayment fee and introduction of a revised Web-based protocol for a test ordering form did not reduce the number of ordered tests in the ED unit. Copayment fee alone resulted in a statistically significant reduction in ED visits. The implementation of two consecutive measures resulted in an increase of ordered tests per patient. Laboratory ordering is a multidimensional process that is primarily supplier induced, therefore, all underlying possible causes must be scrutinized by health authorities. These include lack of guidelines, defensive medicine and thoughtless prescribing. To attain significant gains, an integrated approach must be implemented. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Reducing inappropriate accident and emergency department attendances: a systematic review of primary care service interventions. (United States)

    Ismail, Sharif A; Gibbons, Daniel C; Gnani, Shamini


    Inappropriate attendances may account for up to 40% of presentations at accident and emergency (A&E) departments. There is considerable interest from health practitioners and policymakers in interventions to reduce this burden. To review the evidence on primary care service interventions to reduce inappropriate A&E attendances. Systematic review of UK and international primary care interventions. Studies published in English between 1 January 1986 and 23 August 2011 were identified from PubMed, the NHS Economic Evaluation Database, the Cochrane Collaboration, and Health Technology Assessment databases. The outcome measures were A&E attendances, patient satisfaction, clinical outcome, and intervention cost. Two authors reviewed titles and abstracts of retrieved results, with adjudication of disagreements conducted by the third. Studies were quality assessed using the Scottish Intercollegiate Guidelines Network checklist system where applicable. In total, 9916 manuscripts were identified, of which 34 were reviewed. Telephone triage was the single best-evaluated intervention. This resulted in negligible impact on A&E attendance, but exhibited acceptable patient satisfaction and clinical safety; cost effectiveness was uncertain. The limited available evidence suggests that emergency nurse practitioners in community settings and community health centres may reduce A&E attendance. For all other interventions considered in this review (walk-in centres, minor injuries units, and out-of-hours general practice), the effects on A&E attendance, patient outcomes, and cost were inconclusive. Studies showed a negligible effect on A&E attendance for all interventions; data on patient outcomes and cost-effectiveness are limited. There is an urgent need to examine all aspects of primary care service interventions that aim to reduce inappropriate A&E attendance.

  12. Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing. (United States)

    Fried, Terri R; Niehoff, Kristina M; Street, Richard L; Charpentier, Peter A; Rajeevan, Nallakkandi; Miller, Perry L; Goldstein, Mary K; O'Leary, John R; Fenton, Brenda T


    To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. Randomized clinical trial. Primary care clinics at a Veterans Affairs Medical Center. Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The

  13. Effect of nurse practitioner and pharmacist counseling on inappropriate medication use in family practice. (United States)

    Fletcher, John; Hogg, William; Farrell, Barbara; Woodend, Kirsten; Dahrouge, Simone; Lemelin, Jacques; Dalziel, William


    To measure the effect of nurse practitioner and pharmacist consultations on the appropriate use of medications by patients. We studied patients in the intervention arm of a randomized controlled trial. The main trial intervention was provision of multidisciplinary team care and the main outcome was quality and processes of care for chronic disease management. Patients were recruited from a single publicly funded family health network practice of 8 family physicians and associated staff serving 10 000 patients in a rural area near Ottawa, Ont. A total of 120 patients 50 years of age or older who were on the practice roster and who were considered by their family physicians to be at risk of experiencing adverse health outcomes. A pharmacist and 1 of 3 nurse practitioners visited each patient at his or her home, conducted a comprehensive medication review, and developed a tailored plan to optimize medication use. The plan was developed in consultation with the patient and the patient's doctor. We assessed medication appropriateness at the study baseline and again 12 to 18 months later. We used the medication appropriateness index to assess medication use. We examined associations between personal characteristics and inappropriate use at baseline and with improvements in medication use at the follow-up assessment. We recorded all drug problems encountered during the trial. At baseline, 27.2% of medications were inappropriate in some way and 77.7% of patients were receiving at least 1 medication that was inappropriate in some way. At the follow-up assessments these percentages had dropped to 8.9% and 38.6%, respectively (P trial. This might provide a mechanism to explain some of the reductions in mortality and morbidity observed in other trials of counseling and advice provided by pharmacists and nurses. NCT00238836 (

  14. Quetiapine effective in treatment of inappropriate sexual behavior of lewy body disease with predominant frontal lobe signs. (United States)

    Prakash, Ravi; Pathak, Amit; Munda, Sanjay; Bagati, Dhruv


    Dementia of Lewy body disease is the second most common degenerative cause of dementia after Alzheimer's disease, among all the dementias. The core features are a progressive dementia, fluctuations in cognitive functions, visual hallucinations, and spontaneous parkinsonism. Rapid eye movement sleep behavior disorder, severe neuroleptic sensitivity, and low dopamine transporter uptake in basal ganglia are other suggestive features. Behavioral abnormalities are commonly present in the form of aggressive behavior, irritability, and uninhibited behaviors. These are mostly seen in the advanced stages of dementia. However, inappropriate sexual behavior is uncommonly seen in such cases. Three types of inappropriate sexual behaviors commonly found in cases of dementia are sex talks, sexual acts, and implied sexual acts. Such inappropriate sexual behaviors have not been described adequately in dementia of Lewy body disease. We report inappropriate sexual behaviors in a case of dementia of Lewy body disease, which improved rapidly after treatment with quetiapine.

  15. Appeal of inappropriate technologies: self-inflicted wages, ethnic pride and corruption

    Energy Technology Data Exchange (ETDEWEB)

    Winston, G.C.


    A survey of manufacturing firms in Nigeria produced a set of useful clues to why firms in poor countries so often choose inappropriate production technologies. Some of their explanations do and some do not fit neatly in the neoclassical modelling of production by which economists have judged technological appropriateness. Much of what the firms described affect their real costs and do so in ways that escape economists' notice; technology is appropriate to the managers' view of costs. Often they were responding to more complicated goals than simple profit maximization for the firm; defense of ethnic identity or the goal of increasing their own incomes by stealing from the firm.

  16. Urea for management of the syndrome of inappropriate secretion of ADH: A systematic review. (United States)

    de Solà-Morales, Oriol; Riera, Maribel


    Urea has been recently proposed for the management of hyponatremia linked to the syndrome of inappropriate secretion of ADH (SIADH). The objective of the study was to review the levels of evidence for treatment of hyponatremia associated with SIADH with urea. We performed a: systematic review of experimental trials and grading according to SIGN. No clinical trials were found. The 6 studies analysed had methodological limitations and were prone to biases. In conclusion, there is no evidence to support the efficacy of urea for the treatment of hyponatremia following SIADH. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  17. Adrenal insufficiency secondary to inappropriate oral administration of topical exogenous steroids presenting with hypercalcaemia. (United States)

    Bhatti, Rahila Sarwar; Flynn, Michael D


    A 59-year-old Caucasian gentleman presented with malaise, fatigue and proximal muscle weakness. He had history of long-standing roseate psoriasis treated with topical clobetasol propionate (dermovate). On admission, he had significant postural hypotension, and hypercalcaemia. Endocrinological investigation revealed hypercalcaemia, a serum cortisol of <30 nmol/l, a flat short synacthen test and undetectable adrenocorticotropic hormone. He was treated with hydrocortisone. The abrupt withdrawal of the topical steroids by the patient precipitated the addisonian crisis. Further enquiry documented inappropriate oral administration of clobetasol for more than 10 years in addition to prescribed topical usage.

  18. Inappropriate emergency laboratory test ordering: defensive or peer evidence shared based medicine?

    Directory of Open Access Journals (Sweden)

    C. Descovich


    Full Text Available BACKGROUND The laboratory overuse is widely prevalent in hospital practice, mostly in the emergency care. Reasons for excessive and inappropriate test-ordering include defensive behaviour and fear or uncertainty, lack of experience, the misuse of protocols and guidelines, “routine” and local attitudes, inadequate educational feedback and clinician’s unawareness about the cost of examinations and their related implications. AIM OF THE STUDY AND METHODS The primary target of our working group was to reduce inappropriate ordering on a urgent basis test, implementing further examinations not yet previewed in the hospital panel of the available urgencies, according to the evidence based diagnosis concept. The secondary goal was to indicate strategies of re-engineering of the processes, improving turnaround time in the laboratory management of emergencies. After evaluating, as first intervention, the more reliable sources for practice guidelines, systematic reviews and RCTs, the committee further discussed main topics with in-hospital stakeholders, selected from Emergency, Internal Medicine and Surgery Depts. The working group, in many subsequent audits, tried to obtain a systematic feed back with all involved professionals. RESULTS After reviewing literature’s evidence, the board constrained testing options by defining the basic emergency laboratory panel tests (blood type, hemogram, blood urea nitrogen, plasma creatinine, glucose, sodium, potassium, chloride, osmolarity, CRP, bicarbonate, CPK, creatine phosphokinase-MB, myoglobin, troponin, BNP and NT-proBNP, PT-INR, PTT, D-dimer, beta- HCG, biochemical urinalysis etc.. As final result, the proposed tests reduced the overall number of inappropriate investigations and increased, with newer and updated tests, the available panel for critical patients. DISCUSSION A collegiate review of data reporting, in-hospital deepening of problems and the inter- professional discussion of the evidences

  19. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

    Directory of Open Access Journals (Sweden)

    Baskerville Neill


    Full Text Available Abstract Background Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients. Methods A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated. Results The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was $192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were $148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of $604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003 $Can equating to $3,687 per physician or $63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%. Conclusion Outreach facilitation is more expensive

  20. Dual AV Nodal Nonreentrant Tachycardia Resulting in Inappropriate ICD Therapy in a Patient with Cardiac Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Ankur A. Karnik, MD


    Full Text Available Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT occurs due to concurrent antegrade conduction over fast and slow atrioventricular nodal pathways and is treated by slow pathway modification. We describe a unique case of a patient with cardiac sarcoidosis who received inappropriate ICD shocks for DAVNNT. Atrial and ventricular device electrograms satisfied both rate and V>A criteria for ventricular tachycardia. We postulate that alterations in refractoriness and conduction as is seen in cardiac sarcoidosis (CS may have contributed to occurrence of DAVNNT.

  1. Effect of apparent depth cues on accommodation in a Badal optometer. (United States)

    Otero, Carles; Aldaba, Mikel; Martínez-Navarro, Beatriz; Pujol, Jaume


    The aim was to analyse the effect of peripheral depth cues on accommodation in Badal optometers. Monocular refractions at 0.17 and 5.00 D of accommodative stimulus were measured with the PowerRef II autorefractor (Plusoptix Inc., Atlanta, Georgia, USA). Subjects looked (randomly) at four different scenes, one real scene comprising familiar objects at different depth planes (Real) and three virtual scenes comprising different two-dimensional pictures seen through a Badal lens. The first image consisted of a photograph of the real scene taken in conditions that closely mimic a healthy standard human eye performance (out-of-focus [OoF] blur); the second image was the same photograph rendered with a depth of focus to infinity (OoF sharpness); and finally the third image consisted of a fixation target and a even white surrounding (White). In all cases the field of view was 25.0° and the fixation target was a Maltese cross subtending to two degrees. Twenty-eight right eyes from healthy young subjects were measured. The achieved statistical power was 0.9. At 5.00 D of accommodative stimulus, the repeated measures analysis of variance was statistically significant (p cues inaccurately stimulates accommodation in Badal optometers; however, accommodation can be significantly improved in the same Badal optometer, when displaying a realistic image rich in peripheral depth cues, even though these peripheral cues (also referred to as retinal blur cues) are shown in the same plane as the fixation target. These results have important implications in stereoscopic virtual reality systems that fail to represent appropriately retinal blur. © 2017 Optometry Australia.

  2. Metrics of quality care in veterans: correlation between primary-care performance measures and inappropriate myocardial perfusion imaging. (United States)

    Winchester, David E; Kitchen, Andrew; Brandt, John C; Dusaj, Raman S; Virani, Salim S; Bradley, Steven M; Shaw, Leslee J; Beyth, Rebecca J


    Approximately 10% to 20% of myocardial perfusion imaging (MPI) tests are inappropriate based on professional-society recommendations. The correlation between inappropriate MPI and quality care metrics is not known. Inappropriate MPI will be associated with low achievement of quality care metrics. We conducted a retrospective cross-sectional investigation at a single Veterans Affairs medical center. Myocardial perfusion imaging tests ordered by primary-care clinicians between December 2010 and July 2011 were assessed for appropriateness (by 2009 criteria). Using documentation of the clinical encounter where MPI was ordered, we determined how often quality care metrics were achieved. Among 516 MPI patients, 52 (10.1%) were inappropriate and 464 (89.9%) were not inappropriate (either appropriate or uncertain). Hypertension (82.2%), diabetes mellitus (41.3%), and coronary artery disease (41.1%) were common. Glycated hemoglobin levels were lower in the inappropriate MPI cohort (6.6% vs 7.5%; P = 0.04). No difference was observed in the proportion with goal hemoglobin (62.5% vs 46.3% for appropriate/uncertain; P = 0.258). Systolic blood pressure was not different (132 mm Hg vs 135 mm Hg; P = 0.34). Achievement of several other categorical quality metrics was low in both cohorts and no differences were observed. More than 90% of clinicians documented a plan to achieve most metrics. Inappropriate MPI is not associated with performance on metrics of quality care. If an association exists, it may be between inappropriate MPI and overly aggressive care. Most clinicians document a plan of care to address failure of quality metrics, suggesting awareness of the problem. © 2015 Wiley Periodicals, Inc.

  3. An auditory cue-depreciation effect. (United States)

    Gibson, J M; Watkins, M J


    An experiment is reported in which subjects first heard a list of words and then tried to identify these same words from degraded utterances. Paralleling previous findings in the visual modality, the probability of identifying a given utterance was reduced when the utterance was immediately preceded by other, more degraded, utterances of the same word. A second experiment replicated this "cue-depreciation effect" and in addition found the effect to be weakened, if not eliminated, when the target word was not included in the initial list or when the test was delayed by two days.

  4. Human Perception of Ambiguous Inertial Motion Cues (United States)

    Zhang, Guan-Lu


    Human daily activities on Earth involve motions that elicit both tilt and translation components of the head (i.e. gazing and locomotion). With otolith cues alone, tilt and translation can be ambiguous since both motions can potentially displace the otolithic membrane by the same magnitude and direction. Transitions between gravity environments (i.e. Earth, microgravity and lunar) have demonstrated to alter the functions of the vestibular system and exacerbate the ambiguity between tilt and translational motion cues. Symptoms of motion sickness and spatial disorientation can impair human performances during critical mission phases. Specifically, Space Shuttle landing records show that particular cases of tilt-translation illusions have impaired the performance of seasoned commanders. This sensorimotor condition is one of many operational risks that may have dire implications on future human space exploration missions. The neural strategy with which the human central nervous system distinguishes ambiguous inertial motion cues remains the subject of intense research. A prevailing theory in the neuroscience field proposes that the human brain is able to formulate a neural internal model of ambiguous motion cues such that tilt and translation components can be perceptually decomposed in order to elicit the appropriate bodily response. The present work uses this theory, known as the GIF resolution hypothesis, as the framework for experimental hypothesis. Specifically, two novel motion paradigms are employed to validate the neural capacity of ambiguous inertial motion decomposition in ground-based human subjects. The experimental setup involves the Tilt-Translation Sled at Neuroscience Laboratory of NASA JSC. This two degree-of-freedom motion system is able to tilt subjects in the pitch plane and translate the subject along the fore-aft axis. Perception data will be gathered through subject verbal reports. Preliminary analysis of perceptual data does not indicate that

  5. [Visual cues as a therapeutic tool in Parkinson's disease. A systematic review]. (United States)

    Muñoz-Hellín, Elena; Cano-de-la-Cuerda, Roberto; Miangolarra-Page, Juan Carlos


    Sensory stimuli or sensory cues are being used as a therapeutic tool for improving gait disorders in Parkinson's disease patients, but most studies seem to focus on auditory stimuli. The aim of this study was to conduct a systematic review regarding the use of visual cues over gait disorders, dual tasks during gait, freezing and the incidence of falls in patients with Parkinson to obtain therapeutic implications. We conducted a systematic review in main databases such as Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE and Physiotherapy Evidence Database, during 2005 to 2012, according to the recommendations of the Consolidated Standards of Reporting Trials, evaluating the quality of the papers included with the Downs & Black Quality Index. 21 articles were finally included in this systematic review (with a total of 892 participants) with variable methodological quality, achieving an average of 17.27 points in the Downs and Black Quality Index (range: 11-21). Visual cues produce improvements over temporal-spatial parameters in gait, turning execution, reducing the appearance of freezing and falls in Parkinson's disease patients. Visual cues appear to benefit dual tasks during gait, reducing the interference of the second task. Further studies are needed to determine the preferred type of stimuli for each stage of the disease. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  6. Volume Attenuation and High Frequency Loss as Auditory Depth Cues in Stereoscopic 3D Cinema (United States)

    Manolas, Christos; Pauletto, Sandra


    Assisted by the technological advances of the past decades, stereoscopic 3D (S3D) cinema is currently in the process of being established as a mainstream form of entertainment. The main focus of this collaborative effort is placed on the creation of immersive S3D visuals. However, with few exceptions, little attention has been given so far to the potential effect of the soundtrack on such environments. The potential of sound both as a means to enhance the impact of the S3D visual information and to expand the S3D cinematic world beyond the boundaries of the visuals is large. This article reports on our research into the possibilities of using auditory depth cues within the soundtrack as a means of affecting the perception of depth within cinematic S3D scenes. We study two main distance-related auditory cues: high-end frequency loss and overall volume attenuation. A series of experiments explored the effectiveness of these auditory cues. Results, although not conclusive, indicate that the studied auditory cues can influence the audience judgement of depth in cinematic 3D scenes, sometimes in unexpected ways. We conclude that 3D filmmaking can benefit from further studies on the effectiveness of specific sound design techniques to enhance S3D cinema.

  7. Excess Baggage for Birds: Inappropriate Placement of Tags on Gannets Changes Flight Patterns (United States)

    Vandenabeele, Sylvie P.; Grundy, Edward; Friswell, Michael I.; Grogan, Adam; Votier, Stephen C.; Wilson, Rory P.


    Devices attached to flying birds can hugely enhance our understanding of their behavioural ecology for periods when they cannot be observed directly. For this, scientists routinely attach units to either birds' backs or their tails. However, inappropriate payload distribution is critical in aircraft and, since birds and planes are subject to the same laws of physics during flight, we considered aircraft aerodynamic constraints to explain flight patterns displayed by northern gannets Sula bassana equipped with (small ca. 14 g) tail- and back-mounted accelerometers and (larger ca. 30 g) tail-mounted GPS units. Tail-mounted GPS-fitted birds showed significantly higher cumulative numbers of flap-glide cycles and a higher pitch angle of the tail than accelerometer-equipped birds, indicating problems with balancing inappropriately placed weights with knock-on consequences relating to energy expenditure. These problems can be addressed by carefully choosing where to place tags on birds according to the mass of the tags and the lifestyle of the subject species. PMID:24671007

  8. Lean Methodology Reduces Inappropriate Use of Antipsychotics for Agitation at a Psychiatric Hospital. (United States)

    Goga, Joshana K; Depaolo, Antonio; Khushalani, Sunil; Walters, J Ken; Roca, Robert; Zisselman, Marc; Borleis, Christopher


    To Evaluate the Effects of Applying Lean Methodology-Improving Quality Increasing Efficiency by Eliminating Waste and Reducing Costs-An Approach To Decrease the Prescribing Frequency of Antipsychotics for The Indication of Agitation. Historically Controlled Study. Bheppard Pratt Health System is the Largest Private Provider of Psychiatric Care in Maryland With a Total Bed Capacity of 300. There Were 4 337 Patient Days From November 1 2012 to October 31 2013 on the Dementia Unit. All Patients Admitted on the Dementia Unit Were 65 Years of Age and Older with a Primary Diagnosis of Dementia. our Multidisciplinary Team Used Lean Methodology to Identify the Root Causes and Interventions Necessary to Reduce Inappropriate Antipsychotic Use. The Primary Outcome Was Rate of Inappropriately Indicating Agitation as the Rationale When Prescribing Antipsychotic Medications. There Was a 90% (P Agitation. The Lean Methodology Interventions Led To A 90% (P Agitation and a 10% Rate Reduction in Overall Antipsychotic Prescribing. Key Words: Agitation Alzheimer's Antipsychotics Behavioral and Psychological Symptoms of Dementia Centers For Medicare & Medicaid Services Dementia Root-cause Analysis. BPSD = Behavioral and Psychological Symptoms of Dementia CATIE-AD = Clinical Antipsychotic Trials of Intervention Effectiveness in Alzheimer's Disease EMR = Electronic Medical Records GAO = Government Accountability Office GNCIS = Geriatric Neuropsychiatric Clinical Indicator Scale.

  9. Rooting out institutional corruption to manage inappropriate off-label drug use. (United States)

    Rodwin, Marc A


    Prescribing drugs for uses that the FDA has not approved - off-label drug use - can sometimes be justified but is typically not supported by substantial evidence of effectiveness. At the root of inappropriate off-label drug use lie perverse incentives for pharmaceutical firms and flawed oversight of prescribing physicians. Typical reform proposals such as increased sanctions for manufacturers might reduce the incidence of unjustified off-label use, but they do not remove the source of the problem. Public policy should address the cause and control the practice. To manage inappropriate off-label drug use, off-label prescriptions must be tracked in order to monitor the risks and benefits and the manufacturers' conduct. Even more important, reimbursement rules should be changed so that manufacturers cannot profit from off-label sales. When off-label sales pass a critical threshold, manufacturers should also be required to pay for independent testing of the safety and effectiveness of off-label drug uses and for the FDA to review the evidence. Manufacturers should also finance, under FDA supervision, programs designed to warn physicians and the public about the risks of off-label drug use. © 2013 American Society of Law, Medicine & Ethics, Inc.

  10. How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre? (United States)

    Buri, L; Bersani, G; Hassan, C; Anti, M; Bianco, M A; Cipolletta, L; Di Giulio, E; Di Matteo, G; Familiari, L; Ficano, L; Loriga, P; Morini, S; Pietropaolo, V; Zambelli, A; Grossi, E; Intraligi, M; Tessari, F; Buscema, M


    Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres. A post-hoc analysis of two multicentre cross-sectional studies, including 6270 and 8252 patients consecutively referred to EGD in 44 (group A) and 55 (group B) endoscopic Italian centres in 2003 and 2007, respectively, was performed. A multiple forward stepwise regression was applied to group A, and independently validated in group B. A <70% threshold was adopted to define inadequate appropriateness rate clustered by centre. discrete variability of clustered appropriateness rates among the 44 group A centres was observed (median: 77%; range: 41-97%), and a <70% appropriateness rate was detected in 11 (25%). Independent predictors of centre appropriateness rate were: percentage of patients referred by general practitioners (GP), rate of urgent examinations, prevalence of relevant diseases, and academic status. For group B, sensitivity, specificity and area under receiver operating characteristic curve of the model in detecting centres with a <70% appropriateness rate were 54%, 93% and 0.72, respectively. A simple predictive rule, based on rate of patients referred by GPs, rate of urgent examinations, prevalence of relevant diseases and academic status, identified a small subset of centres characterised by a high rate of inappropriateness. These centres may be presumed to obtain the largest benefit from targeted educational programs. Copyright (c) 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  11. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients. (United States)

    Dekker, Anne R J; Verheij, Theo J M; van der Velden, Alike W


    Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient characteristics and disease severity was not available. The aim of this study is to quantify and qualify inappropriate antibiotic prescribing for RTIs. This is an observational study of the (antibiotic) management of patients with RTIs, using a detailed registration of RTI consultations by general practitioners (GPs). Consultations of which all necessary information was available were benchmarked to the prescribing guidelines for acute otitis media (AOM), acute sore throat, rhinosinusitis or acute cough. Levels of overprescribing for these indications and factors associated with overprescribing were determined. The overall antibiotic prescribing rate was 38%. Of these prescriptions, 46% were not indicated by the guidelines. Relative overprescribing was highest for throat (including tonsillitis) and lowest for ear consultations (including AOM). Absolute overprescribing was highest for lower RTIs (including bronchitis). Overprescribing was highest for patients between 18 and 65 years of age, when GPs felt patients' pressure for an antibiotic treatment, for patients presenting with fever and with complaints longer than 1 week. Underprescribing was observed in overprescribing can help in the development of targeted strategies to improve GPs' prescribing routines for RTIs. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

  12. Voluntary Rehabilitation? On Neurotechnological Behavioural Treatment, Valid Consent and (In)appropriate Offers. (United States)

    Bomann-Larsen, Lene


    Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. Further, for a consent to be normatively valid ("take the wronging out of the act") under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation.

  13. Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. (United States)

    Stewart, Derek; Mair, Alpana; Wilson, Martin; Kardas, Przemyslaw; Lewek, Pawel; Alonso, Albert; McIntosh, Jennifer; MacLure, Katie


    Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities, with the cumulative impact of recommendations often resulting in overwhelming medicines burden. Inappropriate polypharmacy increases the likelihood of adverse drug events, drug interactions and non-adherence. Areas covered: A detailed description of a pan-European initiative, 'Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly, SIMPATHY', which is a project funded by the European Commission to support innovation across the European Union. This includes a systematic review of the literature aiming to summarize and review critically current policies and guidelines on polypharmacy management in older people. The policy driven, evidence-based approach to managing inappropriate polypharmacy in Scotland is described, with consideration of a change management strategy based on Kotter's eight step process for leading sustainable change. Expert opinion: The challenges around promoting appropriate polypharmacy are on many levels, primarily clinical, organisational and political, all of which any workable solution will need to address. To be effective, safe and efficient, any programme that attempts to deal with the complexities of prescribing in this population must be patient-centred, clinically robust, multidisciplinary and designed to fit into the healthcare system in which it is delivered.

  14. Inappropriate Timing of Swallow in the Respiratory Cycle Causes Breathing–Swallowing Discoordination

    Directory of Open Access Journals (Sweden)

    Naomi Yagi


    Full Text Available Rationale: Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing–swallowing discoordination occurs are not well-understood.Objectives: We hypothesized that breathing–swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system.Measurements and Main Results: The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow, pause duration (duration of respiratory pause for swallowing, and the breathing–swallowing coordination pattern. We classified swallows that closely follow inspiration (I as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing–swallows discoordination.Conclusions: We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing–swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.

  15. [Severe nutritional deficiencies in young infants with inappropriate plant milk consumption]. (United States)

    Le Louer, B; Lemale, J; Garcette, K; Orzechowski, C; Chalvon, A; Girardet, J-P; Tounian, P


    Over the past few years, we have observed increasing consumption of inappropriate plant milks as an alternative to infant milk formula. Some families believe that foods labeled as natural are the most healthy and an appropriate nutritional choice. However, their composition does not respect European recommendations. They are always hypocaloric and protein, vitamin, and mineral concentrations are inadequate. The aim of this study was to report severe nutritional complications after inappropriate plant milk consumption. Between 2008 and 2011, we studied severe nutritional deficiencies caused by consumption of plant milks bought in health food stores or online shops. Infants were identified in our centers and examined through medical history, physical examination, and laboratory testing. Nine cases of infants aged from 4 to 14 months were observed. In all cases, these milks were used as an alternative to milk formulas for supposed cow's milk allergy. At diagnosis, four patients were aged 6 months or less. They had received plant milk exclusively for 1-3 months. The beverages consumed were rice, soya, almond and sweet chestnut milks. In three cases, infants presented severe protein-calorie malnutrition with substantial hypoalbuminemia (slow down the progress of this social trend. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Consumer Involvement and Knowledge Influence on Wine Choice Cue Utilisation

    DEFF Research Database (Denmark)

    Bruwer, Johan; Chrysochou, Polymeros; Lesschaeve, Isabelle


    . Product choice cues are grouped into extrinsic, intrinsic and marketing mix. The importance of how these cues are influenced from different dimensions of consumer involvement is illustrated. Findings The results show that product knowledge has a positive impact on intrinsic product cue utilisation......Purpose The purpose of this paper is to examine the utilisation of product choice cues in a retail environment and the impact of consumer involvement on this utilisation. It further investigates the impact of product knowledge on product choice cue utilisation and its moderating role on the impact...... of consumer involvement. Design/methodology/approach The case of wine as an exemplary product category is considered, given the importance and variability of choice cues that have been found to affect product choice. Analysis is conducted on survey data from a sample of wine consumers in Ontario, Canada...

  17. Blood cues induce antipredator behavior in Nile tilapia conspecifics.

    Directory of Open Access Journals (Sweden)

    Rodrigo Egydio Barreto

    Full Text Available In this study, we show that the fish Nile tilapia displays an antipredator response to chemical cues present in the blood of conspecifics. This is the first report of alarm response induced by blood-borne chemical cues in fish. There is a body of evidence showing that chemical cues from epidermal 'club' cells elicit an alarm reaction in fish. However, the chemical cues of these 'club' cells are restricted to certain species of fish. Thus, as a parsimonious explanation, we assume that an alarm response to blood cues is a generalized response among animals because it occurs in mammals, birds and protostomian animals. Moreover, our results suggest that researchers must use caution when studying chemically induced alarm reactions because it is difficult to separate club cell cues from traces of blood.

  18. A statistical approach to identify candidate cues for nestmate recognition

    DEFF Research Database (Denmark)

    van Zweden, Jelle; Pontieri, Luigi; Pedersen, Jes Søe


    The ability of social insects to discriminate nestmates (NMs) from non-nestmates(nNMs) is mainly achieved through chemical communication. To ultimately understandthis recognition and its decision rules, identification of the recognition cues is essential.Although recognition cues are most likely...... cuticular hydrocarbons (CHCs), identifying theexact cues for specific species has remained a daunting task, partly due to the sheernumber of odor compounds. Perhaps unsurprisingly, one of the few species wherethe recognition cues have been identified, Formica exsecta, has only around ten majorhydrocarbons...... on its cuticle. In this study we use previous results of this species to searchfor nestmate recognition cues (NMR cues) in two other species of ants, Camponotusaethiops, and Monomorium pharaonis. Employing chemical distances and observedaggression between colonies, we first ask which type of data...

  19. A signaling perspective on bureaucratic encounters: How public officials interpret signals and cues


    Raaphorst, Nadine; Van de Walle, Steven


    This article provides scholars studying frontline judgements an analytical framework – the signaling perspective – that could be used to examine how street-level bureaucrats evaluate unobservable citizen-client properties. It proposes to not only look at the kind of signals and cues officials gather, but also at the interpretive frames used to make sense of them. This offers a valuable contribution to the street-level bureaucracy literature, which largely focuses on explaining discretionary d...

