The pros and cons of funnel plots as an aid to risk communication and patient decision making

Funnel plots, which simultaneously display a sample statistic and the corresponding sample size for multiple cases, have a range of applications. In medicine, they are used to display treatment outcome rates and caseload volume by institution, which can inform strategic decisions about health care delivery. We investigated lay people's understanding of such plots and explored their suitability as an aid to individual treatment decisions. In two studies, 172 participants answered objective questions about funnel plots representing the surgical outcomes (survival or mortality rates) of institutions varying in caseload, and indicated their preferred institutions. Accuracy for extracting objective information was high, unless question phrasing was inconsistent with the plot's survival/mortality framing, or participants had low numeracy levels. Participants integrated caseload‐volume and outcome‐rate data when forming preferences, but were influenced by reference lines on the plot to make inappropriate discriminations between institutions with similar outcome rates. With careful choice of accompanying language, funnel plots can be readily understood and are therefore a useful tool for communicating risk. However, they are less effective as a decision aid for individual patient's treatment decisions, and we recommend refinements to the standard presentation of the plots if they are to be used for that purpose.     

FOOD NEGLECT AND INFANT DEVELOPMENT

The impact of food insecurity on child development in the general U.S. population is well‐established, yet little is known about the harm of food neglect relative to other types of maltreatment. Due to the harmful physiological impact of inadequate nutrients and the social impact of food‐related stress, it was hypothesized that food neglect would be more likely to impair infant cognitive and language development than physical abuse, sexual abuse, and other forms of neglect. Families of infants (N = 1,951) investigated by Child Protective Services were studied using the second cohort of the National Survey of Child and Adolescent Well‐Being (NSCAW II; NSCAW Research Group, 2002). Results from multivariable logistic regression models that controlled for likely confounding variables showed that the odds of impairment in cognition and language were significantly greater when food neglect was the most serious form of maltreatment. Considering that both food insecurity and child neglect are associated with poverty and parental mental health problems, it will be important for child welfare and mental health professionals to work collaboratively to better the health of these vulnerable children.     

Mental representation of a line when patients with left unilateral spatial neglect bisect it: A study with an endpoint reproduction task

Patients with left unilateral spatial neglect (USN) typically place the subjective midpoint to the right of the objective centre. Based on the previous findings (e.g., Ishiai et al. 1989, Brain, 112, 1485), we hypothesized that the patients with left USN may see the representational image of a line that extends equally towards either side of the subjective midpoint depending not upon the information about the leftward extent. The present study tested whether patients with left USN would place the subjective midpoint at the centre of their mental representation of the line. The participants were 10 patients with left USN and 10 neurologically healthy controls. We devised a new ‘endpoint reproduction task’ using a computer display with a touch panel to seek the representational image when patients with left USN bisect lines and asked the participants to reproduce the location of the right or left endpoint after bisecting lines. The results showed that the representational image of the bisected line depends primarily on the location of the objective right endpoint, not on the location of the objective left endpoint in space. The analyses of the estimated right and left representational extents confirmed our hypotheses that patients with left USN would bisect a line seeing the representational line image that centred across their subjective midpoint. We believe that the findings of the present study with the use of the endpoint reproduction task will contribute to a better understanding of the visuospatial process underlying line bisection of patients with left USN.     

Implicit learning: A way to improve visual search in spatial neglect?

Studies have shown that neglect patients are able to use stimulus regularities to orient faster toward the neglected side, without necessarily being aware of that information, or at the very least without being able to verbalize their knowledge. In order to better control for the involvement of explicit processes, the present study sought to test neglect patients’ ability to detect more complex associations between stimuli using tasks similar to those used in implicit learning studies. Our results demonstrate that neglect patients had difficulties implicitly learning complex associations, contrary to what we found with controls. The possible influence of attentional and working memory impairments are discussed.     

自我概念影响选择性记忆的理论模型与研究

关于自我概念对个人选择性记忆的影响及其机制问题目前主要存在不一致—负性忽略模型和关联模型两种解释。前者假定,个人努力忽略对与其积极自我概念不一致或冲突信息的加工,以维持其自我概念的稳定性,但该模型忽视了自我概念的个别差异。后者则假定,自我概念对选择性记忆的影响是由评价性信息与自我概念的关联程度决定的,并质疑记忆的心境一致性效应,但该模型无法解释积极自我概念者面临消极心境和消极自我概念者面临积极心境时对外部信息的记忆模式。未来研究有必要考察即时性心境状态下不同自我概念对选择性记忆加工的影响,以促进对自我概念和心境状态影响记忆选择性及其机制的深入理解。     

Reducing cognitive biases in probabilistic reasoning by the use of logarithm formats

Research on probability judgment has traditionally emphasized that people are susceptible to biases because they rely on “variable substitution”: the assessment of normative variables is replaced by assessment of heuristic, subjective variables. A recent proposal is that many of these biases may rather derive from constraints on cognitive integration, where the capacity-limited and sequential nature of controlled judgment promotes linear additive integration, in contrast to many integration rules of probability theory (Juslin, Nilsson, & Winman, 2009). A key implication by this theory is that it should be possible to improve peoples’ probabilistic reasoning by changing probability problems into logarithm formats that require additive rather than multiplicative integration. Three experiments demonstrate that recasting tasks in a way that allows people to arrive at the answers by additive integration decreases cognitive biases, and while people can rapidly learn to produce the correct answers in an additive formats, they have great difficulty doing so with a multiplicative format.     

