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Objectives This study aimed to characterize the use and impact of assessments of understanding in parent-clinician communication for critically ill infants. Methods We enrolled parents and clinicians participating in family conferences for infants with neurologic conditions. Family conferences were audio recorded as they occurred. We used a directed content analysis approach to identify clinician assessments of understanding and parent responses to those assessments. Assessments were classified based on an adapted framework; responses were characterized as “absent,” “yes/no,” or “elaborated.” Results Fifty conferences involving the care of 25 infants were analyzed; these contained 374 distinct assessments of understanding. Most (n = 209/374, 56%) assessments were partial (i.e. okay?); a minority (n = 60/374, 16%) were open-ended. When clinicians asked open-ended questions, parents elaborated in their answers most of the time (n = 55/60, 92%). Approximately three-quarter of partial assessments yielded no verbal response from parents. No conferences included a teach-back. Conclusions Although common, most clinician assessments of understanding were partial or close-ended and rarely resulted in elaborated responses from parents. Open-ended assessments are an effective, underutilized strategy to increase parent engagement and clinician awareness of information needs. Practice implications Clinicians hoping to facilitate parent engagement and question-asking should rely on open-ended statements to assess understanding.

Purpose Adults who stutter (AWS) often attempt, with varying degrees of success, to suppress their stuttered speech. The ability to effectively suppress motoric behavior after initiation relies on executive functions such as nonselective inhibition. Although previous studies found that AWS were slower to inhibit manual, button-press response than adults who do not stutter (AWNS), research has yet to confirm a consistent relationship between manual and verbal inhibition. No study has examined verbal inhibition ability in AWS. The purpose of this study, therefore, is to compare verbal response inhibition between AWS and AWNS, and compare verbal response inhibition to both the overt stuttering and the lived experience of stuttering. Method Thirty-four adults (17 AWNS, 17 AWS) completed one manual and three verbal stop-signal tasks. AWS were assessed for stuttering severity (Stuttering Severity Instrument–Fourth Edition: SSI-4) and experience with stuttering (Overall Assessment of the Speaker's Experience With Stuttering [OASES]). Results Results indicate no correlation between manual and verbal inhibition for either group. Generalized linear mixed-model analyses suggested no significant group differences in manual or verbal inhibition. Manual and verbal inhibition did not predict SSI-4 in AWS. However, verbal inhibition was uniquely associated with OASES scores. Conclusion Although underlying manual and verbal inhibition was comparable between AWS and AWNS, verbal inhibition may be linked to the adverse experience of stuttering rather than the overt symptoms of stuttering severity. Supplemental Material https://doi.org/10.23641/asha.15145185

Objectives Children with limited hearing unilaterally might experience more listening effort than children with normal hearing, yet previous studies have not confirmed this. This study compared listening effort in school-age children with normal hearing and children with limited hearing unilaterally using behavioral and subjective listening effort measures. Design Two groups of school-age children (aged 7–12 years) participated: 19 with limited hearing unilaterally and 18 with normal hearing bilaterally. Participants completed digit triplet recognition tasks in quiet and in noise (−12 dB SNR) in three loudspeaker conditions: midline, direct, and indirect. Verbal response times during the recognition task were interpreted as behavioral listening effort. Subjective ratings of “task difficulty” and “hard to think” were interpreted as subjective listening effort. Participant age was included as a covariate in analysis of behavioral data. Results Noise negatively affected digit triplet recognition for both groups in the midline loudspeaker condition and for participants with limited hearing unilaterally in the direct and indirect conditions. Relative to their peers with normal hearing, children with limited hearing unilaterally exhibited significantly longer response times and higher ratings of effort only in the noisy, indirect condition. Differences between groups were evident even when age differences were controlled for statistically. Conclusions Using behavioral and subjective indices of listening effort, children with limited unilateral hearing demonstrated significantly more listening effort relative to their peers with normal hearing during the difficult indirect listening condition. Implications include classroom accommodations to limit indirect listening situations for children with limited useable hearing unilaterally and consideration of intervention options.

Purpose: To examine the concurrent and construct validity of numerically blinded ratings of perceived exertion (RPEs). Methods: A total of 30 elite male youth soccer players (age 16.7 [0.5] y) were monitored during training and matches over a 17-wk in-season period. The players’ external loads were determined via raw 10-Hz global positioning system. Heart rate (HR) was collected continuously and expressed as Bannister and Edwards training impulses, and minutes >80% of the players predetermined the maximum HR by the Yo-Yo Intermittent Recovery Test Level 1. RPE was collected confidentially 10 to 15 min after training/matches using 2 methods: (1) a traditional verbal response to the 0 to 100 category-ratio “centiMax” scale (RPE) and (2) numerically blinded RPE centiMax scale (RPEblind) with the response selected manually via a 5 × 7-in tablet “slider.” The RPE and RPEblind were divided by 10 and multiplied by the duration to derive the sessional RPE. Linear mixed models compared ratings, and within-subject repeated-measures correlations assessed the sessional RPE versus HR and external load associations. Results: There were no differences between the RPE and RPEblind (0.19; 95% confidence intervals, −0.59 to 0.20 au, P = .326) or their session values (13.5; 95% confidence intervals, −17.0 to 44.0 au, P = .386), and the ratings were nearly perfectly correlated (r = .96). The associations between the sessional RPE versus HR and external load metrics were large to very large (r = .65–.81), with no differences between the RPE methods (P ≥ .50). The RPEblind also reduced verbal anchor clustering and integer bias by 11% and 50%, respectively. Conclusions: RPEblind demonstrated concurrent and construct validity versus the traditional method, and may be used in situations where practitioners have concerns regarding the authenticity of athlete ratings.