  20. Design and methods of the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen SignificantlY) study: An investigator-blinded randomized controlled trial of education and feedback intervention to reduce inappropriate echocardiograms. (United States)

    Bhatia, R Sacha; Ivers, Noah; Yin, Cindy X; Myers, Dorothy; Nesbitt, Gillian; Edwards, Jeremy; Yared, Kibar; Wadhera, Rishi; Wu, Justina C; Wong, Brian; Hansen, Mark; Weinerman, Adina; Shadowitz, Steven; Johri, Amer; Farkouh, Michael; Thavendiranathan, Paaladinesh; Udell, Jacob A; Rambihar, Sherryn; Chow, Chi-Ming; Hall, Judith; Thorpe, Kevin E; Rakowski, Harry; Weiner, Rory B


    Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings. The aim of this international, multicenter study is to evaluate the hypothesis that an AUC-based educational and feedback intervention will reduce the proportion of inappropriate echocardiograms ordered by attending physicians in the ambulatory environment. In an ongoing multicentered, investigator-blinded, randomized controlled trial across Canada and the United States, cardiologists and primary care physicians practicing in the ambulatory setting will be enrolled. The intervention arm will receive (1) a lecture outlining the AUC and most recent available evidence highlighting appropriate use of TTE, (2) access to the American Society of Echocardiography mobile phone app, and (3) individualized feedback reports e-mailed monthly summarizing TTE ordering behavior including information on inappropriate TTEs and brief explanations of the inappropriate designation. The control group will receive no education on TTE appropriate use and order TTEs as usual practice. The Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly in an education RCT) study is the first multicenter randomized trial of an AUC-based educational intervention. The study will examine whether an education and feedback intervention will reduce the rate of outpatient inappropriate TTEs ordered by attending level cardiologists and primary care physicians ( identifier NCT02038101). Copyright © 2015 Elsevier Inc. All rights reserved.

  1. The effect of multisensory cues on attention in aging (United States)

    Mahoney, Jeannette R.; Verghese, Joe; Dumas, Kristina; Wang, Cuiling; Holtzer, Roee


    The attention network test (ANT) assesses the effect of alerting and orienting cues on a visual flanker task measuring executive attention. Previous findings revealed that older adults demonstrate greater reaction times (RT) benefits when provided with visual orienting cues that offer both spatial and temporal information of an ensuing target. Given the overlap of neural substrates and networks involved in multisensory processing and cueing (i.e., alerting and orienting), an investigation of multisensory cueing effects on RT was warranted. The current study was designed to determine whether participants, both old and young, benefited from receiving multisensory alerting and orienting cues. Eighteen young (M = 19.17 years; 45% female) and eighteen old (M = 76.44 years; 61% female) individuals that were determined to be non-demented and without any medical or psychiatric conditions that would affect their performance were included. Results revealed main effects for the executive attention and orienting networks, but not for the alerting network. In terms of orienting, both old and young adults demonstrated significant orienting effects for auditory-somatosensory (AS), auditory-visual (AV), and visual-somatosensory (VS) cues. RT benefits of multisensory compared to unisensory orienting effects differed by cue type and age group; younger adults demonstrated greater RT benefits for AS orienting cues whereas older adults demonstrated greater RT benefits for AV orienting cues. Both groups, however, demonstrated significant RT benefits for multisensory VS orienting cues. These findings provide evidence for the facilitative effect of multisensory orienting cues, and not multisensory alerting cues, in old and young adults. PMID:22820295

  2. Task Interruption: Resumption Lag and the Role of Cues

    National Research Council Canada - National Science Library

    Altmann, Erik M; Trafton, J. G


    ...), indicating a substantial disruptive effect. To probe the nature of the disruption, they examined the role of external cues associated with the interrupted task and found that cues available immediately before an interruption facilitate performance immediately afterwards, thus reducing the resumption lag. This "cue-availability" effect suggests that people deploy preparatory perceptual and memory processes, apparently spontaneously, to mitigate the disruptive effects of task interruption.

  3. Salience in Second Language Acquisition:Physical form, learner attention, and instructional focus

    Directory of Open Access Journals (Sweden)

    Myrna C Cintrón-Valentín


    Full Text Available We consider the role of physical form, prior experience, and form focused instruction (FFI in adult language learning. (1 When presented with competing cues to interpretation, learners are more likely to attend to physically more salient cues in the input. (2 Learned attention is an associative learning phenomenon where prior-learned cues block those that are experienced later. (3 The low salience of morphosyntactic cues can be overcome by FFI, which leads learners to attend cues which might otherwise be ignored. Experiment 1 used eye-tracking to investigate how language background influences learners’ attention to morphological cues, as well as the attentional processes whereby different types of FFI overcome low cue salience, learned attention and blocking. Chinese native speakers (no L1 verb-tense morphology viewed Latin utterances combining lexical and morphological cues to temporality under control conditions (CC and three types of explicit FFI: grammar instruction (VG, verb salience with textual enhancement (VS, and verb pretraining (VP, and their use of these cues was assessed in a comprehension test. CC participants were significantly more sensitive to the adverbs than verb morphology. Instructed participants showed greater sensitivity to the verbs. These results reveal attentional processes whereby learners’ prior linguistic experience can shape their attention toward cues in the input, and whereby FFI helps learners overcome the long-term blocking of verb-tense morphology. Experiment 2 examined the role of modality of input presentation – aural or visual – in L1 English learners’ attentional focus on morphological cues and the effectiveness of different FFI manipulations. CC participants showed greater sensitivity toward the adverb cue. FFI was effective in increasing attention to verb-tense morphology, however, the processing of morphological cues was considerably more difficult under aural presentation. From visual exposure

  4. Salience in Second Language Acquisition: Physical Form, Learner Attention, and Instructional Focus. (United States)

    Cintrón-Valentín, Myrna C; Ellis, Nick C


    We consider the role of physical form, prior experience, and form focused instruction (FFI) in adult language learning. (1) When presented with competing cues to interpretation, learners are more likely to attend to physically more salient cues in the input. (2) Learned attention is an associative learning phenomenon where prior-learned cues block those that are experienced later. (3) The low salience of morphosyntactic cues can be overcome by FFI, which leads learners to attend cues which might otherwise be ignored. Experiment 1 used eye-tracking to investigate how language background influences learners' attention to morphological cues, as well as the attentional processes whereby different types of FFI overcome low cue salience, learned attention and blocking. Chinese native speakers (no L1 verb-tense morphology) viewed Latin utterances combining lexical and morphological cues to temporality under control conditions (CCs) and three types of explicit FFI: verb grammar instruction (VG), verb salience with textual enhancement (VS), and verb pretraining (VP), and their use of these cues was assessed in a subsequent comprehension test. CC participants were significantly more sensitive to the adverbs than verb morphology. Instructed participants showed greater sensitivity to the verbs. These results reveal attentional processes whereby learners' prior linguistic experience can shape their attention toward cues in the input, and whereby FFI helps learners overcome the long-term blocking of verb-tense morphology. Experiment 2 examined the role of modality of input presentation - aural or visual - in L1 English learners' attentional focus on morphological cues and the effectiveness of different FFI manipulations. CC participants showed greater sensitivity toward the adverb cue. FFI was effective in increasing attention to verb-tense morphology, however, the processing of morphological cues was considerably more difficult under aural presentation. From visual exposure

  5. Haven't a Cue? Mapping the CUE Space as an Aid to HRA Modeling

    Energy Technology Data Exchange (ETDEWEB)

    David I Gertman; Ronald L Boring; Jacques Hugo; William Phoenix


    Advances in automation present a new modeling environment for the human reliability analysis (HRA) practitioner. Many, if not most, current day HRA methods have their origin in characterizing and quantifying human performance in analog environments where mode awareness and system status indications are potentially less comprehensive, but simpler to comprehend at a glance when compared to advanced presentation systems. The introduction of highly complex automation has the potential to lead to: decreased levels of situation awareness caused by the need for increased monitoring; confusion regarding the often non-obvious causes of automation failures, and emergent system dependencies that formerly may have been uncharacterized. Understanding the relation of incoming cues available to operators during plant upset conditions, in conjunction with operating procedures, yields insight into understanding the nature of the expected operator response in this control room environment. Static systems methods such as fault trees do not contain the appropriate temporal information or necessarily specify the relationship among cues leading to operator response. In this paper, we do not attempt to replace standard performance shaping factors commonly used in HRA nor offer a new HRA method, existing methods may suffice. In this paper we strive to enhance current understanding of the basis for operator response through a technique that can be used during the qualitative portion of the HRA analysis process. The CUE map is a means to visualize the relationship among salient cues in the control room that help influence operator response, show how the cognitive map of the operator changes as information is gained or lost, and is applicable to existing as well as advanced hybrid plants and small modular reactor designs. A brief application involving loss of condensate is presented and advantages and limitations of the modeling approach and use of the CUE map are discussed.

  6. Incidental fear cues increase monetary loss aversion. (United States)

    Schulreich, Stefan; Gerhardt, Holger; Heekeren, Hauke R


    In many everyday decisions, people exhibit loss aversion-a greater sensitivity to losses relative to gains of equal size. Loss aversion is thought to be (at least partly) mediated by emotional--in particular, fear-related--processes. Decision research has shown that even incidental emotions, which are unrelated to the decision at hand, can influence decision making. The effect of incidental fear on loss aversion, however, is thus far unclear. In two studies, we experimentally investigated how incidental fear cues, presented during (Study 1) or before (Study 2) choices to accept or reject mixed gambles over real monetary stakes, influence monetary loss aversion. We find that the presentation of fearful faces, relative to the presentation of neutral faces, increased risk aversion-an effect that could be attributed to increased loss aversion. The size of this effect was moderated by psychopathic personality: Fearless dominance, in particular its interpersonal facet, but not self-centered impulsivity, attenuated the effect of incidental fear cues on loss aversion, consistent with reduced fear reactivity. Together, these results highlight the sensitivity of loss aversion to the affective context. (c) 2016 APA, all rights reserved).

  7. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Yang P


    Full Text Available Ping Yang, Na Chen, Rong-Rong Wang, Lu Li, Sai-Ping Jiang Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Background: With the increasing incidence rate of chronic kidney disease (CKD, inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure.Objective: The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients.Methods: A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified.Results: Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56, contraindicated (n=46, and cautiously used medicines (n=161 accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056. Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%, cardiovascular drugs (n=61, 23.19%, and antimicrobial drugs (n=55, 20.91% represented the top three medicine categories in CKD patients.Conclusion: The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. Keywords: inappropriateness of

  8. Direction of Attentional Focus in Biofeedback Treatment for /R/ Misarticulation (United States)

    McAllister Byun, Tara; Swartz, Michelle T.; Halpin, Peter F.; Szeredi, Daniel; Maas, Edwin


    Background: Maintaining an external direction of focus during practice is reported to facilitate acquisition of non-speech motor skills, but it is not known whether these findings also apply to treatment for speech errors. This question has particular relevance for treatment incorporating visual biofeedback, where clinician cueing can direct the…

  9. Problematic alcohol use and mild intellectual disability: Standardization of pictorial stimuli for an alcohol cue reactivity task

    NARCIS (Netherlands)

    Duijvenbode, N. van; Didden, H.C.M.; Bloemsaat, J.G.; Engels, R.C.M.E.


    The present study focused on the first step in developing a cue reactivity task for studying cognitive biases in individuals with mild to borderline intellectual disability (ID) and alcohol use-related problems: the standardization of pictorial stimuli. Participants (N = 40), both with and without a

  10. [Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients]. (United States)

    Terán-Álvarez, L; González-García, M J; Rivero-Pérez, A L; Alonso-Lorenzo, J C; Tarrazo-Suárez, J A


    Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions. A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression. A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI:5.76-7.08), a mean age of 79.2 years (SD:3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD:1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean: 1.32 (SD:1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were: therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR=1.22 [95% CI:1.04-1.43]) and inversely to the Charlson index (OR=0.76 [95% CI:0.65-0.89]). PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP. Copyright © 2014 Sociedad Española de Médicos de

  11. Preconditioning of Spatial and Auditory Cues: Roles of the Hippocampus, Frontal Cortex, and Cue-Directed Attention

    Directory of Open Access Journals (Sweden)

    Andrew C. Talk


    Full Text Available Loss of function of the hippocampus or frontal cortex is associated with reduced performance on memory tasks, in which subjects are incidentally exposed to cues at specific places in the environment and are subsequently asked to recollect the location at which the cue was experienced. Here, we examined the roles of the rodent hippocampus and frontal cortex in cue-directed attention during encoding of memory for the location of a single incidentally experienced cue. During a spatial sensory preconditioning task, rats explored an elevated platform while an auditory cue was incidentally presented at one corner. The opposite corner acted as an unpaired control location. The rats demonstrated recollection of location by avoiding the paired corner after the auditory cue was in turn paired with shock. Damage to either the dorsal hippocampus or the frontal cortex impaired this memory ability. However, we also found that hippocampal lesions enhanced attention directed towards the cue during the encoding phase, while frontal cortical lesions reduced cue-directed attention. These results suggest that the deficit in spatial sensory preconditioning caused by frontal cortical damage may be mediated by inattention to the location of cues during the latent encoding phase, while deficits following hippocampal damage must be related to other mechanisms such as generation of neural plasticity.

  12. Attentional Focus Effects in Standing Long Jump Performance: Influence of a Broad and Narrow Internal Focus. (United States)

    Becker, Kevin A; Smith, Peter J K


    The content of instructions that strength coaches give can have a significant impact on how an athlete or client performs. Research on motor learning has shown an advantage of instructions focusing on the effects of movements (external focus) over those focusing on the movements themselves (internal focus) in the performance of motor skills. Internally focused cues are abundant in coaching, therefore the purpose of this study was to test whether some internally focused cues might be more helpful than others. Participants (68) were randomly assigned to either an external focus (EX), broad internal focus (B-IN), narrow internal focus (N-IN), or a control group (CON), and performed 5 standing long jumps. All groups were instructed that the goal was to jump as far as possible. In addition, the EX group was told to "jump as far past the start line as possible." The B-IN group was told to "use your legs." The N-IN group was told to "extend your knees as rapidly as possible," and the CON group received no additional instruction. An analysis of covariance showed that the EX group (198.09 ± 31.89 cm) jumped significantly farther than both the B-IN group (173.74 ± 35.36 cm), p = 0.010 and the N-IN group (178.53 ± 31.17 cm), p = 0.049, with no group different from the CON group. The results suggest that a broad internal focus is no more effective than a narrow internal focus, and that an external focus leads to the greatest jump distance. Strength and conditioning professionals should carefully word their instructions to induce an external focus of attention whenever possible.

  13. Flexible spatial perspective-taking: Conversational partners weigh multiple cues in collaborative tasks

    Directory of Open Access Journals (Sweden)

    Alexia eGalati


    Full Text Available Research on spatial perspective-taking often focuses on the cognitive processes of isolated individuals as they adopt or maintain imagined perspectives. Collaborative studies of spatial perspective-taking typically examine speakers’ linguistic choices, while overlooking their underlying processes and representations. We review evidence from two collaborative experiments that examine the contribution of social and representational cues to spatial perspective choices in both language and the organization of spatial memory. Across experiments, speakers organized their memory representations according to the convergence of various cues. When layouts were randomly configured and did not afford intrinsic cues, speakers encoded their partner’s viewpoint in memory, if available, but did not use it as an organizing direction. On the other hand, when the layout afforded an intrinsic structure, speakers organized their spatial memories according to the person-centered perspective reinforced by the layout’s structure. Similarly, in descriptions, speakers considered multiple cues whether available a priori or at the interaction. They used partner-centered expressions more frequently (e.g., to your right when the partner’s viewpoint was misaligned by a small offset or coincided with the layout’s structure. Conversely, they used egocentric expressions more frequently when their own viewpoint coincided with the intrinsic structure or when the partner was misaligned by a computationally difficult, oblique offset. Based on these findings we advocate for a framework for flexible perspective-taking: people weigh multiple cues (including social ones to make attributions about the relative difficulty of perspective-taking for each partner, and adapt behavior to minimize their collective effort. This framework is not specialized for spatial reasoning but instead emerges from the same principles and memory-depended processes that govern perspective-taking in

  14. Development of Feeding Cues During Infancy and Toddlerhood. (United States)

    Hodges, Eric A; Wasser, Heather M; Colgan, Brook K; Bentley, Margaret E

    To enhance responsive feeding, this study aimed to characterize the development of feeding cues during infancy and toddlerhood. A secondary analysis was performed on a dataset of first-time, low-income African American mother-infant pairs assessed at infant age 3, 6, 9, 12, and 18 months. A subsample with the 15 highest, middle, and lowest infant body mass index (BMI) Z-scores at 18 months was selected (n = 45). Using video-recorded home feedings, early, active, and late receptiveness and fullness cues were assessed using the Responsiveness to Child Feeding Cues Scale at each time point. Descriptive statistics were used to characterize development. Early receptiveness cues were relatively rare over time, whereas active receptiveness cues were much more common. However, there were changes over time. For example, settling into the feeding decreased from ~50% at 3 and 6 months to 4.8% by 18 months, whereas postural attention and reaching for food increased after 6 months. In the first 6 months, falling asleep and decreasing muscle tone and activity level were the most common early fullness cues. Thereafter, taking interest in surroundings was most prevalent. Active fullness cues became increasingly diverse after 6 months, led by more assertive cues such as pushing or pulling away and communicating "no" verbally or nonverbally. These findings provide an empirical description of waxing and waning in feeding cues and indicate increasing intentionality of cues over the first 18 months of life. Knowing common cues across development may aid clinicians in enhancing parental feeding responsiveness, avoiding overfeeding, thereby decreasing risk of early childhood obesity.

  15. Role of Self-Generated Odor Cues in Contextual Representation (United States)

    Aikath, Devdeep; Weible, Aldis P; Rowland, David C; Kentros, Clifford G


    As first demonstrated in the patient H.M., the hippocampus is critically involved in forming episodic memories, the recall of “what” happened “where” and “when.” In rodents, the clearest functional correlate of hippocampal primary neurons is the place field: a cell fires predominantly when the animal is in a specific part of the environment, typically defined relative to the available visuospatial cues. However, rodents have relatively poor visual acuity. Furthermore, they are highly adept at navigating in total darkness. This raises the question of how other sensory modalities might contribute to a hippocampal representation of an environment. Rodents have a highly developed olfactory system, suggesting that cues such as odor trails may be important. To test this, we familiarized mice to a visually cued environment over a number of days while maintaining odor cues. During familiarization, self-generated odor cues unique to each animal were collected by re-using absorbent paperboard flooring from one session to the next. Visual and odor cues were then put in conflict by counter-rotating the recording arena and the flooring. Perhaps surprisingly, place fields seemed to follow the visual cue rotation exclusively, raising the question of whether olfactory cues have any influence at all on a hippocampal spatial representation. However, subsequent removal of the familiar, self-generated odor cues severely disrupted both long-term stability and rotation to visual cues in a novel environment. Our data suggest that odor cues, in the absence of additional rule learning, do not provide a discriminative spatial signal that anchors place fields. Such cues do, however, become integral to the context over time and exert a powerful influence on the stability of its hippocampal representation. © 2014 The Authors. Hippocampus Published by Wiley Periodicals, Inc. PMID:24753119

  16. A case of appropriate inappropriate device therapy: Hyperkalemia-induced ventricular oversensing (United States)

    Oudit, Gavin Y; Cameron, Doug; Harris, Louise


    The present case describes a patient who received inappropriate, but potentially life-saving, therapy from her implantable cardioverter defibrillator (ICD) in the setting of acute hyperkalemia (plasma potassium concentration = 8 mM). Hyperkalemia was associated with the development of a slow sinusoidal ventricular tachycardia, at a rate of 100 beats/min to 125 beats/min (610 ms to 480 ms) in a patient who is pacemaker-dependent. There was associated fractionation of the ICD electrogram and T wave oversensing, leading to ventricular oversensing with resultant detection in the ventricular fibrillation rate zone. This was followed by shock therapy, even though the ventricular tachycardia rate was below the programmed detection rate of the ICD. The subsequent emergency treatment of the hyperkalemia normalized the electrogram, corrected the ventricular oversensing and arrhythmia, and restored rate-adaptive single-chamber ventricular pacing. PMID:18340383

  17. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, L; Thirstrup, S; Kristensen, M


    PURPOSE: To evaluate the effect of a combined or a single educational intervention on the prescribing behaviour of general practitioners (GPs). The primary endpoint was effect on inappropriate prescribing according to the Medication Appropriateness Index (MAI). METHODS: General practitioners were...... to polypharmacy (>/=5 medications) were identified and approached for inclusion. Data on medications prescribed over a 3-month period were collected, and the GPs provided detailed information on their patients before and after the intervention. A pre- and post-MAI were scored for all medications. RESULTS......: Of the 277 GPs invited to participate; 41 (14.8%) volunteered. Data were obtained from 166 patients before and after the intervention. Medication appropriateness improved in the combined intervention group but not in the single intervention group. The mean change in MAI and number of medications was -5 [95...

  18. Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder

    Directory of Open Access Journals (Sweden)

    Binu P Pillai


    Full Text Available Hyponatremia occurs in about 30% of hospitalized patients and syndrome of inappropriate antidiuretic hormone secretion (SIADH is a common cause of hyponatremia. SIADH should be differentiated from other causes of hyponatremia like diuretic therapy, hypothyroidism and hypocortisolism. Where possible, all attempts should be made to identify and rectify the cause of SIADH. The main problem in SIADH is fluid excess, and hyponatremia is dilutional in nature. Fluid restriction is the main stay in the treatment of SIADH; however, cerebral salt wasting should be excluded in the clinical setting of brain surgeries, subarachnoid hemorrhage, etc. Fluid restriction in cerebral salt wasting can be hazardous. Sodium correction in chronic hyponatremia (onset >48 hours should be done slowly to avoid deleterious effects in brain.

  19. Vancomycin intoxication in a patient with inappropriate antidiuretic hormone syndrome and diarrhea

    Directory of Open Access Journals (Sweden)

    Patricia Hidalgo-Collazos


    Full Text Available Vancomycin is an antibiotic used for infections by gram-positive bacteria with a two-compartment pharmacokinetic model. Its monitoring has an established therapeutic range (10-20 mg/L to prevent nephrotoxicity and ototoxicity due to supratherapeutic levels, and inefficiency and development of resistance by subtherapeutic levels. Nephrotoxicity for vancomycin monotherapy at standard doses according to pathogen and typical regimens (usual dose: 15-20 mg/kg/12 h is rare and usually reversible. Moreover, monitoring plasma concentrations allows to achieve concentrations within therapeutic range to allow safe and effective drug use. The renal hypoperfusion can cause pre-renal damage, resulting in elevated levels of serum creatinine, resulting in decreased antibiotic elimination and nephrotoxicity. We report a case of unexpected vancomycin nephrotoxicity in a patient with syndrome Inappropriate antidiuretic hormone secretion associated paraneoplastic

  20. The syndrome of inappropriate antidiuretic hormone: current and future management options.

    LENUS (Irish Health Repository)

    Sherlock, Mark


    Hyponatraemia is the commonest electrolyte abnormality, and syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent underlying pathophysiology. Hyponatraemia is associated with significant morbidity and mortality, and as such appropriate treatment is essential. Treatment options for SIADH include fluid restriction, demeclocycline, urea, frusemide and saline infusion, all of which have their limitations. The introduction of the vasopressin-2 receptor antagonists has allowed clinicians to specifically target the underlying pathophysiology of SIADH. Initial studies have shown good efficacy and safety profiles in the treatment of mild to moderate hyponatraemia. However, studies assessing the efficacy and safety of these agents in acute severe symptomatic hyponatraemia are awaited. Furthermore, the cost of these agents at present may limit their use.

  1. Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America

    DEFF Research Database (Denmark)

    Urbiztondo, Inés; Bjerrum, Lars; Caballero, Lidia


    High antibiotic prescribing and antimicrobial resistance in patients attending primary care have been reported in South America. Very few interventions targeting general practitioners (GPs) to decrease inappropriate antibiotic prescribing have been investigated in this region. This study assessed...... limited effect. A cluster randomized two-arm control trial was implemented. Healthcare centres from Bolivia, Argentina, Paraguay and Uruguay participating in the quality improvement program HAPPY AUDIT were randomly allocated to either intervention or control group. During ten consecutive weeks, GPs...... in the intervention group received evidence-based online feedback on the management of suspected RTIs. In patients with acute bronchitis, the intervention reduced the antibiotic prescribing rate from 71.6% to 56% (control group from 61.2% to 52%). In patients with acute otitis media, the intervention reduced...

  2. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH in Strongyloides stercoralis hyperinfection

    Directory of Open Access Journals (Sweden)

    Deepshikha Nag Chowdhury


    Full Text Available Strongyloides stercoralis (S. stercoralis is a soil transmitted intestinal roundworm that has a unique ability to multiply within the human host and reinfect the human carrier by a process of autoinfection. By this property, S. stercoralis can persist as an occult infection for many decades. In situations of immunosuppression or other permissive gastrointestinal conditions, there occurs a massive increase in parasite multiplication. The parasites penetrate through the intestinal mucosa and are carried in circulation and can cause multisystem involvement. We report a case of a 76-year-old Columbian male who presented with intractable vomiting and hyponatremia who was then diagnosed to have syndrome of inappropriate antidiuretic hormone (SIADH. The patient′s symptoms improved after treatment with two doses of ivermectin and his serum sodium levels returned to normal. S. stercoralis infection should be suspected in patients from endemic regions who present with gastrointestinal symptoms and unexplained hyponatremia.

  3. [Validity of the protocol for evaluating the inappropriate use of hospitalization]. (United States)

    Peiró, S; Meneu, R; Roselló, M L; Portella, E; Carbonell-Sanchís, R; Fernández, C; Lázaro, G; Llorens, M A; Martínez-Mas, E; Moreno, E; Ruano, M; Rincón, A; Vila, M


    The study was carried out in order to assess the inter-observer reliability and validity in respect of clinical appraisal given by the Appropriateness Evaluation Protocol (AEP), in the context of the Spanish Public Hospital System. In order to assess the reliability a total of 614 hospital stays chosen at random from 56 hospital admissions were independently analysed by three reviewers (two doctors and one nurse). In order to assess the validity, the findings obtained by the nurse were compared with the majority opinion given by the 7 hospital specialists in respect of each of hospital stays under evaluation. As part of the analytical procedure, indices for observed agreement, and specific agreement were calculated, as well as the Kappa statistic, all forming of various random samples of 614 hospital stays. In order to assess the predictive validity of the AEP, its sensitivity, specificity and predictive values were all measured against the majority clinical judgement. The study exhibited a high degree of inter-observer reliability (specific agreement > 64%, kappa > 0.75) and a reasonable validity in comparison with the consensus of opinions formed by a least 4 or 5 of its 7 clinical reviewers (specific agreement > 61%, kappa > 0.64), these values decreasing notably when the consensus of 6 or 7 of the reviewers was required. The AEP revealed a high degree of sensitivity and a low degree of specificity in comparison with the majority clinical assessment, thus minimising the occurrence of false results when the stay was regarded as appropriate, and producing false negatives (appropriate hospital stays regarded as inappropriate) varying in degree from moderate to very high. The results showing high reliability and moderate validity regarding clinical assessment shows the AEP to be a useful instrument in the sifting-out of inappropriate use of hospitalisation, although they do not allow a definitive judgement to be made concerning the efficiency of hospital services

  4. Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital

    Directory of Open Access Journals (Sweden)

    Vishal Sehgal


    Full Text Available Background and Aim: Readmission to the hospital within 30 days of discharge from the hospital is a common occurrence. Congestive heart failure is the most common cause of readmissions in the hospital. We hypothesized that irrespective of the admission diagnosis polypharmacy and potentially inappropriate use of medications (PIM leads to readmissions within 30 days of discharge from the hospital. Materials and Methods: A retrospective study was carried out by reviewing the hospital records of 414 patients who were readmitted to the hospital within 30 days of discharge from the hospital between January 2008 and December 2009. The data was stratified to see which patients were on polypharmacy and/or on PIM. Polypharmacy was defined as use of more than 5 medications. PIM was defined as per the modified Beers criteria. Day 0 was defined as the day of discharge and day1 was defined as the day-after Admission to the hospital. Statistical analysis was carried out using a two-way analysis of variance (ANOVA on the data to see if polypharmacy and/or PIM was related to readmission within 30 days of discharge irrespective of admission diagnosis. Results: Polypharmacy was related to hospital readmission at day 1 and day 0, however inappropriate drug use was found to be not related at any day. Polypharmacy and PIM combined had a positive correlation to readmission only on days 1 and 0 and it was statistically significant. The use of minimal and appropriate use of drugs was statistically significant compared to polypharmacy and PIM use. Conclusions: Polypharmacy and PIM are under recognized cause of readmissions to the hospital.

  5. High-dose oral medroxyprogesterone for inappropriate hypersexuality in elderly men with dementia: a case series. (United States)

    Cross, Bethany S; DeYoung, G Robert; Furmaga, Kevin M


    To retrospectively examine the utility of high-dose oral medroxyprogesterone (MPA) for the treatment of inappropriate hypersexuality (IH) in elderly men with dementia. Ten men aged 65 years or older (median 79.5 years, range 65-93 years) were identified from all admissions at a 170-bed tertiary referral psychiatric hospital between December 2005 and January 2011. Admission records were used to identify subjects who received at least 100 mg daily of oral MPA. The primary outcome of successful treatment was chart documentation of a substantial decline in IH, such that subjects could return to preadmission residence. Data were collected to assess trends in dose, adverse effects, use of other symptom-modifying medications prior to MPA initiation, and successful return to preadmission placement. A trial serotoneric agent was used in 70% of subjects prior to MPA initiation. Sixty percent of subjects failed a trial of an antipsychotic, while 40% did not have response to the use of both a serotonergic agent and an antipsychotic before MPA was initiated. The average daily dose of MPA was 300 mg (range 100-400 mg/day). No adverse effects were documented from physician, nursing, or behavioral health rounding notes; however, adverse effects may not have been systematically assessed at the time of MPA administration. Seventy percent of subjects experienced favorable changes in target behaviors from MPA. Few data exist on effective therapy options for treatment of IH. The minimum concentration of MPA needed to suppress IH in the male body is unknown. MPA was titrated upward, with the efficacy measure being a decrease in inappropriate behaviors. Use of MPA likely contributed to decreased IH; however, other factors involved in hospitalization could have contributed to improved behavior. While requiring further study, high-dose (100-400 mg/day) oral MPA may represent an effective and well-tolerated treatment option for subjects displaying IH.

  6. A dominance hierarchy of auditory spatial cues in barn owls.

    Directory of Open Access Journals (Sweden)

    Ilana B Witten


    Full Text Available Barn owls integrate spatial information across frequency channels to localize sounds in space.We presented barn owls with synchronous sounds that contained different bands of frequencies (3-5 kHz and 7-9 kHz from different locations in space. When the owls were confronted with the conflicting localization cues from two synchronous sounds of equal level, their orienting responses were dominated by one of the sounds: they oriented toward the location of the low frequency sound when the sources were separated in azimuth; in contrast, they oriented toward the location of the high frequency sound when the sources were separated in elevation. We identified neural correlates of this behavioral effect in the optic tectum (OT, superior colliculus in mammals, which contains a map of auditory space and is involved in generating orienting movements to sounds. We found that low frequency cues dominate the representation of sound azimuth in the OT space map, whereas high frequency cues dominate the representation of sound elevation.We argue that the dominance hierarchy of localization cues reflects several factors: 1 the relative amplitude of the sound providing the cue, 2 the resolution with which the auditory system measures the value of a cue, and 3 the spatial ambiguity in interpreting the cue. These same factors may contribute to the relative weighting of sound localization cues in other species, including humans.

