Clinical Use of the Surgeon General’s “My Family Health Portrait” (MFHP) Tool: Opinions of Future Health Care Providers

This study examined medical students’ and house officers’ opinions about the Surgeon General’s “My Family Health Portrait” (MFHP) tool. Participants used the tool and were surveyed about tool mechanics, potential clinical uses, and barriers. None of the 97 participants had previously used this tool. The average time to enter a family history was 15 min (range 3 to 45 min). Participants agreed or strongly agreed that the MFHP tool is understandable (98%), easy to use (93%), and suitable for general public use (84%). Sixty-seven percent would encourage their patients to use the tool; 39% would ensure staff assistance. Participants would use the tool to identify patients at increased risk for disease (86%), record family history in the medical chart (84%), recommend preventive health behaviors (80%), and refer to genetics services (72%). Concerns about use of the tool included patient access, information accuracy, technical challenges, and the need for physician education on interpreting family history information.     

Dynamic size‐change of peri‐hand space through tool‐use: Spatial extension or shift of the multi‐sensory area

Several studies in humans and non‐human primates have shown that tool‐use can expand near peripersonal space ( Farnè & Làdavas, 2000 ; Iriki, Tanaka, & Iwamura, 1996 ). In humans, the extension of the near peripersonal space is revealed by an increase in the severity of cross‐modal extinction caused by visual stimulation at the distal edge of a rake after its use as a reaching tool. The crucial question addressed here concerns whether the dynamic re‐sizing of the peri‐hand space in humans constitutes a real spatial expansion of visual‐tactile peri‐hand area along the tool axis. Alternatively, it could constitute a shift of the integrative area from the hand towards the distal edge of the tool, or the formation of a novel visual‐tactile integrative area at the same distal location ( Holmes, Calvert, & Spence, 2004 ). We contrasted the alternative predictions made by these hypotheses in a group of RBD patients by probing, at different locations along the tool axis, the changes induced by tool‐use on cross‐modal extinction. By assessing the visual‐tactile extinction near the hand, midway along the tool, and at the distal edge of the tool we found an increase in visual‐tactile extinction after tool‐use both at the middle and the distal location along the tool axis. In contrast, no change intervened at the hand proximity. These findings support the view that the tool‐use dependent re‐mapping of peri‐hand space in humans consists of a continuous elongation of visual‐tactile peri‐hand area from the hand towards the tip of the tool.     

Tool use in neurodegenerative diseases: Planning or technical reasoning?

Recent works showed that tool use can be impaired in stroke patients because of either planning or technical reasoning deficits, but these two hypotheses have not yet been compared in the field of neurodegenerative diseases. The aim of this study was to address the relationships between real tool use, mechanical problem‐solving, and planning skills in patients with Alzheimer's disease (AD, n = 32), semantic dementia (SD, n = 16), and corticobasal syndrome (CBS, n = 9). Patients were asked to select and use ten common tools, to solve three mechanical problems, and to complete the Tower of London test. Motor function and episodic memory were controlled using the Purdue Pegboard Test and the BEC96 questionnaire, respectively. A data‐transformation method was applied to avoid ceiling effects, and single‐case analysis was performed based on raw scores and completion time. All groups demonstrated either impaired or slowed tool use. Planning deficits were found only in the AD group. Mechanical problem‐solving deficits were observed only in the AD and CBS groups. Performance in the Tower of London test was the best predictor of tool use skills in the AD group, suggesting these patients had general rather than mechanical problem‐solving deficits. Episodic memory seemed to play little role in performance. Motor dysfunction tended to be associated with tool use skills in CBS patients, while tool use disorders are interpreted as a consequence of the semantic loss in SD in line with previous works. These findings may encourage caregivers to set up disease‐centred interventions.     

Choosing and using tools: Prior experience and task difficulty influence preschoolers’ tool-use strategies

Children's acquisition of tool use abilities is an important part of development but is not yet well understood. This study compares two modes of tool-use learning, observation and individual haptic experience. Two- and 3-year-olds had haptic experience with tools, observed tool use by others, had both haptic and observational experience, or no tool exposure. Their tool choice and use were evaluated across six problem-solving tasks that varied in degree of difficulty. Children learned about tools better by observation than by individual learning through manual exploration. Performance also varied by task difficulty, with more complex tasks proving more difficult. Findings are discussed from cognitive and evolutionary perspectives.     

