Alla Keselman

The Development of Cognitive Skills To Support Inquiry Learning

Establishing the value of inquiry learning as an educational method, it is argued, rests on thorough, detailed knowledge of the cognitive skills it is intended to promote. Mental models, as representations of the reality being investigated in inquiry learning, stand to influence strategies applied to the task. In the research described here, the hypothesis is investigated that students at the middle school level, and sometimes well beyond, may have an incorrect mental model of multivariable causality (one in which effects of individual features on an outcome are neither consistent nor additive) that impedes the causal analysis involved in most forms of inquiry learning. An extended intervention with 6th to 8th graders was targeted to promote (a) at the metalevel, a correct mental model based on additive effects of individual features (indicated by identification of effects of individual features as the task objective); (b) also at the metalevel, metastrategic understanding of the need to control the influences of other features; and (c) at the performance level, consistent use of the controlled comparison strategy. Both metalevel advancements were observed, in addition to transfer to a new task at the performance level, among many (though not all) students. Findings support the claim that a developmental hierarchy of skills and understanding underlies, and should be identified as an objective of, inquiry learning.

Registering a clinical trial in ClinicalTrials.gov.

2007;131;909-912; Prepublished online February 15, 2007; Chest Deborah A. Zarin and Alla Keselman ClinicalTrials.gov Registering a Clinical Trial in http://chestjournals.org and services can be found online on the World Wide Web at: The online version of this article, along with updated information ). ISSN: 0012-3692. http://www.chestjournal.org/misc/reprints.shtml ( of the copyright holder may be reproduced or distributed without the prior written permission Northbrook IL 60062. All rights reserved. No part of this article or PDF by the American College of Chest Physicians, 3300 Dundee Road, 2007 Physicians. It has been published monthly since 1935. Copyright CHEST is the official journal of the American College of Chest

Toward a framework for understanding lay public's comprehension of disaster and bioterrorism information

In the last decade, we have witnessed a significant increase in disaster preparedness and crisis communication efforts. This stands in sharp contrast with paucity of research that deals with the publics comprehension of disaster information and related decision-making. The objective of this paper is to outline a theoretical and methodological framework for research on lay comprehension of crisis information. The proposed framework integrates two bodies of research: (1) cognitive science literature on comprehension and decision-making and (2) studies of the effects of anxiety on performance. The paper reviews selected works and methods from both fields, discussing how cognitive perspective could be extended to include emotional factors. We also discuss how further research integrating the proposed framework with public health communication perspective could: (1) provide insights for developing effective disaster communication and (2) inform the development of technological support for disaster communication and for education of lay people and health professionals.

Institutional decision-making to select patient care devices: identifying venues to promote patient safety

Many medical errors that involve drug infusion devices are related to classic interface problems. Although manufacturers are becoming increasingly aware of human factors design considerations, many devices that are currently on the market are still sub-optimal for human use. This places significant responsibility for device selection on institutional purchasing groups. Theories of naturalistic decision-making point to many potential strengths and pitfalls of group decision-making processes that may affect the final outcome. This paper describes a retrospective analysis of decision-making process for infusion pump selection in a large hospital and focuses on factors related to patient safety. Through a series of detailed interviews and a study of relevant documentation we characterized the nature of the decision-making, patterns of communication, and the roles of different participants. Findings show that although the process involves a number of different professional groups and committees, the information flow among them is restricted. This results in inadequate representation of critical device usability considerations in the decision-making process. While all participants view device safety as an important consideration in the selection process, administrators (who are the final decision-makers) tend to equate safety with technical accuracy and reliability, paying less attention to the role of human factors in safe device use. Findings suggest that collaborative communication technology and automated evidence-based guidelines could provide support to institutional decision-making, ensuring that the process is efficient, effective, and ultimately safe for the patients.

A framework for capturing the interactions between laypersons' understanding of disease, information gathering behaviors, and actions taken during an epidemic

Abstract This paper provides a description of a methodological framework designed to capture the inter-relationships between the lay publics’ understanding of health-related processes, information gathering behaviors, and actions taken during an outbreak. We developed and refined our methods during a study involving eight participants living in severe acute respiratory syndrome (SARS)-affected areas (Hong Kong, Taiwan, and Toronto). The framework is an adaptation of narrative analysis, a qualitative method that is used to investigate a phenomenon through interpretation of the stories people tell about their experiences. From our work, several hypotheses emerged that will contribute to future research. For example, our findings showed that many decisions in an epidemic are carefully considered and involve use of significant information gathering. Having a good model of lay actions based on information received and beliefs held will contribute to the development of more effective information support systems in the event of a future epidemic.