Background Children with Williams syndrome (WS) show a marked interest in music, a characteristic often explored in clinical settings. However, the actual musical abilities of patients with WS remain debatable due to some of the relevant data being derived from experimental tasks that require a verbal response, despite the known language impairments in WS. The present study aimed to examine musical ability in children with WS using a newly invented pitch discrimination task with minimal involvement of language and clarify its relationship with language skill. Methods Eleven children with WS participated in the study. We used a novel pitch discrimination task that required minimal language use. Two piano tones were presented sequentially, and children were asked to give a non-verbal response as to whether the second tone was higher than, lower than, or the same as the first tone. Results Pitch discrimination performance in children with WS was lower than the level predicted for their chronological age (CA), even in the non-verbal task. Pitch discrimination ability and verbal mental age (VMA) were shown to be dissociated, such that children with WS with a lower skill level for language showed an unexpectedly higher level of pitch discrimination ability and vice versa. Conclusions Our results indicated reduced musical ability with respect to CA in children with WS. The dissociation between musical ability and language skills may indicate unique developmental relationships that differ from those in normal children. These findings provide new evidence to support the importance of assessing actual musical ability in WS prior to implementing interventional music therapy.

Objective To contribute to the limited body of eye movement (EM) studies of children and family members with congenital prosopagnosia (CP), a task requiring a verbal response for the identification of personally familiar faces was used for the 1st time. Method EMs were recorded in a father and his son (both diagnosed with CP) and controls (N = 2). In the identification tasks they watched personally familiar faces and distracters and responded by saying the names of the familiar faces or saying "I don't know." Two discrimination tasks were added to distinguish the specificity of the EM pattern for the recognition tasks. In all tasks, faces were presented 1 by 1 until the response onset; thus, the EM pattern was not saturated by overexposure to the stimulus. The 1st fixation position was examined to localize the 1st area of the face attended to. The spatial-temporal fixation pattern was examined to evaluate the attention devoted to specific regions. Results Both family members were inaccurate and slower than controls in the identification but not the discrimination tasks. In all tasks, they made a number of fixations comparable to those of controls but showed longer fixation durations than controls did. In the identification tasks, they showed poor spatial-temporal distribution of fixations on the eyes and rare 1st fixations on the eyes. Conclusions Consistent with the literature, both family members showed the typical reduced sampling of the eyes. Nevertheless, our protocol based on explicit verbal responses (which included EM only until response onset) showed that they did not increase the spatial sampling overall by making more fixations than controls did. Instead, they showed longer fixation durations across tasks; this was interpreted as a generalized problem with face processing in affording a more robust sampling of information. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Research on risk factors of suicide attempt has yielded little improvement in imminent risk detection for clinicians, due in part to the inherent limitations of self-report methodologies. Therefore, objective behavioral indicators of suicide risk that can be implemented practically with little cost in clinical settings are needed.The current study examined verbal response latency, measured as the length of time to answer a question asking about reasons for living (i.e.,Verbal response latency was significantly correlated with diminished wish to live at the participant level but was not significantly correlated with wish to die or overall severity of suicidal ideation.Verbal response latency may serve as an objective indicator of suicide risk. HighlightsResponse latency to a life construct may be an objective indicator of suicide riskDelayed response latency is indicative of diminished wish to livePathological mechanisms may manifest within dyadic interactions via verbal behaviors.

Purpose The Lidcombe Program is an efficacious and effective intervention for early stuttering. The treatment is based on parent verbal response contingent stimulation procedures, which are assumed to be responsible for treatment effect. The present trial tested this assumption. Method The design was a parallel, open plan, noninferiority randomized controlled trial. In the experimental arm, the five Lidcombe Program verbal contingencies were removed from parent instruction. The primary outcome was beyond-clinic percentage syllables stuttered at 18-month follow-up. Seventy-four children and their parents were randomized to one of the two treatment arms. Results Findings of noninferiority were inconclusive for the primary outcome of stuttering severity, based on a margin of 1.0 percentage syllables stuttered. Conclusions The inconclusive finding of noninferiority means it is possible that verbal contingencies make some contribution to the Lidcombe Program treatment effect. However, considering all primary and secondary outcomes, an overriding impression from the trial is a similarity of outcomes between the control and experimental arms. The clinical applications of the trial are discussed, along with further research that is needed.

BACKGROUND: Dentin hypersensitivity (DH) is a condition characterized by short and sharp episodes of pain which will arise in response to tactile, chemical, thermal, evaporative or osmotic stimuli. The painful symptoms cause discomfort in patients and reduce their quality of life. Recently, the novel zinc-containing desensitizer CAREDYNE Shield has been developed as a new type of desensitizer that acts by inducing chemical occlusion of dentinal tubules, and releasing zinc ion for root caries prevention. However, the clinical effectiveness of CAREDYNE Shield on DH remains unclear. Therefore, the aim of this study is to evaluate the effectiveness of CAREDYNE Shield on DH by comparing with that of another desensitizer, Nanoseal, commonly used in Japan. METHODS/DESIGN: This study protocol is a two-arm, parallel, pilot randomized controlled trial. Forty DH patients will be randomly allocated to two groups. Participants in the intervention group will be treated with CAREDYNE Shield, while those in the control group will be treated with Nanoseal. The primary outcome is the reduction of pain intensity in response to air stimuli measured with a 5-point verbal response scale from baseline to 4 weeks after the intervention, and Fisher's exact test will be used for analyses. DISCUSSION: CAREDYNE Shield can be casually applied to subgingival areas and proximal surfaces because it reacts with only tooth substance. Furthermore, zinc has been reported to reduce the demineralization of enamel and dentin and inhibit biofilm formation, plaque growth and dentin-collagen degradation. Therefore, CAREDYNE Shield may be expected to be a useful novel desensitizer that acts not only as a desensitizer but also as a root caries inhibitor. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), ID: UMIN000038072. Registered on 21 September 2019. TRIAL STATUS: This study (protocol version number: version 1.4.0; approved on 22 October 2019) is ongoing. The recruitment of participants began in December 2019 and will be continued until November 2020 (Hanke, Am Dent Assoc 27:1379-1393, 1940)., Trials, 21(1), art.no.464; 2020

OBJECTIVE Prospective memory (PM) is defined as the ability to remember to complete an intention in the future. The first aim of this study was to address the need for clinically useful measures of PM in children, by assessing the psychometric properties of a new measure of PM in children and adolescents, the Memory for Intentions Screening Test for Youth (MISTY). The second aim was to assess the relationship between prospective memory and age, particularly the relationships between age and the impact of different PM task demands. The third aim was to examine children's performance on different aspects of PM, such as time-based versus event-based cues. METHOD One-hundred twenty-four children between the ages of 4 and 15 were given the MISTY. RESULTS Analyses revealed good internal consistency among the eight individual MISTY trials and among the six MISTY subscales which included two different cue types (event-based and time-based), two different time delays (2 minutes and 10 minutes), and two different response types (action and verbal). Results also revealed good split-half and inter-rater reliability. Findings highlighted significant correlations between age and the MISTY total score and all subscales, consistent with PM lifespan research. On the MISTY, children overall performed better on event-based cues than on time-based cues, and on shorter time delays than longer ones; there was no effect of response type (i.e. action vs. verbal response). CONCLUSIONS The MISTY is a promising instrument with sound psychometric properties that could be useful in both clinical and research settings. Additionally, this study highlights the age-related process of PM development in children.