How to crack nuts: acquisition process in captive chimpanzees (Pan troglodytes) observing a model

Stone tool use for nut cracking consists of placing a hard-shelled nut onto a stone anvil and then cracking the shell open by pounding it with a stone hammer to get to the kernel. We investigated the acquisition of tool use for nut cracking in a group of captive chimpanzees to clarify what kind of understanding of the tools and actions will lead to the acquisition of this type of tool use in the presence of a skilled model. A human experimenter trained a male chimpanzee until he mastered the use of a hammer and anvil stone to crack open macadamia nuts. He was then put in a nut-cracking situation together with his group mates, who were naïve to this tool use; we did not have a control group without a model. The results showed that the process of acquisition could be broken down into several steps, including recognition of applying pressure to the nut, emergence of the use of a combination of three objects, emergence of the hitting action, using a tool for hitting, and hitting the nut. The chimpanzees recognized these different components separately and practiced them one after another. They gradually united these factors in their behavior leading to their first success. Their behavior did not clearly improve immediately after observing successful nut cracking by a peer, but observation of a skilled group member seemed to have a gradual, long-term influence on the acquisition of nut cracking by naïve chimpanzees.     

Learning about tools in infancy

These experiments explored the role of prior experience in 12- to 18-month-old infants' tool-directed actions. In Experiment 1, infants' use of a familiar tool (spoon) to accomplish a novel task (turning on lights inside a box) was examined. Infants tended to grasp the spoon by its handle even when doing so made solving the task impossible (the bowl did not fit through the hole in the box, but the handle did) and even though the experimenter demonstrated a bowl-grasp. In contrast, infants used a novel tool flexibly and grasped both sides equally often. In Experiment 2, infants received training using the novel tool for a particular function; 3 groups of infants were trained to use the tool differently. Later, infants' performance was facilitated on tasks that required infants to grasp the part of the tool they were trained to grasp. The results suggest that (a) infants' prior experiences with tools are important to understanding subsequent tool use, and (b) rather than learning about tool function (e.g., hammering), infants learn about which part of the tool is meant to be held, at least early in their exposure to a novel tool.     

Tool use by chimpanzees (Pan troglodytes) of the Arnhem Zoo community

Abstract: Chimpanzees have a large repertoire of tool-use behaviors. This study reports on the variety and the extent of tool use exhibited by the chimpanzees of the Arnhem Zoo community in The Netherlands, living in an enriched captive setting since 1971. The use of tools by 29 chimpanzees aged from 0 to 37 years was observed. We identified 13 types of tool use comparable to those found in the wild. Some of these types of tool use seem to be specific to this community, and can be explained by the ecological characteristics of this captive setting. Chimpanzees started to use tools from the age of 2 years. Young chimpanzees, from 5 to 9 years old, showed a greater repertoire of tool use than infants and adults. All types of tool use in the community have appeared by the age of 10, the age of puberty for chimpanzees. Multivariate analysis was applied for the 29 individuals by 13 types of tool use in a one-zero matrix. The results show two major categories of tool use, one in a practical or substantial context and the other in a nonpractical or play context. The subjects clustered into groups reflecting developmental stages, although there are great individual differences. In conclusion, this captive community provides a unique opportunity to clarify the details of tool use by chimpanzees.     

Reasoning about artifacts at 24 months: the developing teleo-functional stance

From the age of 2.5, children use social information to rapidly form enduring function-based artifact categories. The present study asked whether even younger children likewise constrain their use of objects according to teleo-functional beliefs that artifacts are "for" particular purposes, or whether they use objects as means to any desired end. Twenty-four-month-old toddlers learned about two novel tools that were physically equivalent but perceptually distinct; one tool was assigned implicit function information through a short demonstration. At test, toddlers returned to the demonstrated tool when asked to repeat the task, but, unlike older children, also used it for another task. Results imply that at 24 months, toddlers expect artifacts to have functions and proficiently use a model's intentional use to inform tool choices, suggesting cognition that differs from that of tool-using monkeys. However, their artifact representations are not yet specified enough to support exclusive patterns of tool use.     

