It’s NOT FAIR! Or is it? The promise and the tyranny of evidence-based performance assessment

Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols.     

Impaired goal-directed behavioural control in human impulsivity

Two dissociable learning processes underlie instrumental behaviour. Whereas goal-directed behaviour is controlled by knowledge of the consequences, habitual behaviour is elicited directly by antecedent Pavlovian stimuli without knowledge of the consequences. Predominance of habitual control is thought to underlie psychopathological conditions associated with corticostriatal abnormalities, such as impulsivity and drug dependence. To explore this claim, smokers were assessed for nicotine dependence, impulsivity, and capacity for goal-directed control over instrumental performance in an outcome devaluation procedure. Reduced goal-directed control was selectively associated with the Motor Impulsivity factor of Barrett's Impulsivity Scale (BIS), which reflects propensity for action without thought. These data support the claim that human impulsivity is marked by impaired use of causal knowledge to make adaptive decisions. The predominance of habit learning may play a role in psychopathological conditions that are associated with trait impulsivity.     

Phonological, visual, and semantic coding strategies and children's short-term picture memory span

Three experiments addressed controversies in the previous literature on the development of phonological and other forms of short-term memory coding in children, using assessments of picture memory span that ruled out potentially confounding effects of verbal input and output. Picture materials were varied in terms of phonological similarity, visual similarity, semantic similarity, and word length. Older children (6/8-year-olds), but not younger children (4/5-year-olds), demonstrated robust and consistent phonological similarity and word length effects, indicating that they were using phonological coding strategies. This confirmed findings initially reported by Conrad (1971), but subsequently questioned by other authors. However, in contrast to some previous research, little evidence was found for a distinct visual coding stage at 4 years, casting doubt on assumptions that this is a developmental stage that consistently precedes phonological coding. There was some evidence for a dual visual and phonological coding stage prior to exclusive use of phonological coding at around 5-6 years. Evidence for semantic similarity effects was limited, suggesting that semantic coding is not a key method by which young children recall lists of pictures.     

Sub‐Dimensions of the Four Factor Model of Cultural Intelligence: Expanding the Conceptualization and Measurement of Cultural Intelligence

Cultural intelligence (CQ) – the capability to function effectively in intercultural settings – has gained increasing attention from researchers and practitioners due to its contemporary relevance to globalization, international management, and workforce diversification. Research‐to‐date demonstrates that CQ predicts a variety of important outcomes in intercultural contexts, such as cultural adaptation, expatriate performance, global leadership, intercultural negotiation, and multicultural team processes. Moving beyond past research that tends to focus on the four primary factors of CQ – metacognitive CQ, cognitive CQ, motivational CQ, and behavioral CQ, we introduce an expanded conceptualization of CQ that delineates sub‐dimensions for each of the four factors. We briefly review psychometric evidence supporting the proposed second order 11‐factor structure and convergent/discriminant validity of the sub‐dimensions. We propose that the next wave of CQ research should be guided by a deeper understanding of each of four factors of CQ.     

Mother–Child Book‐Sharing and Children's Storytelling Skills in Ethnically Diverse,Low‐Income Families

The present study examined book‐sharing interactions between mothers and their 4‐year‐old children from African American (n = 62), Dominican (n = 67), Mexican (n = 59) and Chinese (n = 82) low‐income U.S. families, and children's independent storytelling skills one year later. Mothers' book‐sharing style was analysed in terms of how much storyline information they provided (story components), the extent to which they asked children about the story (dialogic emphasis) and which features of the story they highlighted (story content). African American mothers referred to more story components than did Dominican mothers, and Mexican mothers surpassed Dominican and Chinese mothers. Mothers of all groups were low in dialogic emphasis; they predominantly narrated rather than asked about the story, although Mexican mothers asked relatively more questions than did African American and Dominican mothers. In terms of content, compared with other groups, African American mothers were most likely to emphasize ‘individual goals’, and Chinese mothers were most likely to emphasize ‘negative consequences’. Latino mothers were more likely to emphasize ‘emotions’ than were Chinese mothers. Children's storytelling styles partially mirrored those seen in their mothers. Mothers' dialogic emphasis related to children's contributions to book‐sharing, which in turn predicted children's later independent storytelling skills. Copyright © 2014 John Wiley & Sons, Ltd.     