  7. Task and vehicle dynamics based assessment of motion cueing requirements (United States)


    One significant difference between real and simulated flight on the ground are the stimuli or cues provided to the pilot. Due to physical and/or cost constraints, it is nearly impossible to match all the cues experienced in the air in ground-based si...

  8. Sensory cues employed for the acquisition of familiarity-dependent ...

    Indian Academy of Sciences (India)

    In this study we showed that a freshwater fish, the climbing perch (Anabas testudineus) is incapable of using chemical communication but employs visual cues to acquire familiarity and distinguish a familiar group of conspecifics from an unfamiliar one. Moreover, the isolation of olfactory signals from visual cues did not affect ...

  9. Neural Correlates of Contextual Cueing Are Modulated by Explicit Learning (United States)

    Westerberg, Carmen E.; Miller, Brennan B.; Reber, Paul J.; Cohen, Neal J.; Paller, Ken A.


    Contextual cueing refers to the facilitated ability to locate a particular visual element in a scene due to prior exposure to the same scene. This facilitation is thought to reflect implicit learning, as it typically occurs without the observer's knowledge that scenes repeat. Unlike most other implicit learning effects, contextual cueing can be…

  10. A Review of Swimming Cues and Tips for Physical Education (United States)

    Higginson, Kelsey; Barney, David


    Swimming is a low-impact activity that causes little stress on joints so it can be done for a lifetime. Many teachers may wish to teach swimming but do not have cues or ideas for doing so. This article reviews swimming cues, relays and equipment that can help a physical education teacher include a swimming unit in their curriculum. Certification…

  11. Boosting Vocabulary Learning by Verbal Cueing During Sleep. (United States)

    Schreiner, Thomas; Rasch, Björn


    Reactivating memories during sleep by re-exposure to associated memory cues (e.g., odors or sounds) improves memory consolidation. Here, we tested for the first time whether verbal cueing during sleep can improve vocabulary learning. We cued prior learned Dutch words either during non-rapid eye movement sleep (NonREM) or during active or passive waking. Re-exposure to Dutch words during sleep improved later memory for the German translation of the cued words when compared with uncued words. Recall of uncued words was similar to an additional group receiving no verbal cues during sleep. Furthermore, verbal cueing failed to improve memory during active and passive waking. High-density electroencephalographic recordings revealed that successful verbal cueing during NonREM sleep is associated with a pronounced frontal negativity in event-related potentials, a higher frequency of frontal slow waves as well as a cueing-related increase in right frontal and left parietal oscillatory theta power. Our results indicate that verbal cues presented during NonREM sleep reactivate associated memories, and facilitate later recall of foreign vocabulary without impairing ongoing consolidation processes. Likewise, our oscillatory analysis suggests that both sleep-specific slow waves as well as theta oscillations (typically associated with successful memory encoding during wakefulness) might be involved in strengthening memories by cueing during sleep. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail:

  12. Altered Brain Reactivity to Game Cues After Gaming Experience. (United States)

    Ahn, Hyeon Min; Chung, Hwan Jun; Kim, Sang Hee


    Individuals who play Internet games excessively show elevated brain reactivity to game-related cues. This study attempted to test whether this elevated cue reactivity observed in game players is a result of repeated exposure to Internet games. Healthy young adults without a history of excessively playing Internet games were recruited, and they were instructed to play an online Internet game for 2 hours/day for five consecutive weekdays. Two control groups were used: the drama group, which viewed a fantasy TV drama, and the no-exposure group, which received no systematic exposure. All participants performed a cue reactivity task with game, drama, and neutral cues in the brain scanner, both before and after the exposure sessions. The game group showed an increased reactivity to game cues in the right ventrolateral prefrontal cortex (VLPFC). The degree of VLPFC activation increase was positively correlated with the self-reported increase in desire for the game. The drama group showed an increased cue reactivity in response to the presentation of drama cues in the caudate, posterior cingulate, and precuneus. The results indicate that exposure to either Internet games or TV dramas elevates the reactivity to visual cues associated with the particular exposure. The exact elevation patterns, however, appear to differ depending on the type of media experienced. How changes in each of the regions contribute to the progression to pathological craving warrants a future longitudinal study.

  13. Emotional target cues eliminate age differences in prospective memory

    NARCIS (Netherlands)

    Altgassen, A.M.; Phillips, L.H.; Henry, J.D.; Rendell, P.G.; Kliegel, M.


    Cue saliency is known to influence prospective memory performance, whereby perceptually or conceptually distinct cues facilitate remembering and attenuate adult age-related deficits. The present study investigated whether similar benefits for older adults are also seen for emotional valence. A total

  14. Comprehending Conflicting Science-Related Texts: Graphs as Plausibility Cues (United States)

    Isberner, Maj-Britt; Richter, Tobias; Maier, Johanna; Knuth-Herzig, Katja; Horz, Holger; Schnotz, Wolfgang


    When reading conflicting science-related texts, readers may attend to cues which allow them to assess plausibility. One such plausibility cue is the use of graphs in the texts, which are regarded as typical of "hard science." The goal of our study was to investigate the effects of the presence of graphs on the perceived plausibility and…

  15. Anticipatory smooth pursuit eye movements evoked by probabilistic cues. (United States)

    Santos, Elio M; Kowler, Eileen


    Anticipatory smooth eye movements (ASEM; smooth eye movements in the direction of anticipated target motion) are elicited by cues that signal the direction of future target motion with high levels of certainty. Natural cues, however, rarely convey information with perfect certainty, and responses to uncertainty provide insights about how predictive behaviors are generated. Subjects smoothly pursued targets that moved to the right or left with varying cued probabilities. ASEM strength in a given direction increased with the probability level. The type of cue also played a role. ASEM elicited by symbolic visual cues tended to underweight low probabilities and overweight high probabilities. Cues based on memory (varying the proportion of trials with left or right motion) produced the opposite pattern, overweighting low probabilities and underweighting high probabilities. Finally, cues whose perceptual structure depicted the motion path produced a bias in ASEM in the depicted direction that was maintained across levels of cue congruency. The results show that the smooth pursuit system relies on a combination of signals, including memory for recent target motions, interpretation of cues, and prior beliefs about the relationship between the perceptual configuration and the motion path to determine the anticipatory response in the presence of uncertainty.

  16. A Comparison of the Aged to the Bayesian Ideal Observer Model for Cueing Tasks with Peripheral and Central Cues

    Directory of Open Access Journals (Sweden)

    Eleanor F Swan


    Full Text Available Previous studies investigating automatic (peripheral cues and voluntary (central cues attention decline with age have produced inconsistent findings. The present study investigated automatic and voluntary attention in the aged by comparing performance in 15 younger (18–25 years and 15 older (65–78 years observers to the Bayesian Ideal Observer Model (BIOM. The BIOM predicts cueing effects by the optimal differential weighting of likelihoods of targets appearing at each location (cue validity. It also allows the measure of bias in the responses and accounts for the detectability of targets, a factor that influences the predicted size of the cueing effect in the BIOM (Shimozaki et al 2003, Journal of Vision 3 209–229 and thus may explain some of the inconsistencies in previous research. Observers performed a yes/no cueing task of 2D Gaussian targets (60 ms, eccentricity 8 deg appearing at one of two locations. Pre-cues (150 ms were 70% valid and appeared either in peripheral (2 deg squares, Experiment 1 or central (shapes symbolizing left or right, Experiment 2 locations. Detectability was controlled across observers with a staircase, and difficulty was manipulated (contrast = threshold or one-octave below threshold. Both age groups showed cueing effects whether the cue appeared in peripheral or central locations, suggesting that automatic and voluntary attention are preserved in older adults. Both groups weighted the valid cue optimally at both levels of detectability (threshold and 1-octave below. However, for centrally located cues (voluntary attention, older adults were less accurate and exhibited more bias than their younger counterparts.

  17. Speaker's voice as a memory cue. (United States)

    Campeanu, Sandra; Craik, Fergus I M; Alain, Claude


    Speaker's voice occupies a central role as the cornerstone of auditory social interaction. Here, we review the evidence suggesting that speaker's voice constitutes an integral context cue in auditory memory. Investigation into the nature of voice representation as a memory cue is essential to understanding auditory memory and the neural correlates which underlie it. Evidence from behavioral and electrophysiological studies suggest that while specific voice reinstatement (i.e., same speaker) often appears to facilitate word memory even without attention to voice at study, the presence of a partial benefit of similar voices between study and test is less clear. In terms of explicit memory experiments utilizing unfamiliar voices, encoding methods appear to play a pivotal role. Voice congruency effects have been found when voice is specifically attended at study (i.e., when relatively shallow, perceptual encoding takes place). These behavioral findings coincide with neural indices of memory performance such as the parietal old/new recollection effect and the late right frontal effect. The former distinguishes between correctly identified old words and correctly identified new words, and reflects voice congruency only when voice is attended at study. Characterization of the latter likely depends upon voice memory, rather than word memory. There is also evidence to suggest that voice effects can be found in implicit memory paradigms. However, the presence of voice effects appears to depend greatly on the task employed. Using a word identification task, perceptual similarity between study and test conditions is, like for explicit memory tests, crucial. In addition, the type of noise employed appears to have a differential effect. While voice effects have been observed when white noise is used at both study and test, using multi-talker babble does not confer the same results. In terms of neuroimaging research modulations, characterization of an implicit memory effect

  18. Auditory feedback blocks memory benefits of cueing during sleep (United States)

    Schreiner, Thomas; Lehmann, Mick; Rasch, Björn


    It is now widely accepted that re-exposure to memory cues during sleep reactivates memories and can improve later recall. However, the underlying mechanisms are still unknown. As reactivation during wakefulness renders memories sensitive to updating, it remains an intriguing question whether reactivated memories during sleep also become susceptible to incorporating further information after the cue. Here we show that the memory benefits of cueing Dutch vocabulary during sleep are in fact completely blocked when memory cues are directly followed by either correct or conflicting auditory feedback, or a pure tone. In addition, immediate (but not delayed) auditory stimulation abolishes the characteristic increases in oscillatory theta and spindle activity typically associated with successful reactivation during sleep as revealed by high-density electroencephalography. We conclude that plastic processes associated with theta and spindle oscillations occurring during a sensitive period immediately after the cue are necessary for stabilizing reactivated memory traces during sleep. PMID:26507814

  19. Part-set cueing impairment & facilitation in semantic memory. (United States)

    Kelley, Matthew R; Parihar, Sushmeena A


    The present study explored the influence of part-set cues in semantic memory using tests of "free" recall, reconstruction of order, and serial recall. Nine distinct categories of information were used (e.g., Zodiac signs, Harry Potter books, Star Wars films, planets). The results showed part-set cueing impairment for all three "free" recall sets, whereas part-set cueing facilitation was evident for five of the six ordered sets. Generally, the present results parallel those often observed across episodic tasks, which could indicate that similar mechanisms contribute to part-set cueing effects in both episodic and semantic memory. A novel anchoring explanation of part-set cueing facilitation in order and spatial tasks is provided.

  20. Cue integration and the perception of action in intentional binding

    DEFF Research Database (Denmark)

    Wolpe, Noham; Haggard, Patrick; Siebner, Hartwig R


    , further analyses showed that cue integration accounted for changes in action binding, but not tone binding. These findings establish a role for cue integration in action binding and support the growing evidence suggesting that action and tone binding are, at least in part, driven by distinct mechanisms....... that binding results from cue integration, in which a voluntary action provides information about the timing of its consequences or vice versa. The perception of the timing of either event is then a weighted average, determined according to the reliability of each of these two cues. Here we tested...... the contribution of cue integration to the perception of action and its sensory effect in binding, that is, action and tone binding, by manipulating the sensory reliability of the outcome tone. As predicted, when tone reliability was reduced, action binding was diminished and tone binding was increased. However...

  1. Reading emotion cues: social communication difficulties in pediatric populations. (United States)

    Timler, Geralyn R


    Speech-language pathologists frequently address social communication difficulties in children with diverse linguistic profiles. Of consequence to effective management of social communication skills is that some children with language disorders may also have difficulty understanding emotional cues. The ability to recognize and comprehend the emotional meaning of messages is accomplished through integration of linguistic cues (e.g., what the speaker says), nonlinguistic cues (e.g., the speaker's facial expressions), and situational cues (e.g., predicting how the speaker is likely to feel about the particular topic). This article explores children's comprehension of emotion as expressed through facial expressions and situational cues. First, development of emotion comprehension in children with normal development is summarized. This is followed by a brief review of studies investigating emotion comprehension in clinical populations. Suggestions for assessment and intervention of children's emotion comprehension skills are presented.

  2. Distinguishing Reconfiguration and Compound-cue Retrieval in Task Switching

    Directory of Open Access Journals (Sweden)

    Gordon D Logan


    Full Text Available Many researchers claim that task switching requires reconfiguration of the cognitive system. Others claim that task switching involves cue-based memory retrieval processes and not reconfiguration. We evaluate these competing claims by developing both reconfiguration and cue-based memory models in a common theoretical framework and by fitting the models to' target functions', which show how performance on individual target stimuli varies depending on the task subjects perform on the targets. Our analyses show that the process of compound-cue retrieval – using the task cue and the target as joint retrieval cues to select a response from memory – is sufficient to explain target functions for parity and magnitude judgments of digits and that reconfiguration does not seem to add anything to the explanation. We address the generality of this conclusion and speculate about the conditions under which reconfiguration may be necessary for task switching.

  3. Auditory feedback blocks memory benefits of cueing during sleep. (United States)

    Schreiner, Thomas; Lehmann, Mick; Rasch, Björn


    It is now widely accepted that re-exposure to memory cues during sleep reactivates memories and can improve later recall. However, the underlying mechanisms are still unknown. As reactivation during wakefulness renders memories sensitive to updating, it remains an intriguing question whether reactivated memories during sleep also become susceptible to incorporating further information after the cue. Here we show that the memory benefits of cueing Dutch vocabulary during sleep are in fact completely blocked when memory cues are directly followed by either correct or conflicting auditory feedback, or a pure tone. In addition, immediate (but not delayed) auditory stimulation abolishes the characteristic increases in oscillatory theta and spindle activity typically associated with successful reactivation during sleep as revealed by high-density electroencephalography. We conclude that plastic processes associated with theta and spindle oscillations occurring during a sensitive period immediately after the cue are necessary for stabilizing reactivated memory traces during sleep.

  4. Winning Faces Vary by Ideology: How Nonverbal Source Cues Influence Election and Communication Success in Politics

    DEFF Research Database (Denmark)

    Laustsen, Lasse; Petersen, Michael Bang


    Not just the content of a communication but also the source of the communication shapes its persuasiveness. Recent research in political communication suggests that important source cues are nonverbal and relate to the physical traits of the source such that attractive- and competent......-looking sources have better success in attracting votes and policy support. Yet, are all nonverbal source cues similarly received irrespective of audience, or does their reception vary across audiences? Specifically, we ask whether some physical traits are received positively by some audiences but backfire...... for others. Utilizing research on ideological stereotypes and the determinants of facial preferences, we focus on the relationship between the facial dominance of the source and the ideology of the receiver. Across five studies, we demonstrate that a dominant face is a winning face when the audience...

  5. Acoustic cue selection and discrimination under degradation: differential contributions of the inferior parietal and posterior temporal cortices. (United States)

    Scharinger, Mathias; Henry, Molly J; Obleser, Jonas


    Auditory categorization is a vital skill for perceiving the acoustic environment. Categorization depends on the discriminability of the sensory input as well as on the ability of the listener to adaptively make use of the relevant features of the sound. Previous studies on categorization have focused either on speech sounds when studying discriminability or on visual stimuli when assessing optimal cue utilization. Here, by contrast, we examined neural sensitivity to stimulus discriminability and optimal cue utilization when categorizing novel, non-speech auditory stimuli not affected by long-term familiarity. In a functional magnetic resonance imaging (fMRI) experiment, listeners categorized sounds from two category distributions, differing along two acoustic dimensions: spectral shape and duration. By introducing spectral degradation after the first half of the experiment, we manipulated both stimulus discriminability and the relative informativeness of acoustic cues. Degradation caused an overall decrease in discriminability based on spectral shape, and therefore enhanced the informativeness of duration. A relative increase in duration-cue utilization was accompanied by increased activity in left parietal cortex. Further, discriminability modulated right planum temporale activity to a higher degree when stimuli were spectrally degraded than when they were not. These findings provide support for separable contributions of parietal and posterior temporal areas to perceptual categorization. The parietal cortex seems to support the selective utilization of informative stimulus cues, while the posterior superior temporal cortex as a primarily auditory brain area supports discriminability particularly under acoustic degradation. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria

    Directory of Open Access Journals (Sweden)

    Bonet M


    Full Text Available Objective: The aims of this study were to identify potentially inappropriate prescribing using the Beers and STOPP criteria. The START criteria were applied to detect prescription omission in the geriatric population. We compared the utility of these criteria in institutionalised older people.Methods: Descriptive study reviewing the medication and clinical records of 81 residents (aged 65 years and more by pharmacists in a nursing home in the Lleida region (Spain.Results: The mean patients’ age was 84 (SD=8 years, with an average of 5 drugs per resident (total prescriptions: 416 medicines. The Beers criteria identified potentially inappropriate medication use in 25% of patients and 48% of patients used at least 1 inappropriate medication according to STOPP criteria. The most frequent potentially inappropriate medications for both criteria were long-acting benzodiazepines and NSAIDs. START detected 58 potential prescribing omissions in 44% of patients. Calcium-vitamin D supplementation in osteoporosis was the most frequent rule (15%, but omissions corresponding to the cardiovascular system implied 23% of patients.Conclusion: The STOPP-START criteria reveal that potentially inappropriate prescribing (PIP is a highly prevalent problem among Spanish nursing home residents, and a statistically significant positive correlation was found between the number of medicines prescribed and the number of PIP detected in this study. The STOPP criteria detect a larger number of PI medications in this geriatric population than the Beers criteria. The prescribing omissions detected by the START criteria are relevant and require intervention. Pharmacists’ review of medications may help identify potentially inappropriate prescribing and, through an interdisciplinary approach, working with physicians may improve prescribing practices among geriatric residents of nursing homes.

  7. Two faces of anonymity : Paradoxical effects of cues to identity in CMC

    NARCIS (Netherlands)

    Tanis, M; Postmes, T.

    This paper presents two experimental studies investigating the effects of presenting cues that provide information about the interactors - called cues to identity - in computer mediated communications (CMCs). Study I shows that even though cues to identity affected interpersonal evaluations, in

  8. Two faces of anonymity: Paradoxical effects of cues to identity in CMC

    NARCIS (Netherlands)

    Tanis, M.A.; Postmes, T.


    This paper presents two experimental studies investigating the effects of presenting cues that provide information about the interactors - called cues to identity - in computer mediated communications (CMCs). Study 1 shows that even though cues to identity affected interpersonal evaluations, in

  9. Differential Contributions of Nucleus Accumbens Subregions to Cue-Guided Risk/Reward Decision Making and Implementation of Conditional Rules. (United States)

    Floresco, Stan B; Montes, David R; Tse, Maric M T; van Holstein, Mieke


    The nucleus accumbens (NAc) is a key node within corticolimbic circuitry for guiding action selection and cost/benefit decision making in situations involving reward uncertainty. Preclinical studies have typically assessed risk/reward decision making using assays where decisions are guided by internally generated representations of choice-outcome contingencies. Yet, real-life decisions are often influenced by external stimuli that inform about likelihoods of obtaining rewards. How different subregions of the NAc mediate decision making in such situations is unclear. Here, we used a novel assay colloquially termed the "Blackjack" task that models these types of situations. Male Long-Evans rats were trained to choose between one lever that always delivered a one-pellet reward and another that delivered four pellets with different probabilities [either 50% (good-odds) or 12.5% (poor-odds)], which were signaled by one of two auditory cues. Under control conditions, rats selected the large/risky option more often on good-odds versus poor-odds trials. Inactivation of the NAc core caused indiscriminate choice patterns. In contrast, NAc shell inactivation increased risky choice, more prominently on poor-odds trials. Additional experiments revealed that both subregions contribute to auditory conditional discrimination. NAc core or shell inactivation reduced Pavlovian approach elicited by an auditory CS+, yet shell inactivation also increased responding during presentation of a CS-. These data highlight distinct contributions for NAc subregions in decision making and reward seeking guided by discriminative stimuli. The core is crucial for implementation of conditional rules, whereas the shell refines reward seeking by mitigating the allure of larger, unlikely rewards and reducing expression of inappropriate or non-rewarded actions. SIGNIFICANCE STATEMENT Using external cues to guide decision making is crucial for adaptive behavior. Deficits in cue-guided behavior have been

  10. A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior. (United States)

    Davis, Tonya N; Machalicek, Wendy; Scalzo, Rachel; Kobylecky, Alicia; Campbell, Vincent; Pinkelman, Sarah; Chan, Jeffrey Michael; Sigafoos, Jeff


    Some individuals with developmental disabilities develop inappropriate sexual behaviors such as public masturbation, disrobing, and touching others in an unwanted sexual manner. Such acts are problematic given the taboo nature of the behaviors and the potential for significant negative consequences, such as restricted community access, injury, and legal ramifications. Therefore, it is necessary to equip caregivers and practitioners with effective treatment options. The purpose of this paper is to review studies that have evaluated behavioral treatments to reduce inappropriate sexual behavior in persons with developmental disabilities. The strengths and weaknesses of each treatment are reviewed, and a model for treatment selection is provided.

  11. Examining the relationship between cue-induced craving and actual smoking


    Conklin, Cynthia A.; Vella, Elizabeth J.; Joyce, Christopher J.; Salkeld, Ronald P.; Perkins, Kenneth A.; Parzynski, Craig


    Smoking cue reactivity studies have consistently demonstrated heightened self-report craving, as well as moderate autonomic reactivity, among smokers exposed to salient drug-related cues. However, significantly fewer studies have examined whether exposure to smoking cues affects smokers’ actual smoking, or examined the predictive relationship between cue-induced craving and smoking behavior. Using our well-tested pictorial cues in a cue-reactivity paradigm, we investigated the impact of smoki...

  12. Multimodal Cues in the Socialization of Joint Attention in Young Children with Varying Degrees of Vision: Getting the POINT Even When You Can't See It (United States)

    Rickard, Carolyn


    Research on joint attention and language learning has focused primarily on cues requiring visual access. However, this narrow focus cannot account for the emergence of language among some congenitally blind children who develop language on the same developmental timescale as their sighted peers. Findings from this longitudinal, retrospective study…

  13. Drinkers’ memory bias for alcohol picture cues in explicit and implicit memory tasks (United States)

    Nguyen-Louie, Tam T.; Buckman, Jennifer F.; Ray, Suchismita


    Background Alcohol cues can bias attention and elicit emotional reactions, especially in drinkers. Yet, little is known about how alcohol cues affect explicit and implicit memory processes, and how memory for alcohol cues is affected by acute alcohol intoxication. Methods Young adult participants (N=161) were randomly assigned to alcohol, placebo, or control beverage conditions. Following beverage consumption, they were shown neutral, emotional and alcohol-related pictures cues. Participants then completed free recall and repetition priming tasks to test explicit and implicit memory, respectively, for picture cues. Average blood alcohol concentration for the alcohol group was 74 ± 13 mg/dl when memory testing began. Two mixed linear model analyses were conducted to examine the effects of beverage condition, picture cue type, and their interaction on explicit and implicit memory. Results Picture cue type and beverage condition each significantly affected explicit recall of picture cues, whereas only picture cue type significantly influenced repetition priming. Individuals in the alcohol condition recalled significantly fewer pictures than those in other conditions, regardless of cue type. Both free recall and repetition priming were greater for emotional and alcohol-related cues compared to neutral picture cues. No interaction effects were detected. Conclusions Young adult drinkers showed enhanced explicit and implicit memory processing of alcohol cues compared to emotionally neutral cues. This enhanced processing for alcohol cues was on par with that seen for positive emotional cues. Acute alcohol intoxication did not alter this preferential memory processing for alcohol cues over neutral cues. PMID:26811126

  14. Drinkers' memory bias for alcohol picture cues in explicit and implicit memory tasks. (United States)

    Nguyen-Louie, Tam T; Buckman, Jennifer F; Ray, Suchismita; Bates, Marsha E


    Alcohol cues can bias attention and elicit emotional reactions, especially in drinkers. Yet, little is known about how alcohol cues affect explicit and implicit memory processes, and how memory for alcohol cues is affected by acute alcohol intoxication. Young adult participants (N=161) were randomly assigned to alcohol, placebo, or control beverage conditions. Following beverage consumption, they were shown neutral, emotional and alcohol-related pictures cues. Participants then completed free recall and repetition priming tasks to test explicit and implicit memory, respectively, for picture cues. Average blood alcohol concentration for the alcohol group was 74±13mg/dl when memory testing began. Two mixed linear model analyses were conducted to examine the effects of beverage condition, picture cue type, and their interaction on explicit and implicit memory. Picture cue type and beverage condition each significantly affected explicit recall of picture cues, whereas only picture cue type significantly influenced repetition priming. Individuals in the alcohol condition recalled significantly fewer pictures than those in other conditions, regardless of cue type. Both free recall and repetition priming were greater for emotional and alcohol-related cues compared to neutral picture cues. No interaction effects were detected. Young adult drinkers showed enhanced explicit and implicit memory processing of alcohol cues compared to emotionally neutral cues. This enhanced processing for alcohol cues was on par with that seen for positive emotional cues. Acute alcohol intoxication did not alter this preferential memory processing for alcohol cues over neutral cues. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Cues to Action as Motivators for Children's Brushing. (United States)

    Walker, Kimberly K; Steinfort, Erin L; Keyler, Maria J


    Dental caries is the most common chronic childhood disease. Home self-care procedures are the most important strategies to prevent tooth decay. Brushing is the most important single intervention for the prevention of tooth decay, yet compliance is not practiced and there is limited understanding of children's behavioral decisions. Guided by the Health Belief Model, this study consisted of eight focus groups with children in the second through fifth grades at three different socioeconomic-level school districts to determine the cues to action that are motivating or can motivate their brushing behavior. Results indicated children are primarily motivated to brush for aesthetic reasons, mainly due to viewed media pictures of "perfect" teeth. Other less commonly expressed motivations for brushing stemmed from interpersonal connections, such as relatives with dentures. Social media, on the other hand, played a key role in some children's understanding of more advanced oral health connections such as links between cardiovascular and oral disease, and smoking and oral cancer. These links were viewed as threatening to children to motivate better brushing. Additionally, the study found that home computers can be used as an external motivator to deliver tailored messages to encourage better brushing.

  16. Environmental Cues: Their Influence within Assisted Living Facilities. (United States)

    Wood-Nartker, Jeanneane; Guerin, Denise A; Beuschel, Emily


    This observational study examined the relationship between the number of environmental sensory cues within assisted living facilities (ALFs) and the number of falls by residents, using Lawton's environmental press theory as framework. A result of declining physical health is unintentional injury, for example, falling, which is one of the leading causes of death for older adults. Physical limitations increase largely due to age-related physical and sensory decline, which can increase the risk of people falling. Therefore, fall prevention becomes essential (Willis, 2000). On-site interviews were scheduled with 140 ALF directors located in the lower peninsula of Michigan. The researchers collected physical environmental data using a sensory cue checklist on a subset of rooms, for example, Lounge/Living Room, Dining Room, Corridor, Public Restroom, and Foyers in ALFs, because of the prevalence of falls within these rooms. Findings showed that fall rates and environmental cues sometimes have a negative correlation. A positive correlation was found between the number of residents living in an ALF and the mean number of cues included in the overall environment. Finally, there were a greater number of environmental cues incorporated when design professionals were involved. The need to control for facility size and for some room types when relating environmental cues to falls became clear. In addition, design professionals should have a thorough understanding of the nature of the facility and the need to control some factors in facilities, especially when including environmental cues. Built environment, elderly, evidence-based design, falls, safety.

  17. Role of Cigarette Sensory Cues in Modifying Puffing Topography (United States)

    Rees, Vaughan W.; Kreslake, Jennifer M.; Wayne, Geoffrey Ferris; O Connor, Richard J.; Cummings, K. Michael; Connolly, Gregory N.


    Background Human puffing topography promotes tobacco dependence by ensuring nicotine delivery, but the factors that determine puffing behavior are not well explained by existing models. Chemosensory cues generated by variations in cigarette product design features may serve as conditioned cues to allow the smoker to optimize nicotine delivery by adjusting puffing topography. Internal tobacco industry research documents were reviewed to understand the influence of sensory cues on puffing topography, and to examine how the tobacco industry has designed cigarettes, including modified risk tobacco products (MRTPs), to enhance puffing behavior to optimize nicotine delivery and product acceptability. Methods Relevant internal tobacco industry documents were identified using systematic searching with key search terms and phrases, and then snowball sampling method was applied to establish further search terms. Results Modern cigarettes are designed by cigarette manufacturers to provide sensory characteristics that not only maintain appeal, but provide cues which inform puffing intensity. Alterations in the chemosensory cues provided in tobacco smoke play an important role in modifying smoking behavior independently of the central effects of nicotine. Conclusions An associative learning model is proposed to explain the influence of chemosensory cues on variation in puffing topography. These cues are delivered via tobacco smoke and are moderated by design features and additives used in cigarettes. The implications for regulation of design features of modified risk tobacco products, which may act to promote intensive puffing while lowering risk perceptions, are discussed. PMID:22365895

  18. Hierarchical acquisition of visual specificity in spatial contextual cueing. (United States)

    Lie, Kin-Pou


    Spatial contextual cueing refers to visual search performance's being improved when invariant associations between target locations and distractor spatial configurations are learned incidentally. Using the instance theory of automatization and the reverse hierarchy theory of visual perceptual learning, this study explores the acquisition of visual specificity in spatial contextual cueing. Two experiments in which detailed visual features were irrelevant for distinguishing between spatial contexts found that spatial contextual cueing was visually generic in difficult trials when the trials were not preceded by easy trials (Experiment 1) but that spatial contextual cueing progressed to visual specificity when difficult trials were preceded by easy trials (Experiment 2). These findings support reverse hierarchy theory, which predicts that even when detailed visual features are irrelevant for distinguishing between spatial contexts, spatial contextual cueing can progress to visual specificity if the stimuli remain constant, the task is difficult, and difficult trials are preceded by easy trials. However, these findings are inconsistent with instance theory, which predicts that when detailed visual features are irrelevant for distinguishing between spatial contexts, spatial contextual cueing will not progress to visual specificity. This study concludes that the acquisition of visual specificity in spatial contextual cueing is more plausibly hierarchical, rather than instance-based.