A cognitive-based model of tool use in normal aging

While several cognitive domains have been widely investigated in the field of aging, the age-related effects on tool use are still an open issue and hardly any studies on tool use and aging is available. A significant body of literature has indicated that tool use skills might be supported by at least two different types of knowledge, namely, mechanical knowledge and semantic knowledge. However, neither the contribution of these kinds of knowledge to familiar tool use, nor the effects of aging on mechanical and semantic knowledge have been explored in normal aging. The aim of the present study was to fill this gap. To do so, 98 healthy elderly adults were presented with three tasks: a classical, familiar tool use task, a novel tool use task assessing mechanical knowledge, and a picture matching task assessing semantic knowledge. The results showed that aging has a negative impact on tool use tasks and on knowledge supporting tool use skills. We also found that aging did not impact mechanical and semantic knowledge in the same way, confirming the distinct nature of those forms of knowledge. Finally, our results stressed that mechanical and semantic knowledge are both involved in the ability to use familiar tools.     

Mechanical knowledge does matter to tool use even when assessed with a non-production task: Evidence from left brain-damaged patients

In the literature on apraxia of tool use, it is now accepted that using familiar tools requires semantic and mechanical knowledge. However, mechanical knowledge is nearly always assessed with production tasks, so one may assume that mechanical knowledge and familiar tool use are associated only because of their common motor mechanisms. This notion may be challenged by demonstrating that familiar tool use depends on an alternative tool selection task assessing mechanical knowledge, where alternative uses of tools are assumed according to their physical properties but where actual use of tools is not needed. We tested 21 left brain-damaged patients and 21 matched controls with familiar tool use tasks (pantomime and single tool use), semantic tasks and an alternative tool selection task. The alternative tool selection task accounted for a large amount of variance in the single tool use task and was the best predictor among all the semantic tasks. Concerning the pantomime of tool use task, group and individual results suggested that the integrity of the semantic system and preserved mechanical knowledge are neither necessary nor sufficient to produce pantomimes. These results corroborate the idea that mechanical knowledge is essential when we use tools, even when tasks assessing mechanical knowledge do not require the production of any motor action. Our results also confirm the value of pantomime of tool use, which can be considered as a complex activity involving several cognitive abilities (e.g., communicative skills) rather than the activation of gesture engrams.     

The challenge of raising ethical awareness: A case-based aiding system for use by computing and ICT students

Students, the future Information and Communication Technology (ICT) professionals, are often perceived to have little understanding of the ethical issues associated with the use of ICTs. There is a growing recognition that the moral issues associated with the use of the new technologies should be brought to the attention of students. Furthermore, they should be encouraged to explore and think more deeply about the social and legal consequences of the use of ICTs. This paper describes the development of a tool designed to raise students’ awareness of the social impact of ICTs. The tool offers guidance to students undertaking computing and computer-related courses when considering the social, legal and professional implications of the actions of participants in situations of ethical conflict. However, unlike previous work in this field, this tool is not based on an artificial intelligence paradigm. Aspects of the theoretical basis for the design of the tool and the tool’s practical development are discussed. Preliminary results from the testing of the tool are also discussed. An earlier version of this paper was presented by one of the authors at the First International Conference on Teaching Applied and Professional Ethics in Higher Education, Federal University of Surrey Centre for Applied Ethics, Southlands College, Roehampton, London, 2–4 September, 2003.     

Spontaneous use of tools as straws in great apes

Great apes can use multiple tools to extract food embedded in substrates and can invent new ways to exploit those resources. We tested five bonobos, five chimpanzees, and six orangutans in a task in which they had to use (and modify) a tool as a straw to drink the juice located inside a container. Experiment 1 showed that four orangutans and one chimpanzee invented the use of a piece of electric cable to get the juice. Experiment 2 investigated whether subjects could transform a non-functional hose into a functional one by removing blockages that impeded the free flow of juice. Orangutans outperformed chimpanzees and bonobos by differentially removing those blockages that prevented the flow of juice, often doing so before attempting to extract the juice. In Experiment 3, we presented chimpanzees and orangutans with four 3-tool sets (each tool set contained a single straw-like tool) and allowed them to select one tool. Unlike chimpanzees, orangutans succeeded in selecting the straw-like tool above chance levels without having to physically manipulate it. We suggest that orangutans’ superior performance is related to their greater reliance on mouth actions during foraging. Experiment 4 investigated whether orangutans were also capable of selecting the suitable tool not by its appearance, but by the effects that it produced. After witnessing the experimenter blow bubbles or absorb liquid with a functional tool but fail to accomplish the same thing with the non-functional tool, orangutans failed to select the functional tool above chance levels.     

