Unpacking Impasse-Related Experience during Insight

Mental impasse has long been recognized as a hallmark of creative insight, but its precise role has been unexplored. The aim of the present work, consisting of two studies, was to experimentally probe mental impasse perspective from insight experience, namely impasse-related experience during insight. In Study 1, participants were requested to complete a compound remote association task and a forced-choice subjective experience depiction task that could provide data on impasse-related experience. The results showed that reports of negative experience, such as feelings of loss (t = -5.51, p < .001, Cohen d = 1.07) and personal experience (mirrored by 'other' response; t = -2.62, p < .05, Cohen d = 0.48), were more common in the impasse condition than in the no-impasse condition; correspondingly positive affect and positive cognitive experiences such as happiness (t = 4.20, p < .001, Cohen d = 0.77), ease (t = 5.90, p < .001, Cohen d = 1.20), certainty (t = 7.46, p < .001, Cohen d = 1.36) and calmness (t = 4.42, p < .001, Cohen d = 0.81) were experienced more frequently in the no-impasse condition. These findings were replicated in Study 2, in which participants were invited to solve a set of classic insight problems and to freely report any feelings of being at an impasse. Across two studies, this work suggests that impasse-related experience during insight problem solving is multi-faceted and consists of negative affective and cognitive components. The implications of these findings are discussed.

The validated circular shape space: Quantifying the visual similarity of shape

Subjective similarity holds a prominent place in many psychological theories, influencing diverse cognitive processes ranging from attention and categorization to memory and problem solving. Despite the known importance of subjective similarity, there are few resources available to experimenters interested in manipulating the visual similarity of shape, one common type of subjective similarity. Here, across seven validation iterations, we incrementally developed a stimulus space consisting of 360 shapes using a novel image-processing method in conjunction with collected similarity judgments. The result is the Validated Circular Shape space, the first Validated Circular Shape space comparable to the commonly used "color wheel", whereby angular distance along a 2D circle is a proxy for visual similarity. This extensively validated resource is freely available to experimenters wishing to precisely manipulate the visual similarity of shape. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Directed forgetting in problem solving

In two experiments, we investigated intentional forgetting of problem-solving routines by adapting the list method of directed forgetting. In Experiment 1, participants practiced solving water-jar problems (Luchins, 1942). After working on a first series of problems that all could be solved by the same formula, one group of participants was instructed to forget the so-far presented items because these, allegedly, had only served as a warm-up, whereas another group did not receive a forget instruction. After practicing a different routine in a second series of problems, participants solved test problems that either could be solved by the formula previously practiced in the first or in the second series of problems. All test problems alternatively could be solved by a more direct formula. The forget instruction significantly reduced the number of test problems solved by the formula of the first series of practice problems. In Experiment 2, participants subsequently practiced two solution formulas in two series of to-be-solved anagrams. Here, a forget instruction regarding the first series of practice anagrams reduced solution speed for test anagrams that had to be solved by the same formula as the to-be-forgotten practice anagrams. Thus, in both experiments, participants relied less on a practiced routine after they had been instructed to intentionally forget the episode of acquiring that routine.

Improved Bat Algorithm Based on Multipopulation Strategy of Island Model for Solving Global Function Optimization Problem

The bat algorithm (BA) is a heuristic algorithm that globally optimizes by simulating the bat echolocation behavior. In order to improve the search performance and further improve the convergence speed and optimization precision of the bat algorithm, an improved algorithm based on chaotic map is introduced, and the improved bat algorithm of Levy flight search strategy and contraction factor is proposed. The optimal chaotic map operator is selected based on the simulation experiments results. Then, a multipopulation parallel bat algorithm based on the island model is proposed. Finally, the typical test functions are used to carry out the simulation experiments. The simulation results show that the proposed improved algorithm can effectively improve the convergence speed and optimization accuracy.