Background: intensive care units frequently use the Glasgow Coma Scale to objectively assess patients’ levels of consciousness. Interobserver reliability of Glasgow Coma Scale scores is critical in determining the degree of impairment. Objective: to evaluate interobserver reliability of intensive care unit patients’ Glasgow Coma Scale scores. Methods: this prospective observational study evaluated Glasgow Coma Scale scoring agreement among 21 intensive care unit nurses and 2 independent researchers who assessed 202 patients with neurosurgi-cal or neurological diseases. Each assessment was completed independently and within 1 minute. Partici-pants had no knowledge of the others’ assessments. Results: agreement between Glasgow Coma Scale component and sum scores recorded by the 2 researchers ranged from 89.5% to 95.9% (P = .001). Significant agreement among nurses and the 2 researchers was found for eye response (73.8%), motor response (75.0%), verbal response (68.1%), and sum scores (62.4%) (all P = .001). Significant agreement among nurses and the 2 researchers (55.2%) was also found for sum scores of patients with sum scores of 10 or less (P = .03). Conclusions: although the study showed near-perfect agreement between the 2 researchers’ Glasgow Coma Scale scores, agreement among nurses and the 2 researchers was moderate (not near perfect) for sub-component and sum scores. Accurate Glasgow Coma Scale evaluation requires that intensive care unit nurses have adequate knowledge and skills. Educational strategies such as simulations or orientation practice with a preceptor nurse can help develop such skills., NA

Background Epistemic Network Analysis (ENA) is a technique for modeling and comparing the structure of connections between elements in coded data. We hypothesized that connections among team discourse elements as modeled by ENA would predict the quality of team performance in trauma simulation. Methods The Modified Non-technical Skills Scale for Trauma (T-NOTECHS) was used to score a simulation-based trauma team resuscitation. Sixteen teams of 5 trainees participated. Dialogue was coded using Verbal Response Modes (VRM), a speech classification system. ENA was used to model the connections between VRM codes. ENA models of teams with lesser T-NOTECHS scores ( n = 9, mean = 16.98, standard deviation [SD] = 1.45) were compared with models of teams with greater T-NOTECHS scores ( n = 7, mean = 21.02, SD = 1.09). Results Teams had different patterns of connections among VRM speech form codes with regard to connections among questions and edifications (meanHIGH = 0.115, meanLOW = −0.089; t = 2.21; P = .046, Cohen d = 1.021). Greater-scoring groups had stronger connections between stating information and providing acknowledgments, confirmation, or advising. Lesser-scoring groups had a stronger connection between asking questions and stating information. Discourse data suggest that this pattern reflected increased uncertainty. Lesser-scoring groups also had stronger connections from edifications to disclosures (revealing thoughts, feelings, and intentions) and interpretations (explaining, judging, and evaluating the behavior of others). Conclusion ENA is a novel and valid method to assess communication among trauma teams. Differences in communication among higher- and lower-performing teams appear to result from the ways teams use questions. ENA allowed us to identify targets for improvement related to the use of questions and stating information by team members.

Objective To describe holistic, empathic, and person-centered approaches to communication and apply these to the context of oncology nurse-provided responses to patients’ expressions of spiritual concern. Data Sources Conceptual, empirical, and practice literature about communication, primarily from the disciplines of psychology and communication sciences, is resourced to inform this practice-oriented discussion. Conclusion Holistic, empathetic, and person-centered models for communication are complementary, and although there is overlap, there is also distinct value added from each. Implications for Nursing Practice Each model offers excellent guidance for nurses seeking to provide a therapeutic verbal response during spiritual care for people affected by cancer.

Objective: A child’s pediatric intensive care unit (PICU) admission may have wide-ranging family implications. We assessed nonmedical out-of-pocket expenses (NMOOPEs) and disruptions in work and normal life for parents with a child admitted to the PICU for at least 2 days with acute, new onset, or exacerbation of a critical condition. Design: We conducted a prospective, single-center study; administered a daily verbal response survey on NMOOPEs; stratified families by annual income ($100 000); and calculated daily expenditures (DEs), estimated daily budgets (DBs), and percentage of NMOOPEs (%DE/DB). We used a modified caregiver version of the Work Productivity and Activity Impairment Scale to assess the impact of PICU admission on work-related and normal life activities. Setting: The PICU in an academic, tertiary medical center in the United States. Patients: Patients admitted to PICU. Interventions: None. Measurements and Main Results: The study included 38 families, with median length of PICU stay of 3 days (range 3-13). The mean total NMOOPE was $127 ± $107 (range $5-$511). Financial impact of DB in the 3 annual income groups ranged from 0% to 136% (median 36%), 5% to 18% (median 10%), and 4% to 39% (median 16%), respectively. Total work absenteeism for cohort was 78 days. High levels of distraction were reported in working families, and normal daily activities were interrupted or suspended. Conclusions: PICU hospitalization results in a range of direct NMOOPEs of varying burden on families and additional work productivity impact. Further research to understand the array of financial implications on families and additional mitigation strategies are needed.