Assessing the well-being of patients with dementia: validity and reliability of the Spanish version of the Dementia Care Mapping (DCM) tool / La evaluación del bienestar en pacientes con demencia: validez y fiabilidad de la versión española del Dementia Care Mapping (DCM)

Abstract

Based on person-centred care (PCC), new instruments to assess the quality of life of elderly people with dementia, such as the Dementia Care Mapping (DCM) tool, have been developed. The aim of the study was to determine the psychometric properties of the DCM tool for its use in research into nursing homes. Sixty-eight elderly people who had dementia living in four different nursing homes participated in the study. DCM was applied twice (with six months difference between each administration) and its results were compared with the GENCAT scale of quality of life. Results showed that DCM has a limited concurrent validity, test-retest reliability and inner consistency, which questions its use as a research tool. The authors discuss the difficulty of evaluating the quality of life in people who have dementia and what the DCM tool really evaluates.     

A novel tool-use mode in animals: New Caledonian crows insert tools to transport objects

New Caledonian crows (Corvus moneduloides) rely heavily on a range of tools to extract prey. They manufacture novel tools, save tools for later use, and have morphological features that facilitate tool use. We report six observations, in two individuals, of a novel tool-use mode not previously reported in non-human animals. Insert-and-transport tool use involves inserting a stick into an object and then moving away, thereby transporting both object and tool. All transported objects were non-food objects. One subject used a stick to transport an object that was too large to be handled by beak, which suggests the tool facilitated object control. The function in the other cases is unclear but seems to be an expression of play or exploration. Further studies should investigate whether it is adaptive in the wild and to what extent crows can flexibly apply the behaviour in experimental settings when purposive transportation of objects is advantageous.     

Look, no hands!

Contrary to Vaesen's argument that humans are unique with respect to nine cognitive capacities essential for tool use, we suggest that although such cognitive processes contribute to variation in tool use, it does not follow that these capacities are necessary for tool use, nor that tool use shaped cognition per se, given the available data in cognitive neuroscience and behavioral biology.     

Selection of tool diameter by New Caledonian crows<Emphasis Type="Italic"> Corvus moneduloides</Emphasis>

One important element of complex and flexible tool use, particularly where tool manufacture is involved, is the ability to select or manufacture appropriate tools anticipating the needs of any given task—an ability that has been rarely tested in non-primates. We examine aspects of this ability in New Caledonian crows—a species known to be extraordinary tool users and manufacturers. In a 2002 study, Chappell and Kacelnik showed that these crows were able to select a tool of the appropriate length for a task among a set of different lengths, and in 2002, Weir, Chappell and Kacelnik showed that New Caledonian crows were able to shape unfamiliar materials to create a usable tool for a specific task. Here we examine their handling of tool diameter. In experiment 1, we show that when facing three loose sticks that were usable as tools, they preferred the thinnest one. When the three sticks were presented so that one was loose and the other two in a bundle, they only disassembled the bundle when their preferred tool was tied. In experiment 2, we show that they manufacture, and modify during use, a tool of a suitable diameter from a tree branch, according to the diameter of the hole through which the tool will have to be inserted. These results add to the developing picture of New Caledonian crows as sophisticated tool users and manufacturers, having an advanced level of folk physics.Electronic Supplementary Material Supplementary material is available in the online version of this article at     