Persistence and conspecific observations improve problem-solving abilities of coyotes

Social learning has important ecological and evolutionary consequences but the role of certain factors, such as social rank, neophobia (i.e., avoidance of novel stimuli), persistence, and task-reward association, remain less understood. We examined the role of these factors in social learning by captive coyotes (Canis latrans) via three studies. Study 1 involved individual animals and eliminated object neophobia by familiarizing the subjects to the testing apparatus prior to testing. Studies 2 and 3 used mated pairs to assess social rank, and included object neophobia, but differed in that study 3 decoupled the food reward from the testing apparatus (i.e., altered task-reward association). For all three studies, we compared performance between coyotes that received a demonstration from a conspecific to control animals with no demonstration prior to testing. Coyotes displayed social learning during study 1; coyotes with a demonstrator were faster and more successful at solving the puzzle box but did not necessarily use the same modality as that observed to be successful. In study 2, there was no difference in success between treatment groups but this is likely because only one coyote within each pair was successful so successful coyote results were masked by their unsuccessful mate. In study 3, there was no difference in success between treatment groups; only two coyotes, both dominant, hand-reared males with demonstrators were able to perform the task. However, coyotes with a demonstrator were less neophobic, measured as latency to approach the object, and more persistent, measured as time spent working on the apparatus. Social rank was the best predictor of neophobia and persistence and was also retained in the best model for time to eat inside the apparatus, a post-trial measurement of object neophobia. These results suggest coyotes are capable of social learning for novel tasks but social rank, neophobia, and persistence influence their social-learning capabilities. This study contributes to understanding the mechanisms underlying how animals gain information about their environment.

Horses prefer to solicit a person who previously observed a food-hiding process to access this food: A possible indication of attentional state attribution

Inferring what others witnessed provides important benefits in social contexts, but evidence remains scarce in nonhuman animals. We investigated this ability in domestic horses by testing whether they could discriminate between two experimenters who differed in what they previously witnessed and decide whom to solicit when confronted with an unreachable food source based on that information. First, horses saw food being hidden in a closed bucket (impossible for them to open) in the presence of two experimenters who behaved identically but differed in their attention to the baiting process (the "witness" experimenter faced the bucket, the "non-witness" faced away). Horses were then let free with both experimenters, and their interest towards each (gaze and touch) was measured. They gazed at and touched the witness significantly more than the non-witness (n = 15, gaze: p = 0.004; touch: p = 0.003). These results might suggest that horses inferred the attentional state of the experimenters during the baiting process and used this information to adapt their later behavior. Although further study would be necessary to conclude, our study provides new insight into attentional state attribution in horses and might hint to the existence of precursors of a Theory of Mind in horses.

The bulb retouchers in the Levant: New insights into Middle Palaeolithic retouching techniques and mobile tool-kit composition

In this paper we describe two assemblages of flint retouchers or “bulb retouchers” retrieved from Nesher Ramla and Quneitra, two Middle Palaeolithic, open-air sites in the Levant. The site of Nesher Ramla yielded the largest assemblage of bulb retouchers (n = 159) currently known, allowing a detailed investigation of this poorly known phenomenon. An extensive experimental program and use-wear analysis enabled us to characterize the different sets of traces related to the retouching activity and to identify different motions applied by the knappers in the course of this action. In both sites, blanks used as bulb retouchers were almost exclusively retouched items, with a special emphasis on convergent morphotypes in Nesher Ramla. The use of retouched items as bulb retouchers is a common trait over different time spans and geographical areas. Our data suggests that bulb retouchers were versatile, multi-purpose tools with a long use-life, transported over long distances as components of the hunter-gatherer mobile tool kit. The high frequencies of bulb retouchers within some archaeological units of Nesher Ramla appear to be connected to the highly curated nature of the lithic assemblages, in turn reflecting a high mobility of the human groups that produced them.

