Cooperative behavior in adolescents: a contribution of empathy and emotional regulation?

Aim

This study aims to identify different levels of empathy and emotional regulation along adolescent years and their relationship with cooperative behavior.

Methods

Eighty healthy males were divided into four age groups: 20 Early Adolescents, 20 Middle Adolescents, 20 Late Adolescents and 20 Adults. Participants responded to empathic and emotional regulation scales, then were assigned to an unknown partner to perform the prisoner's dilemma paradigm.

Results

The statistical analyses allowed to distinguish the groups on the basis of the components making up the two scales: scores on the Perspective Taking component were higher for Adults and Late Adolescents participants than for Middle Adolescents and Early Adolescents groups (p < 0.05); scores on the Personal Distress component were higher for Early Adolescents group than for Late Adolescents and Middle Adolescents groups (p < 0.05); scores on the Difficulties engaging in goal directed behavior component were higher for Middle Adolescents and Early Adolescents groups than for Adults group (p < 0.05). We observed differences between groups (p < 0.001) with higher number of cooperation responses in Adults compared to Middle Adolescents (p < 0.05) and Early Adolescents groups (p < 0.001).

Discussion

These findings suggest that the cooperative behavior changes during the different stages of adolescence seem to be related to the development of empathy and emotional regulation components.

Self-Benefit and Others' Benefit in Cooperative Behavior in Shared Space

OBJECTIVE

The objective is to clarify the nature of cooperative moving behavior that realizes smooth traffic with others from the viewpoint of the trade-off between self-benefit and others' benefit in the shared space.

BACKGROUND

The shared space is not constrained by formal rules or behavioral norms, and is a potentially ambiguous situation where it is not clear who has priority. Therefore, the nature of cooperative behavior in the shared space is unclear.

METHOD

An experimental task was conducted to compare cooperative and nonurgent moving behavior regarding completion time (self-benefit), the amount of interruption (others' benefit), and the amount of operation (cognitive effort).

RESULTS

First, cooperative behavior benefits others. Second, although cooperative behavior decreases self-benefit compared to the baseline without any instructions, it can obtain relatively more self-benefit than nonurgent behavior without considering self-benefit. Third, cooperative behavior requires cognitive effort.

CONCLUSION

Cooperative behavior provides benefit to both oneself and others by spending cognitive effort in not interrupting others.

APPLICATION

If the nature of the cooperative behavior can be clarified, a cooperative module can be implemented into the algorithms of various mobilities.

Variance, norms and cooperative behavior in public goods games

This study examines the relationship between the variance of others' contributions, social norms (empirical and normative expectations), and cooperative behavior using a classic linear public goods game. The following results are observed. First, the variance of a participant's group members' contributions had a negative impact on their contributions, empirical expectations, and normative expectations. Second, deviations from the mean, whether negative or positive, were deemed less socially appropriate. Third, while there was a strong relationship between variance, social norms, and cooperative behavior, the mediating effect of social norms was found to be insignificant. Finally, there were some notable findings regarding behavior type. Although free riders and cooperators exhibited distinct behavioral patterns, their normative expectations were similar. Free riders expected others to cooperate, but their empirical expectations were significantly lower than cooperators' expectations, which were aligned with their actual contributions. These findings contribute to research on the relationship between distribution heterogeneity, social norms and cooperative behavior. Furthermore, these findings provide valuable insights into management practices.

Confusion cannot explain cooperative behavior in public goods games

Some scholars find that behavioral variation in the public goods game is explained by variations in participants' understanding of how to maximize payoff and that confusion leads to cooperation. Their findings lead them to question the common assumption in behavioral economics experiments that choices reflect motivations. We conduct two experiments, in which we minimize confusion by providing participants with increased training. We also introduce a question that specifically assesses participants' understanding of payoff maximization choices. Our experimental results show that the distribution of behavior types is significantly different when participants play with computers versus humans. A significant increase in contributions is also observed when participants play with humans compared to when they play with computers. Moreover, social norms may be the main motive for contributions when playing with computers. Our findings suggest that social preferences, rather than confusion, play a crucial role in determining contributions in public goods games when playing with humans. We therefore argue that the assumption in behavioral economics experiments that choices reveal motivations is indeed valid.

Pollen diet diversity across bee lineages varies with lifestyle rather than colony size

The shift to a pollen diet and the evolution of more highly organized societies, i.e., eusocial, were key milestones in bee diversification over their evolutionary history, culminating in a high dependence on feeding broods with a large variety of floral resources. Here, we hypothesized that obligatory eusocial bees have a wider diet diversity than their relatives with solitary lifestyles, and this would be related to colony size. To test both hypotheses, we surveyed diet breadth data (palynological analysis) based on the Shannon-Wiener index (H') for 85 bee taxa. We also obtained colony size for 47 eusocial bee species. These data were examined using phylogenetic comparative methods. The results support the generalist strategy as a derived trait for the bee taxa evaluated here. The dietary diversity of eusocial bees (H': 2.1, on average) was 67.5% higher than that of noneusocial bees (H': 1.21, on average). There was, however, no relationship between diet breadth and colony size, indicating that smaller colonies can harvest a pollen variety as diverse as larger colonies. Taken together, these results provide new insights into the impact of lifestyle on the diversity of collected pollen. Furthermore, this work sheds light on an advantage of living in more highly structured societies irrespective of the size of the colony.

In-gallery social behaviors of the ambrosia beetle, Xylosandrus germanus (Coleoptera: Curculionidae)

The east Asian ambrosia beetle Xylosandrus germanus (Blanford) was first detected in the United States in 1932. It now occurs across much of eastern North America and parts of the Pacific Northwest. It attacks a broad range of stressed, woody hosts including ornamental and orchard species. The foundress tunnels into the sapwood of hosts where it cultures a symbiotic fungus as food for its offspring. A few other ambrosia beetles have been shown to possess a facultatively eusocial structure among gallery members, but this has not been described for Xylosandrus spp. Using a novel artificial diet arena, we quantified the behaviors of X. germanus larvae and adults (foundress and mature offspring) over 10 wk inside their galleries. Foundresses were responsible for constructing the gallery. They also initially tended the fungal garden and brood but eventually spent most of their time blocking the gallery entrance. Larvae were mainly observed to feed, crawl, or be inactive within the gallery, regardless of the absence or presence of adult siblings. Adult female offspring were primarily inactive, likely due to dormancy. Adult male offspring actively crawled and attempted to mate with their sisters before eventually dispersing out of the gallery. Cooperative hygienic behaviors (removal of frass, cannibalism of dead nest mates, grooming siblings) were observed but a division of labor among offspring was not clear. Rather, foundress behaviors were mostly distinct from offspring behaviors, particularly as the gallery aged. Because no overlap in generations occurred, X. germanus displays a quasisocial structure.

