Three Conceptual Models of Patient and Public Involvement in Standard-setting: From Abstract Principles to Complex Practice

Clinical practice guidelines have been critiqued for prescribing standardized care that neglects patients’ personal circumstances and knowledge in health care decisions. To make care more patient centred, standard-setters are urged to involve patients and the public in guideline development and use. Despite widespread principled support for such Patient and Public Involvement (PPI), the underlying principles guiding PPI in standardization of care are mired on confusion and contradiction. Based on the PPI literature in general, and informed by empirical research on guideline development, it is possible to identify three rationales that justify PPI in clinical standard setting. Each rationale gives rise to a conceptual model which outlines a distinct purpose of participation, who is to be included, and what they are expected to contribute. The Consumer Choice model aims to involve autonomous consumers to personalize clinical care. The Democratic Voice model aims for health care recommendations to better reflect collective values of citizens. The Lay Expertise model aims to re-contextualize universal evidence by including experiential patient knowledge. However, these models can and should not function as ‘Gold Standards’ to be consistently followed in practice. First, the models rely on two distinct types of representation, resulting in contradictory notions of how to be a good representative. Second, imposing models on practice requires a top-down control that is practically and politically problematic. Not only is control difficult to achieve, it may compromise the participatory ideal of participants co-determine practice, and may result in excluding the values and views of ‘real’ patients and public entirely.     

L'accession à l'opérativité formelle chez les enfants intellectuellement précoces

This study is an attempt to contribute data concerning the cognitive functioning and development of intellectually gifted children, at the threshold of formal operational stage. It ascribes to the theory of the operational development of intelligence according to Piaget. “Gifted”, children and “average” children of an equivalent mental age (12 years and 6 months) were compared. A second group of gifted children of the same chronological age as the average children completed this study. Longeot's “Échelle de Développement de la Pensée Logique” was used for all the subjects. The results reveal dissynchronical aspects within the genesis of gifted children. They are discussed taking into account the task characteristics (type of reasoning they require) and functional specificities of compared subjects.     

RSK2 signaling in brain habenula contributes to place aversion learning

RSK2 is a Ser/Thr kinase acting in the Ras/MAPK pathway. Rsk2 gene deficiency leads to the Coffin-Lowry Syndrome, notably characterized by cognitive deficits. We found that mrsk2 knockout mice are unable to associate an aversive stimulus with context in a lithium-induced conditioned place aversion task requiring both high-order cognition and emotional processing. Virally mediated shRNA-RSK2 knockdown in the habenula, whose involvement in cognition is receiving increasing attention, also ablated contextual conditioning. RSK2 signaling in the habenula, therefore, is essential for this task. Our study reveals a novel role for RSK2 in cognitive processes and uncovers the critical implication of an intriguing brain structure in place aversion learning.     

The role of form and meaning in the processing of written morphology: A priming study in French developing readers

Three visual priming experiments using three different prime durations (60 ms in Experiment 1, 250 ms in Experiment 2, and 800 ms in Experiment 3) were conducted to examine which properties of morphemes (form and/or meaning) drive developing readers’ processing of written morphology. French third, fifth, and seventh graders and adults (the latter as a control group) performed lexical decision tasks in which targets were preceded by morphological (e.g., tablette–TABLE, “little table–table”), pseudoderived (e.g., baguette–BAGUE, “little stick–ring”), orthographic control (e.g., abricot–ABRI, “apricot–shelter”), and semantic control (e.g., Tulipe–FLEUR, “tulip–flower”) primes. Across all groups, different patterns of priming were observed in both morphological and orthographic/semantic control conditions, suggesting that they all process morphemes as units when reading. In developing readers, the processing of written morphology is triggered by the form properties of morphemes, and their semantic properties are activated later in the time course of word recognition. In adults, patterns of priming were similar except that the activation of the form properties of morphemes decreased earlier in the time course of word recognition. Taken together, these findings indicate that French developing readers process both the form and meaning properties of morphemes when reading and support a progressive quantitative change in the development of morphological processing over the course of reading development.     