Challenges to pooling models of crowding: Implications for visual mechanisms

A set of phenomena known as crowding reveal peripheral vision's vulnerability in the face of clutter. Crowding is important both because of its ubiquity, making it relevant for many real-world tasks and stimuli, and because of the window it provides onto mechanisms of visual processing. Here we focus on models of the underlying mechanisms. This review centers on a popular class of models known as pooling models, as well as the phenomenology that appears to challenge a pooling account. Using a candidate high-dimensional pooling model, we gain intuitions about whether a pooling model suffices and reexamine the logic behind the pooling challenges. We show that pooling mechanisms can yield substitution phenomena and therefore predict better performance judging the properties of a set versus a particular item. Pooling models can also exhibit some similarity effects without requiring mechanisms that pool at multiple levels of processing, and without constraining pooling to a particular perceptual group. Moreover, we argue that other similarity effects may in part be due to noncrowding influences like cuing. Unlike low-dimensional straw-man pooling models, high-dimensional pooling preserves rich information about the stimulus, which may be sufficient to support high-level processing. To gain insights into the implications for pooling mechanisms, one needs a candidate high-dimensional pooling model and cannot rely on intuitions from low-dimensional models. Furthermore, to uncover the mechanisms of crowding, experiments need to separate encoding from decision effects. While future work must quantitatively examine all of the challenges to a high-dimensional pooling account, insights from a candidate model allow us to conclude that a high-dimensional pooling mechanism remains viable as a model of the loss of information leading to crowding.

Using data to solve problems: Children reason flexibly in response to different kinds of evidence

This study examined children's (5- to 9-year-olds, N = 363) abilities to use information seeking and explanation to solve problems using conclusive or inconclusive (i.e., consistent, inconsistent, or ambiguous) evidence. Results demonstrated that inconsistent and ambiguous evidence, not consistent evidence, motivate more requests for information than conclusive evidence. In addition, children's explanations were flexible in response to evidence; explanations based on transitive inference were more likely to be associated with an accurate conclusion than other explanation types. Children's requests for additional information in response to inconclusive evidence increased with age, as did their problem-solving accuracy. The data demonstrate that children's capacity to use information seeking and explanation develop in tandem as tools for problem solving.

The neural substrates of the problem size and interference effect in children's multiplication: An fMRI study

Within children's multiplication fact retrieval, performance can be influenced by various effects, such as the well-known problem size effect (i.e., smaller problems are solved faster and more accurately) and the more recent interference effect (i.e., the quality of memory representations of problems depends on previously learned problems; the more similar a problem is to a previously learned one, the more proactive interference impacts on storing in long-term-memory). This interference effect has been observed in behavioral studies, and determines a substantial part of performance beyond problem size. Unlike the problem size effect, the neural basis of the interference effect in children has not been studied. To better understand the underpinning mechanisms behind children's arithmetic fact retrieval, we aimed to investigate the neural basis of both effects in typically developing children. Twenty-four healthy 9- to 10-year-olds took part in a behavioral and fMRI scanning session, during which multiplication items had to be solved. Data were analyzed by manipulating problem size and interference level in a 2 × 2 factorial design. Concurring with previous studies, our results reveal clear behavioral effects of problem size and interference, with larger and high interfering items being solved significantly slower. On the neural level, a clear problem size effect was observed in a fronto-parietal and temporal network. The interference effect, however, was not detected; no clear neural distinctions were observed between low and high interfering items.

Distinguishing between cognitive explanations of the problem size effect in mental arithmetic via representational similarity analysis of fMRI data

Not all researchers interested in human behavior remain convinced that modern neuroimaging techniques have much to contribute to distinguishing between competing cognitive models for explaining human behavior, especially if one removes reverse inference from the table. Here, we took up this challenge in an attempt to distinguish between two competing accounts of the problem size effect (PSE), a robust finding in investigations of mathematical cognition. The PSE occurs when people solve arithmetic problems and indicates that numerically large problems are solved more slowly and erroneously than small problems. Neurocognitive explanations for the PSE can be categorized into representation-based and process-based views. Behavioral and traditional univariate neural measures have struggled to distinguish between these accounts. By contrast, a representational similarity analysis (RSA) approach with fMRI data provides competing hypotheses that can distinguish between accounts without recourse to reverse inference. To that end, our RSA (but not univariate) results provided clear evidence in favor of the representation-based over the process-based account of the PSE in multiplication; for addition, the results were less clear. Post-hoc similarity analysis distinguished still further between competing representation-based theoretical accounts. Namely, data favored the notion that individual multiplication problems are stored as individual memory traces sensitive to input frequency over a strictly magnitude-based account of memory encoding. Together, these results provide an example of how human neuroimaging evidence can directly inform cognitive-level explanations of a common behavioral phenomenon, the problem size effect. More broadly, these data may expand our understanding of calculation and memory systems in general.