PurposeThe purpose of this study was to examine (a) explicit and implicit verbal response inhibition in preschool children who do stutter (CWS) and do not stutter (CWNS) and (b) the relationship between response inhibition and language skills.MethodParticipants were 41 CWS and 41 CWNS between the ages of 3;1 and 6;1 (years;months). Explicit verbal response inhibition was measured using a computerized version of the grass–snow task (Carlson & Moses, 2001), and implicit verbal response inhibition was measured using the baa–meow task. Main dependent variables were reaction time and accuracy.ResultsThe CWS were significantly less accurate than the CWNS on the implicit task, but not the explicit task. The CWS also exhibited slower reaction times than the CWNS on both tasks. Between-group differences in performance could not be attributed to working memory demands. Overall, children's performance on the inhibition tasks corresponded with parents' perceptions of their children's inhibition skills in daily life.ConclusionsCWS are less effective and efficient than CWNS in suppressing a dominant response while executing a conflicting response in the verbal domain.

Background Neurological illness can produce a disorganization of behavior, including verbal disinhibition, despite apparent preserved intelligence. Neuropsychological tests of such behavioral control mechanisms may predict real-world performance of healthy people, such as success or misbehavior in educational contexts. Method In two separate studies, we examined how the Hayling Test of verbal response suppression predicts grades and classroom misbehavior. Results Verbal suppression errors and spontaneous strategy use were significant predictors of undergraduate grades. Using a modified version of the Hayling Test designed to reduce strategic responding with high school students (mean age 16), higher grades were predicted by shorter response suppression latencies and better working memory scores, and classroom misbehavior was predicted by lower working memory scores. Conclusion Verbal response suppression and spontaneous strategy use, both closely linked to disorganized behavior in neuropsychological patients, predict academic achievement but seem unrelated to classroom misbehavior, which is associated with weakness in working memory.

Even when speakers are not actively doing another task, they can be interfered in their speech planning by concurrent auditory stimuli. In this study, we used picture naming with passive hearing, or active listening, combined to high-density electroencephalographic (EEG) recordings to investigate the locus and origin of interference on speech production. Participants named pictures while ignoring (or paying attention to) auditory syllables presented at different intervals (+150 ms, +300 ms or +450 ms). Interference of passive hearing was observed at all positive stimulus onset asynchronies (SOA) including when distractors appeared 450 ms after picture onset. Analyses of ERPs and microstates revealed modulations appearing in a time-window close to verbal response onset likely relating to post-lexical planning processes. A shift of latency of the N1 auditory component for syllables displayed 450 ms after picture onset relative to hearing in isolation was also observed. Data from picture naming with active listening to auditory syllables also pointed to post-lexical interference. The present study suggests that, beyond the lexical stage, post-lexical processes can be interfered and that the reciprocal interference between utterance planning and hearing relies on attentional demand and possibly competing neural substrates.

Autism spectrum disorders (ASD) and schizophrenia (SZ) are both associated with response inhibition impairment. However, the relative pattern of deficits in these two disorders remains unclear. Twenty-three male children with ASD, 23 male children with SZ, and 32 typically developing male controls were recruited to complete a set of tasks measuring response inhibition in the visual, auditory, and verbal domains. We found that visual, auditory, and verbal response inhibitions were impaired in both children with ASD and children with SZ. Compared with typically developing controls, children with ASD made more commission errors whereas children with SZ responded much slower in the visual response inhibition task. Both clinical groups showed comparable impairment in verbal response inhibition, but children with SZ were more impaired in auditory response inhibition than children with ASD. These different patterns of response inhibition deficit between male children with ASD and SZ may help to differentiate between these two disorders and may be potential targets for intervention. Autism Res 2020, 13: 591-602. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this study, we found that male children with autism spectrum disorder (ASD) made more commission errors whereas male children with schizophrenia (SZ) responded much slower in the visual response inhibition task. Both clinical groups exhibited comparable impairments in verbal response inhibition, but male children with SZ were more impaired in auditory response inhibition than male children with ASD. Our findings provide potential targets for intervention.

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Objectives: This paper reports two related analyses of verbal material from seven Living Well with Dementia groups: the first examines changes in the verbal behaviours of participants across the course of the sessions in all seven groups; while the second contrasts therapist behaviour in two groups. Methods: In the first analysis, recordings of three sessions from each group were transcribed and participant descriptions of dementia were analysed using the Markers of Assimilation of Problematic Experiences of Dementia (MAPED) rating procedure. In the second analysis, therapist behaviour in weeks 2 and 8 from two groups (F and G) was analysed using the Hill Counsellor Verbal response rating scale. Inter-rater reliabilities for the two sets of ratings were ‘good’ and ‘very good’, respectively. Results: For the MAPED ratings, a five by four contingency table was analysed using chi-squared, which indicated a highly significant change in assimilation. There were significant higher levels of level 1 and 2 markers in the first two sessions and level 4 for sessions 5 and 6. Facilitators used significantly more direct guidance and information giving behaviour in the second session at Location F compared to Location G. Conclusions: The results suggest that important changes occurred in the way that dementia was described across the seven LivDem groups: this includes both reductions in the avoidance of direct references to dementia after the first two sessions, as well as an increase in ‘insight’ statements. Directive facilitator behaviour may be associated with poorer outcomes.

Objective: This study investigates whether performance in a verbal response task ( Color-Word Interference Test [CWIT]) and a motor response task ( Conners’ Continuous Performance Test [CCPT]) discriminates children with Tourette’s Syndrome (TS), ADHD, and typically developing children (TDC). Method: Nineteen children with TS, 79 with ADHD, and 50 with TDC participated (8-17 years). Results: Children with TS committed significantly fewer errors in the verbal response task than those with ADHD. Moreover, children with TS but without ADHD performed better than TDC. Errors in motor task and speed of response did not distinguish between groups. A cautious tendency of response correlated positively with rates of tics in children with TS. Conclusion: Children with TS were superior in inhibiting a prepotent verbal response; however, comorbidity with ADHD in those children negatively influenced performance. Results support the hypothesis that levels of inhibitory control distinguish children with TS, ADHD, and TDC.

