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.     

Increased control demand results in serial processing: evidence from dual-task performance

Increased demands on cognitive control trigger changes in processing mode. One such modulation involves a shift from parallel to serial processing. This study assessed the role of control demand in determining whether dual-task processing is performed serially or in parallel. We used two critical indices, based on the response-selection bottleneck model, to show that response selection was serial when a task switch was involved, but partly parallel when the simultaneous performance of the tasks did not involve task switching.     

Grounding words in perception and action: computational insights

We use words to communicate about things and kinds of things, their properties, relations and actions. Researchers are now creating robotic and simulated systems that ground language in machine perception and action, mirroring human abilities. A new kind of computational model is emerging from this work that bridges the symbolic realm of language with the physical realm of real-world referents. It explains aspects of context-dependent shifts of word meaning that cannot easily be explained by purely symbolic models. An exciting implication for cognitive modeling is the use of grounded systems to 'step into the shoes' of humans by directly processing first-person-perspective sensory data, providing a new methodology for testing various hypotheses of situated communication and learning.     

Underestimating the duration of future events: memory incorrectly used or memory bias?

People frequently underestimate how long it will take them to complete a task. The prevailing view is that during the prediction process, people incorrectly use their memories of how long similar tasks have taken in the past because they take an overly optimistic outlook. A variety of evidence is reviewed in this article that points to a different, although not mutually exclusive, explanation: People base predictions of future duration on their memories of how long past events have taken, but these memories are systematic underestimates of past duration. People appear to underestimate future event duration because they underestimate past event duration.     

Unimanual performance across the age span

The purpose of the current investigation was to examine the age-related changes in the performance of the two hands on the Annett pegboard (Annett, 1970). The current study was part of a large-scale study investigating the development of unimanual and bimanual performance. Three hundred and two right-handed individuals participated in the present study, comprising five different age groups (3-5 year olds, 6 and 7 year olds, 8 and 9 year olds, 10-12 year olds, and 19-24 year olds). All participants completed the Waterloo Handedness Questionnaire and the standard Annett pegboard. Analyses revealed significant overall performance differences between the hands, as expected, where the right hand was significantly faster than the left hand. Additionally, significant performance differences between the hands were noted as a function of age. More specifically, the adults showed a much smaller performance difference between the hands than the other age groups. The results are discussed in light of current theories of the development of hand preference and manual asymmetry.     

A new method of administering the Grooved Pegboard Test: performance as a function of handedness and sex

The purpose of the present study was twofold: first to examine the influences of sex and handedness on manual performance on the Grooved Pegboard Test; and secondly to provide normative data for two versions (Place and Remove tasks) of the Grooved Pegboard Test, as previous work (Bryden & Roy, 1999) had suggested that the Remove task of the Grooved pegboard may provide a purer measure of motor speed of the two hands than the standard administration of the Grooved Pegboard Test. One hundred and fifty-three (47 males and 106 females) participants completed the Grooved Pegboard Test. Individuals performed the standard version of the Grooved Pegboard Test (Place task) and a novel version of the test (Remove task). In the standard version, participants were timed on their speed for placing the pegs, while in the novel version they were timed on their speed for removing the pegs. Results confirmed previously noted hand and sex differences in the Place task of the Grooved Pegboard Test, as well as the lack of effect of handedness on performance (Bornstein, 1995; Ruff & Parker, 1993). Significant performance differences between the hands were also noted for the Remove task. Findings also indicated that the Remove task was sensitive to sex and handedness effects.     

Effects of social exclusion on cognitive processes: anticipated aloneness reduces intelligent thought

Three studies examined the effects of randomly assigned messages of social exclusion. In all 3 studies, significant and large decrements in intelligent thought (including IQ and Graduate Record Examination test performance) were found among people told they were likely to end up alone in life. The decline in cognitive performance was found in complex cognitive tasks such as effortful logic and reasoning; simple information processing remained intact despite the social exclusion. The effects were specific to social exclusion, as participants who received predictions of future nonsocial misfortunes (accidents and injuries) performed well on the cognitive tests. The cognitive impairments appeared to involve reductions in both speed (effort) and accuracy. The effect was not mediated by mood.     

Patterns of apraxia associated with the production of intransitive limb gestures following left and right hemisphere stroke

The model of apraxia proposed by Roy (1996) states that three patterns of apraxia should be observed across pantomime and imitation conditions. In the present analysis the frequency and severity of each pattern of apraxia were examined in a consecutive sample of left-(LHD) and right-hemisphere-damaged (RHD) patients during the production of intransitive limb gestures. The results indicated that a significant proportion of LHD and RHD patients were selectively impaired in formulating the ideational component of intransitive limb gestures.     

Accidental germ-line modifications through somatic cell gene therapies: some ethical considerations

Proposed somatic cell gene-therapies (especially those involving in utero therapies) may involve a small risk of germ-line modifications; this risk has engendered serious concern, and arguments have been made that such therapies ought not be pursued if such risks exists. We argue here that while pursuing deliberate germ-line modifications in humans would be inappropriate given the current state of the art, the risk of accidental germ-line modifications from most currently proposed in utero gene therapy is no different in kind or degree from other risks regularly taken in medical procedures. Given the possible benefits of such therapies, we argue that the risk of accidental germ-line modifications is well worth taking in these cases.