A study of EEG coherence in DCD children during motor synchronization task

This paper investigates the hypothesis that the coordination difficulties of DCD children are associated with an increased coherence in the cortical motor regions, which persists with age. Forty-eight children participated in the study (24 DCD and 24 Controls). Their ages ranged from 8 to 13 years, divided into three groups (8-9, 10-11, and 12-13 years old). Children were required to perform finger flexion or extension either in synchrony or in syncopation with a rhythmic metronome, while a 32-channel EEG was recorded. Along with stability measures of motor performance, we analyzed the spectral EEG coherence between intrahemispheric (left frontal/left central; left central/left parietal) and interhemispheric (left central/right central) sites. Spectral coherence assesses functional coupling between distant areas of the brain. Two frequency bands related to sensorimotor activation were chosen: alpha (8-12 Hz) and beta (12-30 Hz). The synchrony task was chosen as a rest condition against which the two syncopation conditions at 0.5 Hz and 1.3 Hz were contrasted. For intrahemispheric comparison, 8-9-year-old DCD children showed that coherence between fronto-central regions increased for both rhythms and conditions, as compared to controls. No difference was found for interhemispheric comparisons. As frontal sites are related to motor planning, our results suggest that youngest DCD children were forced to maintain a high level of pre-programming to compensate for the difficulties caused by the perceptual-motor requirements of the task in light of their coordination disorder.     

A contribution to the study of the metric and Euclidean structures of dissimilarities

This paper is concerned with the geometric properties of dissimilarity coefficients defined on finite sets and especially with their Euclidean nature. We present several particular transformations which preserve Euclideanarity and we complete, through the study of a one-parameter family, the current knowledge of the metric and Euclidean structure of coefficients based on binary data. These results are directly deduced from two theorems which prove the positive semi-definite status of some quadratic forms which play a large role in some definitions of dissimilarity commonly used.The authors wish to thank B. Fichet for his helpful suggestions, the associate Editor and an anonymous reviewer for comments and highly constructive criticisms on earlier drafts of the paper.     

Forced compliance: Commitment to compliance and commitment to activity

It is argued that the standard manipulation of free choice in a forced compliance situation has fostered confusion between the two different types of choices offered to subjects, namely commitment or non-commitment to compliance with the experimenter and choice of counter-attitudinal activity per se. From a theoretical viewpoint, the two choices have very different implications. The former is a prerequisite to dissonance arousal; the latter may bring about consonant cognitions which reduce the dissonance ratio. Two experiments which separated these two choices confirmed the above predictions, derived from a radical conception of the dissonance theory (Beauvois and Joule, 1981, 1994). The results are inconsistent with the reinterpretation of dissonance effects in self-perception terms.     

When stereotypes hurt: Three studies of penalties for sex-role reversals

Three studies that demonstrate penalties for sex-role reversals are reported. In each study, subjects evaluated men and women who behaved either in line with sex-role stereotypes or counter to them. The results show that popularity ratings and perceived psychological adjustment of both passive-dependent men and aggressive-assertive women were adversely affected. The findings are discussed in terms of their contribution to recent theories about women's achievement motivation.     

The role of semantic memory in short-term recall: effect of strategic retrieval ability in an elderly population

The present paper examines the relationship between two classic phenomena: semantic effects in short-term recall (STR) tasks, which are interpreted as indicating the involvement of long-term memory (LTM) in the functioning of short-term memory, on the one hand, and the existence of individual differences amongst elderly people in strategic retrieval ability (i.e., the ability to activate representations in LTM in a controlled way) on the other hand. Forty elderly participants completed a STR task under four different conditions which were thought to differentially involve LTM representations. Several executive functions, among which the strategic retrieval ability, were evaluated. The results showed that the participants who obtained the best performances in terms of strategic retrieval ability, and only in this executive ability, also exhibited better performances in the STR task, in particular when this task was performed under conditions which favored the use of LTM.