  19. Familiar units prevail over statistical cues in word segmentation. (United States)

    Poulin-Charronnat, Bénédicte; Perruchet, Pierre; Tillmann, Barbara; Peereman, Ronald


    In language acquisition research, the prevailing position is that listeners exploit statistical cues, in particular transitional probabilities between syllables, to discover words of a language. However, other cues are also involved in word discovery. Assessing the weight learners give to these different cues leads to a better understanding of the processes underlying speech segmentation. The present study evaluated whether adult learners preferentially used known units or statistical cues for segmenting continuous speech. Before the exposure phase, participants were familiarized with part-words of a three-word artificial language. This design allowed the dissociation of the influence of statistical cues and familiar units, with statistical cues favoring word segmentation and familiar units favoring (nonoptimal) part-word segmentation. In Experiment 1, performance in a two-alternative forced choice (2AFC) task between words and part-words revealed part-word segmentation (even though part-words were less cohesive in terms of transitional probabilities and less frequent than words). By contrast, an unfamiliarized group exhibited word segmentation, as usually observed in standard conditions. Experiment 2 used a syllable-detection task to remove the likely contamination of performance by memory and strategy effects in the 2AFC task. Overall, the results suggest that familiar units overrode statistical cues, ultimately questioning the need for computation mechanisms of transitional probabilities (TPs) in natural language speech segmentation.

  20. Processing of Horizontal Sound Localization Cues in Newborn Infants. (United States)

    Németh, Renáta; Háden, Gábor P; Török, Miklós; Winkler, István


    By measuring event-related brain potentials (ERPs), the authors tested the sensitivity of the newborn auditory cortex to sound lateralization and to the most common cues of horizontal sound localization. Sixty-eight healthy full-term newborn infants were presented with auditory oddball sequences composed of frequent and rare noise segments in four experimental conditions. The authors tested in them the detection of deviations in the primary cues of sound lateralization (interaural time and level difference) and in actual sound source location (free-field and monaural sound presentation). ERP correlates of deviance detection were measured in two time windows. Deviations in both primary sound localization cues and the ear of stimulation elicited a significant ERP difference in the early (90 to 140 msec) time window. Deviance in actual sound source location (the free-field condition) elicited a significant response in the late (290 to 340 msec) time window. The early differential response may indicate the detection of a change in the respective auditory features. The authors suggest that the late differential response, which was only elicited by actual sound source location deviation, reflects the detection of location deviance integrating the various cues of sound source location. Although the results suggest that all of the tested binaural cues are processed by the neonatal auditory cortex, utilizing the cues for locating sound sources of these cues may require maturation and learning.

  1. Processing of Lexical-Stress Cues by Young Children (United States)

    Quam, Carolyn; Swingley, Daniel


    Though infants learn an impressive amount about their native-language phonological system by the end of the first year of life, after the first year children still have much to learn about how acoustic dimensions cue linguistic categories in fluent speech. The present study investigates what children have learned about how the acoustic dimension of pitch indicates the location of the stressed syllable in familiar words. Preschoolers (2.5–5 years) and adults were tested on their ability to use lexical-stress cues to identify familiar words. Both age groups saw pictures of a bunny and a banana, and heard versions of “bunny” and “banana” in which stress was either indicated normally with convergent cues (pitch, duration, amplitude, and vowel quality), or was manipulated such that only pitch differentiated the words’ initial syllables. Adults (n=48) used both the convergent cues, and the isolated pitch cue, to identify the target words as they unfolded. Children (n=206) used the convergent stress cues, but not pitch alone, in identifying words. We discuss potential reasons for children’s difficulty exploiting isolated pitch cues to stress, despite children’s early sensitivity to pitch in language (e.g., Fernald, 1992). These findings contribute to a view in which phonological development progresses toward the adult state well past infancy. PMID:24705094

  2. A magnetorheological haptic cue accelerator for manual transmission vehicles

    International Nuclear Information System (INIS)

    Han, Young-Min; Noh, Kyung-Wook; Choi, Seung-Bok; Lee, Yang-Sub


    This paper proposes a new haptic cue function for manual transmission vehicles to achieve optimal gear shifting. This function is implemented on the accelerator pedal by utilizing a magnetorheological (MR) brake mechanism. By combining the haptic cue function with the accelerator pedal, the proposed haptic cue device can transmit the optimal moment of gear shifting for manual transmission to a driver without requiring the driver's visual attention. As a first step to achieve this goal, a MR fluid-based haptic device is devised to enable rotary motion of the accelerator pedal. Taking into account spatial limitations, the design parameters are optimally determined using finite element analysis to maximize the relative control torque. The proposed haptic cue device is then manufactured and its field-dependent torque and time response are experimentally evaluated. Then the manufactured MR haptic cue device is integrated with the accelerator pedal. A simple virtual vehicle emulating the operation of the engine of a passenger vehicle is constructed and put into communication with the haptic cue device. A feed-forward torque control algorithm for the haptic cue is formulated and control performances are experimentally evaluated and presented in the time domain

  3. A magnetorheological haptic cue accelerator for manual transmission vehicles (United States)

    Han, Young-Min; Noh, Kyung-Wook; Lee, Yang-Sub; Choi, Seung-Bok


    This paper proposes a new haptic cue function for manual transmission vehicles to achieve optimal gear shifting. This function is implemented on the accelerator pedal by utilizing a magnetorheological (MR) brake mechanism. By combining the haptic cue function with the accelerator pedal, the proposed haptic cue device can transmit the optimal moment of gear shifting for manual transmission to a driver without requiring the driver's visual attention. As a first step to achieve this goal, a MR fluid-based haptic device is devised to enable rotary motion of the accelerator pedal. Taking into account spatial limitations, the design parameters are optimally determined using finite element analysis to maximize the relative control torque. The proposed haptic cue device is then manufactured and its field-dependent torque and time response are experimentally evaluated. Then the manufactured MR haptic cue device is integrated with the accelerator pedal. A simple virtual vehicle emulating the operation of the engine of a passenger vehicle is constructed and put into communication with the haptic cue device. A feed-forward torque control algorithm for the haptic cue is formulated and control performances are experimentally evaluated and presented in the time domain.

  4. Memory for emotional picture cues during acute alcohol intoxication. (United States)

    Ray, Suchismita; Mun, Eun-Young; Buckman, Jennifer F; Udo, Tomoko; Bates, Marsha E


    Memory affects behavior by allowing events to be anticipated and goals to be planned based on previous experiences. Emotional memory, in particular, is thought to play a central role in behavior in general and in drinking behavior in particular. Alcohol intoxication has been shown to disrupt intentional, conscious memory, but not unintentional, implicit memory for neutral stimuli; however, its effects on emotional memory are not well understood. This study examined whether alcohol intoxication affected memory for emotionally valenced stimuli by testing explicit recall and implicit repetition priming of emotional picture cues. Participants were 36 young adults (21-24 years old, 16 women) who received an alcohol, placebo, or no-alcohol beverage. Both cue exposure and memory testing occurred after beverage consumption (i.e., during intoxication for the alcohol group). Alcohol intoxication impaired explicit recall of all cue types but did not impair implicit repetition priming. Emotionally negative and positive cues were more often recalled compared with neutral cues across all beverage groups, and emotionally negative cues demonstrated more priming than emotionally positive or neutral cues in all beverage groups. Alcohol intoxication disrupted effortful recall of all cues, although the relative memory advantage of emotionally valenced over-neutral stimuli remained even after drinking. The effects of alcohol on unintentional memory priming were not statistically significant, but the effects of emotionally negative cues were. Further research is needed to better understand alcohol intoxication and emotional valence effects on memory processes during implicit memory tasks and the possibility that negative mood facilitates memory priming of negative emotional stimuli.

  5. Signaling Elaboration: Combining French Gerund Clauses with Lexical Cohesion Cues

    Directory of Open Access Journals (Sweden)

    Marianne Vergez-Couret


    Full Text Available In this paper, we focus on the Elaboration relation and on its automatic identification in French, using the theoretical framework of Segmented Discourse Representation Theory (SDRT. One of the information sources identified by the SDRT framework to infer the Elaboration relation is based on the existence of a potential subsumption link between the eventualities at stake, depending on lexical semantics and world knowledge. We investigate this claim by combining a weak syntactic marker of the Elaboration relation, namely the gerund clause, with lexical cohesion cues. We aim at automatically identifying gerund clauses which are Elaborations by finding cohesive links between the host main clause and the gerund clause. This approach makes it possible to accurately detect few cases of intra-sentential Elaborations in our corpus, confirming the fact that lexical cohesion cues are relevant for this task.Dans cet article, nous nous focalisons sur la relation d’Élaboration en français, telle qu’elle est décrite dans le modèle théorique de la SDRT (Segmented Discourse Representation Theory, et sur son identification automatique. Selon la SDRT, une des sources d’information permettant d’inférer la relation d’Élaboration est basée sur l’existence d’un lien de subsomption entre les types des éventualités des segments à relier, indiquant que le type de la seconde éventualité est un sous-type de celui de la première dans la sémantique lexicale des éventualités ou grâce à des connaissances du monde. Nous proposons de contribuer à cette question en combinant un indice de la relation d’Élaboration, i. e. la construction syntaxique du gérondif, et des indices de cohésion lexicale. Notre objectif est d’identifier automatiquement des propositions gérondives qui sont des Élaborations en repérant des indices de cohésion lexicale entre la proposition principale et la proposition gérondive. Cette approche permet de d

  6. Designing auditory cues for Parkinson's disease gait rehabilitation. (United States)

    Cancela, Jorge; Moreno, Eugenio M; Arredondo, Maria T; Bonato, Paolo


    Recent works have proved that Parkinson's disease (PD) patients can be largely benefit by performing rehabilitation exercises based on audio cueing and music therapy. Specially, gait can benefit from repetitive sessions of exercises using auditory cues. Nevertheless, all the experiments are based on the use of a metronome as auditory stimuli. Within this work, Human-Computer Interaction methodologies have been used to design new cues that could benefit the long-term engagement of PD patients in these repetitive routines. The study has been also extended to commercial music and musical pieces by analyzing features and characteristics that could benefit the engagement of PD patients to rehabilitation tasks.

  7. "Normal" and "Inappropriate" Childhood Sexual Behaviours: Findings from a Delphi Study of Professionals in the United Kingdom (United States)

    Vosmer, Susanne; Hackett, Simon; Callanan, Margie


    This paper presents the results of a three-stage Delphi study examining the current level of consensus among 24 professionals in the United Kingdom regarding definitions of and distinctions between normal, inappropriate and sexually abusive behaviours in children under 10 years, as well as factors influencing their views. Although firm conclusions…

  8. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals.

    LENUS (Irish Health Repository)

    Gallagher, Paul


    Potentially inappropriate prescribing is common in older people presenting to hospital with acute illness in Ireland. The aim of this study was to determine if this phenomenon is unique to Ireland or whether it is a more widespread problem in hospitals across Europe.

  9. Teachers' Self-Reported Beliefs on Developmentally Appropriate and Inappropriate Practices in Grade K-4 EFL Classrooms (United States)

    Mede, Enisa


    This study investigated the perceived beliefs and reported practices of fourth-grade English teachers in primary (elementary) public schools in Turkey. Significantly, it aimed to examine the participating K-4 English as a foreign language (EFL) teachers' beliefs about the developmentally appropriate and inappropriate practices, discover the…

  10. Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil. (United States)

    Lucena-Silva, Norma; Assunção, Maria Elisa Lucena Sales de Melo; Ramos, Frederico Antônio Pereira; Azevedo, Fernanda; Lessa, Ronaldo; Cordeiro, Marli Tenório; Brito, Carlos Alexandre Antunes de


    The symptoms of chikungunya virus (CHIKV) infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.

  11. Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil

    Directory of Open Access Journals (Sweden)

    Norma Lucena-Silva

    Full Text Available Abstract The symptoms of chikungunya virus (CHIKV infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.

  12. Nontechnical Strategies To Reduce Children's Exposure to Inappropriate Material on the Internet. Summary of a Workshop (December 13, 2000). (United States)

    Iannotta, Joah G., Ed.

    In response to a Congressional mandate in conjunction with the Protection of Children from Sexual Predators Act of 1998, a committee of experts was formed to explore both technical and nontechnical strategies for protecting children from pornography and other inappropriate Internet content. This book summarizes a workshop held in December 2000 to…

  13. Evaluation of electrical aversion therapy for inappropriate sexual behaviour after traumatic brain injury: a single case experimental design study. (United States)

    Ter Mors, Bert Jan; van Heugten, Caroline M; van Harten, Peter N


    Inappropriate sexual behaviour after acquired brain injury is a severe complication. Evidence for effective treatment is not available. Electrical aversion therapy (EAT) is a behavioural therapeutic option used in persons with intellectual disabilities, which might be suitable for brain-injured individuals for whom other therapies are not effective. The effect of EAT in brain injury has not been investigated previously. A single case experimental design was used. In an ABBA (baseline-treatment-treatment-withdrawal) design the frequency of the target behaviour (ie, inappropriate sexual behaviour) in a 40-year-old man was measured daily. A total of 551 measurements were recorded. A significant reduction of the target behaviour was seen after the first treatment phase (baseline 12.18 (2.59) vs 3.15 (3.19) mean target behaviours daily); this reduction remained stable over time. We conclude that EAT was effective in this patient with inappropriate sexual behaviour due to severe brain injury. EAT can therefore be considered in therapy resistant inappropriate sexual behaviour in brain-injured patients.

  14. Reduction of inappropriate prescriptions and adverse effects to medications in hospitalized elderly patients

    Directory of Open Access Journals (Sweden)

    Ana Fajreldines


    Full Text Available Together, potentially inappropriate prescribing of medications (PIP and appropriate prescribing omission (APO constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE. This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment. The intervention consisted in lectures and publications on STOPP-START criteria made available to all the areas of the hospital and suggestions made by the clinical pharmacist to the physician on each individual prescription. Before intervention, PIM was 48.9% on admission and 46.1% at discharge, while after the intervention it was 47.4% on admission and 16.7% at discharge. APO was 10% on admission and 7.6% at discharge, while after intervention it was 12.2% on admission and 7.9% at discharge. ADE were 50.9% before and 34.4% after intervention. The frequency of return to emergency was 12.2% and 4.7% before and after intervention. PIM, EAM, conciliation error, clinically serious drug interaction, and delirium were reduced to statistically significant levels. In line with various international studies, the intervention showed to attain positive results.

  15. Syndrome of inappropriate antidiuretic hormone secretion induced by the phytotherapy Harpagophytum procumbers: case report

    Directory of Open Access Journals (Sweden)

    Renata Reis Carvalho

    Full Text Available Abstract Introduction: The syndrome of inappropriate antidiuretic hormone secretion (SIADH is the inability of antidiuretic hormone (ADH suppression, compromising the mechanisms of water excretion and urinary concentration. It manifests as hyponatremia and its symptoms, especially neurological. There are many causes that trigger such disease, notably: central nervous system disorders, malignant neoplasm, drugs and others. Case Report: A 65 years female hypertensive patient presented clinical and laboratory manifestations of hyponatremia due to SIADH. It happened twice under use of herbal medication for osteoarthritis treatment. Discussion: The drug-related hyponatremia can be triggered by direct effect of the drug or by association with SIADH. The clinical manifestations presented could have been related to psychiatric condition and may have severe outcome if not properly diagnosed. The association of an herbal medicine to SIADH could be confirmed after a new episode of hyponatremia related to Harpagophytum procumbers reintroduction. Our literature review did not find this herbal medicine associated with SIADH, so far. Conclusion: SIADH may be caused by herbal medicine described from now on their association in the literature.

  16. [Potentially inappropriate prescribing in older Spanish population according to STOPP/START criteria (STARTREC study)]. (United States)

    Cruz-Esteve, Inés; Marsal-Mora, Josep Ramón; Galindo-Ortego, Gisela; Galván-Santiago, Leonardo; Serrano-Godoy, Marcos; Ribes-Murillo, Esther; Real-Gatius, Jordi


    Rational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases. Cross-sectional population study. Primary Care, Lleida Health Region, Spain. 45.408 patients 70 years old and over, attended in the primary health care centers at least once the last year. 43 STOPP and 12 START criteria are applied to their 2012 clinical and prescription records. Logistic regression models are adjusted to determine PIP association with several factors. 45,408 patients are included. The mean age is 79.7 years, 58% being female. The overall prevalence of PPI is 58.1%. According to STOPP, the most common drugs identified are benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors; according to START, osteoporosis treatments, antiplatelet agents, statins, metformin and beta blockers. PIP increases with age and polypharmacy and it is higher in long-term care facilities residents and patients receiving home health care. In our Health Region, at least 50% of the population aged 70 or older has one or more PIP, according to STOPP/START criteria. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  17. Inappropriate Use of Psychotropic Drugs in People Aged 60 and over

    Directory of Open Access Journals (Sweden)

    María Magdalena Caro Mantilla


    Full Text Available Background: indiscriminate use of psychoactive medication can provoke multiple disorders to the elderly system. Furthermore, it can also result in drug abuse. Objective: to characterize the inappropriate use of psychotropic drugs in people aged 60 and over. Methods: a descriptive, cross-sectional and prospective study was conducted in two consultations of Health Area # II in the municipality of Cienfuegos from June to December 2006. The sample consisted of 93 adults aged over 60. The variables analyzed were age, sex, educational level, prescribed medication and its application, symptoms leading to the indication, duration of the treatment according to the prescription, follow-up, therapeutic alternatives, tolerance and abstinence. We applied a functional assessment scale: the Lawton and Brody Scale. For the statistical processing, descriptive statistics tests were performed. For computational processing, a database was created in the SPSS 11.0 program for Windows. Results: it is mostly women who consume these types of drugs. The most consumed psychoactive drugs were benzodiazepines and mainly through self-medication. Elderly presented tolerance and abstinence. There was a misuse of these drugs in relation to the time of consumption, prescription, follow-up and treatment options such as natural and traditional medicine. Conclusions: high rates of medical prescription, failures in patient’s follow-up, self-medication and non-use of therapeutic alternatives are some of the many causes of the indiscriminate use of psychoactive drugs in people aged over 60.

  18. Paliperidone Inducing Concomitantly Syndrome of Inappropriate Antidiuretic Hormone, Neuroleptic Malignant Syndrome, and Rhabdomyolysis

    Directory of Open Access Journals (Sweden)

    Jaspinder Kaur


    Full Text Available Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH, neuroleptic malignant syndrome (NMS, and rhabdomyolysis are the uncommon side effects of psychotropic drugs. We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline. On the third day, he developed high grade fever and severe muscle rigidity with raised creatine phosphokinase (CPK and liver enzymes levels. He was treated with dantrolene 100 mg, bromocriptine 2.5 mg, and lorazepam 2 mg. Our patient required management of the three rare conditions following treatment with paliperidone. This case highlights the need for health care providers to be aware of the rare, potentially life threatening but preventable hyponatremia, NMS, and rhabdomyolysis as a possible adverse effect of paliperidone.

  19. Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children’s Nursing Teams

    Directory of Open Access Journals (Sweden)

    Kyle Richard G


    Full Text Available Abstract Background Children’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs. Methods Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs, consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8. Results Five facilitators were identified: 1 CCN/CCNT visibility; 2 clear clinical governance procedures; 3 financial and organisational investment in the role of CCNTs in acute care pathways; 4 access and out of hours availability; 5 facilitative financial frameworks. Conclusion GPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.

  20. Adult female with symptomatic AVPR2-related nephrogenic syndrome of inappropriate antidiuresis (NSIAD

    Directory of Open Access Journals (Sweden)

    Jennifer Hague


    Full Text Available Activating mutations in AVPR2 are associated with nephrogenic syndrome of inappropriate antidiuresis (NSIAD. NSIAD causes hyponatremia, decreased serum osmolality and clinical symptoms, which may present from birth or in infancy and include hypotonia, irritability, vomiting and/or seizures. Symptoms in later life are often less specific and include malaise, dizziness, confusion, tiredness and headache. NSIAD is a rare X-linked condition, which is associated with a variable phenotype in males, of whom some present in infancy but others do not become symptomatic until adulthood, or occasionally, never. Female carriers may present with episodes of hyponatremia, usually found incidentally. Literature in this field is limited; namely, two clinical reports describing a female proband, both diagnosed in infancy. We describe, for the first time, the case of an adult female proband with NSIAD, who had longstanding associated symptoms of tiredness, headache, temporary memory loss and mood changes as well as hyponatremia and decreased serum osmolality. A water load test demonstrated an inability to dilute urine and gene sequencing confirmed a recurrent activating mutation in AVPR2. The variant was inherited from the proband’s mother who had had longstanding episodes of transient asymptomatic hyponatremia. This is the third report of a female proband with NSIAD and is the first female reported who sought medical treatment for chronic symptoms from adulthood. This case acts as a reminder of the importance of considering NSIAD as a diagnosis in females of all ages with unexplained hyponatremia.

  1. Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases. (United States)

    Pérez-Jover, Virtudes; Mira, José J; Carratala-Munuera, Concepción; Gil-Guillen, Vicente F; Basora, Josep; López-Pineda, Adriana; Orozco-Beltrán, Domingo


    The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological. A systematic review of articles published from January 2000 to October 2015 was performed using MEDLINE, EMBASE, PsychInfo, Scopus, The Cochrane Library, and Index Medicus databases. We selected 80 studies in order to analyse the content that addressed the question under consideration. Our literature review found that half of patients know what their prescribed treatment is; that most of elderly people take five or more medications a day; that in elderly, polymedicated people, the probability of a medication error occurring is higher; that new tools have been recently developed to reduce errors; that elderly patients can understand written information but the presentation and format is an important factor; and that a high percentage of patients have remaining doubts after their visit. Thus, strategies based on the evidence should be applied in order to reduce medication errors.

  2. Proton pump inhibitors overuse: only inappropriate prescriptions or further iatrogenic damage?

    Directory of Open Access Journals (Sweden)

    Mario Visconti


    Full Text Available Proton pump inhibitors (PPIs are the most potent drugs for reducing gastric acid secretion; so, since their release in the late 1980s, they have been recommended as the first therapeutic choice for many gastroesophageal diseases, risk reduction in or healing of non-steroidal anti-inflammatory drugs-associated ulcer disease and stress ulcer prophylaxis in intensive care unit patients. Thus PPIs account for a significant proportion of pharmaceutical health-care expenditure. Much of this high expenditure results from overuse of PPIs in account of inappropriate indications or prolongation of therapies for excessive time compared to real need. PPIs overutilization occurs in all medical care settings: in the majority of hospitalized patients with low risks for gastrointestinal bleeding, in patients healed at discharge from hospital, in outpatients in ambulatory practice. However potential adverse effects associated with PPIs therapy have been described, including enteric (especially by Clostridium difficile in elderly patients and pneumonia infections, nutritional deficiencies, rebound acid hypersecretion, acute interstitial nephritis, gastric neoplasms, bone fractures. Caution is required for some coprescription, particularly with clopidogrel.

  3. [The treament of hyponatremia secundary to the syndrome of inappropriate antidiuretic hormone secretion]. (United States)

    Runkle, Isabelle; Villabona, Carles; Navarro, Andrés; Pose, Antonio; Formiga, Francesc; Tejedor, Alberto; Poch, Esteban


    The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most frequent cause of hyponatremia in a hospital setting. However, detailed protocols and algorithms for its management are lacking. Our objective was to develop 2 consensus algorithms for the therapy of hyponatremia due to SIADH in hospitalized patients. A multidisciplinary group made up of 2 endocrinologists, 2 nephrologists, 2 internists, and one hospital pharmacist held meetings over the period of a year. The group worked under the auspices of the European Hyponatremia Network and the corresponding Spanish medical societies. Therapeutic proposals were based on widely-accepted recommendations, expert opinion and consensus guidelines, as well as on the authors' personal experience. Two algorithms were developed. Algorithm 1 addresses acute correction of hyponatremia posing as a medical emergency, and is applicable to both severe euvolemic and hypovolemic hyponatremia. The mainstay of this algorithm is the iv use of 3% hypertonic saline solution. Specific infusion rates are proposed, as are steps to avoid or reverse overcorrection of serum sodium levels. Algorithm 2 is directed to the therapy of SIADH-induced mild or moderate, non-acute hyponatremia. It addresses when and how to use fluid restriction, solute, furosemide, and tolvaptan to achieve eunatremia in patients with SIADH. Two complementary strategies were elaborated to treat SIADH-induced hyponatremia in an attempt to increase awareness of its importance, simplify its therapy, and improve prognosis. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  4. Home bases formed to visual cues but not to self-movement (dead reckoning) cues in exploring hippocampectomized rats. (United States)

    Hines, Dustin J; Whishaw, Ian Q


    Spatial theory proposes that the hippocampus contributes to exploratory behavior allowing animals to acquire information about their environment. In the present study, the exploratory movements of control rats, bulbectomized (anosmic) rats and hippocampectomized rats using the neurotoxin N-methyl-D-aspartate (NMDA) were monitored on a large circular table without walls and around which visual cues were manipulated. The rats displayed organized spatial behavior in that they developed home bases, one or more places operationally defined as those in which they spent a preponderance of time, in which they moved slowly, and to which they returned after excursions. Control rats and hippocampectomized rats were similar in that they established home bases: (i) adjacent to a proximal stable or moving visual landmark; (ii) in relation to more distant visual room cues; and (iii) in relation to contextually conditioned visual cues. Nevertheless, in exploratory tests given under infrared light, a wavelength to which rats are insensitive, control rats and bulbectomized rats established one or more home bases that were not dependent upon surface (e.g. olfactory) cues, whereas home base behavior was absent/fragmented in hippocampectomized rats. Thus, exploratory behavior, as exemplified by home base behavior, is organized in control and hippocampectomized rats in relation to visual cues, but is not organized in hippocampectomized rats when visual cues are absent. This result is discussed in relation to the idea that the hippocampus contributes to spatial behavior that is dependent upon guidance (dead reckoning) derived from self-movement cues.

  5. Beyond Cue Reactivity: Non-Drug-Related Motivationally Relevant Stimuli Are Necessary to Understand Reactivity to Drug-Related Cues. (United States)

    Versace, Francesco; Engelmann, Jeffrey M; Deweese, Menton M; Robinson, Jason D; Green, Charles E; Lam, Cho Y; Minnix, Jennifer A; Karam-Hage, Maher A; Wetter, David W; Schembre, Susan M; Cinciripini, Paul M


    Neurobiological models of addiction posit that drug use can alter reward processes in two ways: (1) by increasing the motivational relevance of drugs and drug-related cues and (2) by reducing the motivational relevance of non-drug-related rewards. Here, we discuss the results from a series of neuroimaging studies in which we assessed the extent to which these hypotheses apply to nicotine dependence. In these studies, we recorded smokers’ and nonsmokers’ brain responses to a wide array of motivationally relevant visual stimuli that included pleasant, unpleasant, cigarette-related, and neutral images. Based on these findings, we highlight the flaws of the traditional cue reactivity paradigm and we conclude that responses to non-drug-related motivationally relevant stimuli should be used to appropriately gauge the motivational relevance of cigarette-related cues and to identify smokers attributing higher motivational relevance to drug-related cues than to non-drug-related rewards. Identifying these individuals is clinically relevant as they achieve lower rates of long-term smoking abstinence when attempting to quit. Finally, we show how this approach may be extended beyond nicotine dependence to inform theoretical and clinical research in the study of obesity. The cue reactivity paradigm (ie, comparing responses evoked by drug-related cues to those evoked by neutral cues) cannot provide conclusive information about the motivational relevance of drug-related cues. Responses to non-drug-related motivationally relevant stimuli should be used to appropriately gauge the level of motivational relevance that substance-dependent individuals attribute to drug-related cues. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail:

  6. Examining the relationship between cue-induced craving and actual smoking. (United States)

    Conklin, Cynthia A; Vella, Elizabeth J; Joyce, Christopher J; Salkeld, Ronald P; Perkins, Kenneth A; Parzynski, Craig S


    Smoking cue-reactivity studies have consistently demonstrated heightened self-report craving, as well as moderate autonomic reactivity, among smokers exposed to salient drug-related cues. However, significantly fewer studies have examined whether exposure to smoking cues affects smokers' actual smoking, or examined the predictive relationship between cue-induced craving and smoking behavior. Using our well-tested pictorial cues in a cue-reactivity paradigm, we investigated the impact of smoking-related cues relative to neutral cues on subjective craving and smoking behavior (assessed via CReSS; Plowshare Technologies, Baltimore, MD) measures of latency to smoke, puff volume, and number of puffs). Further, we examined the predictive value of cue-induced craving on subsequent smoking behavior. Sixty nondeprived daily smokers completed 2 experimental sessions involving exposure to either smoking-related or neutral pictorial cues. Following initial exposure to cues, smokers rated their craving and were then allowed to smoke freely if they chose to during a subsequent 6-min cue exposure period. Result showed that exposure to smoking cues relative to neutral predicted significantly greater craving and increases in smoking behavior. Likewise, the magnitude of the difference in cue-induced craving when exposed to smoking cues relative to neutral cues (i.e., the cue-reactivity effect) was highly predictive of shorter latency to smoke, as well as increased number of puffs and puff volume. (c) 2015 APA, all rights reserved).

  7. Integrating cues of social interest and voice pitch in men's preferences for women's voices. (United States)

    Jones, Benedict C; Feinberg, David R; Debruine, Lisa M; Little, Anthony C; Vukovic, Jovana


    Most previous studies of vocal attractiveness have focused on preferences for physical characteristics of voices such as pitch. Here we examine the content of vocalizations in interaction with such physical traits, finding that vocal cues of social interest modulate the strength of men's preferences for raised pitch in women's voices. Men showed stronger preferences for raised pitch when judging the voices of women who appeared interested in the listener than when judging the voices of women who appeared relatively disinterested in the listener. These findings show that voice preferences are not determined solely by physical properties of voices and that men integrate information about voice pitch and the degree of social interest expressed by women when forming voice preferences. Women's preferences for raised pitch in women's voices were not modulated by cues of social interest, suggesting that the integration of cues of social interest and voice pitch when men judge the attractiveness of women's voices may reflect adaptations that promote efficient allocation of men's mating effort.

  8. Physical violence by an intimate partner and the inappropriate use of prenatal care services among women in Northeastern Brazil. (United States)

    Carneiro, Jackelyne Faierstein; Valongueiro, Sandra; Ludermir, Ana Bernarda; Araújo, Thália Velho Barreto de


    To analyze the association between physical violence by an intimate partner (PVIP) and the inappropriate use of prenatal care services. A nested cross-sectional study was conducted with 1,026 women, based on data from a prospective cohort study designed to investigate intimate partner violence among pregnant women enrolled in the Family Health Program (PSF) in Recife, Northeastern Brazil. The use of prenatal care services was assessed with basis on the guidelines from the Program for Humanization of Prenatal Care and Childbirth (Brazilian Ministry of Health) and considered the time of the first prenatal care visit and the total number of visits during the pregnancy. Data were collected through two face-to-face interviews (one in the last pregnancy trimester and the other in the postpartum period), using standardized questionnaires and data on Pregnancy Card records. An unconditional logistic regression was performed to estimate the odds ratio (OR) and the 95% confidence intervals to measure the association between an PVIP and the inappropriate use of prenatal care services, using the stepwise method. The prevalence of the inappropriate use of prenatal care services was 44.1% and of an PVIP, 25.6%. In the logistic regression analysis, an intimatePVIP was associated with inappropriate prenatal care (OR = 1.37; 95%CI 1.01 - 1.85; p = 0.04) after adjustment by variables confirmed as confounders (parity, alcohol use in pregnancy, and education level). Women who are victims of an PVIP have more chance of receiving inappropriate prenatal care due to late onset of prenatal care, fewer prenatal care visits, or both.