The pediatric Glasgow coma scale (pGCS) is a consciousness score that, although widely applied, requires skill to apply. The AVPU scale uses four simple categories (Alert; Verbal response; response to Pain; Unresponsive), but has not been studied in a large pediatric population. We compared the performance of the AVPU and pGCS scales in a large pediatric cohort in an acute, prehospital setting.In a six-month-long prospective cohort study, AVPU and pGCS scores were determined by emergency physicians in children less than 10 years of age at their first prehospital encounter.We included 302 children (median age 2.3 years) with a broad spectrum of diagnoses. Data were complete for 287 children. AVPU and pGCS scores showed good a correlation in the extreme categories A and U (positive predictive values of 98% and 100%, respectively). Corresponding pGCS scores for each AVPU category were as follows: 11-15 for A; 5-15 for V; 4-12 for P; and 3-5 for U. The positive predictive value to detect patients with pGCS ≥ 8 for AVPU category V was 100%.We demonstrated good correlation of simple and fast consciousness AVPU scoring to the standard pGCS in a large cohort of pediatric patients in a prehospital setting. The AVPU category "V" identifies patients with a pGCS of or exceeding 8 and, therefore, identifies children at low risk requiring more invasive procedures or intensive care treatment.Glasgow coma scale (GCS); Alert-verbal-pain-unresponsive-score; AVPU-score; consciousness assessment; children, pediatric emergency.

We here quantify the qualities of language. Specifically, we derive numerical values, and associated variability scores for statements of general probability as well as for anchor terms commonly expressed on Likert-type scales. Our results show significant inter-responder variability in the understanding of such terms. We also demonstrate scale compression such that average estimates are poorly aligned to the a priori expectations of equal response spacing in commonly used verbal response instruments. Terms further show intriguing propensities such that people agree more about statements of agreement, but manifestly disagree more about statements of disagreement. The valence of these terms is thus systematically related to their degree of common understanding. The accuracy of language, especially when used in conjunction with modern advanced technologies, proves vital for effective communication. Our work demonstrates that the tool of language still remains a fairly blunt one, but one that can be sharpened by systematic quantitative evaluation, as we demonstrate here.

This study examined verbal response times—that is, the duration from stimulus offset to voice onset—as a potential measure of cognitive load during conventional testing of speech-in-noise understanding. Response times were compared with a measure of perceived effort as assessed by listening effort scaling. Three listener groups differing in age and hearing status participated in the study. Testing was done at two target intelligibility levels (80%, 95%) and with two noise types (stationary and fluctuating). Verbal response times reflected effects of intelligibility level, noise type, and listener group. Response times were shorter for 95% compared with 80% target intelligibility, shorter for fluctuating compared with stationary noise, and shorter for young listeners compared with older listeners. Responses were also faster for the older listeners with near normal hearing compared with the older hearing-aid users. In contrast, subjective listening effort scaling predominantly revealed effects of target intelligibility level but did not show consistent noise-type or listener-group effects. These findings show that verbal response times and effort scalings tap into different domains of listening effort. Verbal response times can be easily assessed during conventional speech audiometry and have the potential to show effects beyond performance measures and subjective effort estimates.

The present study investigated the interplay between selective inhibition (the ability to suppress specific competing responses) and nonselective inhibition (the ability to suppress any inappropriate response) during single word production. To this end, we combined two well-established research paradigms: the picture-word interference task and the stop-signal task. Selective inhibition was assessed by instructing participants to name target pictures (e.g., dog) in the presence of semantically related (e.g., cat) or unrelated (e.g., window) distractor words. Nonselective inhibition was tested by occasionally presenting a visual stop-signal, indicating that participants should withhold their verbal response. The stop-signal was presented early (250 ms) aimed at interrupting the lexical selection stage, and late (325 ms) to influence the word-encoding stage of the speech production process. We found longer naming latencies for pictures with semantically related distractors than with unrelated distractors (semantic interference effect). The results further showed that, at both delays, stopping latencies (i.e., stop-signal RTs) were prolonged for naming pictures with semantically related distractors compared to pictures with unrelated distractors. Taken together, our findings suggest that selective and nonselective inhibition, at least partly, share a common inhibitory mechanism during different stages of the speech production process.

The ideomotor principle states that actions are represented by their anticipated sensory effects. This notion is often tested using the response-effect compatibility (REC) paradigm, where participants' responses are followed either by a compatible or incompatible response effect (e.g., an effect on the right side after a right-hand response is considered R-E compatible due to the spatial overlap, whereas an effect on the left side after the right-hand response is considered incompatible). Shorter reaction times are typically observed in the compatible condition compared to the incompatible condition (i.e., REC effect), suggesting that effect anticipation plays a role in action control. Previous evidence from verbal REC suggested that effect anticipation can be due to conceptual R-E overlap, but there was also phonological overlap (i.e., anticipated reading of a word preceded by the vocal response of saying that very word). To examine the representational basis of REC, in three experiments, we introduced a bilingual R-E mapping to exclude phonological R-E overlap (i.e., in the R-E compatible condition, the translation equivalent of the response word is presented as an effect word in a different language). Our findings show that the REC effect is obtained when presenting the effect word in the same language as the response (i.e., monolingual condition), but the compatibility effect was not found when the semantically same word is presented in a different language, suggesting no conceptually generalized REC in a bilingual setting. (232 words).

Verbal responses are a convenient and naturalistic way for participants to provide data in psychological experiments (Salzinger, The Journal of General Psychology, 61(1),65-94:1959). However, audio recordings of verbal responses typically require additional processing, such as transcribing the recordings into text, as compared with other behavioral response modalities (e.g., typed responses, button presses, etc.). Further, the transcription process is often tedious and time-intensive, requiring human listeners to manually examine each moment of recorded speech. Here we evaluate the performance of a state-of-the-art speech recognition algorithm (Halpern et al., 2016) in transcribing audio data into text during a list-learning experiment. We compare transcripts made by human annotators to the computer-generated transcripts. Both sets of transcripts matched to a high degree and exhibited similar statistical properties, in terms of the participants' recall performance and recall dynamics that the transcripts captured. This proof-of-concept study suggests that speech-to-text engines could provide a cheap, reliable, and rapid means of automatically transcribing speech data in psychological experiments. Further, our findings open the door for verbal response experiments that scale to thousands of participants (e.g., administered online), as well as a new generation of experiments that decode speech on the fly and adapt experimental parameters based on participants' prior responses.

