Focal lung pathology detection in radiology: Is there an effect of experience on visual search behavior?

In radiology, 60% to 80% of diagnostic errors are perceptual. The use of more efficient visual search behaviors is expected to reduce these errors. We collected eye-tracking data from participants with different levels of experience when interpreting chest X-rays during the completion of a pathology-detection task. Eye-tracking measures were assessed in the context of three existing visual search theories from the literature to understand the association between visual search behavior and underlying processes: the long-term working memory theory, the information-reduction hypothesis, and the holistic model of image perception. The most experienced participants (radiology residents) showed the highest level of performance, albeit their visual search behaviors did not differ from the intermediate group. This suggests that radiology residents better processed the represented information on the X-ray, using a visual search strategy similar to the intermediate group. Since similar visual search resulted in more information extraction in the radiology residents compared with the intermediates, we suggest that this result might support the long-term working memory theory. Furthermore, compared with novices, intermediates and radiology residents fixated longer on areas that were more important to avoid missing any pathology, which possibly confirms the information-reduction hypothesis. Finally, the larger distances between fixations observed in more experienced participants could support the holistic model of image perception. In addition, measures of generic skills were related to a lower time cost for switching between global and local information processing. Our findings suggest that the three theories may be complementary in chest X-ray interpretation. Therefore, a unified theory explaining perceptual-cognitive superiority in radiology is considered.

     

Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers,Training/Technical Assistance,and Points of Leverage

We present interim findings of a cross‐site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence‐based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early implementation were conducted in six Canadian communities receiving HF TTA. The primary data are field notes gathered over 1.5 years and evaluations from site‐specific training events (k = 5, n = 302) and regional network training events (k = 4, n = 276). We report findings related to: (a) the facilitators of and barriers to early implementation, (b) the influence of TTA on early implementation, and (c) the “levers” used to facilitate broader systems change. Systems change theory enabled us to understand how various “levers” created opportunities for change within the communities, including establishing system boundaries, understanding how systems components can function as causes of or solutions to a problem, and assessing and changing systems interactions. We conclude by arguing that systems theory adds value to existing implementation science frameworks and can be helpful in future research on the implementation of evidence‐based practices such as HF which is a complex community intervention. Implications for community psychology are discussed.     

Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada

The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi‐component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team‐based practice, and facilitating case‐based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system—practitioners, teams, and communities—while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.     

Scale‐dependent automatic shifts in brand evaluation standards

Different schema-based expectations for competing brands can produce shifting evaluative standards in consumers' relative ratings of these brands. This shift in standards differentially affects objective (number-based) and subjective (word-based) rating scales. Several studies support the proposition that a brand rated as objectively inferior to another can be subjectively perceived as equivalent to—or even better than—the same brand. Such anomalous response inconsistency originates in consumers' recourse to different expectations for the competing brands and their automatic adjustment of expectations for the inferior brand when responding to subjective measures. The implicit relaxing of evaluative standards for the objectively dominated brand leads to an unconscious upward bias in its subjective ratings. The effect is moderated by consumer expertise and is asymmetric—it is not accompanied by an escalation of evaluative standards for objectively dominating brands.     

The Mediating Role of Moral Ownership in the Relationship Between Organizational Support and Employees’ Ethical Behavior: A Study of Higher Education Faculty Members

We examined the mediating role of employee moral ownership in the relationship between employees’ perception of organizational support and their actual ethical behavior. Data were collected from 689 faculty members affiliated with different educational institutions in India. Structural equation modeling analysis showed that perceived organizational support significantly impacts employee ethical behavior. In addition, the results revealed that employee moral ownership mediates the relationship between perceived organizational support and employee ethical behavior. Implications and limitations of the study are discussed.