  9. Health IT and inappropriate utilization of outpatient imaging: A cross-sectional study of U.S. hospitals. (United States)

    Appari, Ajit; Johnson, M Eric; Anthony, Denise L


    To determine whether the use of information technology (IT), measured by Meaningful Use capability, is associated with lower rates of inappropriate utilization of imaging services in hospital outpatient settings. A retrospective cross-sectional analysis of 3332 nonfederal U.S. hospitals using data from: Hospital Compare (2011 outpatient imaging efficiency measures), HIMSS Analytics (2009 health IT), and Health Indicator Warehouse (market characteristics). Hospitals were categorized for their health IT infrastructure including EHR Stage-1 capability, and three advanced imaging functionalities/systems including integrated picture archiving and communication system, Web-based image distribution, and clinical decision support (CDS) with physician pathways. Three imaging efficiency measures suggesting inappropriate utilization during 2011 included: percentage of "combined" (with and without contrast) computed tomography (CT) studies out of all CT studies for abdomen and chest respectively, and percentage of magnetic resonance imaging (MRI) studies of lumbar spine without antecedent conservative therapy within 60days. For each measure, three separate regression models (GLM with gamma-log link function, and denominator of imaging measure as exposure) were estimated adjusting for hospital characteristics, market characteristics, and state fixed effects. Additionally, Heckman's Inverse Mills Ratio and propensity for Stage-1 EHR capability were used to account for selection bias. We find support for association of each of the four health IT capabilities with inappropriate utilization rates of one or more imaging modality. Stage-1 EHR capability is associated with lower inappropriate utilization rates for chest CT (incidence rate ratio IRR=0.72, p-value use of Stage-1 Meaningful Use capable EHR systems along with advanced imaging related functionalities could have a beneficial impact on reducing some of the inappropriate utilization of outpatient imaging. Copyright © 2017

  10. External Retrieval Cues Facilitate Prospective Remembering in Children. (United States)

    Meacham, John A.; Colombo, John A.


    Young children exhibit improved prospective memory when an external cue is used as a reminder. Children's attempts at prospective remembering may be an important precursor to the development of strategies for retrospective remembering. (JD)

  11. Sensor Network Disposition Facing the Task of Multisensor Cross Cueing

    Directory of Open Access Journals (Sweden)

    Ce Pang


    Full Text Available In order to build the sensor network facing the task of multisensor crossing cueing, the requirements of initiating cueing and being cued are analyzed. Probability theory is used when building models, then probability of sensor cueing in the case of target moving is given, and, after that, the best distance between two sensors is calculated. The operational environment is described by normal distribution function. In the process of distributing sensor network, their elements, operational environment demand of cueing, and the probability of sensor network coverage are considered; then the optimization algorithm of sensor network based on hypothesis testing theory is made. The simulation result indicates that the algorithm can make sensor network which is required. On the basis of that, the two cases, including targets that make linear motion and orbit motion, are used to test the performance of the sensor network, which show that the sensor network can make uninterrupted detection on targets through multisensor cross cuing.

  12. Facial, Olfactory, and Vocal Cues to Female Reproductive Value

    Directory of Open Access Journals (Sweden)

    Susanne Röder


    Full Text Available Facial, olfactory, and vocal cues may advertise women's fertility. However, most of the evidence for this proposal has come from studies of changes in young adult women's attractiveness over the menstrual cycle. By contrast with this emphasis on changes in attractiveness over the menstrual cycle, possible changes in women's attractiveness over their lifespan have received little attention. The present study investigated men's ratings of young girls' (11–15 years old, adult women's (19–30 years old and circum-menopausal women's (50–65 years old facial, body odor, and vocal attractiveness and femininity. Faces and voices, but not body odors, of young girls and adult women were perceived to be significantly more attractive and feminine than those of circum-menopausal women. These data suggest that facial and vocal cues may be cues to women's reproductive value, but that body odor cues do not necessarily advertise this information.

  13. Modeling the Effects of Attentional Cueing on Meditators

    NARCIS (Netherlands)

    van Vugt, Marieke K.; van den Hurk, Paul M.


    Training in meditation has been shown to affect functioning of several attentional subsystems, most prominently conflict monitoring, and to some extent orienting. These previous findings described the effects of cueing and manipulating stimulus congruency on response times and accuracies. However,

  14. Norwegian Retroflexion − Licensing by Cue or Prosody?

    Directory of Open Access Journals (Sweden)

    Silke Hamann


    Full Text Available This article deals with the class of retroflex segments in Norwegian. The question is handled whether the phonotactic restrictions on retroflexes to occur mainly only in coda position cannot be better described in terms of the availability of the retroflex cues in post-vocalic position instead of refering to their syllable-position. The latter approach, the so-called prosodic licensing (Lombardi 1995, is shown to be insufficient in cases of retroflexion across word-boundaries, where retroflexes appear in onset-position. The so-called lincensing by cue-approach (Steriade 1995, on the other hand, is shown to be able to cover all the instances of retroflex occurrences: retroflexes in Norwegian occur only when a vowel precedes, which enhances their strong transitional cues from vowel to retroflex. In addition to this, licensing by cue can account for the progressive assimilation of retroflexion also found in Norwegian.

  15. Memory for incidentally perceived social cues: Effects on person judgment. (United States)

    Pawling, Ralph; Kirkham, Alexander J; Tipper, Steven P; Over, Harriet


    Dynamic face cues can be very salient, as when observing sudden shifts of gaze to a new location, or a change of expression from happy to angry. These highly salient social cues influence judgments of another person during the course of an interaction. However, other dynamic cues, such as pupil dilation, are much more subtle, affecting judgments of another person even without awareness. We asked whether such subtle, incidentally perceived, dynamic cues could be encoded in to memory and retrieved at a later time. The current study demonstrates that in some circumstances changes in pupil size in another person are indeed encoded into memory and influence judgments of that individual at a later time. Furthermore, these judgments interact with the perceived trustworthiness of the individual and the nature of the social context. The effect is somewhat variable, however, possibly reflecting individual differences and the inherent ambiguity of pupil dilation/constriction. © 2016 The British Psychological Society.

  16. Determination of the Trainability of Deception Detection Cues

    National Research Council Canada - National Science Library

    Ford, Christopher


    .... Therefore, it is important that our leaders be able to recognize if they are being deceived. This study examines the results of training five categories of deception cues to 190 Air Force Officers...

  17. Herc SAR Task 112: AIMSsim Visual Target Identification Cues

    National Research Council Canada - National Science Library

    Schoenborn, Oliver; Bahramifarid, Nima


    .... Three types of cues were added: bounding box, image overlay, and inverted color in such a way that the new functionality could be integrated to the main development branch of the system and support extendibility...

  18. Floral humidity as a reliable sensory cue for profitability assessment by nectar-foraging hawkmoths (United States)

    von Arx, Martin; Goyret, Joaquín; Davidowitz, Goggy; Raguso, Robert A.


    Most research on plant–pollinator communication has focused on sensory and behavioral responses to relatively static cues. Floral rewards such as nectar, however, are dynamic, and foraging animals will increase their energetic profit if they can make use of floral cues that more accurately indicate nectar availability. Here we document such a cue—transient humidity gradients—using the night blooming flowers of Oenothera cespitosa (Onagraceae). The headspace of newly opened flowers reaches levels of about 4% above ambient relative humidity due to additive evapotranspirational water loss through petals and water-saturated air from the nectar tube. Floral humidity plumes differ from ambient levels only during the first 30 min after anthesis (before nectar is depleted in wild populations), whereas other floral traits (scent, shape, and color) persist for 12–24 h. Manipulative experiments indicated that floral humidity gradients are mechanistically linked to nectar volume and therefore contain information about energy rewards to floral visitors. Behavioral assays with Hyles lineata (Sphingidae) and artificial flowers with appropriate humidity gradients suggest that these hawkmoth pollinators distinguish between subtle differences in relative humidity when other floral cues are held constant. Moths consistently approached and probed flowers with elevated humidity over those with ambient humidity levels. Because floral humidity gradients are largely produced by the evaporation of nectar itself, they represent condition-informative cues that facilitate remote sensing of floral profitability by discriminating foragers. In a xeric environment, this level of honest communication should be adaptive when plant reproductive success is pollinator limited, due to intense competition for the attention of a specialized pollinator. PMID:22645365

  19. The prelimbic cortex uses higher-order cues to modulate both the acquisition and expression of conditioned fear.

    Directory of Open Access Journals (Sweden)

    Melissa Judith Sharpe


    Full Text Available The prelimbic (PL cortex allows rodents to adapt their responding under changing experimental circumstances. In line with this, the PL cortex has been implicated in strategy set shifting, attentional set shifting, the resolution of response conflict, and the modulation of attention towards predictive stimuli. One interpretation of this research is that the PL cortex is involved in using information garnered from higher-order cues in the environment to modulate how an animal responds to environmental stimuli. However, data supporting this view of PL function in the aversive domain are lacking. In the following experiments, we attempted to answer two questions. Firstly, we wanted to investigate whether the role of the PL cortex in using higher-order cues to influence responding generalizes across appetitive and aversive domains. Secondly, as much of the research has focused on a role for the PL cortex in performance, we wanted to assess whether this region is also involved in the acquisition of hierarchal associations which facilitate an ability to use higher-order cues to modulate responding. In order to answer these questions, we assessed the impact of PL inactivation during both the acquisition and expression of a contextual bi-conditional discrimination. A contextual bi-conditional discrimination involves presenting two stimuli. In one context, one stimulus is paired with shock while the other is presented without shock. In another context, these contingencies are reversed. Thus, animals have to use the present contextual cues to disambiguate the significance of the stimulus and respond appropriately. We found that PL inactivation disrupted both the encoding and expression of these context-dependent associations. This supports a role for the PL cortex in allowing higher-order cues to modulate both learning about, and responding towards, different cues. We discuss these findings in the broader context of functioning in the medial prefrontal

  20. Mechanisms of Choice Behavior Shift Using Cue-approach Training


    Bakkour, Akram; Leuker, Christina; Hover, Ashleigh M.; Giles, Nathan; Poldrack, Russell A.; Schonberg, Tom


    Cue-approach training has been shown to effectively shift choices for snack food items by associating a cued button-press motor response to particular food items. Furthermore, attention was biased toward previously cued items, even when the cued item is not chosen for real consumption during a choice phase. However, the exact mechanism by which preferences shift during cue-approach training is not entirely clear. In three experiments, we shed light on the possible underlying mechanisms at pla...

  1. Augmented Reality Cues and Elderly Driver Hazard Perception (United States)

    Schall, Mark C.; Rusch, Michelle L.; Lee, John D.; Dawson, Jeffrey D.; Thomas, Geb; Aksan, Nazan; Rizzo, Matthew


    Objective Evaluate the effectiveness of augmented reality (AR) cues in improving driving safety in elderly drivers who are at increased crash risk due to cognitive impairments. Background Cognitively challenging driving environments pose a particular crash risk for elderly drivers. AR cueing is a promising technology to mitigate risk by directing driver attention to roadway hazards. This study investigates whether AR cues improve or interfere with hazard perception in elderly drivers with age-related cognitive decline. Methods Twenty elderly (Mean= 73 years, SD= 5 years), licensed drivers with a range of cognitive abilities measured by a speed of processing (SOP) composite participated in a one-hour drive in an interactive, fixed-base driving simulator. Each participant drove through six, straight, six-mile-long rural roadway scenarios following a lead vehicle. AR cues directed attention to potential roadside hazards in three of the scenarios, and the other three were uncued (baseline) drives. Effects of AR cueing were evaluated with respect to: 1) detection of hazardous target objects, 2) interference with detecting nonhazardous secondary objects, and 3) impairment in maintaining safe distance behind a lead vehicle. Results AR cueing improved the detection of hazardous target objects of low visibility. AR cues did not interfere with detection of nonhazardous secondary objects and did not impair ability to maintain safe distance behind a lead vehicle. SOP capacity did not moderate those effects. Conclusion AR cues show promise for improving elderly driver safety by increasing hazard detection likelihood without interfering with other driving tasks such as maintaining safe headway. PMID:23829037

  2. Deceptive body movements reverse spatial cueing in soccer.

    Directory of Open Access Journals (Sweden)

    Michael J Wright

    Full Text Available The purpose of the experiments was to analyse the spatial cueing effects of the movements of soccer players executing normal and deceptive (step-over turns with the ball. Stimuli comprised normal resolution or point-light video clips of soccer players dribbling a football towards the observer then turning right or left with the ball. Clips were curtailed before or on the turn (-160, -80, 0 or +80 ms to examine the time course of direction prediction and spatial cueing effects. Participants were divided into higher-skilled (HS and lower-skilled (LS groups according to soccer experience. In experiment 1, accuracy on full video clips was higher than on point-light but results followed the same overall pattern. Both HS and LS groups correctly identified direction on normal moves at all occlusion levels. For deceptive moves, LS participants were significantly worse than chance and HS participants were somewhat more accurate but nevertheless substantially impaired. In experiment 2, point-light clips were used to cue a lateral target. HS and LS groups showed faster reaction times to targets that were congruent with the direction of normal turns, and to targets incongruent with the direction of deceptive turns. The reversed cueing by deceptive moves coincided with earlier kinematic events than cueing by normal moves. It is concluded that the body kinematics of soccer players generate spatial cueing effects when viewed from an opponent's perspective. This could create a reaction time advantage when anticipating the direction of a normal move. A deceptive move is designed to turn this cueing advantage into a disadvantage. Acting on the basis of advance information, the presence of deceptive moves primes responses in the wrong direction, which may be only partly mitigated by delaying a response until veridical cues emerge.

  3. Recency-to-Primacy Shift in Cue Competition


    Lipatova, Olga; Wheeler, Daniel S.; Vadillo, Miguel A.; Miller, Ralph R.


    Three experiments were conducted using a lick-suppression preparation with rats to determine whether temporal and physical context shifts modulate the effectiveness of 2 sequentially trained blocking stimuli. Experiment 1 ascertained that it is possible to obtain blocking by conditioning rats to react to a target cue using 2 different blocking cues, each trained with a single-phase blocking paradigm. Experiment 2 showed that the more recently trained blocking stimulus was more effective (i.e....

  4. Segmentation cues in conversational speech: robust semantics and fragile phonotactics. (United States)

    White, Laurence; Mattys, Sven L; Wiget, Lukas


    Multiple cues influence listeners' segmentation of connected speech into words, but most previous studies have used stimuli elicited in careful readings rather than natural conversation. Discerning word boundaries in conversational speech may differ from the laboratory setting. In particular, a speaker's articulatory effort - hyperarticulation vs. hypoarticulation (H&H) - may vary according to communicative demands, suggesting a compensatory relationship whereby acoustic-phonetic cues are attenuated when other information sources strongly guide segmentation. We examined how listeners' interpretation of segmentation cues is affected by speech style (spontaneous conversation vs. read), using cross-modal identity priming. To elicit spontaneous stimuli, we used a map task in which speakers discussed routes around stylized landmarks. These landmarks were two-word phrases in which the strength of potential segmentation cues - semantic likelihood and cross-boundary diphone phonotactics - was systematically varied. Landmark-carrying utterances were transcribed and later re-recorded as read speech. Independent of speech style, we found an interaction between cue valence (favorable/unfavorable) and cue type (phonotactics/semantics). Thus, there was an effect of semantic plausibility, but no effect of cross-boundary phonotactics, indicating that the importance of phonotactic segmentation may have been overstated in studies where lexical information was artificially suppressed. These patterns were unaffected by whether the stimuli were elicited in a spontaneous or read context, even though the difference in speech styles was evident in a main effect. Durational analyses suggested speaker-driven cue trade-offs congruent with an H&H account, but these modulations did not impact on listener behavior. We conclude that previous research exploiting read speech is reliable in indicating the primacy of lexically based cues in the segmentation of natural conversational speech.

  5. A statistical approach to identify candidate cues for nestmate recognition

    Directory of Open Access Journals (Sweden)

    Jelle Stijn van Zweden


    Full Text Available The ability of social insects to discriminate nestmates from non-nestmates is mainly achieved through chemical communication. To ultimately understand this recognition and its decision rules, identification of the recognition cues is essential. Although recognition cues are most likely cuticular hydrocarbons, identifying the exact cues for specific species has remained a daunting task, partly due to the sheer number of odor compounds. Perhaps unsurprisingly, one of the few species where the recognition cues have been identified, Formica exsecta, has only around ten major hydrocarbons on its cuticle. In this study we use previous results of this species to search for nestmate recognition cues in two other species of ants, Camponotus aethiops and Monomorium pharaonis. Employing chemical distances and observed aggression between colonies, we first ask which type of data normalization, centroid, and distance calculation is most diagnostic to discriminate between nestmate recognition cues and other compounds. We find that using a global centroid instead of a colony centroid significantly improves the analysis. One reason may be that this new approach, unlike previous ones, provides a biologically meaningful way to quantify the chemical distances between nestmates, allowing for within-colony variation in recognition cues. Next, we ask which subset of hydrocarbons most likely represents the cues that the ants use for nestmate recognition, which shows less clear results for C. aethiops and M. pharaonis than for F. exsecta, possibly due to less than ideal datasets. Nonetheless, some compound sets performed better than others, showing that this approach can be used to identify candidate compounds to be tested in bio-assays, and eventually crack the sophisticated code that governs nestmate recognition.

  6. Xenohormesis: Sensing the Chemical Cues of Other Species (United States)

    Howitz, Konrad T.; Sinclair, David A.


    Many plant molecules interact with and modulate key regulators of mammalian physiology in ways that are beneficial to health, but why? We propose that heterotrophs (animals and fungi) are able to sense chemical cues synthesized by plants and other autotrophs in response to stress. These cues provide advance warning about deteriorating environmental conditions, allowing the heterotrophs to prepare for adversity while conditions are still favorable. PMID:18455976

  7. Segmentation cues in conversational speech: Robust semantics and fragile phonotactics

    Directory of Open Access Journals (Sweden)

    Laurence eWhite


    Full Text Available Multiple cues influence listeners’ segmentation of connected speech into words, but most previous studies have used stimuli elicited in careful readings rather than natural conversation. Discerning word boundaries in conversational speech may differ from the laboratory setting. In particular, a speaker’s articulatory effort – hyperarticulation vs hypoarticulation (H&H – may vary according to communicative demands, suggesting a compensatory relationship whereby acoustic-phonetic cues are attenuated when other information sources strongly guide segmentation. We examined how listeners’ interpretation of segmentation cues is affected by speech style (spontaneous conversation vs read, using cross-modal identity priming. To elicit spontaneous stimuli, we used a map task in which speakers discussed routes around stylised landmarks. These landmarks were two-word phrases in which the strength of potential segmentation cues – semantic likelihood and cross-boundary diphone phonotactics – was systematically varied. Landmark-carrying utterances were transcribed and later re-recorded as read speech.Independent of speech style, we found an interaction between cue valence (favourable/unfavourable and cue type (phonotactics/semantics. Thus, there was an effect of semantic plausibility, but no effect of cross-boundary phonotactics, indicating that the importance of phonotactic segmentation may have been overstated in studies where lexical information was artificially suppressed. These patterns were unaffected by whether the stimuli were elicited in a spontaneous or read context, even though the difference in speech styles was evident in a main effect. Durational analyses suggested speaker-driven cue trade-offs congruent with an H&H account, but these modulations did not impact on listener behaviour. We conclude that previous research exploiting read speech is reliable in indicating the primacy of lexically-based cues in the segmentation of natural

  8. Flexibility of cue use in the fox squirrel (Sciurus niger). (United States)

    Waisman, Anna S; Jacobs, Lucia F


    Recent work on captive flying squirrels has demonstrated a novel degree of flexibility in the use of different orientation cues. In the present study, we examine to what extent this flexibility is present in a free-ranging population of another tree squirrel species, the fox squirrel. We trained squirrels to a rewarded location within a square array of four feeders and then tested them on transformations of the array that either pitted two cue types against one cue type, the majority tests, or all cue types against each other, the forced-hierarchy test. In Experiment 1, squirrels reoriented to the two-cue-type location in all majority tests and to the location indicated by the visual features of the feeders in the forced-hierarchy test. This preference for visual features runs contrary to previous studies that report the use of spatial cues over visual features in food-storing species. In Experiments 2-5 we tested squirrels with different trial orders (Experiments 2 and 3), a different apparatus (Experiment 4) and at different times of the year (Experiment 5) to determine why these squirrels had chosen to orient using visual features in the first experiment. Like captive flying squirrels, free-ranging fox squirrels showed a large degree of flexibility in their use of cues. Furthermore, their cue use appeared to be sensitive both to changes in the test apparatus and the season in which we tested. Altogether our results suggest that the study of free-ranging animals over a variety of conditions is necessary for understanding spatial cognition.

  9. Olfactory cues are more effective than visual cues in experimentally triggering autobiographical memories. (United States)

    de Bruijn, Maaike J; Bender, Michael


    Folk wisdom often refers to odours as potent triggers for autobiographical memory, akin to the Proust phenomenon that describes Proust's sudden recollection of a childhood memory when tasting a madeleine dipped into tea. Despite an increasing number of empirical studies on the effects of odours on cognition, conclusive evidence is still missing. We set out to examine the effectiveness of childhood and non-childhood odours as retrieval cues for autobiographical memories in a lab experiment. A total of 170 participants were presented with pilot-tested retrieval cues (either odours or images) to recall childhood memories and were then asked to rate the vividness, detail, and emotional intensity of these memories. Results showed that participants indeed reported richer memories when presented with childhood-related odours than childhood-related images or childhood-unrelated odours or images. An exploratory analysis of memory content with Linguistic Inquiry and Word Count did not reveal differences in affective content. The findings of this study support the notion that odours are particularly potent in eliciting rich memories and open up numerous avenues for further exploration.

  10. Acoustic cues in the perception of second language speech sounds (United States)

    Bogacka, Anna A.


    The experiment examined to what acoustic cues Polish learners of English pay attention when distinguishing between English high vowels. Predictions concerned the influence of Polish vowel system (no duration differences and only one vowel in the high back vowel region), salience of duration cues and L1 orthography. Thirty-seven Polish subjects and a control group of English native speakers identified stimuli from heed-hid and who'd-hood continua varying in spectral and duration steps. Identification scores by spectral and duration steps, and F1/F2 plots of identifications, were given as well as fundamental frequency variation comments. English subjects strongly relied on spectral cues (typical categorical perception) and almost did not react to temporal cues. Polish subjects relied strongly on temporal cues for both continua, but showed a reversed pattern of identification of who'd-hood contrast. Their reliance on spectral cues was weak and had a reversed pattern for heed-hid contrast. The results were interpreted with reference to the speech learning model [Flege (1995)], perceptual assimilation model [Best (1995)] and ontogeny phylogeny model [Major (2001)].

  11. Does heightened affect make smoking cues more salient? (United States)

    Shiffman, Saul; Gwaltney, Chad J


    Negative affect (NA) states are robustly related to relapse. However, the mechanisms for this relationship are not well understood. Whereas most models have proposed that NA directly promotes lapsing, some models suggest that NA may promote lapses indirectly by increasing reactivity to smoking cues. This hypothesis was tested in secondary analyses of a study in which 248 smokers used ecological momentary assessment to self-monitor affective valence, smoking cues, and lapses during an attempt to quit smoking. The smoking cues the authors examined were others' smoking and consumption of alcohol or coffee. The odds of lapsing when exposed to smoking cues were compared across conditions of positive affect, neutral affect, and NA. Consistent main effects of affective valence were seen but not the hypothesized interaction. Indeed, analyses showed that the effect of cues was typically diminished under conditions of NA. No evidence was found to support the hypothesis that smoking cues and lapsing are more closely linked under NA conditions. Copyright (c) 2008 APA, all rights reserved.

  12. Transferrable Learning of Multisensory Cues in Flight Simulation

    Directory of Open Access Journals (Sweden)

    Georg F Meyer


    Full Text Available Flight simulators which provide visual, auditory, and kinematic (physical motion cues are increasingly used for pilot training. We have previously shown that kinematic cues, but not auditory cues, representing aircraft motion improve target tracking performance for novice ‘pilots’ in a simulated flying task (Meyer et al IMRF 2010. Here we explore the effect of learning on task performance. Our subjects were first tested on a target tracking task in a helicopter flight simulation. They were then trained in a simulator-simulator, which provided full audio, simplified visuals, but not kinematic signals to test whether learning of auditory cues is possible. After training we evaluated flight performance in the full simulator again. We show that after 2 hours training auditory cues are used by our participants as efficiently as kinematic cues to improve target tracking performance. The performance improvement relative to a condition where no audio signals are presented is robust if the sound environment used during training is replaced by a very different audio signal that is modulated in amplitude and pitch in the same way as the training signal. This shows that training is not signal specific but that our participants learn to extract transferrable information on sound pitch and amplitude to improve their flying performance.

  13. Genital lubrication: A cue-specific sexual response? (United States)

    Sawatsky, Megan L; Dawson, Samantha J; Lalumière, Martin L


    Women's genital responses are sensitive to the presence and intensity of sexual cues, yet some stimulus features (e.g., male vs. female actors, consensual vs. non-consensual interactions) have little influence on the magnitude of response-a phenomenon called low cue-specificity. Genital responses are typically assessed using vaginal photoplethysmography, a measure of vaginal vasocongestion, itself a precursor to lubrication. One explanation for low cue-specificity is the preparation hypothesis: Women genitally respond to almost all sexual cues because lubrication functions to protect genital organs from potential injury should vaginal penetration occur. In order to test the preparation hypothesis, both vaginal vasocongestion and introital lubrication were assessed in a sample of 20 women in response to sexually explicit films. While patterns of vasocongestion were consistent with low cue-specificity for gender cues and type of sexual activity, lubrication was specific to women's most preferred sexual stimulus categories. These results are inconsistent with the preparation hypothesis. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. Empagliflozin Increases Short-Term Urinary Volume Output in Artificially Induced Syndrome of Inappropriate Antidiuresis

    Directory of Open Access Journals (Sweden)

    Julie Refardt


    Full Text Available Objective. Syndrome of inappropriate antidiuresis (SIADH is the predominant cause of hyponatremia, but treatment options are unsatisfying. SGLT2 inhibitors increase urinary glucose excretion with concomitant osmotic diuresis. We therefore hypothesized SGLT2-inhibitors as a novel treatment for SIADH. Design. Double-blind placebo-controlled randomised crossover study in 14 healthy volunteers. Methods. We induced an artificial SIADH model by administration of desmopressin and overhydration. Afterwards, empagliflozin 25 mg or placebo was given in random order. The main outcomes were total urinary excretion, glucosuria, and the area under the curve (AUC of serum sodium concentration. Outcome measures were obtained 2–8 hours after administration of study drug. Results. 14 participants (64% males, BMI 23 kg/m2 (±2.4, aged 28.6 years (±9, completed the study. Empagliflozin led to significantly increased total urinary excretion (579.3 ml (±194.8 versus 367.3 ml (±158.8; treatment effect 158 ml (CI 48.29, 267.74, p=0.017 due to glucosuria (74.18 mmol (±22.3 versus 0.12 mmol (±0.04; treatment effect (log scale 2.85 (CI 2.75, 2.96, p<0.001. There was no difference in the AUC of serum sodium concentration (treatment effect 0.2 (CI −7.38, 6.98, p=0.96. Conclusion. In our SIADH model, empagliflozin increased urinary excretion due to osmotic diuresis. Due to the short treatment duration, serum sodium levels remained unchanged. Real-live studies are needed to further examine empagliflozin as a new treatment for SIADH.

  15. Positive urine cultures: A major cause of inappropriate antimicrobial use in hospitals? (United States)

    Silver, Samuel A; Baillie, Laura; Simor, Andrew E


    Urine specimens are among the most common samples submitted for culture to microbiology laboratories. The objectives of the present study were to describe the indications for obtaining urine cultures in a cohort of hospitalized patients, and to determine the appropriateness of antimicrobial therapy in response to urine culture results. The study was performed at a teaching hospital with an adjoining long-term care facility from June 1 to July 31, 2006. The medical records of nonpregnant adult patients with and without bacteriuria were reviewed. A symptomatic urinary tract infection was defined as the presence of bacteriuria in a patient with fever or urinary symptoms; asymptomatic bacteriuria was defined as bacteriuria without urinary symptoms and no infection evident at another site. Medical records of 335 eligible patients (64% male; mean age 68 years) were reviewed, including all 137 with bacteriuria, and 198 with negative urine cultures. In total, 51% of the urine specimens were obtained from an indwelling urinary catheter, and 28% were voided urine samples. Confusion (57%) and fever (36%) were the most common indications noted for obtaining the urine cultures. Only 34 patients (25% of those with positive urine cultures) met the criteria for a symptomatic urinary tract infection; 67 (49%) had asymptomatic bacteriuria and 36 (26%) had infection at a nonurinary site. Of those with asymptomatic bacteriuria, 64% received antimicrobial therapy for a total of 347 days. Confused patients with asymptomatic bacteriuria were more likely to be treated than were bacteriuric patients without altered mental status (OR 1.8, 95% CI 1.2 to 4.1; P=0.03). Urine cultures are frequently obtained from hospitalizedpatients,evenintheabsenceofurinarysymptoms.Asymptomatic bacteriuria is often treated in these patients, and accounts for a substantial burden of inappropriate antimicrobial use in hospitals. Effective strategies to improve urine culture ordering and antimicrobial

  16. Carbon dioxide narcosis due to inappropriate oxygen delivery: a case report. (United States)

    Herren, Thomas; Achermann, Eva; Hegi, Thomas; Reber, Adrian; Stäubli, Max


    Oxygen delivery to patients with chronic obstructive pulmonary disease may be challenging because of their potential hypoxic ventilatory drive. However, some oxygen delivery systems such as non-rebreathing face masks with an oxygen reservoir bag require high oxygen flow for adequate oxygenation and to avoid carbon dioxide rebreathing. A 72-year-old Caucasian man with severe chronic obstructive pulmonary disease was admitted to the emergency department because of worsening dyspnea and an oxygen saturation of 81% measured by pulse oximetry. Oxygen was administered using a non-rebreathing mask with an oxygen reservoir bag attached. For fear of removing the hypoxic stimulus to respiration the oxygen flow was inappropriately limited to 4L/minute. The patient developed carbon dioxide narcosis and had to be intubated and mechanically ventilated. Non-rebreathing masks with oxygen reservoir bags must be fed with an oxygen flow exceeding the patient's minute ventilation (>6-10 L/minute.). If not, the amount of oxygen delivered will be too small to effectively increase the arterial oxygen saturation. Moreover, the risk of carbon dioxide rebreathing dramatically increases if the flow of oxygen to a non-rebreathing mask is lower than the minute ventilation, especially in patients with chronic obstructive pulmonary disease and low tidal volumes. Non-rebreathing masks (with oxygen reservoir bags) must be used cautiously by experienced medical staff and with an appropriately high oxygen flow of 10-15 L/minute. Nevertheless, arterial blood gases must be analyzed regularly for early detection of a rise in partial pressure of carbon dioxide in arterial blood in patients with chronic obstructive pulmonary disease and a hypoxic ventilatory drive. These patients are more safely managed using a nasal cannula with an oxygen flow of 1-2L/minute or a simple face mask with an oxygen flow of 5L/minute.