Background Even though research in turn-taking in spoken dialogues is now abundant, a typical EEG-signature associated with the anticipation of turn-ends has not yet been identified until now. New method The purpose of this study was to examine if readiness potentials (RP) can be used to study the anticipation of turn-ends by using it in a motoric finger movement and articulatory movement task. The goal was to determine the preconscious onset of turn-end anticipation in early, preconscious turn-end anticipation processes by the simultaneous registration of EEG measures (RP) and behavioural measures (anticipation timing accuracy, ATA). For our behavioural measures, we used both button-press and verbal response (“yes”). In the experiment, 30 subjects were asked to listen to auditorily presented utterances and press a button or utter a brief verbal response when they expected the end of the turn. During the task, a 32-channel-EEG signal was recorded. Results The results showed that the RPs during verbal- and button-press-responses developed similarly and had an almost identical time course: the RP signals started to develop 1170 vs. 1190 ms before the behavioural responses. Comparison with existing methods Until now, turn-end anticipation is usually studied using behavioural methods, for instance by measuring the anticipation timing accuracy, which is a measurement that reflects conscious behavioural processes and is insensitive to preconscious anticipation processes. Conclusion The similar time course of the recorded RP signals for both verbal- and button-press responses provide evidence for the validity of using RPs as an online marker for response preparation in turn-taking and spoken dialogue research.

Purpose The purpose of this study was to investigate the influence of phonetic complexity as measured by the Word Complexity Measure (WCM) on the speed of single-word production in adults who do (AWS, n = 15) and do not stutter (AWNS, n = 15). Method Participants were required to name pictures of high versus low phonetic complexity and balanced for lexical properties. Speech reaction time was recorded from initial presentation of the picture to verbal response of participant for each word type. Accuracy and fluency were manually coded for each production. Results AWS named pictures significantly slower than AWNS, but there were no significant differences observed in response latency when producing word of high versus low phonetic complexity as measured by the WCM. Conclusion Findings corroborate past research of overall slowed picture naming latencies in AWS, compared to AWNS. Findings conflict with data that suggest that the phonetic complexity of words uniquely compromises the speed of production in AWS. The potential interaction between lexical and phonetic factors on single-word production within each group are discussed.

Objective To determine the strength of the correlation between the Hunt and Hess scale, Fisher score, Brussels coma score, World Federation of Neurosurgeons score, and Glasgow coma score and health-related quality of life. Methods Evaluable questionnaires from 236 patients (5.6 years [± standard deviation, 2.854 years] on average after hemorrhage) were included in the analysis. Quality of life was documented using the MOS-36 item short form health survey. Because of the ordinal nature of the variables, Kendall tau was used for calculation. Significance was established as P ≤ 0.05. Results Weak and very weak correlations were found in general ( r ≤ 0.28). The strongest correlations were found between the Glasgow coma score and quality of life ( r = 0.236, P = 0.0001). In particular, the "best verbal response" achieved the strongest correlations in the comparison, at r = 0.28/ P = 0.0001. The Fisher score showed very weak correlations ( r = −0.148/ P = 0.012). The Brussels coma score ( r = −0.216/ P = 0.0001), Hunt and Hess scale ( r = −0.197/ P = 0.0001), and the World Federation of Neurosurgeons score ( r = −0.185/ P = 0.0001) revealed stronger correlations, especially in terms of the physical aspects of quality of life. Conclusions The Glasgow coma scale revealed the strongest, and the Fisher score showed the weakest correlations. Thus the Fisher score, as an indicator of the severity of a hemorrhage, has little significance in terms of health-related quality of life.

For each of four therapists, we studied two clients who did not return after intake (non-engagers) and two clients who continued for at least eight sessions of psychodynamic psychotherapy (engagers), for a total of 16 cases yielding 3877 therapist verbal response units. Engagers and non-engagers did not differ in terms of working alliance measured after the intake session. In terms of therapist verbal response modes for non-engagers compared to engagers, therapists used more approval-reassurance in the beginning third of intake sessions, and more reflections of feeling but less information about the helping process in the last third of intake sessions. Non-engagers had higher pre-intake attachment anxiety than engagers. Implications for practice and research are discussed.

The comparative effects of different types of empathic verbal responses were identified through a quantitative, experimental study. In particular, the study explored how reflection and validation interacted with negative emotions among 80 university student participants (29 men, 51 women). Participants were manipulated to experience social exclusion through a game and were randomly assigned to 1 of 3 groups (control/reflection/validation). Findings indicated varied levels of affects among groups. Both reflection and validation as an empathic verbal response increased sense of belonging, whereas validation increased self-esteem more than reflection did. Moreover, validation was more effective than reflection in lowering both negative mood and aggression toward the people who excluded the participant. Implications and future directions for research and training are discussed.

Purpose: The aim of this study was to evaluate the translated response categories used in eight translations of the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire, which is used in many international clinical trials. Twenty-eight of the 30 items in the questionnaire have the same four response categories: "Not at all", "A little", "Quite a bit" and "Very Much".Methods: People with knowledge of both English and one of eight European languages were asked to complete an Internet survey. The strength (intensity) of the translated categories was assessed using two separate approaches: one using a verbal response scale and the other a visual analogue scale (VAS).Results: Two hundred and seventy-nine people participated in the survey. Most translations were rated similarly to English. The largest differences were for the German translation of "Quite a bit", which was rated 16.3 points lower than the corresponding English category on a 0-100 VAS.Conclusions: Most of the translated categories were found to be similar to the English versions and should continue to be used. We recommend that three translated categories should be considered for revision. Similar surveys could be used to assess the categories used in other translated quality of life instruments.