The Relationships among Childhood Maltreatment,Emotion Regulation,and Sexual Risk Taking in Men from Urban STD Clinics

This study sought to examine the relationships among emotion regulation difficulties, childhood maltreatment, and risky sexual behavior in a sample of 320 heterosexual men recruited from urban sexually transmitted disease clinics. Overall childhood maltreatment and several specific types of child abuse were significantly associated with emotion dysregulation, number of sexual partners, and sexually transmitted infection (STI) diagnosis. There was evidence of an additive effect of multiple forms of maltreatment on difficulties with emotion regulation and sexual risk taking. Impulse control difficulties and access to emotion regulation strategies, two components of emotion dysregulation, were related to measures of risky sexual behavior. Furthermore, limited access to emotion regulation strategies mediated the relationship between frequency of childhood sexual abuse and a greater number of lifetime sexual partners. This study has important implications for developing effective interventions to reduce the spread of STIs and HIV by expanding affect regulation and distress tolerance strategies among men who have experienced childhood maltreatment.     

Child Protection and Psychology Education in Australian Universities

Child maltreatment is a significant problem in Australia. Psychologists in a wide range of occupations play an important role in the identification and prevention of child abuse and neglect, the provision of interventions to children and families, and the development and conduct of research in related areas. Psychology graduates must be adequately prepared to work in this field; however, little is known about the extent to which child abuse and neglect related contents are taught in current university curricula. A purpose‐developed curriculum‐mapping survey was used to examine Australian undergraduate, fourth year, and postgraduate Australian Psychology Accreditation Council‐accredited programmes available in 2008. Results showed that students in the majority of programmes were exposed to child protection‐related content; however, the extent of exposure was limited. Three postgraduate units specifically addressed the prevention, identification, and response to child abuse and neglect. Course coordinators reported that child maltreatment content was mostly integrated into general units throughout the programme, typically within developmental psychology units in the undergraduate curriculum and in ethics, research, or professional issues units in the fourth year and postgraduate programmes. Results suggest the need for child protection content to be included in minimum national standards and accreditation guidelines for universities.     

Mapping One Strong ‘Ohana: Using Network Analysis and GIS to Enhance the Effectiveness of a Statewide Coalition to Prevent Child Abuse and Neglect

Network analysis and GIS enable the presentation of meaningful data about organizational relationships and community characteristics, respectively. Together, these tools can provide a concrete representation of the ecological context in which coalitions operate, and may help coalitions identify opportunities for growth and enhanced effectiveness. This study uses network analysis and GIS mapping as part of an evaluation of the One Strong ‘Ohana (OSO) campaign. The OSO campaign was launched in 2012 via a partnership between the Hawai‘i Children’s Trust Fund (HCTF) and the Joyful Heart Foundation. The OSO campaign uses a collaborative approach aimed at increasing public awareness of child maltreatment and protective factors that can prevent maltreatment, as well as enhancing the effectiveness of the HCTF Coalition. This study focuses on three elements of the OSO campaign evaluation: (1) Network analysis exploring the relationships between 24 active Coalition member organizations, (2) GIS mapping of responses to a randomized statewide phone survey (n = 1,450) assessing awareness of factors contributing to child maltreatment, and (3) Combined GIS maps and network data, illustrating opportunities for geographically-targeted coalition building and public awareness activities.     

Prose Reading in Neglect

Prose reading has been shown to be a very sensitive measure of Unilateral Spatial Neglect. However, little is known about the relationship between prose reading and other measures of neglect and its severity, or between prose reading and single word reading. Thirty participants with a first stroke in the right hemisphere and clear symptoms of spatial neglect in everyday life were assessed with tests of prose reading (text in one column book-like, and in two columns magazine-like), single words reading, and a battery of 13 tests investigating neglect. Seventy percent of these participants omitted words at the beginning of the text (left end), showing Prose Reading Neglect (PRN). The participants showing PRN differed from those not showing PRN only for the overall severity of neglect, and had a lesion centred on the insula, putamen and superior temporal gyrus. Double dissociations emerged between PRN and single word reading neglect, suggesting different cognitive requirements between the two tests: parallel processing in single word reading vs. serial analysis in text reading. Notably, the pattern of neglected text varied dramatically across participants presenting with PRN, including dissociations between reading performance of one and two columns text. Prose reading proved a complex and unique task which should be directly investigated to predict the effects of unilateral neglect. The outcome of this study should also inform clinical assessment and advises given to patients and care-givers.