Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

The Norton Dome and the Nineteenth Century Foundations of Determinism

The recent discovery of an indeterministic system in classical mechanics, the Norton dome, has shown that answering the question whether classical mechanics is deterministic can be a complicated matter. In this paper I show that indeterministic systems similar to the Norton dome were already known in the nineteenth century: I discuss four nineteenth century authors who wrote about such systems, namely Poisson, Duhamel, Boussinesq and Bertrand. However, I argue that their discussion of such systems was very different from the contemporary discussion about the Norton dome, because physicists in the nineteenth century conceived of determinism in essentially different ways: whereas in the contemporary literature on determinism in classical physics, determinism is usually taken to be a property of the equations of physics, in the nineteenth century determinism was primarily taken to be a presupposition of theories in physics, and as such it was not necessarily affected by the possible existence of systems such as the Norton dome.     

Selectors' Decision Strategies when Assessing Immigrant Job Applicants

Immigrant job applicants are often not fluent in the majority language. This raises the question whether selectors adjust their decision strategy when selecting immigrants. In two field studies (N = 1,949 and N = 156), we examined the decision strategies of professional selectors. Selectors used differential strategies, giving less weight to the test scores and impression scores of immigrants. Dutch language proficiency served as a moderator variable; test scores were considered less important in the employment recommendation especially for immigrants with low language skills. Yet professional selectors also used similar strategies for different groups; the same test scores led to the same recommendations, regardless of ethnicity. In sum, personnel selectors adjusted their decision strategy for immigrants, but this did not lead to immigrants receiving higher recommendations than majority applicants with similar test scores.     

Neuroticism and extraversion are associated with amygdala resting-state functional connectivity

The personality traits neuroticism and extraversion are differentially related to socioemotional functioning and susceptibility to affective disorders. However, the neurobiology underlying this differential relationship is still poorly understood. This discrepancy could perhaps best be studied by adopting a brain connectivity approach. Whereas the amygdala has repeatedly been linked to neuroticism and extraversion, no study has yet focused on the intrinsic functional architecture of amygdala-centered networks in relation to both traits. To this end, seed-based correlation analysis was employed to reveal amygdala resting-state functional connectivity (RSFC) and its associations with neuroticism and extraversion in 50 healthy participants. Higher neuroticism scores were associated with increased amygdala RSFC with the precuneus, and decreased amygdala RSFC with the temporal poles, insula, and superior temporal gyrus (p < .05, cluster corrected). Conversely, higher extraversion scores were associated with increased amygdala RSFC with the putamen, temporal pole, insula, and several regions of the occipital cortex (p < .05, cluster corrected). The shifts in amygdala RSFC associated with neuroticism may relate to the less-adaptive perception and processing of self-relevant and socioemotional information that is frequently seen in neurotic individuals, whereas the amygdala RSFC pattern associated with extraversion may relate to the heightened reward sensitivity and enhanced socioemotional functioning in extraverts. We hypothesize that the variability in amygdala RSFC observed in the present study could potentially link neuroticism and extraversion to the neurobiology underlying increased susceptibility or resilience to affective disorders.     

When expressing forgiveness backfires in the workplace: victim power moderates the effect of expressing forgiveness on transgressor compliance

Expressing (vs. withholding) forgiveness is often promoted as a beneficial response for victims. In the present research, we argue that withholding (vs. expressing) forgiveness can also be beneficial to victims by stimulating subsequent transgressor compliance – a response that is valuable in restoring the victim’s needs for control. Based on deterrence theory, we argue that a victim’s withheld (vs. expressed) forgiveness promotes transgressor compliance when the victim has low power, relative to the transgressor. This is because withheld (vs. expressed) forgiveness from a low-power victim elicits transgressor fear. On the other hand, because people are fearful of high-power actors, high-power victims can expect high levels of compliance from a transgressor, regardless of whether they express forgiveness or not. A critical incidents survey (Study 1) and an autobiographic recall study (Study 2) among employees, as well as a laboratory experiment among business students (Study 3), support these predictions. These studies are among the first to reveal that withholding forgiveness can be beneficial for low-power victims in a hierarchical context – ironically, a context in which offering forgiveness is often expected.     

