Simulation and virtual reality in medical education and therapy: a protocol.

Continuing medical education has historically been provided primarily by didactic lectures, though adult learners prefer experiential or self-directed learning. Young physicians have extensive experience with computer-based or "video" games, priming them for medical education--and treating their patients--via new technologies. We report our use of standardized patients (SPs) to educate physicians on the diagnosis and treatment of biological and chemical warfare agent exposure. We trained professional actors to serve as SPs representing exposure to biological agents such as anthrax and smallpox. We rotated workshop participants through teaching stations to interview, examine, diagnose and treat SPs. We also trained SPs to simulate a chemical mass casualty (MASCAL) incident. Workshop participants worked together to treat MASCAL victims, followed by discussion of key teaching points. More recently, we developed computer-based simulation (CBS) modules of patients exposed to biological agents. We compare the strengths and weaknesses of CBS vs. live SPs. Finally, we detail plans for a randomized controlled trial to assess the efficacy of virtual reality (VR) exposure therapy compared to pharmacotherapy for post-traumatic stress disorder (PTSD). PTSD is associated with significant disability and healthcare costs, which may be ameliorated by the identification of more effective therapy.     

Duties to the Distant: Aid, Assistance, and Intervention in the Developing World

In his classic article, Famine, Affluence, and Morality (Philosophy and Public Affairs 1 (1972), pp. 229–243), Peter Singer claimed that affluent people in the developed world are morally obligated to transfer large amounts of resources to poor people in the developing world. For present purposes I will not call Singers argument into question. While people can reasonably disagree about exactly how demanding morality is with respect to duties to the desperate, there is little question in my mind that it is much more demanding than common sense morality or our everyday behavior suggests. Even someone who disagrees with this might still find some interest in seeing what a demanding morality would imply for well-off residents of the rich countries of the world. I proceed in the following way. First, I survey humanitarian aid, development assistance, and intervention to protect human rights as ways of discharging duties to the desperate. I claim that we should be more cautious about such policies than is often thought. I go on to suggest two principles that should guide our actions, based on an appreciation of our roles, relationships, and the social and political context in which we find ourselves.     

Biases and fallacies, memories and predictions: comment on Roy, Christenfeld, and McKenzie (2005)

Comparative theory testing is a useful method for assessing the value of a new theoretical account such as the memory bias account of optimistic time predictions. However, such comparisons can be misleading when they do not carefully consider the domain limitations of the respective theories. M. M. Roy, N. J. S. Christenfeld, and C. R. M. McKenzie have contrasted the memory bias and planning fallacy accounts in their ability to explain the prevalence and degree of optimistic bias in time predictions. However, the authors argue that many of the points of distinction they draw are actually reflections of the domain limitations of the 2 theories. The authors clarify the definition and scope of the planning fallacy account and show how the apparent contradictions diminish or disappear.     

The emergence of homegrown stereotypes

Homegrown stereotypes are generalizations that groups develop about their own typical characteristics. They are a distinct class of in-group stereotypes in the contexts and processes that give rise to them, as well as in their consequences for individual group members. The authors develop the concept of homegrown stereotypes and locate the origins of these stereotypes in self-presentation processes. They discuss the accuracy of these stereotypes and consider their similarities to and differences from a number of related phenomena. An examination of homegrown stereotypes highlights the importance of taking into account the impact of in-group, as well as intergroup, dynamics on the production of stereotypes.     

Aspiration-Based and Reciprocity-Based Rules in Learning Dynamics for Symmetric Normal-Form Games

Psychologically based rules are important in human behavior and have the potential of explaining equilibrium selection and separatrix crossings to a payoff dominant equilibrium in coordination games. We show how a rule learning theory can easily accommodate behavioral rules such as aspiration-based experimentation and reciprocity-based cooperation and how to test for the significance of additional rules. We confront this enhanced rule learning model with experimental data on games with multiple equilibria and separatrix-crossing behavior. Maximum likelihood results do not support aspiration-based experimentation or anticipated reciprocity as significant explanatory factors, but do support a small propensity for non-aspiration-based experimentation by random belief and non-reciprocity-based cooperation.     

Patterns of impaired verbal,spatial, and object working memory after thalamic lesions

Working memory processes in six individuals with isolated thalamic lesions were assessed. Participants were given a verbal, spatial, and object n-back task, each at three levels of task load (1-back, 2-back, and 3-back). Relative to a control group, the patients were impaired on the verbal and spatial n-back tasks, and possibly on the object n-back task as well. None of the patients showed impaired short-term memory as measured by digit span. Group differences on trials measuring matching, sequencing, and inhibitory abilities were consistent with other reports suggesting that thalamic lesions may impair the operation of executive processes.     

Observational Effects on Preference Selection for Four Children on the Autism Spectrum: A Replication

Individuals with autism have been noted to have restricted interests and repetitive behavior such as nonfunctional manipulation of objects. In this study, we used an observational conditioning procedure to switch the preference of items for four individuals diagnosed with autism who are considered lower functioning. The procedure consisted of the participant observing an adult playing with toys that were initially non‐preferred by the participant in a functional and engaging manner. For two participants, results were similar to the findings by Leaf; one participant required additional conditioning procedures, and we were unable to switch the preference for the other participant. Copyright © 2015 John Wiley & Sons, Ltd.     

Is the Bifactor Model a Better Model or Is It Just Better at Modeling Implausible Responses? Application of Iteratively Reweighted Least Squares to the Rosenberg Self-Esteem Scale

Although the structure of the Rosenberg Self-Esteem Scale (RSES) has been exhaustively evaluated, questions regarding dimensionality and direction of wording effects continue to be debated. To shed new light on these issues, we ask (a) for what percentage of individuals is a unidimensional model adequate, (b) what additional percentage of individuals can be modeled with multidimensional specifications, and (c) what percentage of individuals respond so inconsistently that they cannot be well modeled? To estimate these percentages, we applied iteratively reweighted least squares (IRLS) to examine the structure of the RSES in a large, publicly available data set. A distance measure, d_s, reflecting a distance between a response pattern and an estimated model, was used for case weighting. We found that a bifactor model provided the best overall model fit, with one general factor and two wording-related group factors. However, on the basis of d_r?values, a distance measure based on individual residuals, we concluded that approximately 86% of cases were adequately modeled through a unidimensional structure, and only an additional 3% required a bifactor model. Roughly 11% of cases were judged as “unmodelable” due to their significant residuals in all models considered. Finally, analysis of d_s revealed that some, but not all, of the superior fit of the bifactor model is owed to that model's ability to better accommodate implausible and possibly invalid response patterns, and not necessarily because it better accounts for the effects of direction of wording.