Empathy and cooperation vary with gender in Chinese junior high school adolescents

Previous research on the relationship between empathy and subcategories of prosocial behavior, specifically cooperation, has shown inconsistent findings. It has also paid limited attention to gender differences in the impact of empathy. Therefore, this study examined the relationship between empathy and cooperation in Chinese junior high school adolescents, and the gender differences, through three studies. In Study 1, 448 eighth-grade adolescents (age = 12-15 years, 55.1% males) completed the Interpersonal Reactivity Index and Cooperative Propensity Rating Scale; the results showed that adolescent empathy was positively associated with cooperative propensity, and this association was significantly higher for males than for females. Study 2 used longitudinal data from 246 eighth-grade adolescents (age = 12-15 years, 54.5% males) to further support the positive association between empathy and cooperation propensity and the gender differences found in Study 1. Study 3 employed the public goods dilemma to examine the effects of empathic states on the cooperative behavior of 157 eighth-grade adolescents (age = 13-16 years, 48% males) by evoking empathy. Using different research methods, this study revealed a facilitative relationship between empathy and cooperation and demonstrated that empathy was more predictive of cooperation among male than among female adolescents.

Coordinating upper limbs for octave playing on the piano via neuro-musculoskeletal modeling

Understanding the coordination of multiple biomechanical degrees of freedom in biological organisms is crucial for unraveling the neurophysiological control of sophisticated motor tasks. This study focuses on the cooperative behavior of upper-limb motor movements in the context of octave playing on the piano. While the vertebrate locomotor system has been extensively investigated, the coherence and precision timing of rhythmic movements in the upper-limb system remain incompletely understood. Inspired by the spinal cord neuronal circuits (central pattern generator, CPG), a computational neuro-musculoskeletal model is proposed to explore the coordination of upper-limb motor movements during octave playing across varying tempos and volumes. The proposed model incorporates a CPG-based nervous system, a physiologically-informed mechanical body, and a piano environment to mimic human joint coordination and expressiveness. The model integrates neural rhythm generation, spinal reflex circuits, and biomechanical muscle dynamics while considering piano playing quality and energy expenditure. Based on real-world human subject experiments, the model has been refined to study tempo transitions and volume control during piano playing. This computational approach offers insights into the neurophysiological basis of upper-limb motor coordination in piano playing and its relation to expressive features.

Cooperative behavior in the workplace: Empirical evidence from the agent-deed-consequences model of moral judgment

Introduction

Moral judgment is of critical importance in the work context because of its implicit or explicit omnipresence in a wide range of work-place practices. The moral aspects of actual behaviors, intentions, and consequences represent areas of deep preoccupation, as exemplified in current corporate social responsibility programs, yet there remain ongoing debates on the best understanding of how such aspects of morality (behaviors, intentions, and consequences) interact. The ADC Model of moral judgment integrates the theoretical insights of three major moral theories (virtue ethics, deontology, and consequentialism) into a single model, which explains how moral judgment occurs in parallel evaluation processes of three different components: the character of a person (Agent-component); their actions (Deed-component); and the consequences brought about in the situation (Consequences-component). The model offers the possibility of overcoming difficulties encountered by single or dual-component theories.

Methods

We designed a 2 × 2 × 2-between-subjects design vignette experiment with a Germany-wide sample of employed respondents (N = 1,349) to test this model.

Results

Results showed that the Deed-component affects willingness to cooperate in the work context, which is mediated via moral judgments. These effects also varied depending on the levels of the Agent- and Consequences-component.

Discussion

Thereby, the results exemplify the usefulness of the ADC Model in the work context by showing how the distinct components of morality affect moral judgment.

Effects of Positive and Negative Experiences on Cooperative Behavior: The Role of Sharedness

Cooperation is a fundamental ingredient of society. However, research on the effects of positive and negative experiences on cooperation remain largely inconsistent. Therefore, through two experiments, the present study examined the effects of positive and negative experiences on cooperative behavior, and the moderation effect of sharedness on this relationship. In Study 1, we directly compared positive and negative experiences in the same context. Seventy-four students participated the experiment (M_age = 19.88, SD_age = 2.21). Results showed that participants reported higher levels of cooperative behavior in negative experiences than in positive experiences. In Study 2, we examined the moderation effect of sharedness on the relationship between positive/negative experiences and cooperative behavior. The result of the experiments involving 126 participants (M_age = 19.53, SD_age = 1.14) showed a significant interaction effect between positive/negative experiences and sharedness on cooperative behavior. Participants exhibited higher level of cooperative behavior in shared negative experiences than in shared positive experiences, while there were no significant differences in cooperative behavior between unshared negative and positive experiences. These results suggested that shared negative experiences could facilitate cooperative behavior.

Being Negatively Cued, are People Less Cooperative? The Influence of Watching Eyes on Cooperative Behavior

In the course of human evolution, watching eyes have had an important influence on individual cooperative behavior. However, researchers have not explored how the valence of watching eyes affects cooperative behavior. Therefore, this study includes three studies to investigate the effect of watching eyes with different valences on cooperative behavior. The results showed that positive watching eyes (vs. negative watching eyes) induced positive emotions (PA) in the participants and thus increased their tendency to cooperate (Studies 1-2). The role of the decision maker (making decisions for oneself vs. making decisions on behalf of others) moderates the effect of watching eyes on cooperative behavior through emotion (Study 3). In conclusion, the valence of watching eyes significantly affects cooperation. This study not only further enriches research on environmental stimulation and cooperation but also provides inspiration and a reference for solving problems of cooperation in social dilemmas.

Miconazole Promotes Cooperative Ability of a Mouse Model of Alzheimer Disease

BACKGROUND

Cooperative defect is 1 of the earliest manifestations of disease patients with Alzheimer disease (AD) exhibit, but the underlying mechanism remains unclear.

METHODS

We evaluated the cooperative function of APP/PS1 transgenic AD model mice at ages 2, 5, and 8 months by using a cooperative drinking task. We examined neuropathologic changes in the medial prefrontal cortex (mPFC). Another experiment was designed to observe whether miconazole, which has a repairing effect on myelin sheath, could promote the cooperative ability of APP/PS1 mice in the early AD-like stage. We also investigated the protective effects of miconazole on cultured mouse cortical oligodendrocytes exposed to human amyloid β peptide (Aβ1-42).

RESULTS

We observed an age-dependent impairment of cooperative water drinking behavior in APP/PS1 mice. The AD mice with cooperative dysfunction showed decreases in myelin sheath thickness, oligodendrocyte nuclear heterochromatin percentage, and myelin basic protein expression levels in the mPFC. The cooperative ability was significantly improved in APP/PS1 mice treated with miconazole. Miconazole treatment increased oligodendrocyte maturation and myelin sheath thickness without reducing Aβ plaque deposition, reactive gliosis, and inflammatory factor levels in the mPFC. Miconazole also protected cultured oligodendrocytes from the toxicity of Aβ1-42.

CONCLUSIONS

These results demonstrate that mPFC hypomyelination is involved in the cooperative deficits of APP/PS1 mice. Improving myelination through miconazole therapy may offer a potential therapeutic approach for early intervention in AD.

Lessons learned from an enterprise-wide clinical datathon

In 2020, Baylor College of Medicine held a datathon to inform potential users of a new data warehouse, allow users to address clinical questions, identify warehouse capabilities and limitations, foster collaborations, and engage trainees. Senior faculty selected proposals based on feasibility and impact. Selectees worked with Information Technology for 2 months and presented findings. A survey of participants showed diverse levels of experience, high perceived value of the datathon, high rates of collaboration, and significant increases in knowledge. A datathon can promote familiarity with a new data warehouse, guide data warehouse improvement, and promote collaboration.