  17. [Results of an intervention to reduce potentially inappropriate prescriptions of beta blockers and calcium channel blockers]. (United States)

    Machado-Alba, J E; Giraldo-Giraldo, C; Aguirre Novoa, A


    To determine the frequency of simultaneous prescription of β-blockers and calcium channel blockers, notify the cardiovascular risk of these patients to the health care professionals in charge of them, and achieve a reduction in the number of those who use them. Quasi-experimental, prospective study by developing an intervention on medical prescriptions of patients older than 65 years treated between January 1 and July 30, 2014, affiliated to the Health System in 101 cities in Colombia. A total of 43,180 patients received a β-blocker each month, and 14,560 receiving a calcium channel blocker were identified. Educational interventions were performed and an evaluation was made, using sociodemographic and pharmacological variables, on the number of patients that stopped taking any of the two drugs in the following three months. A total of 535 patients, with a mean age 75.8±6.7 years received concomitant β-blockers plus calcium channel blockers. Modification of therapy was achieved in 235 patients (43.9% of users) after 66 educational interventions. In 209 cases (88.9%) one of the two drugs was suspended, and 11.1% changed to other antihypertensive drugs. The variable of being more than 85 years old (OR: 1.93; 95% CI: 1.07-3.50), and receiving concomitant medication with inhibitors of the renin-angiotensin system (OR: 2.16; 95% CI: 1.28-3.65) were associated with increased risk of their doctor changing or stopping the prescription. An improved adherence to recommendations for appropriate use of β-blockers and calcium channel blockers by health service providers was achieved. Intervention programs that reduce potentially inappropriate prescriptions for patients treated for cardiovascular disease should be used more frequently. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  18. Independent review of inappropriate identification, storage and treatment methods of polychlorinated biphenyl waste streams

    International Nuclear Information System (INIS)


    The purpose of the review was to evaluate incidents involving the inappropriate identification, storage, and treatment methods associated with polychlorinated biphenyl (PCB) waste streams originating from the V-tank system at the Test Area North (TAN). The team was instructed to perform a comprehensive review of Lockheed Martin Idaho Technologies Company (LMITCO's) compliance programs related to these incidents to assess the adequacy and effectiveness of the management program in all respects including: adequacy of the waste management program in meeting all LMITCO requirements and regulations; adequacy of policies, plans, and procedures in addressing and implementing all federal and state requirements and regulations; and compliance status of LMITCO, LMITCO contract team members, and LMITCO contract/team member subcontractor personnel with established PCB management policies, plans, and procedures. The V-Tanks are part of an intermediate waste disposal system and are located at the Technical Support Facility (TSF) at TAN at the Idaho National Engineering and Environmental Laboratory (INEEL). The IRT evaluated how a waste was characterized, managed, and information was documented; however, they did not take control of wastes or ensure followup was performed on all waste streams that may have been generated from the V-Tanks. The team has also subsequently learned that the Environmental Restoration (ER) program is revising the plans for the decontamination and decommissioning of the intermediate waste disposal system based on new information listed and PCB wastes. The team has not reviewed those in-process changes. The source of PCB in the V-Tank is suspected to be a spill of hydraulic fluid in 1968

  19. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. (United States)

    O'Mahony, Denis; O'Sullivan, David; Byrne, Stephen; O'Connor, Marie Noelle; Ryan, Cristin; Gallagher, Paul


    Screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. We reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. The expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society.

  20. Radiation Therapy Results of Invasive Cervical Carcinoma Found After Inappropriate Hysterectomy

    International Nuclear Information System (INIS)

    Choi, Doo Ho; Kim, Eun Seog; Nam, Kae Hyun; Huh, Seung Jae


    remained after inappropriate hysterectomy was poor. So, early cancer detection and proper management with precise pretreatment staging is necessary to avoid inadherent hysterectomy especially in the cases of gross residual disease

  1. Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list. (United States)

    Pohl-Dernick, Katharina; Meier, Florian; Maas, Renke; Schöffski, Oliver; Emmert, Martin


    Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list. Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios. In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million. The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.

  2. Nogo stimuli do not receive more attentional suppression or response inhibition than neutral stimuli: evidence from the N2pc, PD and N2 components in a spatial cueing paradigm

    Directory of Open Access Journals (Sweden)

    Caroline eBarras


    Full Text Available It has been claimed that stimuli sharing the color of the nogo-target are suppressed because of the strong incentive to not process the nogo-target, but we failed to replicate this finding. Participants searched for a color singleton in the target display and indicated its shape when it was in the go color. If the color singleton in the target display was in the nogo color, they had to withhold the response. The target display was preceded by a cue display that also contained a color singleton (the cue. The cue was either in the color of the go or nogo target, or it was in an unrelated, neutral color. With cues in the go color, reaction times (RTs were shorter when the cue appeared at the same location as the target compared to when it appeared at a different location. Also, electrophysiological recordings showed that an index of attentional selection, the N2pc, was elicited by go cues. Surprisingly, we failed to replicate cueing costs for cues in the nogo color that were originally reported by Anderson and Folk (2012. Consistently, we also failed to find an electrophysiological index of attentional suppression (the PD for cues in the nogo color. Further, fronto-central ERPs to the cue display showed the same negativity for nogo and neutral stimuli relative to go stimuli, which is at odds with response inhibition and conflict monitoring accounts of the Nogo-N2. Thus, the modified cueing paradigm employed here provides little evidence that features associated with nogo-targets are suppressed at the level of attention or response selection. Rather, nogo-stimuli are efficiently ignored and attention is focused on features that require a response.

  3. Magnitude and duration of cue-induced craving for marijuana in volunteers with cannabis use disorder. (United States)

    Lundahl, Leslie H; Greenwald, Mark K


    Evaluate magnitude and duration of subjective and physiologic responses to neutral and marijuana (MJ)-related cues in cannabis dependent volunteers. 33 volunteers (17 male) who met DSM-IV criteria for Cannabis Abuse or Dependence were exposed to neutral (first) then MJ-related visual, auditory, olfactory and tactile cues. Mood, drug craving and physiology were assessed at baseline, post-neutral, post-MJ and 15-min post MJ cue exposure to determine magnitude of cue- responses. For a subset of participants (n=15; 9 male), measures of craving and physiology were collected also at 30-, 90-, and 150-min post-MJ cue to examine duration of cue-effects. In cue-response magnitude analyses, visual analog scale (VAS) items craving for, urge to use, and desire to smoke MJ, Total and Compulsivity subscale scores of the Marijuana Craving Questionnaire, anxiety ratings, and diastolic blood pressure (BP) were significantly elevated following MJ vs. neutral cue exposure. In cue-response duration analyses, desire and urge to use MJ remained significantly elevated at 30-, 90- and 150-min post MJ-cue exposure, relative to baseline and neutral cues. Presentation of polysensory MJ cues increased MJ craving, anxiety and diastolic BP relative to baseline and neutral cues. MJ craving remained elevated up to 150-min after MJ cue presentation. This finding confirms that carry-over effects from drug cue presentation must be considered in cue reactivity studies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. The role of smell, taste, flavour and texture cues in the identification of vegetables

    NARCIS (Netherlands)

    Stokkom, van V.L.; Blok, A.E.; Kooten, van O.; Graaf, de C.; Stieger, M.


    It has been shown that the identification of many foods including vegetables based on flavour cues is often difficult. The effect of providing texture cues in addition to flavour cues on the identification of foods and the effect of providing taste cues only on the identification of foods have not

  5. Fifteen-Month-Old Infants Match Vocal Cues to Intentional Actions (United States)

    Hoicka, Elena; Wang, Su-hua


    Fifteen-month-old infants detected a violation when an actor performed an action that did not match her preceding vocal cue: The infants looked reliably longer when the actor expressed a humorous vocal cue followed by a sweet action or expressed a sweet vocal cue followed by a humorous action, than when the vocal cue was followed by a matching…

  6. Computer-Mediated Impression Formation: A Test of the Sticky Cues Model Using Facebook (United States)

    Van Der Heide, Brandon Lee


    This research offers a model of online impression formation that explains how different impression-bearing cues may carry more or less informational value. This research considers the possibility that impression-bearing cues have greater informational value when those cues are distinctive and are task-relevant. This research refers to such cues as…

  7. Trust in haptic assistance: weighting visual and haptic cues based on error history. (United States)

    Gibo, Tricia L; Mugge, Winfred; Abbink, David A


    To effectively interpret and interact with the world, humans weight redundant estimates from different sensory cues to form one coherent, integrated estimate. Recent advancements in physical assistance systems, where guiding forces are computed by an intelligent agent, enable the presentation of augmented cues. It is unknown, however, if cue weighting can be extended to augmented cues. Previous research has shown that cue weighting is determined by the reliability (inversely related to uncertainty) of cues within a trial, yet augmented cues may also be affected by errors that vary over trials. In this study, we investigate whether people can learn to appropriately weight a haptic cue from an intelligent assistance system based on its error history. Subjects held a haptic device and reached to a hidden target using a visual (Gaussian distributed dots) and haptic (force channel) cue. The error of the augmented haptic cue varied from trial to trial based on a Gaussian distribution. Subjects learned to estimate the target location by weighting the visual and augmented haptic cues based on their perceptual uncertainty and experienced errors. With both cues available, subjects were able to find the target with an improved or equal performance compared to what was possible with one cue alone. Our results show that the brain can learn to reweight augmented cues from intelligent agents, akin to previous observations of the reweighting of naturally occurring cues. In addition, these results suggest that the weighting of a cue is not only affected by its within-trial reliability but also the history of errors.

  8. Default mode network deactivation to smoking cue relative to food cue predicts treatment outcome in nicotine use disorder. (United States)

    Wilcox, Claire E; Claus, Eric D; Calhoun, Vince D; Rachakonda, Srinivas; Littlewood, Rae A; Mickey, Jessica; Arenella, Pamela B; Goodreau, Natalie; Hutchison, Kent E


    Identifying predictors of treatment outcome for nicotine use disorders (NUDs) may help improve efficacy of established treatments, like varenicline. Brain reactivity to drug stimuli predicts relapse risk in nicotine and other substance use disorders in some studies. Activity in the default mode network (DMN) is affected by drug cues and other palatable cues, but its clinical significance is unclear. In this study, 143 individuals with NUD (male n = 91, ages 18-55 years) received a functional magnetic resonance imaging scan during a visual cue task during which they were presented with a series of smoking-related or food-related video clips prior to randomization to treatment with varenicline (n = 80) or placebo. Group independent components analysis was utilized to isolate the DMN, and temporal sorting was used to calculate the difference between the DMN blood-oxygen-level dependent signal during smoke cues and that during food cues for each individual. Food cues were associated with greater deactivation compared with smoke cues in the DMN. In correcting for baseline smoking and other clinical variables, which have been shown to be related to treatment outcome in previous work, a less positive Smoke - Food difference score predicted greater smoking at 6 and 12 weeks when both treatment groups were combined (P = 0.005, β = -0.766). An exploratory analysis of executive control and salience networks demonstrated that a more positive Smoke - Food difference score for executive control network predicted a more robust response to varenicline relative to placebo. These findings provide further support to theories that brain reactivity to palatable cues, and in particular in DMN, may have a direct clinical relevance in NUD. © 2017 Society for the Study of Addiction.

  9. Prospective evaluation of inappropriate unable-to-assess CAM-ICU documentations of critically ill adult patients. (United States)

    Terry, Kimberly J; Anger, Kevin E; Szumita, Paul M


    Delirium occurs in the intensive care unit and identification is often performed using a validated assessment tool such as the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) patients. The CAM-ICU has three ratings: positive, negative, and unable to assess (UTA). Patients may often be assigned UTA when it is inappropriate given the level of sedation or medical condition. The purpose of this study is to evaluate the rate of inappropriate UTA CAM-ICU documentations. A single-center prospective observational analysis was performed evaluating CAM-ICU documentations from October 27, 2014, to December 26, 2014. Patients admitted to the medical and surgical ICU were included and excluded if admitted to the ICU for less than 24 h. CAM-ICU assessments were performed per institutional guidelines using CAM-ICU scoring as validated in literature. CAM-ICU patient documentations were recorded as positive, negative, UTA, or not assessed. Patients with an appropriate UTA documentation were deeply sedated, non-English speaking, or not medically able to participate in the assessment. The major endpoint assessed rates of inappropriate UTA CAM-ICU documentations. Minor endpoints evaluated adherence to CAM-ICU documentations and use of pharmacologic agents for symptoms of delirium. Sixty-one patients were identified with 45 (74 %) medical, 16 (26 %) surgical, of which 27 (44.3 %) were mechanically ventilated. There were 116 UTA documentations with 35 (30.2 %) identified as inappropriate. Of the 906 identified CAM-ICU documentation opportunities, adherence was 439 (48.5 %). Overall, 18 (29.5 %) of the 61 patients were administered pharmacologic agents for delirium management and 5 (27.7 %) had a positive CAM-ICU documented within 24 h. Rates of inappropriate UTA CAM-ICU documentations may be significantly higher than reported in literature. Additional research is needed to identify an acceptable rate of inappropriate UTA CAM-ICU assessments and its clinical impact

  10. Prevalence and factors associated with inappropriate use of treadmill exercise stress test for coronary artery disease: a cross-sectional study. (United States)

    Silva, Antônio M L; Armstrong, Anderson C; Silveira, Fernando J C; Cavalcanti, Marcelo D; França, Fernando M F; Correia, Luis C L


    In some countries, the public health system has less availability when compared to the population covered by health insurance. In addition, inappropriate referrals for treadmill exercise stress test increase spending and lead to unnecessary interventions. We aim to determine the prevalence and characteristics of inappropriate referrals for treadmill exercise stress tests in the assessment of coronary artery disease (CAD), considering public and private health systems scenarios. A cross-sectional design was used to describe the frequency of inappropriate use of exercise testing in the diagnosis of CAD and to determine its predictors. We consecutively enrolled 191 patients from two outpatient facilities in Northeast Brazil. For inclusion, the exercise testing should be referred for the assessment of CAD. We performed logistic regression models to identify independent predictors of inappropriate use. Treadmill exercise stress tests were rated as inappropriate in 150 (78 %) patients. The majority of patients had low or very low pre-test probability of CAD. Presence of hypertension, diabetes and dyslipidemia were more frequent in the appropriate than inappropriate indications (71 %, 19 % and 29 % versus 43 %, 8 % and 16 %, respectively). Tests performed both at the public and private system showed high prevalence of inappropriate examinations, higher in the latter (57 % versus 87 %, P test referrals in the assessment of CAD were inappropriate. The availability of the method and not the estimate probability of CAD appear to be the underlying condition for a treadmill test referral.

  11. Women born preterm or with inappropriate weight for gestational age are at risk of subsequent gestational diabetes and pre-eclampsia

    DEFF Research Database (Denmark)

    á Rogvi, Rasmus; Forman, Julie Lyng; Damm, Peter


    Low birthweight, which can be caused by inappropriate intrauterine growth or prematurity, is associated with development of gestational diabetes mellitus (GDM) as well as pre-eclampsia later in life, but the relative effects of prematurity and inappropriate intrauterine growth remain uncertain....

  12. Inadequate drug prescribing: comparison of inappropriate drug rates at the end of a geriatric short-stay service with three prescribing tools. (United States)

    Fanon, Jean-Luc; Dechavigny, Sandra; Dramé, Moustapha; Godaert, Lidvine


    To compare the proportion of prescriptions containing at least one inappropriate drug, as identified using three tools for optimizing drug prescriptions in the elderly. Cross-sectional, observational study based on the analysis of prescriptions of patients discharged between 1 September and 31 October 2014 in a short-stay geriatrics unit at the Louis Domergue de Trinité Hospital in Martinique (France). Each prescription was analysed using 3 tools, namely one for general medicine (Vidal © drug dictionary) and two tools specifically designed for geriatrics (the Laroche list of potentially inappropriate medications, and the STOPP-START toolkit). The number of prescriptions containing at least one inappropriate medication was recorded as evaluated with each tool. These prescriptions were then compared to investigate whether the two geriatric tools identified the same prescriptions as being inappropriate. In total, 53 prescriptions were analysed. The male-female sex ratio was 0.70. The average age of the patients was 84.5±6.2 years. Analysis according to the Vidal © drug dictionary identified the greatest number of inappropriate prescriptions (28.3% of all prescriptions). The proportion of prescriptions containing at least one inappropriate drug was lower with the two tools specific to geriatrics (11% for the Laroche list and 7.5% for the STOPP-START method). The general medicine Vidal © drug dictionary identified more inappropriate prescriptions than the tools specifically designed for geriatrics. The tools for aiding drug prescriptions in the elderly identified different drugs as being inappropriate.

  13. Improving visual spatial working memory in younger and older adults: effects of cross-modal cues. (United States)

    Curtis, Ashley F; Turner, Gary R; Park, Norman W; Murtha, Susan J E


    Spatially informative auditory and vibrotactile (cross-modal) cues can facilitate attention but little is known about how similar cues influence visual spatial working memory (WM) across the adult lifespan. We investigated the effects of cues (spatially informative or alerting pre-cues vs. no cues), cue modality (auditory vs. vibrotactile vs. visual), memory array size (four vs. six items), and maintenance delay (900 vs. 1800 ms) on visual spatial location WM recognition accuracy in younger adults (YA) and older adults (OA). We observed a significant interaction between spatially informative pre-cue type, array size, and delay. OA and YA benefitted equally from spatially informative pre-cues, suggesting that attentional orienting prior to WM encoding, regardless of cue modality, is preserved with age.  Contrary to predictions, alerting pre-cues generally impaired performance in both age groups, suggesting that maintaining a vigilant state of arousal by facilitating the alerting attention system does not help visual spatial location WM.

  14. Domain general learning: infants use social and non-social cues when learning object statistics

    Directory of Open Access Journals (Sweden)

    Ryan A. Barry


    Full Text Available Previous research has shown that infants can learn from social cues. But is a social cue more effective at directing learning than a non-social cue? This study investigated whether 9-month-old infants (N=55 could learn a visual statistical regularity in the presence of a distracting visual sequence when attention was directed by either a social cue (a person or a non-social cue (a rectangle. The results show that both social and non-social cues can guide infants’ attention to a visual shape sequence (and away from a distracting sequence. The social cue more effectively directed attention than the non-social cue during the learning phase, but the social cue did not result in significantly stronger learning than the non-social cue. The findings suggest that domain general attention mechanisms allow for the comparable learning seen in both conditions.

  15. Informative Cues Facilitate Saccadic Localization in Blindsight Monkeys. (United States)

    Yoshida, Masatoshi; Hafed, Ziad M; Isa, Tadashi


    Patients with damage to the primary visual cortex (V1) demonstrate residual visual performance during laboratory tasks despite denying having a conscious percept. The mechanisms behind such performance, often called blindsight, are not fully understood, but the use of surgically-induced unilateral V1 lesions in macaque monkeys provides a useful animal model for exploring such mechanisms. For example, V1-lesioned monkeys localize stimuli in a forced-choice condition while at the same time failing to report awareness of identical stimuli in a yes-no detection condition, similar to human patients. Moreover, residual cognitive processes, including saliency-guided eye movements, bottom-up attention with peripheral non-informative cues, and spatial short-term memory, have all been demonstrated in these animals. Here we examined whether post-lesion residual visuomotor processing can be modulated by top-down task knowledge. We tested two V1-lesioned monkeys with a visually guided saccade task in which we provided an informative foveal pre-cue about upcoming target location. Our monkeys fixated while we presented a leftward or rightward arrow (serving as a pre-cue) superimposed on the fixation point (FP). After various cue-target onset asynchronies (CTOAs), a saccadic target (of variable contrast across trials) was presented either in the affected (contra-lesional) or seeing (ipsi-lesional) hemifield. Critically, target location was in the same hemifield that the arrow pre-cue pointed towards in 80% of the trials (valid-cue trials), making the cue highly useful for task performance. In both monkeys, correct saccade reaction times were shorter during valid than invalid trials. Moreover, in one monkey, the ratio of correct saccades towards the affected hemifield was higher during valid than invalid trials. We replicated both reaction time and correct ratio effects in the same monkey using a symbolic color cue. These results suggest that V1-lesion monkeys can use informative

  16. The development of prospective memory in young schoolchildren: the impact of ongoing task absorption, cue salience, and cue centrality. (United States)

    Kliegel, Matthias; Mahy, Caitlin E V; Voigt, Babett; Henry, Julie D; Rendell, Peter G; Aberle, Ingo


    This study presents evidence that 9- and 10-year-old children outperform 6- and 7-year-old children on a measure of event-based prospective memory and that retrieval-based factors systematically influence performance and age differences. All experiments revealed significant age effects in prospective memory even after controlling for ongoing task performance. In addition, the provision of a less absorbing ongoing task (Experiment 1), higher cue salience (Experiment 2), and cues appearing in the center of attention (Experiment 3) were each associated with better performance. Of particular developmental importance was an age by cue centrality (in or outside of the center of attention) interaction that emerged in Experiment 3. Thus, age effects were restricted to prospective memory cues appearing outside of the center of attention, suggesting that the development of prospective memory across early school years may be modulated by whether a cue requires overt monitoring beyond the immediate attentional context. Because whether a cue is in or outside of the center of attention might determine the amount of executive control needed in a prospective memory task, findings suggest that developing executive control resources may drive prospective memory development across primary school age. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. The Effects of Cues on Neurons in the Basal Ganglia in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Sridevi V. Sarma


    Full Text Available Visual cues open a unique window to the understanding of Parkinson’s disease (PD. These cues can temporarily but dramatically improve PD motor symptoms. Although details are unclear, cues are believed to suppress pathological basal ganglia (BG activity through activation of corticostriatal pathways. In this study, we investigated human BG neurophysiology under different cued conditions. We evaluated bursting, 10-30Hz oscillations (OSCs, and directional tuning (DT dynamics in the subthalamic nucleus activity while 7 patients executed a two-step motor task. In the first step (predicted +cue, the patient moved to a target when prompted by a visual go cue that appeared 100% of the time. Here, the timing of the cue is predictable and the cue serves an external trigger to execute a motor plan. In the second step, the cue appeared randomly 50% of the time, and the patient had to move to the same target as in the first step. When it appeared (unpredicted +cue, the motor plan was to be triggered by the cue, but its timing was not predictable. When the cue failed to appear (unpredicted -cue, the motor plan was triggered by the absence of the visual cue. We found that during predicted +cue and unpredicted -cue trials, OSCs significantly decreased and DT significantly increased above baseline, though these modulations occurred an average of 640 milliseconds later in unpredicted -cue trials. Movement and reaction times were comparable in these trials. During unpredicted +cue trials, OSCs and DT failed to modulate though bursting significantly decreased after movement. Correspondingly, movement performance deteriorated. These findings suggest that during motor planning either a predictably timed external cue or an internally generated cue (generated by the absence of a cue trigger the execution of a motor plan in premotor cortex, whose increased activation then suppresses pathological activity in STN through direct pathways, leading to motor facilitation in

  18. Understanding the role of contextual cues in supporting the formation of medication-taking habits

    Directory of Open Access Journals (Sweden)

    Katarzyna Stawarz


    in the presence of stable cues, with time they start to guide the behaviour and provide triggers to action (Lally & Gardner, 2011. However, adherence technologies tend to disregard contextual cues and the habitual nature of many medication regimens, and instead alert users when it is time to take the pill (Stawarz et al., 2014. Similarly, behaviour change technologies designed specifically to support habit formation also neglect contextual cues and instead focus on behaviour tracking and reminders (Stawarz et al, 2015. By supporting the identification and reinforcement of contextual cues, technology could aid both prospective memory and habit formation: it could help patients remember the new regimen and turn it into a reliable medication habit. Aims: Previous research by Stawarz et al. (2015 suggests that contextual cues support habit formation, but because habits take time to develop, people can still forget; conversely, reminders support remembering, but they can inhibit habit development. However, their study measured the development of an artificial habit (texting the researchers, lasted only for 4 weeks, and did not account for the role of location as a contextual cue. Therefore, the aim of this study was to explore the impact of contextual cues and reminders on the development of automaticity of behaviour (representing habit strength and frequency of repetition (representing adherence to the regimen over a longer period and with behaviours participants wanted to turn into habit. The understanding of how these factors influence the process of habit formation would enable us to design more effective adherence technologies that assist patients when they start a new regimen (prospective memory support as well as over the long term (habit support. Method: 209 participants were recruited on social networks, and among students and university staff. They were 18-58 years old (mean age = 27, SD = 7.6 years; 68% were women, 74% were students. They were asked to repeat a

  19. Symptomatic Hypoglycemia Related to Inappropriately High IGF-II Serum Levels in a Patient with Desmoplastic Small Round Cell Tumor

    Directory of Open Access Journals (Sweden)

    Williams Fernandes Barra


    Full Text Available A 45-year old man was diagnosed with desmoplastic small round cell tumor (DSRCT with involvement of the peritoneum and pelvis. Disease progression was observed despite systemic chemotherapy. Six months after diagnosis, he developed severe hypoglycemia presented with seizures. He received intravenous glucose infusion and hydrocortisone with poor glycemic control, but with seizures resolution. The investigation excluded insulinoma, adrenal, liver and GH deficiencies. Laboratory showed slight rise of IGF-II and significant increase of the ratio IGF-II : IGF-I, which is pathognomonic of non-islet cell tumor hypoglycemia (NICTH. He received the diagnoses of NICTH related to IGF-II inappropriate production by DSRCT. Despite the attempt to control tumor mass and hypoglycemia, the patient died 9 months after diagnosis. NICTH related to inappropriate IGF-II secretion should be investigated in all cancer patients with refractory hypoglycemia whom insulinoma and other metabolic abnormalities were excluded from.

  20. Fungal suppression of resistance against inappropriate ¤Blumeria graminis formae speciales¤ in barley, oat and wheat

    DEFF Research Database (Denmark)

    Olesen, K.L.; Carver, T.L.W.; Lyngkjær, Michael Foged


    When barley, wheat or oat leaf epidermal cells were attacked by their appropriate forma specialis (f.sp.) of Blumeria graminis DC. Speer (f.sp. hordei, tritici and avenae, respectively), many attempted penetrations succeeded, functional haustoria were formed and very few plant cells died. When...... attacked by either of the two possible inappropriate ff.spp., penetration attempts failed in association with papilla deposition by epidermal cells, attacked cells died, or if visible haustoria were formed the plant cell died very soon afterwards. Double inoculation experiments were performed where each...... the inducer haustorium, evident to some extent in adjacent cells, but undetectable at two cells distance. Suppression of penetration resistance allowed most challenger attacks, even by inappropriate ff.spp., to form a haustorium. Furthermore, death of penetrated epidermal cells was also suppressed so...

  1. Cue-induced reinstatement of food seeking in rats that differ in their propensity to attribute incentive salience to food cues


    Yager, Lindsay M.; Robinson, Terry E.


    Cues associated with food availability and consumption can evoke desire for food, sometimes leading to excessive intake. We have found, however, that food cues acquire incentive motivational properties (the ability to attract and to serve as conditional reinforcers) in some individuals (sign-trackers), but not others (goal-trackers). We asked, therefore, whether rats that are attracted (attribute incentive salience) to a food cue are the same individuals in which a food cue reinstates food se...

  2. [Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments]. (United States)

    Toledo del Castillo, B; González Ruiz de León, E; Rivas García, A; Vázquez López, P; Miguez Navarro, M C; Marañón Pardillo, R


    To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  3. Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis. (United States)

    Jha, Sujeet; Waghdhare, Swati; Reddi, Rajashekar; Bhattacharya, Priyanka


    Thyroid storm (TS) is a rare life-threatening condition that is characterized by fever and altered mental status precipitated by endogenous or exogenous critical events, illness/injury, acute iodine load, and thyroid or non thyroid surgery. A large number of thyroid extracts are available and extensively used, even though they are not recommended clinically in hypothyroid or euthyroid patients. Consumption of such products can be dangerous and result in life-threatening TS. Here, we report a case of TS caused by inadvertent intake of very high dosages of triiodothyronine (T3) and thyroxine (T4) in compounded thyroid extracts. Plasmapheresis may be considered an option for the management of exogenous TS. A 62-year-old woman with no significant past medical history presented with severe myalgia, fever, tachycardia, and blood pressure of 170/80 mmHg, which precipitated to an altered mental state within 24 hours. Neurological examination did not reveal any focal deficit or any signs of meningeal irritation. Further investigation revealed that she had been taking thyroid supplements. The patient had accidentally been supplied with a batch of thyroid extract pills that had an inadvertently high content of T4. Her free T3 (FT3) and free T4 (FT4) levels were found to be very high beyond the laboratory readable range (FT3>30 pg/mL; FT4>6.06 ng/dL; thyrotropin [TSH]=0.07 IU/mL). Three days post commencement of standard conservative management of TS, the patient developed posterior reversible encephalopathy syndrome, resulting in a seizure. She remained unresponsive and in a poor mental state. The confirmed exogenous etiology for TS led to a decision to conduct plasmapheresis. Plasmapheresis conducted for two consecutive days proved successful as a therapeutic measure for TS and improved her thyroid profile as well as her mental state. The inappropriate use of thyroid extracts in euthyroid and hypothyroid patients can result in life-threatening TS. Plasmapheresis is probably

  4. Inappropriate Use of Proton Pump Inhibitors in Elderly Patients Discharged from Acute Care Hospitals. (United States)

    Schepisi, R; Fusco, S; Sganga, F; Falcone, B; Vetrano, D L; Abbatecola, A; Corica, F; Maggio, M; Ruggiero, C; Fabbietti, P; Corsonello, A; Onder, G; Lattanzio, F


    Proton-pump inhibitors (PPI) are extensively prescribed in older patients. However, little information is available on factors associated to PPI prescribing patterns among older patients discharged from hospital. To evaluate the appropriateness and clinical correlates of PPI prescription at discharge in a population of 1081 older patients discharged from acute care Italian hospitals. We used data from the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) study, a multicenter observational study. The appropriateness of PPI prescriptions was defined according to the Italian Medicines Agency (AIFA) rules. Correlates of overprescribing (i.e prescribing without recognized AIFA indications) and underprescribing (i.e. not prescribing despite the presence of recognized AIFA indications) were investigated by logistic regression analysis. Overprescribing was observed in 30% of patients receiving PPIs at discharge. Underprescribing was observed in 11% of patients not receiving PPIs at discharge. Overprescribing of PPIs at discharge was negatively associated with age (OR=0.88, 95%CI=0.85-0.91), depression (OR=0.58, 95%CI=0.35-0.96), use of aspirin (OR=0.03, 95%CI=0.02-0.06) and systemic corticosteroids (OR=0.02, 95%CI=0.01-0.04). The negative association with number of medications (OR=0.95, 95%CI=0.88-1.03) and overall comorbidities (OR=0.92, 95%CI=0.83-1.02) was nearly significant. Conversely, older age (OR=1.09, 95%CI=1.04-1.14), use of aspirin (OR=24.0, 95%CI=11.5-49.8) and systemic corticosteroids (OR=19.3, 95%CI=11.5-49.8) and overall comorbidities (OR=1.22, 95%CI=1.04-1.42) were independent correlates of underprescribing. Overprescribing of PPIs is more frequent in younger patients with lower burden of depression, whilst underprescribing is characterized by older age and greater burden of comorbidity and polypharmacy. Hospitalization should be considered as a clue to identify inappropriate use of PPIs and improve appropriateness of

  5. Impact of potential inappropriate NSAIDs use in chronic pain

    Directory of Open Access Journals (Sweden)

    Ussai S


    Full Text Available S Ussai,1,2 L Miceli,3 F E Pisa,4 R Bednarova,5 A Giordano,1,2 G Della Rocca,3 R Petelin6 1Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; 2Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA; 3Department of Anesthesiology and Intensive Care Medicine, 4Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, 5Department of Palliative Care and Pain Medicine, Health Company n.5, Bassa Friulana, Italy; 6School of Management, Santa Clara University, Santa Clara, CA, USA Abstract: Pain remains one of the main reasons for medical consultation worldwide: moderate- to severe-intensity pain occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Nonsteroidal anti-inflammatory drugs (NSAIDs are not recommended for long-term use and a careful surveillance to monitor for toxicity and efficacy is critical. This study aims to assess: 1 the pattern of use of NSAIDs and opioids in a population covered by a cloud-based pharmacovigilance surveillance system; and 2 potential inappropriate use. A retrospective 18-months systematic analysis on patients’ pain treatment was performed. The primary endpoint was evaluating the prevalence of NSAIDs and opioids use and the duration of therapy regimen. The secondary endpoint was to investigate the prevalence of NSAIDs taken for >21 consecutive days concomitant with drugs for peptic ulcer and gastroesophageal reflux disease (GORD or antiplatelet drugs. The yearly cost for individual users of concomitant NSAIDs for more than 21 consecutive days and of GORD medications has been estimated. A total of 3,050 subjects with chronic pain were enrolled; 97% of them took NSAIDs for >21 consecutive days; about one-fourth of these users also received drugs for peptic ulcer and GORD (Anatomical Therapeutic Chemical

  6. The semantic representation of event information depends on the cue modality: an instance of meaning-based retrieval. (United States)

    Karlsson, Kristina; Sikström, Sverker; Willander, Johan


    The semantic content, or the meaning, is the essence of autobiographical memories. In comparison to previous research, which has mainly focused on the phenomenological experience and the age distribution of retrieved events, the present study provides a novel view on the retrieval of event information by quantifying the information as semantic representations. We investigated the semantic representation of sensory cued autobiographical events and studied the modality hierarchy within the multimodal retrieval cues. The experiment comprised a cued recall task, where the participants were presented with visual, auditory, olfactory or multimodal retrieval cues and asked to recall autobiographical events. The results indicated that the three different unimodal retrieval cues generate significantly different semantic representations. Further, the auditory and the visual modalities contributed the most to the semantic representation of the multimodally retrieved events. Finally, the semantic representation of the multimodal condition could be described as a combination of the three unimodal conditions. In conclusion, these results suggest that the meaning of the retrieved event information depends on the modality of the retrieval cues.

