Karen L. Roper

Matching-to-sample performance by pigeons trained with visual-duration compound samples

Pigeons were trained on duration matching-to-sample in which each of four combinations of signal type (red or white light) and duration (2 or 10 see) was mapped onto a different choice stimulus. Probe trials in Experiments 1 and 2 involved a successive presentation of two duration samples. In each experiment, birds tended to summate two durations when the same signal was presented twice, but not when two different signals appeared. These results contrast with those reported by Spetch and Sinha (1989), who found a summation effect with both same-signal and different-signal compounds. In Experiment 3, pigeons chose among two alternatives which were both associated with the duration of the sample but of which only one was also associated with the signal type of the sample. Pigeons systematically chose the stimulus that matched both sample duration and signal type. The implications of these findings are discussed in terms of transfer of training and coding of event duration.

Directed forgetting in animals.

Directed-forgetting research with animals suggests that animals show disrupted test performance only under certain conditions. Important variables are (a) whether during training, the cue to forget (F cue) signals nonreward (i.e., that the trial is over) versus reward (i.e., that reinforcement can be obtained) and (b) given that reinforcement can be obtained on F-cue trials, whether the post-F-cue response pattern is compatible with the baseline memory task. It is proposed that some findings of directed forgetting can be attributed to trained response biases, whereas others may be attributable perhaps to frustration-produced interference. It is suggested that directed forgetting in animals should be studied using procedures similar to those used to study directed forgetting in humans. This can be accomplished by presenting, within a trial, both to-be-remembered and to-be-forgotten material.

Common coding in pigeons: Partial versus total reversals of one-to-many conditional discriminations

Common coding in pigeons was examined using a delayed conditional discrimination in which each sample stimulus was associated with two different comparison stimuli (one-to-many mapping). In Experiment 1, pigeons matched circle and dot samples to red and green hues and vertical and horizontal line orientations. In Experiment 2, the samples were red and green and the comparisons were vertical and horizontal spatial positions (up vs. down and left vs. right). Following acquisition to high levels of accuracy in each experiment, the associations between the samples and either both sets or only one set of comparisons were reversed. Pigeons learned the total reversals faster than the partial reversals. These results suggest that when different comparisons are associated with a common sample, they may become functionally equivalent.

True directed forgetting in pigeons may occur only when alternative working memory is required on forget-cue trials

Results of directed-forgetting research with pigeons are difficult to interpret because of alternative nonmemorial accounts of performance decrements and important procedural differences from comparable research with humans. Prior research has noted the absence of directed forgetting when artifacts have been removed (e.g., nonreward following forget cues and differences in response patterns on remember and forget trials in training). In this article, it is argued that, in human directed-forgetting research, presentation of a forget cue allows for the reallocation of memory maintenance to items to be remembered. In the present experiment, true directed forgetting is found when nonmemorial performance decrements are eliminated and forget cues allow for the reallocation of sample memory to test-relevant cues.

Terminate lung cancer (TLC) study—A mixed-methods population approach to increase lung cancer screening awareness and low-dose computed tomography in Eastern Kentucky

For low dose CT lung cancer screening to be effective in curbing disease mortality, efforts are needed to overcome barriers to awareness and facilitate uptake of the current evidence-based screening guidelines. A sequential mixed-methods approach was employed to design a screening campaign utilizing messages developed from community focus groups, followed by implementation of the outreach campaign intervention in two high-risk Kentucky regions. This study reports on rates of awareness and screening in intervention regions, as compared to a control region.

Systematic Review of Ambulatory Transitional Care Management (TCM) Visits on Hospital 30-Day Readmission Rates.

To reduce readmission rates and prevent adverse outcomes after discharge, hospitals have begun implementing “transitional care” initiatives. This systematic review identifies research on the particular set of services now reimbursable by Medicare (transitional care management [TCM]) and evaluates the studies for program effectiveness. Results of 3 databases were screened for peer-reviewed journal articles published between January 2004 and 2015 that report on readmissions of adults in the US health care system under the Medicare TCM bundle. ClinicalTrials.gov was queried for funded studies. Of 969 identified studies, 77 met inclusion criteria for relevance to transitional care and appropriateness of population and setting. Of these, only 3 articles incorporated all required elements for TCM service. Although 2 were program improvement designs and none were randomized controlled studies, each report reduced readmission rates. Evidence for TCM effectiveness is limited. Additional study of TCM implementation and programmatic support for TCM is warranted.

An examination of the perceived impact of a continuing interprofessional education experience on opiate prescribing practices

ABSTRACT Chronic pain is increasingly recognized as a public health problem. We assessed the effectiveness of a multi-modal, interprofessional educational approach aimed at empowering healthcare professionals to make deliberative changes, especially in opiate prescribing practices. Education activities included enduring webcasts, regional interprofessional roundtable events, and state-level conference presentations within targeted Kentucky and West Virginia regions of the United States. Over 1,000 participants accessed the various activities. For the live events, the largest groups reached included nurses (38.1%), nurse practitioners (31.2%), and physicians (22.1%). In addition to our reach, higher levels of educational effectiveness were measured, specifically, learner’s intentions to change practice patterns, confidence in meeting patient’s needs, and knowledge of pain management guidelines. The majority of the conference (58%) and roundtable (69%) participants stated they intend to make a practice change in one or more areas of chronic pain patient management in post-event evaluation. Differences in pre- and post-activity responses on the measures of confidence and knowledge, with additional comparison to a control population who were not in attendance, were analyzed using non-parametric tests of significance. While neither activity produced significant changes in confidence from pre-activity, participants were more confident post-activity than their control group peers. There were significant changes in knowledge for both live event and webcast participants. Impactful chronic pain continuing the education that emphasizes collaborative care is greatly needed; these results show that the approaches taken here can impact learner’s knowledge and confidence, and hold potential for creating change in how opioid prescribing is managed.

Effect of Ambulatory Transitional Care Management on 30-Day Readmission Rates:

A process improvement initiative for transitional care management (TCM) was evaluated for effectiveness in reducing 30-day readmission rates in a retrospective cohort study. Regression models analyzed the association between level of TCM component implementation and readmission rates among patients discharged from a university medical center hospital. Of the 1884 patients meeting inclusion criteria, only 3.7% (70) experienced a 30-day readmission. Patients receiving the full complement of TCM had 86.6% decreased odds of readmission compared with patients who did not receive TCM (P < .001). However, the complete package of TCM services under Medicare guidelines may not be essential. A postdischarge telephone call did not reduce readmission odds, provided a TCM office visit occurred. Important for risk assessment models targeting patients for TCM, the number of previous hospital admissions, not age, predicted 30-day readmission risk. This study provides evidence that primary care–based TCM can reduce 30-day readmissions even when overall rates are low.