Vocal Attractiveness Matters: Social Preferences in Cooperative Behavior

Research has shown the phenomenon that "what sounds beautiful is good" is a stereotype. It is not clear whether vocal attractiveness affects social decision-making in economic games. Using a modified trust game task, we investigated the neural mechanism of the influence of vocal attractiveness on cooperative decision-making. Participants first heard the voice (attractive or unattractive) of the partner. They had enough time to decide whether to cooperate with the partner for a chance to earn monetary rewards. The behavioral results showed that participants made more invest choices in the attractive partner condition, and they were more likely to cooperate with the female partners in the unattractive voice condition. The event-related potential (ERP) analysis for voice stimuli showed that attractive voices induced larger N1 amplitude than unattractive voices only in the male voice condition. And female voices elicited smaller N1 and larger P2 amplitudes than male voices in both the attractive and unattractive voices condition. A larger P3 amplitude was evoked by female voices and attractive voices. In addition, a more positive late positive complex (LPC) was induced by male voices and attractive voices. This study suggested that attractive voices facilitated cooperative behavior, providing evidence for the "beauty premium" effect of the attractive voices. Moreover, participants were more likely to cooperate with female partners. In the early stage, gender information and male vocal attractiveness were processed automatically, suggesting that male vocal attractiveness was processed preferentially than the female voice. In the late stage, participants allocated attention to both male and female vocal attractiveness.

The Effects of Social Distance and Asymmetric Reward and Punishment on Individual Cooperative Behavior in Dilemma Situations

The behavior decisions in social dilemmas are highlighted in sociological, economic, and social psychological studies. Across two studies, the iterated prisoner's dilemma is used as a basic paradigm to explore the effects of social distance and asymmetric reward and punishment on an individual's cooperative behavior. Experiment 1 (N = 80) used a 2 (social distance: intimacy vs. strangeness) × 2 (symmetry of rewards: symmetric rewards vs. asymmetric rewards) within-subject design and demonstrated that when there were only two options, namely, cooperation and defection, cooperative behavior was influenced by social distance and symmetry of rewards, respectively, and the interaction was not significant. Experiment 2 (N = 80) used a 2 (social distance: intimacy vs. strangeness) × 2 (symmetry of punishment: symmetric punishment vs. asymmetric punishment) within-subject design and showed that the cooperative behavior of participants decreased when the punishment option was added, and the two levels of symmetry and asymmetry were set. Specifically, compared with the symmetric punishment group, the asymmetric punishment group was more likely to choose a defection strategy and less likely to use a punishment strategy. Moreover, there was a marginal interaction effect between social distance and symmetry of punishment, and symmetry of punishment was a significant mediator in the relationship between social distance and individual cooperation. Specifically, asymmetric punishment reduced only the cooperation rate (CR) between participants and their friends. In conclusion, in dilemma situations, asymmetric reward did not influence individual cooperative behavior at different social distances, while asymmetric punishment did, because the sense of loss was more likely to awaken an individual's social comparison motives.

Evolution and neural representation of mammalian cooperative behavior

Cooperation is common in nature and is pivotal to the development of human society. However, the details of how and why cooperation evolved remain poorly understood. Cross-species investigation of cooperation may help to elucidate the evolution of cooperative strategies. Thus, we design an automated cooperative behavioral paradigm and quantitatively examine the cooperative abilities and strategies of mice, rats, and tree shrews. We find that social communication plays a key role in the establishment of cooperation and that increased cooperative ability and a more efficient cooperative strategy emerge as a function of the evolutionary hierarchy of the tested species. Moreover, we demonstrate that single-unit activities in the orbitofrontal and prelimbic cortex in rats represent neural signals that may be used to distinguish between the cooperative and non-cooperative tasks, and such signals are distinct from the reward signals. Both signals may represent distinct components of the internal drive for cooperation.

The Creation and Validation of Active Cooperative Behavior Scales for Nurses

BACKGROUND AND PURPOSE

General conflict management instruments are employed in healthcare settings despite their lack of focus on active and cooperative behaviors which are linked to positive outcomes. The purpose of this study is to create and validate active cooperative behavior scales for nurses.

METHODS

Two convenience samples were collected via an online panel and a public registry of nurses to create and validate the new scales using factor analysis, and hierarchical regression in a nursing/healthcare sample.

RESULTS

The newly created active cooperative behavior scales (ACBS) showed acceptable internal consistency and explained more variance on job satisfaction than a commonly used compromising subscale.

CONCLUSIONS

The ACBS can assist currently practicing nurses and hospitals in identifying easily implementable behaviors, active listening, appropriate assertiveness, and brainstorming, that lead to effective conflict management.

Huddles and their effectiveness at the frontlines of clinical care: a scoping review

BACKGROUND

Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research.

METHODS

A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts.

RESULTS

Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%).

DISCUSSION

Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes.

STUDY REGISTRATION

This scoping review was registered with the Open Science Framework on 18 January 2019 ( https://osf.io/bdj2x/ ).

Disentangling social support mobilization via online neighborhood networks

This paper proposes and tests a theoretical model to investigate the mechanism underpinning local social support exchange via online neighborhood networks (ONNs). We drew on community psychology, social support, and social media literature and used a survey conducted in the Dutch-speaking part of Belgium among 561 ONN users (n_females  = 409; 72.9%) between 18 and 82 years old (M_age  = 43.73; SD_age  = 15.37). We found that engaging in online neighboring behaviors was associated to both online and offline neighborhood sense of community. Subsequently, these provide access to perceived local social support and the intention to mobilize local social support online. The latter was predominantly explained via the path along online sense of community. ONNs facilitate local bridging behavior, connecting otherwise distinct local networks and ties. At the same time, online neighboring behaviors provide the normative context that supports the exchange process.

Is the juice worth the squeeze? Transdisciplinary team science in bladder health

AIMS

Prior research on lower urinary tract symptoms (LUTS) has focused on the treatment and management of these conditions with scant attention to prevention. The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium was formed to address the complexities of preventing LUTS and promoting bladder health.

METHODS

Herein, we describe challenges faced and strategies used to develop the PLUS Research Consortium into an engaged and productive transdisciplinary scientific team. We apply four previously defined team science phases (development, conceptualization, implementation, and translation) to frame our progress.

RESULTS

Strategies to progress through the development phase included the generation of a shared mission, and valuing of other disciplinary perspectives. The conceptualization phase included generating a shared language and developing a team transdisciplinary orientation. During the implementation phase, the group developed roles and procedures and focused on conflict management. The translation phase includes continued refinement of the mission and goals, implementation of research protocols, and robust dissemination of the scientific work products related to bladder health.

CONCLUSION

A diverse group has matured into a productive transdisciplinary team science consortium. Achieving this outcome required dedicated effort for each member to engage in activities that often required more time than single discipline research activities. Provision of the necessary time and tools has fostered a transdisciplinary team science culture and rich research agenda that reflects the complexity of the health issue to be addressed. Our experience may be useful for others embarking on team science projects.