Socio-affective and cognitive predictors of social adaptation in vulnerable contexts

People living in vulnerable environments face a harder set of challenges adapting to their context. Nevertheless, an important number of them adapt successfully. However, which cognitive and socio-affective variables are specifically related to these variations in social adaptation in vulnerable contexts has not been fully understood nor directly addressed. Here we evaluated socio-affective variables (anxious attachment style, internal locus of control, self-esteem and stress) and cognitive variables (fluid intelligence, crystallized intelligence, working memory, numeracy, probabilistic reasoning and logical reasoning) to explain variations in social adaptation in a sample of 232 adults living in vulnerable contexts (M = 42.3, SD = 14.9, equal amount of men and women). Our results show that an important amount of variance in social adaptation can be explained by socio-affective variables, principally by self-esteem, while cognitive variables also contributed significantly. As far as we know, this is one of the first steps towards understanding the role of cognitive and socio-affective features on social adaptation. In the long run, this area of research could play an important role on the assignation of resources to ease people’s integration into society. Our data and R analysis scripts can be found at: https://osf.io/egxy5/.

Characterizing innovators: Ecological and individual predictors of problem-solving performance

Behavioural innovation, the use of new behaviours or existing ones in novel contexts, can have important ecological and evolutionary consequences for animals. An understanding of these consequences would be incomplete without considering the traits that predispose certain individuals to exhibit innovative behaviour. Several individual and ecological variables are hypothesized to affect innovativeness, but empirical studies show mixed results. We examined the effects of dominance rank, exploratory personality, and urbanisation on the innovativeness of wild-caught black-capped chickadees using a survival analysis of their performance in two problem-solving tasks. Additionally, we provide one of the first investigations of the predictors of persistence in a problem-solving context. For lever pulling, we found a trend for dominants to outperform subordinates, particularly in rural birds, which did not align with predictions from the necessity drives innovation hypothesis. When examining possible explanations for this trend we found that older chickadees outperformed younger birds. This follow-up analysis also revealed a positive effect of exploratory personality on the lever-pulling performance of chickadees. Our results suggest that experience may foster innovation in certain circumstances, for instance via the application of previously-acquired information or skills to a novel problem. As we found different predictors for both tasks, this suggests that task characteristics influence the innovative propensity of individuals, and that their effects should be investigated experimentally.

The neural association between arithmetic and basic numerical processing depends on arithmetic problem size and not chronological age

The intraparietal sulcus (IPS) is thought to be an important region for basic number processing (e.g. symbol-quantity associations) and arithmetic (e.g. addition). Evidence for shared circuitry within the IPS is largely based on comparisons across studies, and little research has investigated number processing and arithmetic in the same individuals. It is also unclear how the neural overlap between number processing and arithmetic is influenced by age and arithmetic problem difficulty. This study investigated these unresolved questions by examining basic number processing (symbol-quantity matching) and arithmetic (addition) networks in 26 adults and 42 children. Number processing and arithmetic elicited overlapping activity in the IPS in children and adults, however, the overlap was influenced by arithmetic problem size (i.e. which modulated the need to use procedural strategies). The IPS was recruited for number processing, and for arithmetic problems more likely to be solved using procedural strategies. We also found that the overlap between number processing and small-problem addition in children was comparable to the overlap between number processing and large-problem addition in adults. This finding suggests that the association between number processing and arithmetic in the IPS is related to the cognitive operation being performed rather than age.