Pliers,not fingers: Tool-action effect in a motor intention paradigm

Tool-use representations have been suggested to be supported by the representation of hand actions and/or by the representation of tool actions. A major issue is to know which one of these two representations is preferentially activated when people intend to use a tool. To address this issue, we developed a paradigm in which, in 20% of trials, participants had to press a button and actually use pliers to move an object in response to a predefined target symbol. Importantly, two masks hiding the symbols performed “opening” or “closing” actions before symbols appeared. In Experiment 1, participants used normal pliers: Hand’s opening actions induced pliers’ opening actions and vice versa for hands’ closing actions. Results indicated a compatibility effect between masks’ actions and pliers’ actions. Participants were faster to press the button in response to the target symbol when opening and closing actions of the masks were congruent with the corresponding actions of the hand. In Experiment 2 participants used inverse pliers: Hand’s opening actions involved pliers’ closing actions and vice versa. In this situation, results showed that the congruency of masks’ actions occurred with pliers’ actions and not hand’s actions. Altogether, these findings demonstrate that intention of use is preferentially based on the representation of tool actions, and have important implications for the domain of neuropsychology of tool use and the theories of goal-directed behavior.     

Building a Tool to Identify Risk for Lynch Syndrome Among Individuals Presenting for Screening Colonoscopy

The goal of this work was to build and pilot-test a user-friendly Lynch syndrome risk assessment tool among individuals presenting for routine screening colonoscopy. Participants included adults presenting to a private practice-based, open-access endoscopy unit. Working with health literacy experts and gastroenterologists, and based on established criteria, we developed a simplified tool to assess Lynch syndrome risk, pre-procedure. A pilot-test of the tool assessed its: 1) clinical utility; 2) patient-reported usability; and 3) feasibility. The tool, in paper format, was written at a 9th grade reading level and included instructions for use followed by seven Lynch syndrome risk-related questions, structured such that one “Yes” response signified potential risk. A pilot-test of the tool among 334 patients revealed that 29 met criteria for Lynch syndrome risk. Of these, following telephone review of their responses, risk was confirmed in 9 patients (3% of total). The tool was reported as easy-to-use and was seen as feasible for use. Limitations include: 1) the need for infrastructure to distribute and collect the tool and 2) the availability of knowledgeable staff to review tool responses, confirm risk, and facilitate appropriate referral for genetic counseling. These data suggest that the tool affects assessment of Lynch syndrome risk among the routine colon cancer screening population.     

What is the future for tool-specific generalized motor programs?

A key issue in cognitive sciences is to understand the cognitive bases of human tool use. Answers have been provided by two competing approaches. The manipulation-based approach assumes that humans can use tools because of the ability to store sensorimotor knowledge about how to manipulate tools. By contrast, for the reasoning-based approach, human tool use is based on the ability to reason about physical object properties. Recently, Caruana and Cuccio proposed a kind of reconciliation, based on the distinction between three types of abductive inference, involving a different contribution of motor and cognitive elements: Automatic abduction (motor + and cognitive-), abduction by selection (motor ± and cognitive±) and creative abduction (motor- and cognitive+). This perspective offers new interesting avenues. Nevertheless, it is also subject to several theoretical and epistemological limitations, which make it in its present form inappropriate for the study of the cognitive bases of human tool use. This article aims to discuss these limitations.     

Outpatient Clinic Identification of Trauma Symptoms in Children in Foster Care

As understanding of the impact of trauma on children has grown, there has been increasing interest in the use of screening the medical setting to identify which children at risk may be symptomatic. This study was undertaken to determine whether the use of a trauma assessment tool to screen for trauma symptoms in the setting of a foster care clinic was feasible and more sensitive than non-standardized approaches in the context of outpatient primary care. Using a chart review of trauma symptom identification before and after the implementation of the Trauma Symptom Checklist for Children (TSC-C) and the Trauma Symptom Checklist for Young Children (TSC-YC), validated trauma assessment tools, we looked at the feasibility of use of this tool and likelihood of trauma symptom identification. 73 % (n = 204) of eligible patients had a trauma screening tool in the medical record following the introduction of the use of the TSC. Detection of trauma symptoms was higher in the screening period than in the baseline period for the entire population (78 vs. 46 %, p < 0.0001), and trauma symptoms were identified with more specificity following the introduction of, and likely due to, formal trauma screening. However, there were limitations as to feasibility in the outpatient medical clinic. In conclusion, the use of the TSC-C and TSC-YC in the setting of an outpatient foster care evaluation clinic increased rates and precision of identification of trauma symptoms, but had limitations to its feasibility of use in the outpatient clinic setting.