Environmental Governance Cooperative Behavior among Enterprises with Reputation Effect Based on Complex Networks Evolutionary Game Model

This paper first portrays the equilibrium payoff of enterprise’s cooperation of environmental governance based on the Cournot model. Secondly, the evolutionary game model in complex networks is adopted to depict the evolution of environmental governance cooperative behavior among enterprises. Further, the evolutionary process of environmental governance cooperative behavior of enterprises is simulated considering the supervision behavior of government and the reputation evaluation behavior of environmental social organization. The results show that the cooperation level of enterprise group under self-organization condition will reach a low level; the supervision of government can enhance the cooperation level of enterprise group with high betrayal tempatation while it has limited effect on enterprise group with low betrayal tempatation. The reputation evaluation behavior of environmental social organization can realize reputation effect to improve the the cooperation level of enterprise group with high betrayal tempatation. The enhance of reputation sensitivity can optimize equilibrium distribution of reputation and it can strengthen the reputation effect on cooperation level. Based on the analysis above, the suggestions to effectively improve cooperation level are given.

Collective Force Generation by Molecular Motors Is Determined by Strain-Induced Unbinding

In the living cell, we encounter a large variety of motile processes such as organelle transport and cytoskeleton remodeling. These processes are driven by motor proteins that generate force by transducing chemical free energy into mechanical work. In many cases, the molecular motors work in teams to collectively generate larger forces. Recent optical trapping experiments on small teams of cytoskeletal motors indicated that the collectively generated force increases with the size of the motor team but that this increase depends on the motor type and on whether the motors are studied in vitro or in vivo. Here, we use the theory of stochastic processes to describe the motion of N motors in a stationary optical trap and to compute the N-dependence of the collectively generated forces. We consider six distinct motor types, two kinesins, two dyneins, and two myosins. We show that the force increases always linearly with N but with a prefactor that depends on the performance of the single motor. Surprisingly, this prefactor increases for weaker motors with a lower stall force. This counter-intuitive behavior reflects the increased probability with which stronger motors detach from the filament during strain generation. Our theoretical results are in quantitative agreement with experimental data on small teams of kinesin-1 motors.

A Spatial Regression Analysis on the Effect of Neighborhood-Level Trust on Cooperative Behaviors: Comparison With a Multilevel Regression Analysis

There is no reason to suppose that neighborhood effects based on residents' trust vary according to administrative boundaries. We examined the relationship between neighborhood trust and cooperative behaviors using the spatial Durbin model which assumed that people are influenced by closer neighbors regardless of administrative boundaries, comparing the results with those of the multilevel model. We used data from 476 residents in Arakawa Ward, Tokyo, Japan. For each respondent, we assigned a unique 'neighborhood trust' value weighted by the inverse distance between the respondent and all other respondents as an independent variable. The dependent variables were perceived neighbors' cooperative behaviors and respondents' own cooperative behaviors. The spatial Durbin model showed that spatially weighted neighborhood trust was positively associated with cooperative behaviors. Meanwhile, the multilevel models did not show the statistically significant effect of neighborhood trust. We concluded that the spatial model might model the neighborhood effects in society more precisely.

Self-perception of smile attractiveness as a reliable predictor of increased patient compliance with an orthodontist

BACKGROUND

Predicting the cooperation of orthodontic patients seems to be of the utmost importance for successful results in treatment with removable appliances, especially if their cost is to be covered from public funding. Therefore, the issue of unbiased pre-treatment assessment of cooperation still calls for an investigation.

OBJECTIVES

The objective of this study was to check whether smile attractiveness and its importance, subjectively evaluated by the patients/their caregivers, are reliable predictors of a patient's compliance during treatment with removable appliances.

MATERIAL AND METHODS

The study group comprised 97 patients aged 9-12 years, treated with active plates or twin-blocks, equipped with the TheraMon® system. Before treatment, the caregivers and the patients filled out the questionnaires ranking both of the investigated variables. After 9 months of treatment, we analyzed the correlations of the daily wear time (DWT) and other variables.

RESULTS

The analysis revealed the following: no relevance of the DWT to the type of removable appliances; negative correlation between the DWT and smile attractiveness assessed by the children and their caregivers; evidently elongated DWT (up to 9.68 h in children), who, together with the caregivers, evaluated their smile attractiveness as poor; coherence of children's and their caregivers' responses evaluating smile attractiveness and its importance, as well as the lack of consistency when comparing responses provided separately by the children and their caregivers.

CONCLUSIONS

Application of the TheraMon® sensors objectively proved that the patient's smile attractiveness ranked subjectively as low predicts the orthodontic patient's irreproachable cooperation. Therefore, our easy-to-use questionnaire calls for changing the protocol regarding the wearing time of removable appliances during treatment and introducing an evidence-based policy of reimbursement for such therapy from public funds. Further investigation of the effectiveness of removable appliances worn shorter than previously presumed and of the motivation to continue treatment, once smile attractiveness has been improved, is necessary.

Educating Nursing Home Staff in Dementia Sensitive Communication: Impact on Antipsychotic Medication Use

OBJECTIVES

An educational program to enhance communication in nursing home dementia care increased person-centered communication by staff and resulted in reduced resident behavioral symptoms measured as resistiveness to care. The purpose of this analysis was to evaluate effects on resident antipsychotic medication use in participating nursing homes. The National Partnership to Improve Dementia Care set a goal of reducing antipsychotic medications in nursing homes by 15% during the study period.

DESIGN

A post hoc analysis of Nursing Home Compare data was used to evaluate change in antipsychotic medication rates in nursing homes receiving the communication education versus the corresponding statewide average change.

SETTING AND PARTICIPANTS

Eleven nursing homes participated in a cluster-randomized controlled trial from 2011 to 2013 in one Midwestern state.

MEASURES

Antipsychotic medication rates were abstracted from Nursing Home Compare data sets. Antipsychotic medication rates were compared for each participating nursing home for the 2 quarters before and the 2 quarters after the communication intervention. To control for other factors supporting reduction in antipsychotic use, changes in the participating nursing homes were compared to the state average change for the corresponding quarters using a 1-sample t test.

RESULTS

Antipsychotic medication use decreased on average by 4.88 percentage points (22.9%) in participating nursing homes compared to the state average decrease of 0.68 percentage points (2.7%) during the same period (P = .06).

CONCLUSIONS

A clinically meaningful reduction in antipsychotic medication usage occurred in the nursing homes that received communication education. Measurable changes in communication and behavioral symptoms were reflected in reductions in antipsychotic medication usage. Improving staff communication has the potential to reduce inappropriate antipsychotic medication use in long-term care.

Association between measured teamwork and medical errors: an observational study of prehospital care in the USA

OBJECTIVES

The goal of this study was to examine the relationship between measured teamwork and adverse safety events in the prehospital emergency care of children using high-fidelity simulation. We posit that non-technical skills such as leadership, teamwork, situation awareness and decision-making are associated with the clinical success of teams.

DESIGN

Observational study.

SETTING

Emergency medical services (EMS) responders were recruited from public fire and private transport agencies in Oregon State to participate in four simulations of paediatric emergencies using high-fidelity patient simulators, scene design, and professional actors playing parents and bystanders.

PARTICIPANTS

Forty-four fire/transport teams consisting of 259 EMS professionals consented to participate and completed simulations.

PRIMARY AND SECONDARY OUTCOME MEASURES

Teams were assessed using the Clinical Teamwork Scale (CTS), a validated instrument that measures overall teamwork and 15 specific elements in five overarching domains: communication, decision-making, role responsibility (leadership and followership), situational awareness/resource management and patient-friendliness. We used generalised estimating equations to estimate the odds of error with increasing overall CTS teamwork score while adjusting for clinical scenario and potential clustering by team.