The Social Context of Infant Intention Understanding

Traditional looking-time paradigms are often used to assess infants' attention to sociocognitive phenomena, but the link between these laboratory scenarios and real-world interactions is unclear. The current study investigated hypothesized relations between traditional social-cognitive looking-time paradigms and their real-world counterparts in caregiver–infant social interaction. Seventy-five 10- to 12-month-old infants participated in a structured play session with their caregiver, as well as a traditional looking-time paradigm targeting intentional action. Infants' ability to quickly parse intentional displays correlated with several key qualities of their everyday interactions. In particular, caregiver and infant interaction quality, maternal supportiveness, caregiver and infant joint engagement skill, and social attentiveness in infants correlated with faster habituation to looking-time displays. These results support a linkage between social-cognitive looking-time laboratory paradigms and more naturalistic partner interaction, at this key age. The data provide external validation for the large body of social-cognitive findings emerging from laboratory looking-time paradigms and contribute to a growing literature tracking the developmental trajectory of infants' understanding of people during the first 2 years.     

Development and evaluation of the positive psychology intervention for older adults

Although research suggests that positive psychology intervention can enhance subjective well-being and reduce depression, its effectiveness on older adults remains largely unknown. Therefore the present study aimed to develop and evaluate a custom-tailored positive psychology intervention program for older adults. The program offered nine-week group sessions to 74 older people recruited from district community centers and nursing homes in Hong Kong. The intervention program covers eight themes, including optimism, gratitude, savoring, happiness, curiosity, courage, altruism, and meaning of life. The participants consisted mostly of females aged between 63 and 105?years. One-group pre-test/post-test design was adopted to evaluate the effectiveness of the intervention on depression, life satisfaction, gratitude, and happiness. Results revealed that the intervention reduced the number of depressive symptoms and increased the levels of life satisfaction, gratitude, and happiness. Effectiveness of the intervention is discussed in relation to self-awareness, education, self-reinforcement, and sensitivity to age and culture.     

Collective memories of three wars in United States history in younger and older adults

A collective memory is a representation of the past that is shared by members of a group. We investigated similarities and differences in the collective memories of younger and older adults for three major wars in U.S. history (the Civil War, World War II, and the Iraq War). Both groups were alive during the recent Iraq War, but only the older subjects were alive during World War II, and both groups learned about the Civil War from historical sources. Subjects recalled the 10 most important events that occurred during each war and then evaluated the emotional valence, the relative importance, and their level of knowledge for each event. They also estimated the percentage of people that would share their memory of each event within their age group and the other age group. Although most historical events were recalled by fewer than 25 % of subjects, younger and older adults commonly recalled a core set of events for each war that conform to a narrative structure that may be fundamental to collective remembering. Younger adults showed greater consensus in the events that they recalled for all three wars, relative to older adults, but there was less consensus in both groups for the Iraq War. Whereas younger adults recalled more specific events of short duration, older adults recalled more extended and summarized events of long duration. Our study shows that collective memories can be studied empirically and can differ depending on whether the events are experienced personally or learned from historical sources.     

The production effect in paired-associate learning: Benefits for item and associative information

In five experiments, we extended the production effect—better memory for items said aloud than for items read silently—to paired-associate learning, the goal being to explore whether production enhances associative information in addition to enhancing item information. In Experiments 1 and 2, we used a semantic-relatedness task in addition to the production manipulation and found no evidence of a production effect, whether the measure was cued recall or item recognition. Experiment 3 showed that the semantic-relatedness task had overshadowed the production effect; the effect was present when the semantic-relatedness task was removed, again whether cued recall or item recognition was the measure. Experiments 4 and 5 provided further evidence that production can enhance recall for word pairs and, using an associate recognition test with intact versus rearranged pairs, indicated that production may also enhance associative information. That production boosts memory for both types of information is considered in terms of distinctive encoding.     

Notes on Psychoanalysis,Psychotherapy and Methodology

Abstract

Technical innovations always carry with them clinical and scientific challenges. The aim of this paper is to provide a context for exploring the consequences of technical innovations for psychoanalysis as an interrelated method of observation, treatment, and body of knowledge about mental functioning. The problems are approached from a methodological perspective because scientific progress requires methodological clarity. The inquiry begins with a methodological investigation of the technical and theoretical consequences of first principles, that is, the consequences of the assumptions and methods we adopt for the kind of data that are obtained by their application and for the theory required to understand and unify the resulting observations. The conclusion suggests that if one organizes a doctor-patient relationship around the clinical-historical and free-association methods with the aim of removing all obstacles to communication, if the understandings that emerge include a full range of dynamic, structural, genetic and adaptive propositions, one is engaged in psychoanalytic inquiry. The circumstances under which Rothstein's technical recommendations enable such understandings to develop are an important topic for future research.