Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records

Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool (ECQAT). ECQAT enables raters to assess the quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation (ethics question, consultation-specific information, ethical analysis, and conclusions and/or recommendations), established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT, the resulting product, and recommended future testing and potential uses for the tool.     

Using heteromodal communication to optimize knowledge and awareness

Accurate, error-free communication is essential for success in many areas, such as eyewitness testimony, human factors design, business, education, and personal relationships. Traditional communication uses similar modalities: Participants communicate by talking or by writing, but not both at the same time with the same addressees. New communicative technologies have broadened this vista. For example, one communicator can speak and the other can type. We tested communicative effectiveness using accuracy and error detection in a trivia recall test, evaluating the roles of presentation and retrieval modalities on reporting facts stored in long-term memory. Heteromodal communication (hearing and writing or reading and saying) was more effective than homomodal communication (hearing and saying or reading and writing), with the most correct responses and the most errors caught. This has direct connections to communicative success and applied tests of skill.     

Immediate postsession feeding reduces operant responding in rats

Three experiments investigated the effects of immediate and delayed postsession feeding on progressive-ratio and variable-interval schedule performance in rats. During Experiments 1 and 2, immediate postsession feeding decreased the breakpoint, or largest completed ratio, under progressive-ratio schedules. Experiment 3 was conducted to extend the results of the first two experiments to responding maintained by variable-interval schedules with different session lengths (15 and 60 min). Response rates decreased in all 4 subjects when postsession feeding immediately followed a 15-min session and in 3 of 4 subjects when postsession feeding immediately followed a 60-min session. The implications of this research are twofold: (1) The functional context in which within-session reinforcers are embedded extends outside the experimental chamber, and (2) supplemental postsession feedings should be sufficiently delayed from the end of a session to avoid weakening operant behavior in the experimental sessions.     

The causal role of phoneme awareness and letter-sound knowledge in learning to read: combining intervention studies with mediation analyses

There is good evidence that phoneme awareness and letter-sound knowledge are reliable longitudinal predictors of learning to read, though whether they have a causal effect remains uncertain. In this article, we present the results of a mediation analysis using data from a previous large-scale intervention study. We found that a phonology and reading intervention that taught letter-sound knowledge and phoneme awareness produced significant improvements in these two skills and in later word-level reading and spelling skills. Improvements in letter-sound knowledge and phoneme awareness at the end of the intervention fully mediated the improvements seen in children's word-level literacy skills 5 months after the intervention finished. Our findings support the conclusion that letter-sound knowledge and phoneme awareness are two causal influences on the development of children's early literacy skills.     

An Approach to Examining the Proximal and Intermediate Outcomes of an Intensive Family Preservation Program

This study examined the effects of the Boys Town In-Home Family Program (BT-IHFP) on parenting skills, family functioning, and child behavior for at-risk families involved with child protective services. The BT-IHFP is designed as a home-based, family-centered alternative to out-of-home placement with the goal of improving family functioning, keeping families together, and preventing further involvement with child protective services. The model uses a hands-on cognitive-behavioral approach, promotes family engagement, provides 24/7 services to families, and links families to community resources. While it is essential to examine ultimate, long-term outcomes such as family preservation, it is also important to investigate the proximal and intermediate outcomes that address the key changes in behavior that support successful long-term outcomes. The goals of this study were to (1) examine the pre-post change of proximal and intermediate outcomes and (2) examine if improvements in parenting skills, parental roles, and parental stress (proximal outcomes) will be related to improvements in child behavior at home, child behavior at school, and family functioning (intermediate outcomes). Inspecting intake and discharge data for 44 families, 94% were intact at discharge and significant pre-post improvements were found in proximal and intermediate outcomes. These findings suggest that this six-week intensive BT-IHFP holds promise for teaching at-risk families skills to promote positive family functioning.     

Cognitive structure of emotion terms in Indonesia and The Netherlands

The rapid detection of facial expressions of anger or threat has obvious adaptive value. In this study, we examined the efficiency of facial processing by means of a visual search task. Participants searched displays of schematic faces and were required to determine whether the faces displayed were all the same or whether one was different. Four main results were found: (1) When displays contained the faces, people were slower in detecting the absence of a discrepant face when the faces displayed angry (or sad/angry) rather than happy expressions. (2) When displays contained a discrepant face people were faster in detecting this when the discrepant face displayed an angry rather than a happy expression. (3) Neither of these patterns for same and different displays was apparent when face displays were inverted, or when just the mouth was presented in isolation. (4) The search slopes for angry targets were significantly lower than for happy targets. These results suggest that detection of angry facial expressions is fast and efficient, although does not “pop-out” in the traditional sense.     

The face of fear: Effects of eye gaze and emotion on visual attention

We investigated whether a fearful expression enhances the effect of another's gaze in directing the attention of an observer. Participants viewed photographs of faces whose gaze was directed ahead, to the left or to the right. Target letters then appeared unpredictably to the left or right. As expected, targets in the location indicated by gaze were detected more rapidly. In nonanxious volunteers the effects of fearful gaze did not differ from neutral gaze, but fearful expression had a more powerful influence in a selected high anxious group. Attention is thus more likely to be guided by the direction of fearful than neutral gaze, but only in anxiety-prone individuals.     

Action mechanisms for social cognition: behavioral and neural correlates of developing Theory of Mind

Many psychological theories posit foundational links between two fundamental constructs: (1) our ability to produce, perceive, and represent action; and (2) our ability to understand the meaning and motivation behind the action (i.e. Theory of Mind; ToM). This position is contentious, however, and long‐standing competing theories of social‐cognitive development debate roles for basic action‐processing in ToM. Developmental research is key to investigating these hypotheses, but whether individual differences in neural and behavioral measures of motor action relate to social‐cognitive development is unknown. We examined 3‐ to 5‐year‐old children's (N = 26) EEG mu‐desynchronization during production of object‐directed action, and explored associations between mu‐desynchronization and children's behavioral motor skills, behavioral action‐representation abilities, and behavioral ToM. For children with high (but not low) mu‐desynchronization, motor skill related to action‐representation abilities, and action‐representation mediated relations between motor skill and ToM. Results demonstrate novel foundational links between action‐processing and ToM, suggesting that basic motor action may be a key mechanism for social‐cognitive development, thus shedding light on the origins and emergence of higher social cognition.