RESULTS

Across 176 simulations, the mean overall score on the CTS was 6.04 (SD 2.10; range 1=poor to 10=perfect) and was normally distributed. The distribution of scores was similar across the four clinical scenarios. At least one error was observed in 82% of the simulations. In simulations with at least one observed error, the mean CTS score was 5.76 (SD 2.04) compared with 7.16 (SD 1.95) in scenarios with no observed error. Logistic regression analysis accounting for clustering at the team level revealed that the odds of an error decreased 28% with each unit increase in CTS (OR 0.72, 95% CI 0.59 to 0.88).

CONCLUSIONS

This study found that overall teamwork among care delivery teams was strongly associated with the risk of serious adverse events in simulated scenarios of caring for critically ill and injured children.

Perspectives on Volunteer-Professional Collaboration in Palliative Care: A Qualitative Study Among Volunteers, Patients, Family Carers, and Health Care Professionals

CONTEXT

Governments intend to meet resource constraints in professional palliative care by stimulating informal care, including volunteerism. However, little is known about current volunteer-professional collaboration. Such insights are relevant for future policy development regarding volunteer efficiency, quality of care, and the capacity of volunteer care to support health care services and professionals.

OBJECTIVES

To explore what constitutes volunteer-professional collaboration around palliative care.

METHODS

A qualitative study was conducted using semistructured focus groups with volunteers, nurses, psychologists, and family physicians and semistructured interviews with people with serious illnesses and with family carers. Participants were recruited from hospital, home-care, day-care, and live-in services in Flanders, Belgium. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed by using a phenomenological approach. Two researchers coded independently in NVIVO 11 and reached a definitive coding scheme by comparing their resulting conceptual schemes.

RESULTS

Seventy-nine people participated in the study. Volunteers collaborate mostly with nurses, less with psychologists but not with physicians. Volunteer-professional collaboration entails mutual information-sharing regarding patient conditions and coordination of care provision, whereas nurses and psychologists provide emotional and functional support for volunteers. Lack of access to nurses, of leadership, and of patient-information-sharing guidelines were the most prominent barriers to collaboration.

CONCLUSION

Volunteers are at the front line of palliative care provision and therefore collaborate intensely with nurses, particularly in dedicated palliative care services. However, collaboration with other professionals is limited. The presence and availability of nurses was found to be crucial for volunteers, both for support and to achieve integration through collaboration.

A Plastic Visual Pathway Regulates Cooperative Behavior in Drosophila Larvae

Cooperative behavior emerges in biological systems through coordinated actions among individuals [1, 2]. Although widely observed across animal species, the cellular and molecular mechanisms underlying the establishment and maintenance of cooperative behaviors remain largely unknown [3]. To characterize the circuit mechanisms serving the needs of independent individuals and social groups, we investigated cooperative digging behavior in Drosophila larvae [4-6]. Although chemical and mechanical sensations are important for larval aggregation at specific sites [7-9], an individual larva's ability to participate in a cooperative burrowing cluster relies on direct visual input as well as visual and social experience during development. In addition, vision modulates cluster dynamics by promoting coordinated movements between pairs of larvae [5]. To determine the specific pathways within the larval visual circuit underlying cooperative social clustering, we examined larval photoreceptors (PRs) and the downstream local interneurons (lOLPs) using anatomical and functional studies [10, 11]. Our results indicate that rhodopsin-6-expressing-PRs (Rh6-PRs) and lOLPs are required for both cooperative clustering and movement detection. Remarkably, visual deprivation and social isolation strongly impact the structural and functional connectivity between Rh6-PRs and lOLPs, while at the same time having no effect on the adjacent rhodopsin-5-expressing PRs (Rh5-PRs). Together, our findings demonstrate that a specific larval visual pathway involved in social interactions undergoes experience-dependent modifications during development, suggesting that plasticity in sensory circuits could act as the cellular substrate for social learning, a possible mechanism allowing an animal to integrate into a malleable social environment and engage in complex social behaviors.

Survey of collaborative drug therapy management in U.S. hospitals

PURPOSE

Results of a survey assessing the extent and scope of collaborative drug therapy management (CDTM) in U.S. hospitals are presented.

METHODS

A survey questionnaire was mailed to a national random sample of hospital pharmacies. Pharmacy directors provided data on CDTM activities; their views on support for CDTM, the financial and strategic impact of CDTM, and the effect of state regulations on CDTM practice were assessed using summative Likert-type scales. Logistic regression was performed to assess associations of respondent demographics and hospital characteristics with CDTM use.

RESULTS

The usable response rate was 30.2%. Pharmacists were reported to be engaged in CDTM in 66% of respondents' hospitals, a significantly (p < 0.0001) greater proportion than reported in a comparable 2003 survey. The most prevalent CDTM activities were ordering laboratory and related tests (58.7% of hospitals), adjusting drug strength (57.9%), and changing the frequency of administration (53.8%). The most commonly reported diseases or treatment areas for CDTM use were anticoagulation (52.4% of hospitals), infectious diseases (44.8%), and parenteral nutrition (32.6%).

CONCLUSION

From 2003 to 2013, the prevalence of CDTM use in surveyed U.S. hospitals increased significantly, from about 50% to 66%. The 3 most common specific CDTM activities in 2003-ordering test results, adjusting drug strength, and changing frequency of administration-were still the most common in 2013 but were allowed at higher percentages of hospitals.

Protecting User Privacy and Rights in Academic Data-Sharing Partnerships: Principles From a Pilot Program at Crisis Text Line

Data sharing between technology companies and academic health researchers has multiple health care, scientific, social, and business benefits. Many companies remain wary about such sharing because of unaddressed concerns about ethics, data security, logistics, and public relations. Without guidance on these issues, few companies are willing to take on the potential work and risks involved in noncommercial data sharing, and the scientific and societal potential of their data goes unrealized. In this paper, we describe the 18-month long pilot of a data-sharing program led by Crisis Text Line (CTL), a not-for-profit technology company that provides a free 24/7 text line for people in crisis. The primary goal of the data-sharing pilot was to design, develop, and implement a rigorous framework of principles and protocols for the safe and ethical sharing of user data. CTL used a stakeholder-based policy process to develop a feasible and ethical data-sharing program. The process comprised forming a data ethics committee; identifying policy challenges and solutions; announcing the program and generating interest; and revising the policy and launching the program. Once the pilot was complete, CTL examined how well the program ran and compared it with other potential program models before putting in place the program that was most suitable for its organizational needs. By drawing on CTL's experiences, we have created a 3-step set of guidelines for other organizations that wish to develop their own data-sharing program with academic researchers. The guidelines explain how to (1) determine the value and suitability of the data and organization for creating a data-sharing program; (2) decide on an appropriate data sharing and collaboration model; and (3) develop protocols and technical solutions for safe and ethical data sharing and the best organizational structure for implementing the program. An internal evaluation determined that the pilot satisfied CTL's goals of sharing scientific data and protecting client confidentiality. The policy development process also yielded key principles and protocols regarding the ethical challenges involved in data sharing that can be applied by other organizations. Finally, CTL's internal review of the pilot program developed a number of alternative models for sharing data that will suit a range of organizations with different priorities and capabilities. In implementing and studying this pilot program, CTL aimed both to optimize its own future data-sharing programs and to inform similar decisions made by others. Open data programs are both important and feasible to establish. With careful planning and appropriate resources, data sharing between big data companies and academic researchers can advance their shared mission to benefit society and improve lives.