  7. Sexual selection in the squirrel treefrog Hyla squirella: the role of multimodal cue assessment in female choice (United States)

    Taylor, Ryan C.; Buchanan, Bryant W.; Doherty, Jessie L.


    Anuran amphibians have provided an excellent system for the study of animal communication and sexual selection. Studies of female mate choice in anurans, however, have focused almost exclusively on the role of auditory signals. In this study, we examined the effect of both auditory and visual cues on female choice in the squirrel treefrog. Our experiments used a two-choice protocol in which we varied male vocalization properties, visual cues, or both, to assess female preferences for the different cues. Females discriminated against high-frequency calls and expressed a strong preference for calls that contained more energy per unit time (faster call rate). Females expressed a preference for the visual stimulus of a model of a calling male when call properties at the two speakers were held the same. They also showed a significant attraction to a model possessing a relatively large lateral body stripe. These data indicate that visual cues do play a role in mate attraction in this nocturnal frog species. Furthermore, this study adds to a growing body of evidence that suggests that multimodal signals play an important role in sexual selection.

  8. Individual differences in phonetic cue use in production and perception of a non-native sound contrast (United States)

    Schertz, Jessamyn; Cho, Taehong; Lotto, Andrew; Warner, Natasha


    The current work examines native Korean speakers’ perception and production of stop contrasts in their native language (L1, Korean) and second language (L2, English), focusing on three acoustic dimensions that are all used, albeit to different extents, in both languages: voice onset time (VOT), f0 at vowel onset, and closure duration. Participants used all three cues to distinguish the L1 Korean three-way stop distinction in both production and perception. Speakers’ productions of the L2 English contrasts were reliably distinguished using both VOT and f0 (even though f0 is only a very weak cue to the English contrast), and, to a lesser extent, closure duration. In contrast to the relative homogeneity of the L2 productions, group patterns on a forced-choice perception task were less clear-cut, due to considerable individual differences in perceptual categorization strategies, with listeners using either primarily VOT duration, primarily f0, or both dimensions equally to distinguish the L2 English contrast. Differences in perception, which were stable across experimental sessions, were not predicted by individual variation in production patterns. This work suggests that reliance on multiple cues in representation of a phonetic contrast can form the basis for distinct individual cue-weighting strategies in phonetic categorization. PMID:26644630

  9. Effects of rhythmic stimulus presentation on oscillatory brain activity: the physiology of cueing in Parkinson’s disease


    te Woerd, Erik S.; Oostenveld, Robert; Bloem, Bastiaan R.; de Lange, Floris P.; Praamstra, Peter


    The basal ganglia play an important role in beat perception and patients with Parkinson's disease (PD) are impaired in perception of beat-based rhythms. Rhythmic cues are nonetheless beneficial in gait rehabilitation, raising the question how rhythm improves movement in PD. We addressed this question with magnetoencephalography recordings during a choice response task with rhythmic and non-rhythmic modes of stimulus presentation. Analyses focused on (i) entrainment of slow oscillations, (ii) ...

  10. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J


    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  11. Individual differences in regulatory focus predict neural response to reward. (United States)

    Scult, Matthew A; Knodt, Annchen R; Hanson, Jamie L; Ryoo, Minyoung; Adcock, R Alison; Hariri, Ahmad R; Strauman, Timothy J


    Although goal pursuit is related to both functioning of the brain's reward circuits and psychological factors, the literatures surrounding these concepts have often been separate. Here, we use the psychological construct of regulatory focus to investigate individual differences in neural response to reward. Regulatory focus theory proposes two motivational orientations for personal goal pursuit: (1) promotion, associated with sensitivity to potential gain, and (2) prevention, associated with sensitivity to potential loss. The monetary incentive delay task was used to manipulate reward circuit function, along with instructional framing corresponding to promotion and prevention in a within-subject design. We observed that the more promotion oriented an individual was, the lower their ventral striatum response to gain cues. Follow-up analyses revealed that greater promotion orientation was associated with decreased ventral striatum response even to no-value cues, suggesting that promotion orientation may be associated with relatively hypoactive reward system function. The findings are also likely to represent an interaction between the cognitive and motivational characteristics of the promotion system with the task demands. Prevention orientation did not correlate with ventral striatum response to gain cues, supporting the discriminant validity of regulatory focus theory. The results highlight a dynamic association between individual differences in self-regulation and reward system function.

  12. Cues of fatigue: effects of sleep deprivation on facial appearance. (United States)

    Sundelin, Tina; Lekander, Mats; Kecklund, Göran; Van Someren, Eus J W; Olsson, Andreas; Axelsson, John


    To investigate the facial cues by which one recognizes that someone is sleep deprived versus not sleep deprived. Experimental laboratory study. Karolinska Institutet, Stockholm, Sweden. Forty observers (20 women, mean age 25 ± 5 y) rated 20 facial photographs with respect to fatigue, 10 facial cues, and sadness. The stimulus material consisted of 10 individuals (five women) photographed at 14:30 after normal sleep and after 31 h of sleep deprivation following a night with 5 h of sleep. Ratings of fatigue, fatigue-related cues, and sadness in facial photographs. The faces of sleep deprived individuals were perceived as having more hanging eyelids, redder eyes, more swollen eyes, darker circles under the eyes, paler skin, more wrinkles/fine lines, and more droopy corners of the mouth (effects ranging from b = +3 ± 1 to b = +15 ± 1 mm on 100-mm visual analog scales, P sleep deprivation (P sleep deprivation, nor associated with judgements of fatigue. In addition, sleep-deprived individuals looked sadder than after normal sleep, and sadness was related to looking fatigued (P sleep deprivation affects features relating to the eyes, mouth, and skin, and that these features function as cues of sleep loss to other people. Because these facial regions are important in the communication between humans, facial cues of sleep deprivation and fatigue may carry social consequences for the sleep deprived individual in everyday life.

  13. Social cues modulate the representations underlying cross-situational learning. (United States)

    MacDonald, Kyle; Yurovsky, Daniel; Frank, Michael C


    Because children hear language in environments that contain many things to talk about, learning the meaning of even the simplest word requires making inferences under uncertainty. A cross-situational statistical learner can aggregate across naming events to form stable word-referent mappings, but this approach neglects an important source of information that can reduce referential uncertainty: social cues from speakers (e.g., eye gaze). In four large-scale experiments with adults, we tested the effects of varying referential uncertainty in cross-situational word learning using social cues. Social cues shifted learners away from tracking multiple hypotheses and towards storing only a single hypothesis (Experiments 1 and 2). In addition, learners were sensitive to graded changes in the strength of a social cue, and when it became less reliable, they were more likely to store multiple hypotheses (Experiment 3). Finally, learners stored fewer word-referent mappings in the presence of a social cue even when given the opportunity to visually inspect the objects for the same amount of time (Experiment 4). Taken together, our data suggest that the representations underlying cross-situational word learning of concrete object labels are quite flexible: In conditions of greater uncertainty, learners store a broader range of information. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Retrospective cues based on object features improve visual working memory performance in older adults. (United States)

    Gilchrist, Amanda L; Duarte, Audrey; Verhaeghen, Paul


    Research with younger adults has shown that retrospective cues can be used to orient top-down attention toward relevant items in working memory. We examined whether older adults could take advantage of these cues to improve memory performance. Younger and older adults were presented with visual arrays of five colored shapes; during maintenance, participants were presented either with an informative cue based on an object feature (here, object shape or color) that would be probed, or with an uninformative, neutral cue. Although older adults were less accurate overall, both age groups benefited from the presentation of an informative, feature-based cue relative to a neutral cue. Surprisingly, we also observed differences in the effectiveness of shape versus color cues and their effects upon post-cue memory load. These results suggest that older adults can use top-down attention to remove irrelevant items from visual working memory, provided that task-relevant features function as cues.

  15. Crystal structures of E. coli laccase CueO at different copper concentrations

    International Nuclear Information System (INIS)

    Li Xu; Wei Zhiyi; Zhang Min; Peng Xiaohui; Yu Guangzhe; Teng Maikun; Gong Weimin


    CueO protein is a hypothetical bacterial laccase and a good laccase candidate for large scale industrial application. Four CueO crystal structures were determined at different copper concentrations. Low copper occupancy in apo-CueO and slow copper reconstitution process in CueO with exogenous copper were demonstrated. These observations well explain the copper dependence of CueO oxidase activity. Structural comparison between CueO and other three fungal laccase proteins indicates that Glu106 in CueO constitutes the primary counter-work for reconstitution of the trinuclear copper site. Mutation of Glu106 to a Phe enhanced CueO oxidation activity and supported this hypothesis. In addition, an extra α-helix from Leu351 to Gly378 covers substrate biding pocket of CueO and might compromises the electron transfer from substrate to type I copper

  16. Smoker Reactivity to Cues: Effects on Craving and on Smoking behavior (United States)

    Shiffman, Saul; Dunbar, Michael; Kirchner, Thomas; Li, Xiaoxue; Tindle, Hilary; Anderson, Stewart; Scholl, Sarah


    We assessed craving and smoking in response to smoking-relevant cues. 207 daily smokers viewed images related to one of six cue sets (cigarettes, positive and negative affect, alcohol, smoking prohibitions, and neutral cues) in separate sessions. Compared to neutral cues, cigarette cues significantly increased craving, and positive affect cues significantly decreased craving. When subjects were then allowed to smoke during continuing cue exposure, cues did not affect the likelihood of smoking or the amount smoked (number of cigarettes, number of puffs, puff time, or increased carbon monoxide). However, craving intensity predicted likelihood of smoking, latency to smoke, and amount smoked, with craving increases after cue exposure making significant independent contributions. Some craving effects were curvilinear, suggesting that they are subject to thresholds and might not be observed under some circumstances. PMID:22708884

  17. Head orientation of walking blowflies is controlled by visual and mechanical cues. (United States)

    Monteagudo, José; Lindemann, Jens P; Egelhaaf, Martin


    During locomotion, animals employ visual and mechanical cues in order to establish the orientation of their head, which reflects the orientation of the visual coordinate system. However, in certain situations, contradictory cues may suggest different orientations relative to the environment. We recorded blowflies walking on a horizontal or tilted surface surrounded by visual cues suggesting a variety of orientations. We found that the different orientations relative to gravity of visual cues and walking surface were integrated, with the orientation of the surface being the major contributor to head orientation, while visual cues and gravity also play an important role. In contrast, visual cues did not affect body orientation much. Cue integration was modeled as the weighted sum of orientations suggested by the different cues. Our model suggests that in the case of lacking visual cues, more weight is given to gravity. © 2017. Published by The Company of Biologists Ltd.

  18. Using Auditory Cues to Perceptually Extract Visual Data in Collaborative, Immersive Big-Data Display Systems (United States)

    Lee, Wendy

    The advent of multisensory display systems, such as virtual and augmented reality, has fostered a new relationship between humans and space. Not only can these systems mimic real-world environments, they have the ability to create a new space typology made solely of data. In these spaces, two-dimensional information is displayed in three dimensions, requiring human senses to be used to understand virtual, attention-based elements. Studies in the field of big data have predominately focused on visual representations and extractions of information with little focus on sounds. The goal of this research is to evaluate the most efficient methods of perceptually extracting visual data using auditory stimuli in immersive environments. Using Rensselaer's CRAIVE-Lab, a virtual reality space with 360-degree panorama visuals and an array of 128 loudspeakers, participants were asked questions based on complex visual displays using a variety of auditory cues ranging from sine tones to camera shutter sounds. Analysis of the speed and accuracy of participant responses revealed that auditory cues that were more favorable for localization and were positively perceived were best for data extraction and could help create more user-friendly systems in the future.

  19. A strategic account of the cue-depreciation effect. (United States)

    Thapar, A; Greene, R L


    A word fragment is less likely to be completed if it is presented incrementally (R______P, R____R _ P, R_I__R_P, R_I__R O P) than if it is presented all at once (e.g., R_I__R O P). This phenomenon is known as the cue-depreciation effect. The present study examined the role of strategies in this phenomenon. The magnitude of the cue-depreciation effect was increased when subjects were asked to adopt a passive generation approach to word fragment completion. The current study investigated an extension of Bruner and Potter's (1964) early hypothesis-generation account of the cue-depreciation effect. Findings demonstrated the influence of completion strategies for a general theory of fragment completion.

  20. Probabilistic orthographic cues to grammatical category in the brain. (United States)

    Arciuli, Joanne; McMahon, Katie; Zubicaray, Greig de


    What helps us determine whether a word is a noun or a verb, without conscious awareness? We report on cues in the way individual English words are spelled, and, for the first time, identify their neural correlates via functional magnetic resonance imaging (fMRI). We used a lexical decision task with trisyllabic nouns and verbs containing orthographic cues that are either consistent or inconsistent with the spelling patterns of words from that grammatical category. Significant linear increases in response times and error rates were observed as orthography became less consistent, paralleled by significant linear decreases in blood oxygen level dependent (BOLD) signal in the left supramarginal gyrus of the left inferior parietal lobule, a brain region implicated in visual word recognition. A similar pattern was observed in the left superior parietal lobule. These findings align with an emergentist view of grammatical category processing which results from sensitivity to multiple probabilistic cues. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  1. Implicit Age Cues in Resumes: Subtle Effects on Hiring Discrimination

    Directory of Open Access Journals (Sweden)

    Eva Derous


    Full Text Available Anonymous resume screening, as assumed, does not dissuade age discriminatory effects. Building on job market signaling theory, this study investigated whether older applicants may benefit from concealing explicitly mentioned age signals on their resumes (date of birth or whether more implicit/subtle age cues on resumes (older-sounding names/old-fashioned extracurricular activities may lower older applicants’ hirability ratings. An experimental study among 610 HR professionals using a mixed factorial design showed hiring discrimination of older applicants based on implicit age cues in resumes. This effect was more pronounced for older raters. Concealing one’s date of birth led to overall lower ratings. Study findings add to the limited knowledge on the effects of implicit age cues on hiring discrimination in resume screening and the usefulness of anonymous resume screening in the context of age. Implications for research and practice are discussed.

  2. Children Use Nonverbal Cues to Make Inferences About Social Power (United States)

    Brey, Elizabeth; Shutts, Kristin


    Four studies (N=192) tested whether young children use nonverbal information to make inferences about differences in social power. Five- and 6-year-old children were able to determine which of two adults was “in charge” in dynamic videotaped conversations (Study 1) and in static photographs (Study 4) using only nonverbal cues. Younger children (3–4 years) were not successful in Study 1 or Study 4. Removing irrelevant linguistic information from conversations did not improve the performance of 3–4-year-old children (Study 3), but including relevant linguistic cues did (Study 2). Thus, at least by 5 years of age, children show sensitivity to some of the same nonverbal cues adults use to determine other people’s social roles. PMID:25521913

  3. Spatial Hearing with Incongruent Visual or Auditory Room Cues

    DEFF Research Database (Denmark)

    Gil Carvajal, Juan Camilo; Cubick, Jens; Santurette, Sébastien


    whether a mismatch between playback and recording room reduces perceived distance, azimuthal direction, and compactness of the auditory image, and whether this is mostly due to incongruent auditory cues or to expectations generated from the visual impression of the room. Perceived distance ratings...... decreased significantly when collected in a more reverberant environment than the recording room, whereas azimuthal direction and compactness remained room independent. Moreover, modifying visual room-related cues had no effect on these three attributes, while incongruent auditory room-related cues between......In day-to-day life, humans usually perceive the location of sound sources as outside their heads. This externalized auditory spatial perception can be reproduced through headphones by recreating the sound pressure generated by the source at the listener’s eardrums. This requires the acoustical...

  4. Children use nonverbal cues to make inferences about social power. (United States)

    Brey, Elizabeth; Shutts, Kristin


    Four studies (N = 192) tested whether young children use nonverbal information to make inferences about differences in social power. Five- and six-year-old children were able to determine which of two adults was "in charge" in dynamic videotaped conversations (Study 1) and in static photographs (Study 4) using only nonverbal cues. Younger children (3-4 years) were not successful in Study 1 or Study 4. Removing irrelevant linguistic information from conversations did not improve the performance of 3- to 4-year-old children (Study 3), but including relevant linguistic cues did (Study 2). Thus, at least by 5 years of age, children show sensitivity to some of the same nonverbal cues adults use to determine other people's social roles. © 2014 The Authors. Child Development © 2014 Society for Research in Child Development, Inc.

  5. White sucker Catostomus commersonii respond to conspecific and sea lamprey Petromyzon marinus alarm cues but not potential predator cues (United States)

    Jordbro, Ethan J.; Di Rocco, Richard T.; Imre, Istvan; Johnson, Nicholas; Brown, Grant E.


    Recent studies proposed the use of chemosensory alarm cues to control the distribution of invasive sea lamprey Petromyzon marinus populations in the Laurentian Great Lakes and necessitate the evaluation of sea lamprey chemosensory alarm cues on valuable sympatric species such as white sucker. In two laboratory experiments, 10 replicate groups (10 animals each) of migratory white suckers were exposed to deionized water (control), conspecific whole-body extract, heterospecific whole-body extract (sea lamprey) and two potential predator cues (2-phenylethylamine HCl (PEA HCl) and human saliva) during the day, and exposed to the first four of the above cues at night. White suckers avoided the conspecific and the sea lamprey whole-body extract both during the day and at night to the same extent. Human saliva did not induce avoidance during the day. PEA HCl did not induce avoidance at a higher concentration during the day, or at night at the minimum concentration that was previously shown to induce maximum avoidance by sea lamprey under laboratory conditions. Our findings suggest that human saliva and PEA HCl may be potential species-specific predator cues for sea lamprey.

  6. Novel ICD Programming and Inappropriate ICD Therapy in CRT-D Versus ICD Patients: A MADIT-RIT Sub-Study. (United States)

    Kutyifa, Valentina; Daubert, James P; Schuger, Claudio; Goldenberg, Ilan; Klein, Helmut; Aktas, Mehmet K; McNitt, Scott; Stockburger, Martin; Merkely, Bela; Zareba, Wojciech; Moss, Arthur J


    The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate therapy (MADIT-RIT) trial showed a significant reduction in inappropriate implantable cardioverter defibrillator (ICD) therapy in patients programmed to high-rate cut-off (Arm B) or delayed ventricular tachycardia therapy (Arm C), compared with conventional programming (Arm A). There is limited data on the effect of cardiac resynchronization therapy with a cardioverter defibrillator (CRT-D) on the effect of ICD programming. We aimed to elucidate the effect of CRT-D on ICD programming to reduce inappropriate ICD therapy in patients implanted with CRT-D or an ICD, enrolled in MADIT-RIT. The primary end point of this study was the first inappropriate ICD therapy. Secondary end points were inappropriate anti-tachycardia pacing and inappropriate ICD shock. The study enrolled 742 (49%) patients with an ICD and 757 (51%) patients with a CRT-D. Patients implanted with a CRT-D had 62% lower risk of inappropriate ICD therapy than those with an ICD only (hazard ratio [HR] =0.38, 95% confidence interval: 0.25-0.57; Pprogramming significantly reduced the risk of inappropriate ICD therapy compared with conventional ICD programming in ICD (HR=0.14 [B versus A]; HR=0.21 [C versus A]) and CRT-D patients (HR=0.15 [B versus A]; HR=0.23 [C versus A]; Pprogramming significantly reduces the risk of inappropriate ICD therapy in both ICD and CRT-D patients.; Unique identifier: NCT00947310. © 2016 American Heart Association, Inc.

  7. Motor Training: Comparison of Visual and Auditory Coded Proprioceptive Cues

    Directory of Open Access Journals (Sweden)

    Philip Jepson


    Full Text Available Self-perception of body posture and movement is achieved through multi-sensory integration, particularly the utilisation of vision, and proprioceptive information derived from muscles and joints. Disruption to these processes can occur following a neurological accident, such as stroke, leading to sensory and physical impairment. Rehabilitation can be helped through use of augmented visual and auditory biofeedback to stimulate neuro-plasticity, but the effective design and application of feedback, particularly in the auditory domain, is non-trivial. Simple auditory feedback was tested by comparing the stepping accuracy of normal subjects when given a visual spatial target (step length and an auditory temporal target (step duration. A baseline measurement of step length and duration was taken using optical motion capture. Subjects (n=20 took 20 ‘training’ steps (baseline ±25% using either an auditory target (950 Hz tone, bell-shaped gain envelope or visual target (spot marked on the floor and were then asked to replicate the target step (length or duration corresponding to training with all feedback removed. Visual cues (mean percentage error=11.5%; SD ± 7.0%; auditory cues (mean percentage error = 12.9%; SD ± 11.8%. Visual cues elicit a high degree of accuracy both in training and follow-up un-cued tasks; despite the novelty of the auditory cues present for subjects, the mean accuracy of subjects approached that for visual cues, and initial results suggest a limited amount of practice using auditory cues can improve performance.

  8. Dyspnea-Related Cues Engage the Prefrontal Cortex (United States)

    Herigstad, Mari; Hayen, Anja; Evans, Eleanor; Hardinge, Frances M.; Davies, Robert J.; Wiech, Katja


    BACKGROUND: Dyspnea is the major source of disability in COPD. In COPD, environmental cues (eg, the prospect of having to climb stairs) become associated with dyspnea and may trigger dyspnea even before physical activity commences. We hypothesized that brain activation relating to such cues would be different between patients with COPD and healthy control subjects, reflecting greater engagement of emotional mechanisms in patients. METHODS: Using functional MRI (FMRI), we investigated brain responses to dyspnea-related word cues in 41 patients with COPD and 40 healthy age-matched control subjects. We combined these findings with scores on self-report questionnaires, thus linking the FMRI task with clinically relevant measures. This approach was adapted from studies in pain that enabled identification of brain networks responsible for pain processing despite absence of a physical challenge. RESULTS: Patients with COPD demonstrated activation in the medial prefrontal cortex and anterior cingulate cortex, which correlated with the visual analog scale (VAS) response to word cues. This activity independently correlated with patient responses on questionnaires of depression, fatigue, and dyspnea vigilance. Activation in the anterior insula, lateral prefrontal cortex, and precuneus correlated with the VAS dyspnea scale but not with the questionnaires. CONCLUSIONS: The findings suggest that engagement of the emotional circuitry of the brain is important for interpretation of dyspnea-related cues in COPD and is influenced by depression, fatigue, and vigilance. A heightened response to salient cues is associated with increased symptom perception in chronic pain and asthma, and the findings suggest that such mechanisms may be relevant in COPD. PMID:26134891

  9. Reconciling sensory cues and varied consequences of avian repellents. (United States)

    Werner, Scott J; Provenza, Frederick D


    We learned previously that red-winged blackbirds (Agelaius phoeniceus) use affective processes to shift flavor preference, and cognitive associations (colors) to avoid food, subsequent to avoidance conditioning. We conducted three experiments with captive red-winged blackbirds to reconcile varied consequences of treated food with conditioned sensory cues. In Experiment 1, we compared food avoidance conditioned with lithium chloride (LiCl) or naloxone hydrochloride (NHCl) to evaluate cue-consequence specificity. All blackbirds conditioned with LiCl (gastrointestinal toxin) avoided the color (red) and flavor (NaCl) of food experienced during conditioning; birds conditioned with NHCl (opioid antagonist) avoided only the color (not the flavor) of food subsequent to conditioning. In Experiment 2, we conditioned experimentally naïve blackbirds using free choice of colored (red) and flavored (NaCl) food paired with an anthraquinone- (postingestive, cathartic purgative), methiocarb- (postingestive, cholinesterase inhibitor), or methyl anthranilate-based repellent (preingestive, trigeminal irritant). Birds conditioned with the postingestive repellents avoided the color and flavor of foods experienced during conditioning; methyl anthranilate conditioned only color (not flavor) avoidance. In Experiment 3, we used a third group of blackbirds to evaluate effects of novel comparison cues (blue, citric acid) subsequent to conditioning with red and NaCl paired with anthraquinone or methiocarb. Birds conditioned with the postingestive repellents did not avoid conditioned color or flavor cues when novel comparison cues were presented during the test. Thus, blackbirds cognitively associate pre- and postingestive consequences with visual cues, and reliably integrate visual and gustatory experience with postingestive consequences to procure nutrients and avoid toxins. Published by Elsevier Inc.

  10. Family focused nursing education

    Directory of Open Access Journals (Sweden)

    R. A. E. Thompson


    Full Text Available At the present time the majority of nurse education programmes are firmly tied to the perspectives of curative medicine within hospitals - they are disease and hospital oriented. This model, which indicates a 'sickness’ concept of nursing is entirely inappropriate if contemporary and future health care needs are to be met. The shift in education should be towards a health, family and whole person centered approach. The family is the most fundamental and dynamic unit in society with a profound influence upon its members. Besides performing a variety of other functions, the family has a central role in promoting and maintaining the health of its members. Because the family unit is the microcosm of society and accurately reflects the needs of society at large it is appropriate that this should be a key area of experience. Family attachments during training provide opportunities for close and committed contact with people in their everyday world and for learning what is really important to them.

  11. Gait parameter control timing with dynamic manual contact or visual cues (United States)

    Shi, Peter; Werner, William


    We investigated the timing of gait parameter changes (stride length, peak toe velocity, and double-, single-support, and complete step duration) to control gait speed. Eleven healthy participants adjusted their gait speed on a treadmill to maintain a constant distance between them and a fore-aft oscillating cue (a place on a conveyor belt surface). The experimental design balanced conditions of cue modality (vision: eyes-open; manual contact: eyes-closed while touching the cue); treadmill speed (0.2, 0.4, 0.85, and 1.3 m/s); and cue motion (none, ±10 cm at 0.09, 0.11, and 0.18 Hz). Correlation analyses revealed a number of temporal relationships between gait parameters and cue speed. The results suggest that neural control ranged from feedforward to feedback. Specifically, step length preceded cue velocity during double-support duration suggesting anticipatory control. Peak toe velocity nearly coincided with its most-correlated cue velocity during single-support duration. The toe-off concluding step and double-support durations followed their most-correlated cue velocity, suggesting feedback control. Cue-tracking accuracy and cue velocity correlations with timing parameters were higher with the manual contact cue than visual cue. The cue/gait timing relationships generalized across cue modalities, albeit with greater delays of step-cycle events relative to manual contact cue velocity. We conclude that individual kinematic parameters of gait are controlled to achieve a desired velocity at different specific times during the gait cycle. The overall timing pattern of instantaneous cue velocities associated with different gait parameters is conserved across cues that afford different performance accuracies. This timing pattern may be temporally shifted to optimize control. Different cue/gait parameter latencies in our nonadaptation paradigm provide general-case evidence of the independent control of gait parameters previously demonstrated in gait adaptation paradigms

  12. Cue-Reactive Altered State of Consciousness Mediates the Relationship Between Problem-Gambling Severity and Cue-Reactive Urge in Poker-Machine Gamblers. (United States)

    Tricker, Christopher; Rock, Adam J; Clark, Gavin I


    In order to enhance our understanding of the nature of poker-machine problem-gambling, a community sample of 37 poker-machine gamblers (M age = 32 years, M PGSI = 5; PGSI = Problem Gambling Severity Index) were assessed for urge to gamble (responses on a visual analogue scale) and altered state of consciousness (assessed by the Altered State of Awareness dimension of the Phenomenology of Consciousness Inventory) at baseline, after a neutral cue, and after a gambling cue. It was found that (a) problem-gambling severity (PGSI score) predicted increase in urge (from neutral cue to gambling cue, controlling for baseline; sr (2) = .19, p = .006) and increase in altered state of consciousness (from neutral cue to gambling cue, controlling for baseline; sr (2) = .57, p gambling cue) mediated the relationship between problem-gambling severity and increase in urge (from neutral cue to gambling cue; κ(2) = .40, 99 % CI [.08, .71]). These findings suggest that cue-reactive altered state of consciousness is an important component of cue-reactive urge in poker-machine problem-gamblers.