Evidence for a retrieval over a sum counting theory of adults' simple addition

Researchers have recently proposed that educated adults solve the simplest addition problems (e.g., 3 + 2) by an automatic counting procedure, challenging the long-held view that educated adults solve small additions by associative memory retrieval. We tested predications of a sum-counting model that assumes a procedure in which the 2 quantities represented by the operands are encoded and counted sequentially. Here, we presented the 2 operands sequentially (e.g., "3 +" first and then "2") and manipulated the preview time for the first operand (O1) and operator across 2 experiments (both n = 36); the O1 preview times were 1000 ms and 500 ms in Experiments 1 and 2, respectively. We measured response time (RT) from the presentation of the second operand (O2) and compared it with RT when both operands appeared simultaneously. Contrary to the sum-counting model, with sequential presentation, problems with the same O2 sizes (e.g., 3 + 2, 4 + 2) demonstrated significant RT differences across levels of O1, and the sum of the operands was a better RT predictor than O2 with both sequential and simultaneous displays. These results challenge a sum-counting model of the present data but are consistent with a memory retrieval theory. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Debriefing for the Transfer of Learning: The Importance of Context

The advent of simulation-based education has caused a renewed interest in feedback and debriefing. However, little attention has been given to the issue of transfer of learning from the simulation environment to real-life and novel situations. In this article, the authors discuss the importance of context in learning, based on the frameworks of analogical transfer and situated cognition, and the limitations that context imposes on transfer. They suggest debriefing strategies to improve transfer of learning: positioning the lived situation within its family of situations and implementing the metacognitive strategies of contextualizing, decontextualizing, and recontextualizing. In contextualization, the learners' actions, cognitive processes, and frames of reference are discussed within the context of the lived experience, and their mental representation of the situation and context is explored. In decontextualization, the underlying abstract principles are extracted without reference to the situation, and in recontextualization, those principles are adapted and applied to new situations and to the real-life counterpart. This requires that the surface and deep features that characterize the lived situation be previously compared and contrasted with those of the same situation with hypothetical scenarios ("what if"), of new situations within the same family of situations, of the prototype situation, and of real-life situations. These strategies are integrated into a cyclical contextualization, decontextualization, and recontextualization model to enhance debriefing.

Connections Between Reading Comprehension and Word-Problem Solving via Oral Language Comprehension: Implications for Comorbid Learning Disabilities

In this article, we discuss the approach adopted within the Vanderbilt University Learning Disabilities Innovation Hub, which focuses on students with higher-order comorbidity: students with concurrent difficulty with reading comprehension and word-problem solving. The aim of the Hub's Research Project is to test what we refer to as the higher-order comorbidity hypothesis: that language comprehension plays a critical role in reading comprehension and word-problem solving. In the Hub's study, we test the hypothesize that language comprehension offers a coordinated approach for improving both outcomes and that this approach thus provides direction for understanding higher-order comorbidity and support for the validity of reading comprehension and word-problem solving comorbidity as a learning disabilities subtyping framework. In the first segment of this article, we describe a model that connects reading comprehension and word-problem solving development via oral language comprehension, and we provide a brief overview of prior related research on these connections. This first section provides the basis for the second segment of this article, in which we discuss the Vanderbilt Hub's innovative approach for investigating these connections. This study tests a theoretically-coordinated framework on students' performance in both high-priority domains of academic development, while exploring effects for boys versus girls and for linguistically diverse learners.

Like what you see: Generalization of social learning determines art appreciation

We examine whether a stimulus generalization framework can provide insight in how experience shapes evaluative responses to artworks. Participants received positive information about one artwork and negative information about another artwork. Afterwards, we tested their evaluative responses not only to these artworks but also to similar artworks, which allowed us to assess generalization. Results showed that the artwork that was paired with positive information and the artwork that was similar to it were evaluated more positively than the other artworks. These findings confirm that theories that aim to explain art appreciation could benefit from taking learning and its generalization into account.