Attitudes towards interprofessional collaboration of Primary Care teams participating in the 'More Doctors' (Mais Médicos) program

OBJECTIVES

to compare the attitudes regarding interprofessional collaboration of health professionals that make up the Family Health Strategy teams participating in the 'More Doctors' (Mais Médicos) program; and to identify factors associated with attitudes of interprofessional collaboration.

METHOD

a descriptive, transversal and comparative study developed with 63 health professionals who responded to the Jefferson Scale of Attitudes Toward Interprofessional Collaboration. The data were statistically analyzed.

RESULTS

the sum of the scale items ranged from 88 to 139 points. The analysis of all the Family Health teams indicated statistically significant differences between the scores of the scale and the professional category and between the scores and the education level, suggesting that nurses and professionals with higher education are more inclined towards collaborative practice. The analysis according to the profile of the doctor - Brazilian, Cuban or foreign exchange doctor - found no statistical differences regarding the physicians' scores, nor in the scores of the components of teams with different profiles.

CONCLUSION

the profile did not suggest a statistically significant greater or lesser inclination of the doctors or teams toward interprofessional work. This study can support new studies which will contribute to the analysis of inter-professional collaboration and the impact of the Mais Médicos program.

Building a Community of Inquiry Within an Online-Based Health Informatics Program: Instructional Design and Lessons Learned

The rapid medical and technological progress and the resulting need for life-long learning lead to the proliferation of online-based programs in health informatics for health care and health informatics professionals. Effective learning in these online-based programs demands close interaction and cooperation between students and instructors. In such cooperative online-based programs, special emphasis is thus put on fostering a community of inquiry between all participants. The online-based master program on Health Information Management at the University UMIT is firmly based on the constructivist theory of situated learning in such a community of inquiry. Online activities in this master program are designed to promote social presence, cognitive presence and teacher presence as preconditions for successful learning. To verify whether these three forms of presences are visible and whether learning was successful, the first four six-week online-based modules with overall 60 participants were analyzed in depth, combining data from community of inquiry surveys, student evaluations, workload assessments and final assessment results. Results indicate that it was possible to build a community of inquiry (with scores of 4.2 and higher) and to foster effective learning. We conclude with recommendations on how to build a community of inquiry in online-based cooperative learning and also discuss some constraints.

Identification of Parameters of Host Cell Vulnerability during Salmonella Infection by Quantitative Image Analysis and Modeling

Salmonella targets and enters epithelial cells at permissive entry sites: some cells are more likely to be infected than others. However, the parameters that lead to host cell heterogeneity are not known. Here, we quantitatively characterized host cell vulnerability to Salmonella infection based on imaged parameters. We performed successive infections of the same host cell population followed by automated high-throughput microscopy and observed that infected cells have a higher probability of being reinfected. Establishing a predictive model, we identified two combined origins of host cell vulnerability: pathogen-induced cellular vulnerability emerging from Salmonella uptake and persisting at later stages of the infection and host cell-inherent vulnerability. We linked the host cell-inherent vulnerability with its morphological attributes, such as local cell crowding, and with host cell cholesterol content. This showed that the probability of Salmonella infection success can be forecast from morphological or molecular host cell parameters.

Perceived Dentist and Dental Hygienist Task Distribution After Dental and Dental Hygiene Students' Team Intervention

Attitudes of dental students regarding the provision of treatment tend to be dentist-centered; however, facilitating mixed student group formation could change such perceptions. The aim of this study was to investigate the perceived scope of practice of dental and dental hygiene students and whether their perceptions of task distribution between dentists and dental hygienists would change following an educational intervention consisting of feedback, intergroup comparison, and competition between mixed-group teams. The study employed a pretest-posttest single group design. Third-year dental students and second-year dental hygiene students at a university in The Netherlands were randomly assigned to intraprofessional teams (four or five members) and received team-based performance feedback and comparison. The intervention was finalized with an award ceremony for the best intraprofessional team. Before and after the intervention, students completed a questionnaire measuring their perceived distribution of ten tasks between dentists and dental hygienists. A total of 38 dental students and 32 dental hygiene students participated in the intervention-all 70 of those eligible. Questionnaires were completed by a total 88.4% (n=61) of the participants: 34 dental (89.5%) and 27 dental hygiene students (84.4%). Dental and dental hygiene students had similar perceptions regarding teeth cleaning (prophylaxis) (p=0.372, p=0.404) and, after the intervention, preventive tasks (p=0.078). Following the intervention, dental students considered four out of ten tasks as less dentist-centered: radiograph for periodontal diagnosis (p=0.003), local anesthesia (p=0.037), teeth cleaning (p=0.037), and periodontal treatment (p=0.045). Dental hygiene students perceived one task as being less dentist-centered after the intervention: radiograph for cariologic diagnosis (p=0.041). This study found that these dental and dental hygiene students had different opinions regarding the scope of practice for dentistry and dental hygiene. The number of redistributed tasks after the intervention was especially substantial among the dental students, although the amount of change per task was minimal. Half of all tasks were perceived as less dentist-centered as a result of the intervention.

The Undiagnosed Diseases Network: Accelerating Discovery about Health and Disease

Diagnosis at the edges of our knowledge calls upon clinicians to be data driven, cross-disciplinary, and collaborative in unprecedented ways. Exact disease recognition, an element of the concept of precision in medicine, requires new infrastructure that spans geography, institutional boundaries, and the divide between clinical care and research. The National Institutes of Health (NIH) Common Fund supports the Undiagnosed Diseases Network (UDN) as an exemplar of this model of precise diagnosis. Its goals are to forge a strategy to accelerate the diagnosis of rare or previously unrecognized diseases, to improve recommendations for clinical management, and to advance research, especially into disease mechanisms. The network will achieve these objectives by evaluating patients with undiagnosed diseases, fostering a breadth of expert collaborations, determining best practices for translating the strategy into medical centers nationwide, and sharing findings, data, specimens, and approaches with the scientific and medical communities. Building the UDN has already brought insights to human and medical geneticists. The initial focus has been on data sharing, establishing common protocols for institutional review boards and data sharing, creating protocols for referring and evaluating patients, and providing DNA sequencing, metabolomic analysis, and functional studies in model organisms. By extending this precision diagnostic model nationally, we strive to meld clinical and research objectives, improve patient outcomes, and contribute to medical science.

The Challenges of Collecting and Using Patient Care Data From Diverse Care Systems: Lessons From COMPASS

The ability to aggregate clinical data across multiple diverse organizations and to use it for performance measurement, quality improvement, evaluation, and research is rapidly becoming a national necessity, but there are few examples of how to do that. This article uses lessons from a national effort to implement the collaborative care management model for patients with both depression and diabetes or heart disease across 8 partner organizations, 18 medical groups, and more than 170 clinics in 8 states to identify the challenges and provide experience-based recommendations for those tasks. The challenges are divided into those needed for (1) collecting similar data, (2) aggregating those data across care systems, and (3) using the data to both improve and evaluate care. Start with agreement on goals, methods, transparency, and a data system integrated into the electronic medical record while promptly addressing all the legal, regulatory, and human subject requirements.