  13. Sensorimotor Adaptation Following Exposure to Ambiguous Inertial Motion Cues (United States)

    Wood, S. J.; Clement, G. R.; Rupert, A. H.; Reschke, M. F.; Harm, D. L.; Guedry, F. E.


    The central nervous system must resolve the ambiguity of inertial motion sensory cues in order to derive accurate spatial orientation awareness. Adaptive changes in how inertial cues from the otolith system are integrated with other sensory information lead to perceptual and postural disturbances upon return to Earth s gravity. The primary goals of this ground-based research investigation are to explore physiological mechanisms and operational implications of tilt-translation disturbances during and following re-entry, and to evaluate a tactile prosthesis as a countermeasure for improving control of whole-body orientation during tilt and translation motion.

  14. Food packaging cues influence taste perception and increase effort provision for a recommended snack product in children

    Directory of Open Access Journals (Sweden)

    Laura eEnax


    Full Text Available Food marketing research shows that child-directed marketing cues have pronounced effects on food preferences and consumption, but are most often placed on products with low nutritional quality. Effects of child-directed marketing strategies for healthy food products remain to be studied in more detail. Previous research suggests that effort provision explains additional variance in food choice. This study investigated the effects of packaging cues on explicit preferences and effort provision for healthy food items in elementary school children. Each of 179 children rated three, objectively identical, recommended yoghurt-cereal-fruit snacks presented with different packaging cues. Packaging cues included a plain label, a label focusing on health aspects of the product, and a label that additionally included unknown cartoon characters. The children were asked to state the subjective taste-pleasantness of the respective food items. We also used a novel approach to measure effort provision for food items in children, namely handgrip strength. Results show that packaging cues significantly induce a taste-placebo effect in 88% of the children, i.e., differences in taste ratings for objectively identical products. Taste ratings were highest for the child-directed product that included cartoon characters. Also, applied effort to receive the child-directed product was significantly higher. Our results confirm the positive effect of child-directed marketing strategies also for healthy snack food products. Using handgrip strength as a measure to determine the amount of effort children are willing to provide for a product may explain additional variance in food choice and might prove to be a promising additional research tool for field studies and the assessment of public policy interventions.

  15. The use of virtual reality in craving assessment and cue-exposure therapy in substance use disorders

    Directory of Open Access Journals (Sweden)

    Antoine eHone-Blanchet


    Full Text Available Craving is recognized as an important diagnosis criterion for substance use disorders (SUDs and a predictive factor of relapse. Various methods to study craving exist, however, suppressing craving to successfully promote abstinence remains an unmet clinical need in SUDs. One reason is that social and environmental contexts recalling drug and alcohol consumption in the everyday life of patients suffering from SUDs often initiate craving and provoke relapse.Current behavioural therapies for SUDs use the cue-exposure approach to suppress salience of social and environmental contexts that may induce craving. They facilitate learning and cognitive reinforcement of new behavior and entrain craving suppression in the presence of cues related to drug and alcohol consumption. Unfortunately, craving often overweighs behavioural training especially in real social and environmental contexts with peer-pressure encouraging the use of substance, such as parties and bars. In this perspective, virtual reality is gaining interest in the development of cue-reactivity paradigms and practice new skills in treatment. Virtual reality enhances ecological validity of traditional craving induction measurement. In this review, we discuss results from 1 studies using virtual reality and alternative virtual agents in the induction of craving and 2 studies combining cue-exposure therapy with virtual reality in the promotion of abstinence from drugs and alcohol use. They used virtual environments, displaying alcohol and drugs to SUD patients. Moreover, some environments included avatars. Hence, some studies have focused on the social interactions that are associated with drug seeking behaviours and peer pressure.Findings indicate that virtual reality can successfully increase craving. Studies combining cue exposure-therapy with virtual environment however reported mitigated success so far.

  16. Food packaging cues influence taste perception and increase effort provision for a recommended snack product in children. (United States)

    Enax, Laura; Weber, Bernd; Ahlers, Maren; Kaiser, Ulrike; Diethelm, Katharina; Holtkamp, Dominik; Faupel, Ulya; Holzmüller, Hartmut H; Kersting, Mathilde


    Food marketing research shows that child-directed marketing cues have pronounced effects on food preferences and consumption, but are most often placed on products with low nutritional quality. Effects of child-directed marketing strategies for healthy food products remain to be studied in more detail. Previous research suggests that effort provision explains additional variance in food choice. This study investigated the effects of packaging cues on explicit preferences and effort provision for healthy food items in elementary school children. Each of 179 children rated three, objectively identical, recommended yogurt-cereal-fruit snacks presented with different packaging cues. Packaging cues included a plain label, a label focusing on health aspects of the product, and a label that additionally included unknown cartoon characters. The children were asked to state the subjective taste-pleasantness of the respective food items. We also used a novel approach to measure effort provision for food items in children, namely handgrip strength. Results show that packaging cues significantly induce a taste-placebo effect in 88% of the children, i.e., differences in taste ratings for objectively identical products. Taste ratings were highest for the child-directed product that included cartoon characters. Also, applied effort to receive the child-directed product was significantly higher. Our results confirm the positive effect of child-directed marketing strategies also for healthy snack food products. Using handgrip strength as a measure to determine the amount of effort children are willing to provide for a product may explain additional variance in food choice and might prove to be a promising additional research tool for field studies and the assessment of public policy interventions.

  17. "I'm Not Stupid": How Assessment Drives (In)Appropriate Reading Instruction (United States)

    Dennis, Danielle V.


    Middle school students who score below proficient on state reading assessments are often placed in remedial reading programs that focus on phonics and decoding skills and do not acknowledge students' literate abilities. The purpose of this study is to demonstrate the reading abilities of young adolescent readers. Five assessments measuring…

  18. Protocol to disseminate a hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of asymptomatic bacteriuria. (United States)

    Trautner, Barbara W; Prasad, Pooja; Grigoryan, Larissa; Hysong, Sylvia J; Kramer, Jennifer R; Rajan, Suja; Petersen, Nancy J; Rosen, Tracey; Drekonja, Dimitri M; Graber, Christopher; Patel, Payal; Lichtenberger, Paola; Gauthier, Timothy P; Wiseman, Steve; Jones, Makoto; Sales, Anne; Krein, Sarah; Naik, Aanand Dinkar


    Antimicrobial stewardship to combat the spread of antibiotic-resistant bacteria has become a national priority. This project focuses on reducing inappropriate use of antimicrobials for asymptomatic bacteriuria (ASB), a very common condition that leads to antimicrobial overuse in acute and long-term care. We previously conducted a successful intervention, entitled "Kicking Catheter Associated Urinary Tract Infection (CAUTI): the No Knee-Jerk Antibiotics Campaign," to decrease guideline-discordant ordering of urine cultures and antibiotics for ASB. The current objective is to facilitate implementation of a scalable version of the Kicking CAUTI campaign across four geographically diverse Veterans Health Administration facilities while assessing what aspects of an antimicrobial stewardship intervention are essential to success and sustainability. This project uses an interrupted time series design with four control sites. The two main intervention tools are (1) an evidence-based algorithm that distills the guidelines into a streamlined clinical pathway and (2) case-based audit and feedback to train clinicians to use the algorithm. Our conceptual framework for the development and implementation of this intervention draws on May's General Theory of Implementation. The intervention is directed at providers in acute and long-term care, and the goal is to reduce inappropriate screening for and treatment of ASB in all patients and residents, not just those with urinary catheters. The start-up for each facility consists of centrally-led phone calls with local site champions and baseline surveys. Case-based audit and feedback will begin at a given site after the start-up period and continue for 12 months, followed by a sustainability assessment. In addition to the clinical outcomes, we will explore the relationship between the dose of the intervention and clinical outcomes. This project moves from a proof-of-concept effectiveness study to implementation involving

  19. Visual cues for person-centered communication. (United States)

    Williams, Kristine; Harris, Brynn; Lueger, Amy; Ward, Kathleen; Wassmer, Rebecca; Weber, Amy


    Nursing home communication is frequently limited and task-focused and fails to affirm resident personhood. We tested the feasibility and effects of automated digital displays of resident photographs to remind staff (N = 11) of resident (n = 6) personhood. Historical photographs were displayed in digital photo frames mounted in each resident's room. To evaluate the intervention's effects, staff-resident conversations were audio-recorded prior to displaying the frames and repeated 2 weeks and 3 months later. Conversations were transcribed and statements were topic coded (task-focused vs. interpersonal). Staff person-centered talk increased from 11% to 32% (z = 2.37, p = .02) after the intervention and task-talk decreased from 64% to 40%. Resident interpersonal topics increased from 20% to 37%. Staff statements increased from 29 at baseline, to 37 postintervention, and 41 at 3-month follow-up and resident engagement and reminiscence also increased. Effects were reduced after 3 months. Automated photo displays are an easily implemented, low-cost intervention to promote person-centered communication.

  20. Food and drug cues activate similar brain regions: a meta-analysis of functional MRI studies. (United States)

    Tang, D W; Fellows, L K; Small, D M; Dagher, A


    In healthy individuals, food cues can trigger hunger and feeding behavior. Likewise, smoking cues can trigger craving and relapse in smokers. Brain imaging studies report that structures involved in appetitive behaviors and reward, notably the insula, striatum, amygdala and orbital frontal cortex, tend to be activated by both visual food and smoking cues. Here, by carrying out a meta-analysis of human neuro-imaging studies, we investigate the neural network activated by: 1) food versus neutral cues (14 studies, 142 foci) 2) smoking versus neutral cues (15 studies, 176 foci) 3) smoking versus neutral cues when correlated with craving scores (7 studies, 108 foci). PubMed was used to identify cue-reactivity imaging studies that compared brain response to visual food or smoking cues to neutral cues. Fourteen articles were identified for the food meta-analysis and fifteen articles were identified for the smoking meta-analysis. Six articles were identified for the smoking cue correlated with craving analysis. Meta-analyses were carried out using activation likelihood estimation. Food cues were associated with increased blood oxygen level dependent (BOLD) response in the left amygdala, bilateral insula, bilateral orbital frontal cortex, and striatum. Smoking cues were associated with increased BOLD signal in the same areas, with the exception of the insula. However, the smoking meta-analysis of brain maps correlating cue-reactivity with subjective craving did identify the insula, suggesting that insula activation is only found when craving levels are high. The brain areas identified here are involved in learning, memory and motivation, and their cue-induced activity is an index of the incentive salience of the cues. Using meta-analytic techniques to combine a series of studies, we found that food and smoking cues activate comparable brain networks. There is significant overlap in brain regions responding to conditioned cues associated with natural and drug rewards

  1. Do environmental cues prompt attempts to stop smoking? A prospective natural history study. (United States)

    Hughes, John R; Naud, Shelly; Fingar, James R; Callas, Peter W; Solomon, Laura J


    We prospectively tested whether environmental cues prompts attempts to stop smoking. We recruited 134 smokers who intended to quit in the next 3 months to complete nightly calls to report cues as well as smoking status, intentions to smoke or not on the next day, and quit attempts over 12 weeks. We provided no treatment. Participants averaged 6.5 cues/week. The most common cues were embarrassment, cost of cigarettes and messages in the media. The number of cues over a 7-day period predicted the incidence of a quit attempt on the eighth day (e.g. from 1.5% when no cues occurred to 3% when 7 cues occurred during the 7 days). This effect was dose-dependent and was due to both between and within-subject predictors. Five cues predicted quit attempts. A cue that made smokers concerned about the cost of cigarettes appeared to be the strongest cue. Cues on the day prior were not more powerful predictors than more distal cues. Intention to not smoke the next day on the evening prior to the eighth day was a partial mediator of the effect of cues on quit attempts. Retrospective recall of cues was poor. Our results suggest the occurrence of cues may be a cause of quit attempts and that programs to increase the frequency of cues may increase quit attempts. Further research should examine whether environmental cues and introspective states (e.g. self-efficacy) interact to prompt quit attempts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. The location but not the attributes of visual cues are automatically encoded into working memory. (United States)

    Chen, Hui; Wyble, Brad


    Although it has been well known that visual cues affect the perception of subsequent visual stimuli, relatively little is known about how the cues themselves are processed. The present study attempted to characterize the processing of a visual cue by investigating what information about the cue is stored in terms of both location ("where" is the cue) and attributes ("what" are the attributes of the cue). In 11 experiments subjects performed several trials of reporting a target letter and then answered an unexpected question about the cue (e.g., the location, color, or identity of the cue). This surprise question revealed that participants could report the location of the cue even when the cue never indicated the target location and they were explicitly told to ignore it. Furthermore, the memory trace of this location information endured during encoding of the subsequent target. In contrast to location, attributes of the cue (e.g., color) were poorly reported, even for attributes that were used by subjects to perform the task. These results shed new light on the mechanisms underlying cueing effects and suggest also that the visual system may create empty object files in response to visual cues. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Overtraining and the use of feature and geometric cues for reorientation. (United States)

    Sturz, Bradley R; Gaskin, Katherine A; Bodily, Kent D


    Using a dynamic three-dimensional virtual environment task, we investigated the influence of overtraining of feature and geometric cues on preferential spatial cue use. We trained two groups of human participants to respond to feature and geometric cues in separate enclosures before placing these cues in conflict on a critical test trial. All participants learned to respond to rewarded features located along the principal axis of a rectangular search space and to rewarded geometric cues of a rectangular search space in separate training phases followed by a single test trial. During the test trial, we situated the rewarded features in the unrewarded geometric corners and the unrewarded features in rewarded geometric corners. For one group, participants were overtrained with feature cues compared to geometric cues before experiencing the conflict test; whereas, for another group, participants were overtrained with geometric cues compared to feature cues before experiencing the conflict test. Although both groups learned to respond to both feature and geometric cues at an equivalent rate and to an equivalent level of terminal accuracy, testing results revealed no difference between the groups with respect to their preference for feature or geometric cues. Despite a lack of influence of overtraining on spatial cue preference, participants showed an overall preference for feature cues. We discuss the results with respect to implications for theoretical accounts of spatial learning.

  4. Integration of texture and disparity cues to surface slant in dorsal visual cortex. (United States)

    Murphy, Aidan P; Ban, Hiroshi; Welchman, Andrew E


    Reliable estimation of three-dimensional (3D) surface orientation is critical for recognizing and interacting with complex 3D objects in our environment. Human observers maximize the reliability of their estimates of surface slant by integrating multiple depth cues. Texture and binocular disparity are two such cues, but they are qualitatively very different. Existing evidence suggests that representations of surface tilt from each of these cues coincide at the single-neuron level in higher cortical areas. However, the cortical circuits responsible for 1) integration of such qualitatively distinct cues and 2) encoding the slant component of surface orientation have not been assessed. We tested for cortical responses related to slanted plane stimuli that were defined independently by texture, disparity, and combinations of these two cues. We analyzed the discriminability of functional MRI responses to two slant angles using multivariate pattern classification. Responses in visual area V3B/KO to stimuli containing congruent cues were more discriminable than those elicited by single cues, in line with predictions based on the fusion of slant estimates from component cues. This improvement was specific to congruent combinations of cues: incongruent cues yielded lower decoding accuracies, which suggests the robust use of individual cues in cases of large cue conflicts. These data suggest that area V3B/KO is intricately involved in the integration of qualitatively dissimilar depth cues.

  5. Responding to the direction of the eyes: in search of the masked gaze-cueing effect. (United States)

    Al-Janabi, Shahd; Finkbeiner, Matthew


    Recent studies have demonstrated that masked gaze cues can produce a cueing effect. Those studies, however, all utilized a localization task and, hence, are ambiguous with respect to whether the previously observed masked gaze-cueing effect reflects the orienting of attention or the preparation of a motor response. The aim of the present study was to investigate this issue by determining whether masked gaze cues can modulate responses in detection and discrimination tasks, both of which isolate spatial attention from response priming. First, we found a gaze-cueing effect for unmasked cues in detection, discrimination, and localization tasks, which suggests that the gaze-cueing effect for visible cues is not task dependent. Second, and in contrast, we found a gaze-cueing effect for masked cues in a localization task, but not in detection or discrimination tasks, which suggests that the gaze-cueing effect for masked cues is task dependent. Therefore, the present study shows that the masked gaze-cueing effect is attributed to response priming, as opposed to the orienting of spatial attention.

  6. Alignment of sound localization cues in the nucleus of the brachium of the inferior colliculus (United States)

    Young, Eric D.


    Accurate sound localization is based on three acoustic cues (interaural time and intensity difference and spectral cues from directional filtering by the pinna). In natural listening conditions, every spatial position of a sound source provides a unique combination of these three cues in “natural alignment.” Although neurons in the central nucleus (ICC) of the inferior colliculus (IC) are sensitive to multiple cues, they do not favor their natural spatial alignment. We tested for sensitivity to cue alignment in the nucleus of the brachium of the IC (BIN) in unanesthetized marmoset monkeys. The BIN receives its predominant auditory input from ICC and projects to the topographic auditory space map in the superior colliculus. Sound localization cues measured in each monkey were used to synthesize broadband stimuli with aligned and misaligned cues; spike responses to these stimuli were recorded in the BIN. We computed mutual information (MI) between the set of spike rates and the stimuli containing either aligned or misaligned cues. The results can be summarized as follows: 1) BIN neurons encode more information about auditory space when cues are aligned compared with misaligned. 2) Significantly more units prefer aligned cues in the BIN than in ICC. 3) An additive model based on summing the responses to stimuli with the localization cues varying individually accurately predicts the alignment preference with all cues varying. Overall, the results suggest that the BIN is the first site in the ascending mammalian auditory system that is tuned to natural combinations of sound localization cues. PMID:24671535

  7. Reliability-dependent contributions of visual orientation cues in parietal cortex (United States)

    Angelaki, Dora E.


    Creating accurate 3D representations of the world from 2D retinal images is a fundamental task for the visual system. However, the reliability of different 3D visual signals depends inherently on viewing geometry, such as how much an object is slanted in depth. Human perceptual studies have correspondingly shown that texture and binocular disparity cues for object orientation are combined according to their slant-dependent reliabilities. Where and how this cue combination occurs in the brain is currently unknown. Here, we search for neural correlates of this property in the macaque caudal intraparietal area (CIP) by measuring slant tuning curves using mixed-cue (texture + disparity) and cue-isolated (texture or disparity) planar stimuli. We find that texture cues contribute more to the mixed-cue responses of CIP neurons that prefer larger slants, consistent with theoretical and psychophysical results showing that the reliability of texture relative to disparity cues increases with slant angle. By analyzing responses to binocularly viewed texture stimuli with conflicting texture and disparity information, some cells that are sensitive to both cues when presented in isolation are found to disregard one of the cues during cue conflict. Additionally, the similarity between texture and mixed-cue responses is found to be greater when this cue conflict is eliminated by presenting the texture stimuli monocularly. The present findings demonstrate reliability-dependent contributions of visual orientation cues at the level of the CIP, thus revealing a neural correlate of this property of human visual perception. PMID:25427796

  8. A novel speech processing algorithm based on harmonicity cues in cochlear implant (United States)

    Wang, Jian; Chen, Yousheng; Zhang, Zongping; Chen, Yan; Zhang, Weifeng


    This paper proposed a novel speech processing algorithm in cochlear implant, which used harmonicity cues to enhance tonal information in Mandarin Chinese speech recognition. The input speech was filtered by a 4-channel band-pass filter bank. The frequency ranges for the four bands were: 300-621, 621-1285, 1285-2657, and 2657-5499 Hz. In each pass band, temporal envelope and periodicity cues (TEPCs) below 400 Hz were extracted by full wave rectification and low-pass filtering. The TEPCs were modulated by a sinusoidal carrier, the frequency of which was fundamental frequency (F0) and its harmonics most close to the center frequency of each band. Signals from each band were combined together to obtain an output speech. Mandarin tone, word, and sentence recognition in quiet listening conditions were tested for the extensively used continuous interleaved sampling (CIS) strategy and the novel F0-harmonic algorithm. Results found that the F0-harmonic algorithm performed consistently better than CIS strategy in Mandarin tone, word, and sentence recognition. In addition, sentence recognition rate was higher than word recognition rate, as a result of contextual information in the sentence. Moreover, tone 3 and 4 performed better than tone 1 and tone 2, due to the easily identified features of the former. In conclusion, the F0-harmonic algorithm could enhance tonal information in cochlear implant speech processing due to the use of harmonicity cues, thereby improving Mandarin tone, word, and sentence recognition. Further study will focus on the test of the F0-harmonic algorithm in noisy listening conditions.

  9. Differences Between Access to Follow-Up Care and Inappropriate Shocks Based on Insurance Status of Implantable Cardioverter Defibrillator Recipients. (United States)

    Sager, Solomon J; Healy, Chris; Ramireddy, Archana; Rivner, Harold; Viles Gonzalez, Juan F; Coffey, James O; Rossin, Natalia; Lo, Ka M; Goldberger, Jeffrey J; Myerburg, Robert J; Mitrani, Raul D


    Differences in implantable cardioverter defibrillator (ICD) utilization based on insurance status have been described, but little is known about postimplant follow-up patterns associated with insurance status and outcomes. We collected demographic, clinical, and device data from 119 consecutive patients presenting with ICD shocks. Insurance status was classified as uninsured/Medicaid (uninsured) or private/Health Maintenance Organization /Medicare (insured). Shock frequencies were analyzed before and after a uniform follow-up pattern was implemented regardless of insurance profile. Uninsured patients were more likely to present with an inappropriate shock (63% vs 40%, p = 0.01), and they were more likely to present with atrial fibrillation (AF) as the shock trigger (37% vs 19%, p = 0.04). Uninsured patients had a longer interval between previous physician contact and index ICD shock (147 ± 167 vs 83 ± 124 days, p = 0.04). Patients were followed for a mean of 521 ± 458 days after being enrolled in a uniform follow-up protocol, and there were no differences in the rate of recurrent shocks based on insurance status. In conclusion, among patients presenting with an ICD shock, underinsured/uninsured patients had significantly longer intervals since previous physician contact and were more likely to present with inappropriate shocks and AF, compared to those with private/Medicare coverage. After the index shock, both groups were followed uniformly, and the differences in rates of inappropriate shocks were mitigated. This observation confirms the importance of regular postimplant follow-up as part of the overall ICD management standard. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Prevalence and Risk of Inappropriate Sexual Behavior of Patients Toward Physical Therapist Clinicians and Students in the United States. (United States)

    Boissonnault, Jill S; Cambier, Ziádee; Hetzel, Scott J; Plack, Margaret M


    For health care providers in the United States, the risk for nonfatal violence in the workplace is 16 times greater than that for other workers. Inappropriate patient sexual behavior (IPSB) is directed at clinicians, staff, or other patients and may include leering, sexual remarks, deliberate touching, indecent exposure, and sexual assault. Inappropriate patient sexual behavior may adversely affect clinicians, the organization, or patients themselves. Few IPSB risk factors for physical therapists have been confirmed. The US prevalence was last assessed in the 1990s. The objectives of this study were to determine career and 12-month exposure to IPSB among US physical therapists, physical therapist assistants, physical therapist students, and physical therapist assistant students and to identify IPSB risk factors. This was a retrospective and observational study. An electronic survey was developed; content validity and test-retest reliability were established. Participants were recruited through physical therapist and physical therapist assistant academic programs and sections of the American Physical Therapy Association. Inappropriate patient sexual behavior risk models were constructed individually for any, mild, moderate, and severe IPSB events reported over the past 12 months. Open-ended comments were analyzed using qualitative methods. Eight hundred ninety-two physical therapist professionals and students completed the survey. The career prevalence among respondents was 84%, and the 12-month prevalence was 47%. Statistical risk modeling for any IPSB over the past 12 months indicated the following risks: having fewer years of direct patient care, routinely working with patients with cognitive impairments, being a female practitioner, and treating male patients. Qualitative analysis of 187 open-ended comments revealed patient-related characteristics, provider-related characteristics, and abusive actions. Self-report, clinician memory, and convenience sampling are

  11. Inappropriate prescribing in outpatient healthcare: an evaluation of respiratory infection visits among veterans in teaching versus non-teaching primary care clinics

    Directory of Open Access Journals (Sweden)

    Diane M. Parente


    Full Text Available Abstract A recent study led by the Centers for Disease Control and Prevention (CDC revealed at least 30% of antibiotic prescriptions in the outpatient setting were inappropriate. In this study of all ages, among adult patients, results were similar to the overall population, with the majority of inappropriate prescribing relating to respiratory infections. We applied the same methodology to investigate rates of antibiotic prescribing for respiratory tract infections in outpatient primary care clinics at the Providence Veterans Affairs Medical Center. The results of our evaluation reflected comparable rates of inappropriate prescribing, but when stratified by teaching versus non-teaching primary care clinics, inappropriate prescribing was significantly higher in non-teaching clinics (17.6% vs 44.0%, p < .0001. Respiratory infection visits in non-teaching outpatient clinics may be a pragmatic target for antimicrobial stewardship programs.

  12. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatraemia associated with valproic Acid : four case reports from the Netherlands and a case/non-case analysis of vigibase

    NARCIS (Netherlands)

    Beers, Erna; van Puijenbroek, Eugène P; Bartelink, Imke H; van der Linden, Carolien M J; Jansen, Paul A F

    The Netherlands Pharmacovigilance Centre Lareb received four cases of severe symptomatic hyponatraemia or syndrome of inappropriate antidiuretic hormone secretion (SIADH) in association with valproic acid use, in which a causal relationship was suspected. This study describes these cases and gives

  13. Clinical guidelines for management of diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion after pituitary surgery. (United States)

    Lamas, Cristina; del Pozo, Carlos; Villabona, Carles


    Changes in water metabolism and regulation of vasopressin (AVP) or antidiuretic hormone (ADH) are common complications of pituitary surgery. The scarcity of studies comparing different treatment and monitoring strategies for these disorders and the lack of prior clinical guidelines makes it difficult to provide recommendations following a methodology based on grades of evidence. This study reviews the pathophysiology of diabetes insipidus and inappropriate ADH secretion after pituitary surgery, and is intended to serve as a guide for their diagnosis, differential diagnosis, treatment, and monitoring. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  14. Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Amyotrophic Lateral Sclerosis in a Patient Developing Carbon Dioxide Narcosis. (United States)

    Inoue, Yui; Murakami, Takaaki; Nakamura, Takeshi; Morita, Kyohei; Kaneda, Daita; Nishino, Ichizo; Hayashi, Tetsuya; Shinoto, Yuya; Hatoko, Tomonobu; Kato, Tomoko; Yonemitsu, Shin; Muro, Seiji; Oki, Shogo


    We report a rare case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) associated with amyotrophic lateral sclerosis (ALS). A 69-year-old man was admitted to our hospital with sustained hyponatremia. Hyposmolality with elevated urinary osmolality and sodium excretion was observed, which indicated SIADH. The treatment for SIADH was challenging; the patient developed carbon dioxide narcosis, which led to the diagnosis of ALS. After the initiation of noninvasive positive-pressure ventilation, the patient's serum sodium concentration normalized and became stable. Thus, ALS should be recognized as a possible cause of SIADH in the clinical setting.

  15. Inappropriate Shock Delivered By Implantable Cardioverter Defibrillator - Cardiac Resynchronization Therapy (ICD-CRT Due To Myopotential Oversensing

    Directory of Open Access Journals (Sweden)

    Hamid Barakpour


    Full Text Available The clinical efficacy of ICD-CRT therapy depends on accurate sensing of intracardiac signals and sensing algorithms. We report the occurrence of sensing abnormality in a patient with ICD-CRT. In this patient, oversensing of myopotentials during strenuous muscular activity resulted in an inappropriate ICD-CRT discharge. Although modern ICDs are highly effective in detecting and terminating malignant tachyarrhythmias, their detection specificity must be improved. It is possible to find the mechanism of arrhythmia by EGM. Simple device reprogramming make it possible to avoid the oversensing of myopotentials.

  16. Erroneous Magnet Positioning Leads to Failure of Inhibition of Inappropriate Shock during Fast Conducting Atrial Fibrillation Episodes. (United States)

    Römers, Hans; VAN Dijk, Vincent; Balt, Jippe


    We present the case of a 75-year-old patient with a single-chamber St. Jude Medical internal cardioverter defibrillator (ICD; St. Jude Medical, St. Paul, MN, USA) for primary prevention, who was admitted with 39 inappropriate ICD shocks because of atrial fibrillation with rapid ventricular frequention, despite magnet placement. Review of the device manual and literature revealed that apart from different responses to magnet placement programmed for the various manufacturers, the type of magnet and the positioning can be of specific interest. In the case presented, the donut-shaped magnet should have been placed off-center instead of directly over the device. © 2017 Wiley Periodicals, Inc.

  17. Cerebral damage in diving: Taking the cue from sports concussion ...

    African Journals Online (AJOL)

    Taking the cue from sports concussion medicine, it is proposed that there is an urgent need to incorporate neurocognitive baseline and follow-up screening as a core component in the medical management of those involved in intensive commercial and recreational compressed air diving activities. The objective would be to ...

  18. Reading in Healthy Aging: Selective Use of Information Structuring Cues (United States)

    Price, Jessica M.; Sanford, Anthony J.


    Previous research has shown that information referring to a named character or to information in the main clause of a sentence is more accessible and facilitates the processing of anaphoric references. We investigated whether the use of such cues are maintained in healthy aging. We present two experiments investigating whether information…

  19. Social influence on metacognitive evaluations: The power of nonverbal cues. (United States)

    Eskenazi, Terry; Montalan, Benoît; Jacquot, Amélie; Proust, Joëlle; Grèzes, Julie; Conty, Laurence


    Metacognitive evaluations refer to the processes by which people assess their own cognitive operations with respect to their current goal. Little is known about whether this process is susceptible to social influence. Here we investigate whether nonverbal social signals spontaneously influence metacognitive evaluations. Participants performed a two-alternative forced-choice task, which was followed by a face randomly gazing towards or away from the response chosen by the participant. Participants then provided a metacognitive evaluation of their response by rating their confidence in their answer. In Experiment 1, the participants were told that the gaze direction was irrelevant to the task purpose and were advised to ignore it. The results revealed an effect of implicit social information on confidence ratings even though the gaze direction was random and therefore unreliable for task purposes. In addition, nonsocial cues (car) did not elicit this effect. In Experiment 2, the participants were led to believe that cue direction (face or car) reflected a previous participant's response to the same question-that is, the social information provided by the cue was made explicit, yet still objectively unreliable for the task. The results showed a similar social influence on confidence ratings, observed with both cues (car and face) but with an increased magnitude relative to Experiment 1. We additionally showed in Experiment 2 that social information impaired metacognitive accuracy. Together our results strongly suggest an involuntary susceptibility of metacognitive evaluations to nonverbal social information, even when it is implicit (Experiment 1) and unreliable (Experiments 1 and 2).

  20. The Role of Memory for Compounds in Cue Competition (United States)

    Vandorpe, Stefaan; de Houwer, Jan; Beckers, Tom


    Revisions of common associative learning models incorporate a within-compound association mechanism in order to explain retrospective cue competition effects (e.g., [Dickinson, A., & Burke, J. (1996). Within-compound associations mediate the retrospective revaluation of causality judgements. "Quarterly Journal of Experimental Psychology, 49B", pp.…