Neuroplasticity, bilingualism, and mental mathematics: A behavior-MEG study

Bilingual experience alters brain structure and enhances certain cognitive functions. Bilingualism can also affect mathematical processing. Reduced accuracy is commonly reported when arithmetic problems are presented in bilinguals' second (L2) vs. first (L1) language. We used MEG brain imaging during mental addition to characterize spatiotemporal dynamics during mental addition in bilingual adults. Numbers were presented auditorally and sequentially in bilinguals' L1 and L2, and brain and behavioral data were collected simultaneously. Behaviorally, bilinguals showed lower accuracy for two-digit addition in L2 compared to L1. Brain data showed stronger response magnitude in L2 versus L1 prior to calculation, especially when two-digit numbers were involved. Brain and behavioral data were significantly correlated. Taken together, our results suggest that differences between languages emerge prior to mathematical calculation, with implications for the role of language in mathematics.

Autism and Accommodations in Higher Education: Insights from the Autism Community

This article builds on the growing body of research on higher education for autistic students by soliciting input from autistic adults on their higher education experiences and suggestions on making these experiences more 'autism-friendly'. Sixty-six individuals participated in a national exploratory survey and thirty-one participated in follow-up, online focus groups. The article reviews the accommodations individuals received and the accommodations they would have liked to receive. Concrete strategies are provided for institutes of higher education to address the social and sensory needs of autistic students, areas many participants reported being neglected in their academic experience, such as mentors and a neurodiverse space. These suggestions are intended to complement traditional academic accommodations to improve the outcomes of autistic students.

Neuropsychological predictors of patient-reported cognitive decline after deep brain stimulation in Parkinson's disease

BACKGROUND

Deep brain stimulation (DBS) is effective for treatment of motor complications of dopaminergic therapy in Parkinson's disease (PD) but occasionally has been associated with multidomain cognitive decline. Patient- and caregiver-reported cognitive decline are clinically meaningful and increasingly recognized as important to consider when evaluating therapeutic interventions for PD.

OBJECTIVE

The objective was to assess presurgical neuropsychological and clinical factors associated with PD patient- and caregiver-reported cognitive decline in two or more domains after DBS.

METHOD

A single telephone survey was used to assess patient- and caregiver-reported cognitive decline in five domains at both one and four months after DBS surgery. Decline in two or more domains was considered multidomain cognitive decline (MDCD). Baseline demographic, clinical, and neuropsychological factors were compared in those with or without MDCD. Preoperative neuropsychological measures were evaluated as risk factors and regressed on the presence of MDCD, with demographic covariates, using multiple logistic regression.

RESULTS

Preoperative performance in verbal recognition memory, language knowledge, and verbal processing decline were associated with postoperative, patient-reported MDCD in the first four weeks. MDCD at four months after DBS was associated with worse preoperative verbal reasoning, verbal recall, and semantic verbal fluency. Caregiver-reported MDCD one month after DBS was associated with poorer baseline verbal memory recognition accuracy/discriminability, visuospatial problem solving, and constructional praxis.

CONCLUSION

Poor presurgical performance in verbal memory recognition, language processing, and visuospatial performance is associated with patient- or caregiver-reported decline following DBS surgery. Posterior cortical dysfunction seems to portend significant self-reported cognitive decline following deep brain stimulation.

Unbounded number line estimation as a measure of numerical estimation

Number magnitude estimation has been investigated over the last decades using different tasks including non-symbolic numerosity but also number line estimation tasks. Recently, a bi-directional mapping process was suggested for numerosity estimation accounting for underestimation in a perception version of the task (i.e., indicating the number of non-symbolic dots in a set) and overestimation in the corresponding production task (i.e., produce the number of dots indicated by a symbolic number). In the present study, we evaluated the generalizability of these estimation biases in perception and production tasks to bounded and unbounded number line estimation. Importantly, target numbers were underestimated/overestimated by participants in the perception/production version of numerosity estimation as well as unbounded number line estimation. However, this pattern was reversed for bounded number line estimation. Thereby, the present data indicate a conceptual similarity of unbounded number line estimation and the established non-symbolic numerosity estimation task as a measure of numerical estimation. Accordingly, this corroborates the notion that unbounded number line estimation may reflect a purer measure of number magnitude representation than the bounded task version. Furthermore, our findings strengthen the bi-directional mapping hypothesis for numerical estimation by providing evidence for its generalizability to unbounded number line estimation for the first time.