Background The memory effect of dexmedetomidine has not been prospectively evaluated in children. We evaluated the feasibility of measuring memory and sedation responses in children during dexmedetomidine sedation for non-painful radiological imaging studies. Secondarily, we quantified changes in memory in relation to the onset of sedation. Methods A 10 min bolus of dexmedetomidine (2 mcg kg−1) was given to children as they named simple line drawings every five s. The absence of sedation was identified as any verbal response, regardless of correctness. After recovery, recognition memory was tested with correct Yes/No recognitions (50% novel pictures) and was matched to sedation responses during the bolus period (subsequent memory paradigm). Results Of 64 accruals, 30 children (mean [SD]6.1 (1.2) yr, eight male) received dexmedetomidine and completed all study tasks. Individual responses were able to be modelled successfully in the 30 children completing all the study tasks, demonstrating feasibility of this approach. Children had 50% probability of verbal response at five min 40 s after infusion start, whereas 50% probability of subsequent recognition memory occurred sooner at four min five s. Conclusions Quantifying memory and sedation effects during dexmedetomidine infusion in verbal children was possible and demonstrated that memory function was present until shortly before verbal unresponsiveness occurred. This is the first study to investigate the effect of dexmedetomidine on memory in children. Clinical trial registration NCT 02354378.

Summary When providing total intravenous anaesthesia, careful selection of end-points is required in titrating dose to effect during induction. Although propofol and remifentanil have predominantly different pharmacodynamic effects, they are seen to interact in achieving loss of consciousness and analgesia. To highlight these differences, we performed a double-blind, randomised controlled trial, comparing one group of patients receiving propofol alone (n = 42) with another group receiving remifentanil plus propofol (n = 46) as a target-controlled infusion of remifentanil (Minto; 3 ng.ml−1). Propofol was also titrated using a target-controlled infusion (Marsh effect model) to produce loss of response to tactile and vocal stimuli, and subsequently to loss of response to pain. The effect-site concentration of propofol at which 50% of patients lost tactile/verbal response was 2.9 μg.ml−1 in the propofol only group and 2.4 μg.ml−1 in the remifentanil with propofol group. In contrast, loss of pain response occurred at 4.4 μg.ml−1 in the propofol group, and 2.7 μg.ml−1 in the remifentanil with propofol group, with correspondingly lower bispectral index values. Judicious use of analgesia in total intravenous anaesthesia can have a propofol-sparing effect and potentially minimise the suppression of brain electrical activity.

Understanding the processes that make responses prepotent is central to understanding the role of inhibitory control in cognitive development. The question of what makes responses prepotent was investigated using the two most widely studied measures of preschoolers' inhibitory control. Across two experiments, 80 children were tested either on a series of stimulus-response compatibility (SRC) tasks or on a series of Go/No-go tasks. Results indicated that high levels of prepotency on SRC tasks (such as the Day/Night task) occur only under specific conditions; making a verbal response can be highly prepotent if the stimulus and response are associated with each other (e.g., saying "cup" to a cup) but is less prepotent when they are unassociated (e.g., saying "cup" to a doorstop). Action responses (e.g., lifting a cup to your mouth) show little prepotency irrespective of whether the stimulus and response are associated. In contrast, with Go/No-go tasks, a much wider variety of behaviors are highly prepotent regardless of whether the stimulus and response are associated. These data suggest that prepotency arises in very different ways, depending on the type of task used. Although both Go/No-go tasks and SRC tasks can make inhibitory demands, they do so for fundamentally different reasons.

Purpose: Assessing toddlers’ speech is challenging. We explored responses made by late talkers and their typically developing peers in structured speech sampling contexts and determined if late talker subgroups could be identified. Method: Twenty-six late talkers and 26 age-matched typically developing toddlers participated in an expressive phonology assessment and an elicited non-word imitation test. We quantified the breadth of toddler responses used in a subset of monosyllabic stimuli from the toddler phonology assessment and in the non-word imitation test. Correlational and cluster analyses were conducted. Result: There were six response types: no response, protoword response, different verbal response, correct phoneme, common and uncommon phonological errors. Toddlers’ use of most of the response types correlated across the two sampling contexts. Use of the response types also correlated with several direct and parent-report assessments. There were significant group differences in the use of several response types in both sampling contexts. Five late talker subgroups were identified that presented with differing profiles of responses. Conclusion: Toddlers respond in a variety of ways during structured speech sampling contexts. Responses made by late talkers offer insights about the nature of late talking and their heterogeneity. Implications for research and clinical management of late talkers are discussed.

Background: Two population surveys were conducted in Belarus: The Living Conditions, Lifestyle and Health (LLH) in 2001 ( n = 2000) and The Health in Times of Transition (HITT) in 2010 ( n = 1800). Each survey included a question on health status. The LLH questionnaire provided a 4-point Verbal Response Scale, but the HITT questionnaire used a 5-point scale. When translated into Russian, only two response categories of these scales had identical wording. These differences made a direct comparison of self-reported health status between 2001 and 2010 difficult. Methods: We conducted a Health Category Response Scale (HCRS) survey in 2010 ( n = 570) using a 100ths graduated Visual Analogue Scale (VAS) to understand how the response categories of different scales are perceived by Russian speakers. We implemented the HCRS survey’s data to calculate the weighted health status (WHS) for each of the original surveys and to compare health status in Belarus between 2001and 2010. Results: The WHS in Belarus showed a small, but statistically significant, improvement of 2.9 points on a 0–100 scale between 2001 and 2010 (56.2 vs. 59.1). Identical response categories were perceived differently on a 4-point and 5-point VAS. The category ‘good’ (‘Хорошее’) measured ∼12 points higher, and the category ‘bad/poor’ (‘Плохое’) measured ∼16 points lower, on the 4-point compared with the 5-point VAS. Conclusion: Our HCRS survey and novel method enabled a direct comparison of questions with different response options. When applied to the LLH and HITT projects, we concluded that health status in Belarus has improved between 2001 and 2010.

We propose modified versions of the line-bisection task for assessing visual bias and effect of proprioceptive feedback in unilateral neglect; that is, the verbal line-bisection (VLB) task and the VLB plus pointing task. The VLB task requires only a verbal response to assess pure visual bias. Conversely, the VLB plus pointing task requires both a verbal response and pointing to assess visual and proprioceptive bias. Ten patients with unilateral neglect were administered these tasks on a computer using presentation software. Eight participants showed obvious rightward deviation in the VLB task, and were thus classified as patients with visual neglect. Four participants showed significantly greater deviation in the VLB plus pointing task than in the VLB task, and were thus classified as patients with proprioceptive bias. Visual bias and effect of proprioceptive feedback in unilateral neglect were successfully assessed by these tasks.