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

BACKGROUND AND OBJECTIVES

There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory.

RESULTS

The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients.

CONCLUSIONS

The comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease.

Preparing Academic Medical Centers for the Clinical Learning Environment Review: Alliance of Independent Academic Medical Centers National Initiative IV Outcomes and Evaluation

BACKGROUND

Driven by changes to improve quality in patient care and population health while reducing costs, evolvement of the health system calls for restructuring health professionals' education and aligning it with the healthcare delivery system. In response to these changes, the Accreditation Council for Graduate Medical Education's Clinical Learning Environment Review (CLER) encourages the integration of health system leadership, faculty, and residents in restructuring graduate medical education (GME). Innovative approaches to achieving this restructuring and the CLER objectives are essential.

METHODS

The Alliance of Independent Academic Medical Centers National Initiative (NI) IV provided a multiinstitutional learning collaborative focused on supporting GME redesign. From October 2013 through March 2015, participants conducted relevant projects, attended onsite meetings, and participated in teleconferences and webinars addressing the CLER areas. Participants shared best practices, resources, and experiences. We designed a pre/post descriptive study to examine outcomes.

RESULTS

Thirty-three institutions completed NI IV, and at its conclusion, the majority reported greater CLER readiness compared with baseline. Twenty-two (88.0%) institutions reported that NI IV had a great impact on advancing their efforts in the CLER area of their project focus, and 15 (62.5%) reported a great impact in other CLER focus areas. Opportunities to share progress with other teams and the national group meetings were reported to contribute to teams' success.

CONCLUSION

The NI IV learning collaborative prepared institutions for CLER, suggesting successful integration of the clinical and educational enterprises. We propose that national learning collaboratives of GME-sponsoring health systems enable advancement of their education mission, leading ultimately to better healthcare outcomes. This learning model may be generalizable to newfound programs for academic medical centers.

Implementation and evaluation of an interprofessional simulation-based education program for undergraduate nursing students in operating room nursing education: a randomized controlled trial

BACKGROUND

The present study was designed to implement an interprofessional simulation-based education program for nursing students and evaluate the influence of this program on nursing students' attitudes toward interprofessional education and knowledge about operating room nursing.

METHODS

Nursing students were randomly assigned to either the interprofessional simulation-based education or traditional course group. A before-and-after study of nursing students' attitudes toward the program was conducted using the Readiness for Interprofessional Learning Scale. Responses to an open-ended question were categorized using thematic content analysis. Nursing students' knowledge about operating room nursing was measured.

RESULTS

Nursing students from the interprofessional simulation-based education group showed statistically different responses to four of the nineteen questions in the Readiness for Interprofessional Learning Scale, reflecting a more positive attitude toward interprofessional learning. This was also supported by thematic content analysis of the open-ended responses. Furthermore, nursing students in the simulation-based education group had a significant improvement in knowledge about operating room nursing.

CONCLUSIONS

The integrated course with interprofessional education and simulation provided a positive impact on undergraduate nursing students' perceptions toward interprofessional learning and knowledge about operating room nursing. Our study demonstrated that this course may be a valuable elective option for undergraduate nursing students in operating room nursing education.

Simulation Activity in Otolaryngology Residencies

OBJECTIVES

Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty.

STUDY DESIGN

Web-based survey.

SETTING

US otolaryngology residency training programs.

SUBJECTS AND METHODS

An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported.

RESULTS

Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives.

CONCLUSION

Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs.

Wikipedia and medicine: quantifying readership, editors, and the significance of natural language

Background

Wikipedia is a collaboratively edited encyclopedia. One of the most popular websites on the Internet, it is known to be a frequently used source of health care information by both professionals and the lay public.

Objective

This paper quantifies the production and consumption of Wikipedia’s medical content along 4 dimensions. First, we measured the amount of medical content in both articles and bytes and, second, the citations that supported that content. Third, we analyzed the medical readership against that of other health care websites between Wikipedia’s natural language editions and its relationship with disease prevalence. Fourth, we surveyed the quantity/characteristics of Wikipedia’s medical contributors, including year-over-year participation trends and editor demographics.

Methods

Using a well-defined categorization infrastructure, we identified medically pertinent English-language Wikipedia articles and links to their foreign language equivalents. With these, Wikipedia can be queried to produce metadata and full texts for entire article histories. Wikipedia also makes available hourly reports that aggregate reader traffic at per-article granularity. An online survey was used to determine the background of contributors. Standard mining and visualization techniques (eg, aggregation queries, cumulative distribution functions, and/or correlation metrics) were applied to each of these datasets. Analysis focused on year-end 2013, but historical data permitted some longitudinal analysis.

Results

Wikipedia’s medical content (at the end of 2013) was made up of more than 155,000 articles and 1 billion bytes of text across more than 255 languages. This content was supported by more than 950,000 references. Content was viewed more than 4.88 billion times in 2013. This makes it one of if not the most viewed medical resource(s) globally. The core editor community numbered less than 300 and declined over the past 5 years. The members of this community were half health care providers and 85.5% (100/117) had a university education.

Conclusions

Although Wikipedia has a considerable volume of multilingual medical content that is extensively read and well-referenced, the core group of editors that contribute and maintain that content is small and shrinking in size.

Teamwork and clinical error reporting among nurses in Korean hospitals

PURPOSE

To examine levels of teamwork and its relationships with clinical error reporting among Korean hospital nurses.

METHODS

The study employed a cross-sectional survey design. We distributed a questionnaire to 674 nurses in two teaching hospitals in Korea. The questionnaire included items on teamwork and the reporting of clinical errors. We measured teamwork using the Teamwork Perceptions Questionnaire, which has five subscales including team structure, leadership, situation monitoring, mutual support, and communication. Using logistic regression analysis, we determined the relationships between teamwork and error reporting.

RESULTS

The response rate was 85.5%. The mean score of teamwork was 3.5 out of 5. At the subscale level, mutual support was rated highest, while leadership was rated lowest. Of the participating nurses, 522 responded that they had experienced at least one clinical error in the last 6 months. Among those, only 53.0% responded that they always or usually reported clinical errors to their managers and/or the patient safety department. Teamwork was significantly associated with better error reporting. Specifically, nurses with a higher team communication score were more likely to report clinical errors to their managers and the patient safety department (odds ratio = 1.82, 95% confidence intervals [1.05, 3.14]).

CONCLUSIONS

Teamwork was rated as moderate and was positively associated with nurses' error reporting performance. Hospital executives and nurse managers should make substantial efforts to enhance teamwork, which will contribute to encouraging the reporting of errors and improving patient safety.

Antigen-driven focal inflammatory death of malaria liver stages

Multiple immunizations using live irradiated sporozoites, the infectious plasmodial stage delivered into the host skin during a mosquito bite, can elicit sterile immunity to malaria. CD8⁺ T cells seem to play an essential role in this protective immunity, since their depletion consistently abolishes sterilizing protection in several experimental models. So far, only a few parasite antigens are known to induce CD8⁺ T cell-dependent protection, but none of them can reach the levels of protection afforded by live attenuated parasites. Systematic attempts to identify novel antigens associated with this efficient cellular protection were so far unsuccessful. In addition, the precise mechanisms involved in the recognition and elimination of parasitized hepatocytes in vivo by CD8⁺ T cells still remain obscure. Recently, it has been shown that specific effector CD8⁺ T cells, after recognition of parasitized hepatocytes, recruit specific and non-specific activated CD8⁺ T cells to the site of infection, resulting in the formation of cellular clusters around and in the further elimination of intracellular parasites. The significance of this finding is discussed in the perspective of a general mechanism of antigen-dependent focalized inflammation and its consequences for the elimination of malaria liver stages.

