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.     

Emotional memory for central and peripheral details in children with callous-unemotional traits

A limited number of studies have shown that adults and adolescents with psychopathic traits suffer from emotional memory impairment. The present study examined whether this finding could be replicated in a sample of children between 8 and 12?years of age with callous-unemotional (CU) traits. Children with high CU traits (n?=?24) were compared with children with low CU traits (n?=?18) with regard to performance on a peripheral memory recognition test that examined memory for central and peripheral components of neutral and negative pictures. Results showed that overall recognition rates did not differ between the high- and low-CU groups. For negative pictures, both groups demonstrated better recognition of the central component at the expense of the peripheral component, while for neutral pictures, the peripheral component was better recognized than the central component. This study is the first to demonstrate that children with high CU traits do not suffer from an impaired emotional memory. Copyright ? 2012 John Wiley & Sons, Ltd.     

Counseling in Singapore

Singapore, a tiny island nation, rose from 3rd‐ to 1st‐world status in just 3 decades. Unlike in most developed countries, counseling in Singapore has a short history with faith‐based beginnings and currently faces challenges to remain culturally relevant. The authors trace the development of Singapore's counseling services, provide an update regarding counseling practices in the school and community, and describe counseling and its relation to psychology in the educational setting. The authors conclude by examining professional issues and future directions.     

Survival processing in times of stress

Recent studies have found that processing information according to an evolutionary relevant (i.e., survival) scenario improves its subsequent memorability, potentially as a result of fitness advantages gained in the ancestral past. So far, research has not revealed much about any proximate mechanisms that might underlie this so-called survival processing advantage in memory. Intriguingly, research has shown that the memorability of stressful situations is enhanced via the release of stress hormones acting on brain regions involved in memory. Since survival situations habitually involve some degree of stress, in the present study, we investigated whether stress serves as a proximate mechanism to promote survival processing. Participants rated words for their relevance to either a survival or a neutral (moving) scenario after they had been exposed to a psychosocial stressor or a no-stress control condition. Surprise retention tests immediately following the rating task revealed that survival processing and acute stress independently boosted memory performance. These results therefore suggest that stress does not serve as a proximate mechanism of the survival processing advantage in memory.     

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.     

Sperm control

Evidence is accumulating that in many species, males deliver more sperm to some females and fewer to others depending on how valuable they perceive the copulation. Do humans have any control over the number of sperm they ejaculate?     

Does HPA‐Axis Dysregulation Account for the Effects of Income on Effortful Control and Adjustment in Preschool Children?

The effects of low income on children's adjustment might be accounted for by disruptions to hypothalamic–pituitary–adrenal (HPA)‐axis activity and to the development of effortful control. Using longitudinal data and a community sample of preschool‐age children (N = 306, 36–39 months) and their mothers, recruited to over‐represent low‐income families, we explored the associations among diurnal cortisol levels and effortful control, and we tested a model in which diurnal cortisol and effortful control account for the effects of family income on child adjustment. Continuous indicators of morning cortisol level and diurnal slope, as well as dichotomous indicators reflecting low morning levels and flat diurnal slope, were examined as predictors of rank‐order changes in two dimensions of effortful control, executive control and delay ability. Low income was related to a flat diurnal cortisol slope, and above the effects of family income, a flat diurnal cortisol slope predicted lower social competence. Low morning cortisol level predicted smaller gains in executive control and higher total adjustment problems. Further, delay ability predicted lower adjustment problems above the effects of income and diurnal cortisol levels. The results suggest that HPA‐axis dysregulation and effortful control contribute additively to children's adjustment. Copyright © 2013 John Wiley & Sons, Ltd.