Means-end problem solving in infancy: Development, emergence of intentionality, and transfer of knowledge

Behaviors and performance of 23 typically developing infants were assessed longitudinally at 6, 9, 12, 18, and 24 months in two means-end tasks: pulling a towel or rotating a turntable to obtain a supported object. With age, infants performed more goal-directed behaviors, leading to increased problem-solving success. Intentionality emerged earlier in the towel task than in the turntable task (6.9 vs. 10.8 months). Potential knowledge transfer between the tasks was first observed at 9 months. This study provides insight into the development of means-end learning, the emergence of intentionality, and potential transfer of knowledge in tasks involving a similar concept (support) but requiring different modes of action for success (pulling vs. rotating).

Informing the uninformed: a multitier approach to uncover students' misconceptions on cardiovascular physiology

Misconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual understanding; however, students are frequently unaware of their incorrect understanding. We explored the multitier approach as a tool to obtain insight into students' awareness and misconceptions regarding cardiovascular physiology. Biomedical sciences students ( N = 81) participated in a diagnostic multitier assessment on cardiovascular physiology. Each question consisted of an answer tier and an explanation tier. Both tiers were paired with confidence tiers, i.e., 5-point Likert scales, which were used as an indicator for metacognitive evaluation, i.e., awareness. The average test score was 3.07 (maximum 4.0) for the answer tier only, and reduced to 1.57 when answer and explanation tiers were combined. A weak correlation ( R² = 0.13, P = 0.001) between students' confidence and their test scores was found for the combined responses. Correct combined answers were associated with an increase in confidence score of 0.27 vs. incorrect answers. Using a Bland-Altman analysis, we showed that students generally overestimated their knowledge. In total, 28.7% of all responses were classified as misconceptions, defined as incorrect answers paired with high confidence. In all, findings indicate that the multitier approach is useful to study students' conceptual understanding and uncover misconceptions on cardiovascular physiology. Furthermore, this study supports the need for metacognitive measures in order to improve teaching and learning in medical education.

A Direct Observational Measure of Family Functioning for a Low-Resource Setting: Adaptation and Feasibility in a Kenyan Sample

Family interactions are recognized as highly influential for youth development of psychopathology. Key challenges for assessing family functioning include cross-cultural variability in functioning and self-report measurement challenges. Observational measures-adapted to cultural context-provide an approach to addressing challenges. This study aimed to adapt a direct observational tool for assessing family interaction patterns in Kenya, to outline a replicable adaptation process, and to explore tool feasibility and acceptability. We reviewed existing tools to assess their adaptability based on compatibility with context-specific data. After initial modifications, the measure was iteratively adapted through pilot testing and collaborative discussions between U.S. and Kenyan collaborators that drove changes and further piloting. The measure was administered to 26 families. The Family Problem Solving Code was chosen for adaptation. The tool's activity structure was feasible to administer, but activity content showed low acceptability, requiring new content. Final activities included (a) a hands-on problem-solving task, (b) a discussion of marital conflict with couples, and (c) a structured discussion of family hopes. Codes were adapted to reflect culturally congruent descriptions of behavior, expressions, and interactions, including an emphasis on nonverbal interactions. The scoring system was modified to facilitate training and consistent rating among trainees with limited experience. Observational tool findings were consistent with those of an interview assessing family functioning, rated by clinical and non-clinical raters. Adaptation resulted in a culturally relevant tool assessing family functioning that proved feasible and acceptable. The adaptation process also proved feasible and efficient in a low-resource setting, suggesting its utility for other contexts.