Finding collaborators: toward interactive discovery tools for research network systems

Background

Research networking systems hold great promise for helping biomedical scientists identify collaborators with the expertise needed to build interdisciplinary teams. Although efforts to date have focused primarily on collecting and aggregating information, less attention has been paid to the design of end-user tools for using these collections to identify collaborators. To be effective, collaborator search tools must provide researchers with easy access to information relevant to their collaboration needs.

Objective

The aim was to study user requirements and preferences for research networking system collaborator search tools and to design and evaluate a functional prototype.

Methods

Paper prototypes exploring possible interface designs were presented to 18 participants in semistructured interviews aimed at eliciting collaborator search needs. Interview data were coded and analyzed to identify recurrent themes and related software requirements. Analysis results and elements from paper prototypes were used to design a Web-based prototype using the D3 JavaScript library and VIVO data. Preliminary usability studies asked 20 participants to use the tool and to provide feedback through semistructured interviews and completion of the System Usability Scale (SUS).

Results

Initial interviews identified consensus regarding several novel requirements for collaborator search tools, including chronological display of publication and research funding information, the need for conjunctive keyword searches, and tools for tracking candidate collaborators. Participant responses were positive (SUS score: mean 76.4%, SD 13.9). Opportunities for improving the interface design were identified.

Conclusions

Interactive, timeline-based displays that support comparison of researcher productivity in funding and publication have the potential to effectively support searching for collaborators. Further refinement and longitudinal studies may be needed to better understand the implications of collaborator search tools for researcher workflows.

Pathogen intelligence

Different species inhabit different sensory worlds and thus have evolved diverse means of processing information, learning and memory. In the escalated arms race with host defense, each pathogenic bacterium not only has evolved its individual cellular sensing and behavior, but also collective sensing, interbacterial communication, distributed information processing, joint decision making, dissociative behavior, and the phenotypic and genotypic heterogeneity necessary for epidemiologic success. Moreover, pathogenic populations take advantage of dormancy strategies and rapid evolutionary speed, which allow them to save co-generated intelligent traits in a collective genomic memory. This review discusses how these mechanisms add further levels of complexity to bacterial pathogenicity and transmission, and how mining for these mechanisms could help to develop new anti-infective strategies.

Plasma oxytocin immunoreactive products and response to trust in patients with social anxiety disorder

BACKGROUND

Generalized Social Anxiety Disorder (GSAD) is characterized by excessive fear and avoidance of several types of social and performance situations. The pathophysiology is not well understood, but research in animals and humans has provided evidence that oxytocin helps regulate normal social affiliative behavior. Previous work in healthy male subjects demonstrated a rise in plasma oxytocin after receiving a high trust signal. To examine the oxytocin system in GSAD, we measured plasma oxytocin in GSAD patients and controls, before and after the social "Trust Game," a neuroeconomic test examining trust behavior and reaction to trust using real monetary incentives.

METHODS

Thirty-nine subjects with GSAD and 28 healthy controls provided three blood samples for oxytocin measurement before the Trust Game, and one sample after the game. Plasma estradiol was also measured at baseline. The Trust Game protocol version prioritized the sending of a signal of high cooperation and trust to all participants. All analyses controlled for gender and estradiol levels.

RESULTS

Mean oxytocin levels post-Trust Game (P = .025), and overall (area under the curve, P = .011) were lower in GSADpatients compared to controls, after controlling for sex and estradiol. There was no significant change in oxytocin levels after the game in either group.

CONCLUSIONS

We report low plasma oxytocin levels in patients with GSAD during a prosocial laboratory task paradigm. Additional research will be important to further examine the relationship between oxytocin and social behavior in GSAD.

Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP)

BACKGROUND

Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently facilitated.

OBJECTIVE

To describe the development and the content of a program aimed at: (1) facilitating self-management and shared decision making by frail older people and informal caregivers, and (2) reducing fragmentation of care by improving collaboration among professionals involved in the care of frail older people through a combined multidisciplinary electronic health record (EHR) and personal health record (PHR).

METHODS

We used intervention mapping to systematically develop our program in six consecutive steps. Throughout this development, the target populations (ie, professionals, frail older people, and informal caregivers) were involved extensively through their participation in semi-structured interviews and working groups.

RESULTS

We developed the Health and Welfare Information Portal (ZWIP), a personal, Internet-based conference table for multidisciplinary communication and information exchange for frail older people, their informal caregivers, and professionals. Further, we selected and developed methods for implementation of the program, which included an interdisciplinary educational course for professionals involved in the care of frail older people, and planned the evaluation of the program.

CONCLUSIONS

This paper describes the successful development and the content of the ZWIP as well as the strategies developed for its implementation. Throughout the development, representatives of future users were involved extensively. Future studies will establish the effects of the ZWIP on self-management and shared decision making by frail older people as well as on collaboration among the professionals involved.

Hunting Activity Among Naturalistically Housed Chimpanzees (Pan troglodytes) at the Fundació Mona (Girona, Spain). Predation, Occasional Consumption and Strategies in Rehabilitated Animals

Predatory behavior in wild chimpanzees and other primates has been well documented over the last 30 years. However, as it is an opportunistic behavior, conditions which may promote such behavior are left up to chance. Until now, predatory behavior among captive chimpanzees has been poorly documented. In this paper, we present five instances providing evidence of predatory behavior: four performed by isolated individuals and one carried out in cooperation. The evidence of group predation involved the chimpanzees adopting different roles as pursuers and ambushers. Prey was partially eaten in some cases, but not in the social episode. This study confirms that naturalistic environments allow chimpanzees to enhance species-typical behavioral patterns.

Shared mind: communication, decision making, and autonomy in serious illness

In the context of serious illness, individuals usually rely on others to help them think and feel their way through difficult decisions. To help us to understand why, when, and how individuals involve trusted others in sharing information, deliberation, and decision making, we offer the concept of shared mind-ways in which new ideas and perspectives can emerge through the sharing of thoughts, feelings, perceptions, meanings, and intentions among 2 or more people. We consider how shared mind manifests in relationships and organizations in general, building on studies of collaborative cognition, attunement, and sensemaking. Then, we explore how shared mind might be promoted through communication, when appropriate, and the implications of shared mind for decision making and patient autonomy. Next, we consider a continuum of patient-centered approaches to patient-clinician interactions. At one end of the continuum, an interactional approach promotes knowing the patient as a person, tailoring information, constructing preferences, achieving consensus, and promoting relational autonomy. At the other end, a transactional approach focuses on knowledge about the patient, information-as-commodity, negotiation, consent, and individual autonomy. Finally, we propose that autonomy and decision making should consider not only the individual perspectives of patients, their families, and members of the health care team, but also the perspectives that emerge from the interactions among them. By drawing attention to shared mind, clinicians can observe in what ways they can promote it through bidirectional sharing of information and engaging in shared deliberation.