Beyond Readability: Investigating Coherence of Clinical Text for Consumers

Background A basic tenet of consumer health informatics is that understandable health resources empower the public. Text comprehension holds great promise for helping to characterize consumer problems in understanding health texts. The need for efficient ways to assess consumer-oriented health texts and the availability of computationally supported tools led us to explore the effect of various text characteristics on readers’ understanding of health texts, as well as to develop novel approaches to assessing these characteristics. Objective The goal of this study was to compare the impact of two different approaches to enhancing readability, and three interventions, on individuals’ comprehension of short, complex passages of health text. Methods Participants were 80 university staff, faculty, or students. Each participant was asked to “retell” the content of two health texts: one a clinical trial in the domain of diabetes mellitus, and the other typical Visit Notes. These texts were transformed for the intervention arms of the study. Two interventions provided terminology support via (1) standard dictionary or (2) contextualized vocabulary definitions. The third intervention provided coherence improvement. We assessed participants’ comprehension of the clinical texts through propositional analysis, an open-ended questionnaire, and analysis of the number of errors made. Results For the clinical trial text, the effect of text condition was not significant in any of the comparisons, suggesting no differences in recall, despite the varying levels of support (P = .84). For the Visit Note, however, the difference in the median total propositions recalled between the Coherent and the (Original + Dictionary) conditions was significant (P = .04). This suggests that participants in the Coherent condition recalled more of the original Visit Notes content than did participants in the Original and the Dictionary conditions combined. However, no difference was seen between (Original + Dictionary) and Vocabulary (P = .36) nor Coherent and Vocabulary (P = .62). No statistically significant effect of any document transformation was found either in the open-ended questionnaire (clinical trial: P = .86, Visit Note: P = .20) or in the error rate (clinical trial: P = .47, Visit Note: P = .25). However, post hoc power analysis suggested that increasing the sample size by approximately 6 participants per condition would result in a significant difference for the Visit Note, but not for the clinical trial text. Conclusions Statistically, the results of this study attest that improving coherence has a small effect on consumer comprehension of clinical text, but the task is extremely labor intensive and not scalable. Further research is needed using texts from more diverse clinical domains and more heterogeneous participants, including actual patients. Since comprehensibility of clinical text appears difficult to automate, informatics support tools may most productively support the health care professionals tasked with making clinical information understandable to patients.

Can multilingual machine translation help make medical record content more comprehensible to patients

With the development of electronic personal health records, more patients are gaining access to their own medical records. However, comprehension of medical record content remains difficult for many patients. Because each record is unique, it is also prohibitively costly to employ human translators to solve this problem. In this study, we investigated whether multilingual machine translation could help make medical record content more comprehensible to patients who lack proficiency in the language of the records. We used a popular general-purpose machine translation tool called Babel Fish to translate 213 medical record sentences from English into Spanish, Chinese, Russian and Korean. We evaluated the comprehensibility and accuracy of the translation. The text characteristics of the incorrectly translated sentences were also analyzed. In each language, the majority of the translations were incomprehensible (76% to 92%) and/or incorrect (77% to 89%). The main causes of the translation are vocabulary difficulty and syntactical complexity. A general-purpose machine translation tool like the Babel Fish is not adequate for the translation of medical records; however, a machine translation tool can potentially be improved significantly, if it is trained to target certain narrow domains in medicine.

Adapting semantic natural language processing technology to address information overload in influenza epidemic management

A huge number of informal messages are posted every day in social network sites, blogs, and discussion forums. Emotions seem to be frequently important in these texts for expressing friendship, showing social support or as part of online arguments. Algorithms to identify sentiment and sentiment strength are needed to help understand the role of emotion in this informal communication and also to identify inappropriate or anomalous affective utterances, potentially associated with threatening behavior to the self or others. Nevertheless, existing sentiment detection algorithms tend to be commercially oriented, designed to identify opinions about products rather than user behaviors. This article partly fills this gap with a new algorithm, SentiStrength, to extract sentiment strength from informal English text, using new methods to exploit the de facto grammars and spelling styles of cyberspace. Applied to MySpace comments and with a lookup table of term sentiment strengths optimized by machine learning, SentiStrength is able to predict positive emotion with 60.6p accuracy and negative emotion with 72.8p accuracy, both based upon strength scales of 1–5. The former, but not the latter, is better than baseline and a wide range of general machine learning approaches.

The Relationship between Biology Classes and Biological Reasoning and Common Heath Misconceptions

Abstract This study investigates the relationship among (1) college major, (2) knowledge used in reasoning about common health beliefs, and (3) judgment about the accuracy of those beliefs. Seventy-four college students, advanced biology and non—science majors, indicated their agreement or disagreement with commonly believed, but often inaccurate, statements about health and explained their reasoning. The results indicated that while the direct impact of college-level biology coursework on judgment accuracy was minimal, biology major was associated with increased reliance on advanced biological reasoning, which mediated judgment accuracy. However, the overall association of advanced biological reasoning with judgment accuracy was small. The discussion calls for strengthening the science—daily life connection in biology education for majors and nonmajors.

Knowledge Gaps Among Public Librarians Seeking Vaccination Information: A Qualitative Study

Public libraries have been called the “first responders” to the specialized health information needs of the general public. The challenges inherent in consumer health information (CHI) service are centered around the Patron, the Librarian, the Information Resources, and the Library itself. The pilot study involved interviews with nine individual library workers in eight public libraries in four library systems: the District of Columbia, Montgomery and Prince Georges Counties in Maryland, and Fairfax County in Virginia. Library workers were asked about common consumer health information requests, the nature of their collections, and the role of public libraries in meeting these information needs. The subjects were also presented with a hypothetical scenario, and their responses suggest knowledge gaps. The findings point to the increasing necessity and importance of training and support for public librarians, as well as the importance of understanding where the medical knowledge gaps exist. Public librarians need to commit to formal evaluation of their skill sets and knowledge gaps, in order to identify areas to which libraries can devote limited resources.