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.     

Indirect pathways between depressive symptoms and marital distress: the role of conflict communication, attributions, and attachment style

Previous studies have focused on concomitants of depression and marital distress in order to help explain the relationship between the two, suggesting that several variables, such as conflict communication, attributions, and attachment style, are associated with depression, marital distress, or both. Our contention is that the selected variables may be important mediators (hypothesis 1) or moderators (hypothesis 2) of the concomitance between depression and marital adjustment, exploring the direct and indirect ways in which depressive symptoms and marital adjustment are related. In total, 415 heterosexual couples were recruited, and a series of regression analyses was conducted to test our hypotheses separately for men and women. Results indicated that demand-withdrawal, avoidance, causal attributions, and secure, ambivalent, and avoidant attachment mediated the relation between depressive symptoms and marital adjustment in the female sample, whereas constructive communication and causal and responsible attributions were significant mediators of men's levels of depressive symptoms and marital adjustment. In addition, avoidance and secure attachment moderated the association between depressive symptoms and marital adjustment in the female sample, and causal attributions were significant moderators of the association between depressive symptoms and marital adjustment for men. Several conclusions and implications for theory and future research are discussed.     

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.     

Stimulation seeking and hyperactive behavior in children with ADHD: a re-analysis

To examine the stimulation-seeking function of hyperactivity in children with ADHD, Antrop and colleagues analyzed the behavior of 30 hyperactive and 30 nonhyperactive children during a waiting situation, either with or without extra stimulation. The behavior was assessed by frequency measures. In their study it was hypothesized that children with ADHD would show a greater decrease in activity in the presence of stimulation than control children. Since confirmation for this hypothesis was only found for 2 of 25 target behaviors, the present re-analysis included other behavioral measures to assess two relationships: first, how hyperactivity varies under fixed time conditions, using measures of duration and intensity of behavior instead of frequency measures, and second, how the perceived duration of waiting time affects behavior. Analysis indicated that children with ADHD showed a greater decrease in behavior in the presence of stimulation for touching objects and movements of trunk, as reported. Further, children who underestimated the waiting period were more apt to seek additional stimulation in its absence than those who overestimated the waiting period.     

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.