Changing dominance in mixed profession groups: putting theory into practice

An extended professional identity theory is proposed to enhance interprofessional collaboration. The purpose of this study is to investigate whether comparative feedback on interprofessional interaction can decrease the degree of profession-based dominance and general dominance in mixed profession groups. This observational study comprised a randomized double-blind pretest-posttest control group design with 19 mixed profession groups (10 intervention and nine control groups, each with three dental and three dental hygiene students). All groups received reflective feedback during two consecutive two hour team development meetings. Intervention groups also received comparative feedback. Profession-based dominance concerned the sum of three observation items (conversational turn-taking, dominance and contributing ideas) with a three-point scale: ?1 = dental dominance, 0 = no dominance, +1 = dental hygiene dominance. Polychoric correlations confirmed positive associations with the latent trait and an unidimensional underlying structure. Observation items were internally consistent (α > .70). General dominance concerned the sum of absolute values of observation items with a minimum value of zero (no dominance) and the maximum value of three (strong dominance). A two-way factorial ANOVA was performed. The results revealed a significant interaction effect with regard to general dominance, F(1,17) = 6.630, p = 0.020 and large effect size (partial eta squared = 0.28). Comparative feedback on interprofessional interaction decreases general dominance in mixed profession groups.     

Children prenatally exposed to maternal anxiety devote more attentional resources to neutral pictures

Maternal anxiety during pregnancy can negatively affect fetal neurodevelopment, predisposing the offspring to a higher risk of behavioral and emotional problems later in life. The current study investigates the association between maternal anxiety during pregnancy and child affective picture processing using event‐related brain potentials (ERPs). Mothers reported anxiety during the second trimester using the anxiety subscale of the Symptom Checklist (SCL‐90). At age 4 years, child affective picture processing (N = 86) was measured by recording ERPs during viewing of neutral, pleasant, and unpleasant pictures selected from the International Affective Pictures System. The late positive potential (LPP)—an ERP component reflecting individual differences in affective processing—was used as child outcome. The expected positive association between maternal anxiety and LPP amplitude for unpleasant pictures was not found. Nevertheless, we found a positive association between maternal anxiety during pregnancy and LPP amplitudes for neutral pictures in the middle and late time window at anterior locations (all p < .05). These associations remained significant after adjusting for maternal postnatal anxiety and gestational age at birth and after FDR correction for multiple comparisons. Our study provides neurophysiological evidence that children prenatally exposed to higher maternal anxiety devote more attentional resources to neutral pictures, but not to unpleasant pictures. Possibly, these children show enhanced vigilance for threat when viewing neutral pictures. Although useful in dangerous environments, this enhanced vigilance may predispose children prenatally exposed to higher maternal anxiety to developing behavioral and/or emotional problems later in life. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=kEzYi6IS2HA     

Audio‐visual speech in noise perception in dyslexia

Individuals with developmental dyslexia (DD) may experience, besides reading problems, other speech‐related processing deficits. Here, we examined the influence of visual articulatory information (lip‐read speech) at various levels of background noise on auditory word recognition in children and adults with DD. We found that children with a documented history of DD have deficits in their ability to gain benefit from lip‐read information that disambiguates noise‐masked speech. We show with another group of adult individuals with DD that these deficits persist into adulthood. These deficits could not be attributed to impairments in unisensory auditory word recognition. Rather, the results indicate a specific deficit in audio‐visual speech processing and suggest that impaired multisensory integration might be an important aspect of DD.     

Pupil dilation as an index of effort in cognitive control tasks: A review

Pupillometry research has experienced an enormous revival in the last two decades. Here we briefly review the surge of recent studies on task-evoked pupil dilation in the context of cognitive control tasks with the primary aim being to evaluate the feasibility of using pupil dilation as an index of effort exertion, rather than task demand or difficulty. Our review shows that across the three cognitive control domains of updating, switching, and inhibition, increases in task demands typically leads to increases in pupil dilation. Studies show a diverging pattern with respect to the relationship between pupil dilation and performance and we show how an effort account of pupil dilation can provide an explanation of these findings. We also discuss future directions to further corroborate this account in the context of recent theories on cognitive control and effort and their potential neurobiological substrates.