We analyzed the effects of verbal mediating responses on the acquisition and generalization of say–do correspondence and noncorrespondence. Participants were assigned to groups in which either reinforcers (feedback and tokens) were arranged for say–do correspondence and noncorrespondence, or no reinforcers were programmed. Participants in these groups were further subdivided into groups in which they were required to repeat what was said previously, were required to repeat random numbers, or no verbalizations were required. When correspondence was reinforced, repetition of what was said produced greater acquisition and generalization of correspondence. When noncorrespondence was reinforced, repetition of numbers facilitated acquisition and generalization of noncorrespondence. Verbal mediating responses interacted with contingencies of reinforcement in determining acquisition and generalization of correspondence and noncorrespondence.

Using physiological measures, concealed information can be validly assessed. Orienting theory has been proposed to account for concealed information testing. As orienting is characterized by heart rate deceleration, one would expect this type of heart rate response to concealed information. However, with some exceptions, an initial heart rate acceleration to concealed information is typically observed. In the present paper, we examine the role of verbalization to explain the mixed pattern of heart rate changes. Using a within-subjects design, 30 participants were asked to either remain silent or to give an overt verbal response ("yes"/"no") to concealed autobiographical and control information. The results indicate that verbalization accounts for the initial heart rate acceleration. In line with the orienting theory, initial heart rate deceleration is observed when participants remained silent.

Two response measures for reporting visually perceived egocentric distances-verbal judgments and blind manual reaches-were compared using a within-trial methodology. The expected range of possible target distances was manipulated by instructing the subjects that the targets would be between .50 and 1.00 of their maximum arm reach in one session and between .25 and .90 in another session. The actual range of target distances was always .50-.90. Verbal responses varied as a function of the range of expected distances, whereas simultaneous reaches remained unaffected. These results suggest that verbal responses are subject to a cognitive influence that does not affect actions. It is suggested that action responses are indicative of absolute perception, whereas cognitive responses may reflect only relative perception. The results also indicate that the dependant variable utilized for the study of depth perception will influence the obtained results.

In the field of developmental psychology, there is speculation that pointing gestures by infants are good precursors of infant language acquisition, and some researchers have found correlations between these pointing gestures and some indices of language acquisition. Infants' pointing gestures are presumably related to language acquisition because they provoke verbal responses from adults. To test this, seven boys and six girls were observed during free play time in a nursery classroom, and post-pointing and matched-control data were collected. Comparison between these data confirmed that the nursery staff spoke to infants at a significantly earlier stage in post-pointing sequences, compared with control sequences, indicating that pointing gestures elicit verbal responses from adult caregivers.

The roles of visual and haptic experience in different aspects of haptic processing of objects in peripersonal space are examined. In three trials, early-blind, late-blind, and blindfolded-sighted individuals had to match ten shapes haptically to the cut-outs in a board as fast as possible. Both blind groups were much faster than the sighted in all three trials. All three groups improved considerably from trial to trial. In particular, the sighted group showed a strong improvement from the first to the second trial. While superiority of the blind remained for speeded matching after rotation of the stimulus frame, coordinate positional-memory scores in a non-speeded free-recall trial showed no significant differences between the groups. Moreover, when assessed with a verbal response, categorical spatial-memory appeared strongest in the late-blind group. The role of haptic and visual experience thus appears to depend on the task aspect tested.

Developed as an alternative to traditional deception detection methods, the concealed information test (CIT) assesses recognition of critical (e.g., crime‐relevant) “probes.” Most often, recognition has been measured as enhanced skin conductance responses (SCRs) to probes compared to irrelevant foils (CIT effect). More recently, also differentially enlarged reaction times (RTs) and increased neural activity in the bilateral inferior frontal gyrus, the right middle frontal gyrus, and the right temporo‐parietal junction have been observed. The aims of the current functional magnetic resonance imaging (fMRI) study were to (1) investigate the boundary conditions of the CIT effects in all three measures and thereby (2) gain more insight into the relative contribution of two mechanisms underlying enhanced responding to concealed information (i.e., orienting versus response inhibition). Therefore, we manipulated the proportion of probe versus irrelevant items, and whether suspects were instructed to actively deny recognition of probe knowledge (i.e., deceive) during the test. Results revealed that whereas overt deception was not necessary for the SCR CIT effect, it was crucial for the RT and the fMRI‐based CIT effects. The proportion manipulation enhanced the CIT effect in all three measures. The results indicate that different mental processes might underlie the response pattern in the CIT. While skin conductance responding to concealed information may best be explained by orienting theory, it seems that response inhibition drives RT and blood oxygen level dependent responding to concealed information. Hum Brain Mapp 36:427–439, 2015. © 2014 Wiley Periodicals, Inc.

Cerebral Palsy (CP) is a clinical syndrome involving postural and motor deficits. CP children are less accurate than healthy ones when trying to reach a target. Thus, it is difficult for CP children to perform anticipation-coincidence tasks requiring temporal and/or spatial accuracy to reach the target at the good place in the right time. The purpose of the present experiment was to further investigate CP children’s ability to perform anticipation-coincidence tasks, by dissociating the cognitive from the motor aspects of the task. 11 CP children aged 6–14 years, 51 healthy children aged 6–13 years, and 13 healthy adults performed, as accurately as possible, a coincidence-timing in response to a specific sound of a musical sequence. Two experimental conditions were manipulated: In the verbal condition, temporal estimation occurred through a simple verbal response whereas in the motor condition, temporal estimation was performed by reaching a target at a self-paced velocity. In the verbal condition, CP children made similar temporal errors than their healthy counterpart. However, even though all participants underestimated stimulus occurrence, CP children also exhibited greater and more variable temporal errors when they provided a motor response for estimating stimulus occurrence. These data suggested that CP children were able to anticipate stimulus occurrence and to partially take into account their sensory-motor deficits to reach the target at this time occurrence.

This study reports three cases of synaesthesia who experience colors in response to written musical notation, graphemes and heard music. The synaesthetes show Stroop-like interference when asked to name the colour of graphemes but not for written musical notes. However, reliable interference is found in two further studies that require deeper processing of the musical notation (namely playing music from colored notation, and naming the synaesthetic color of the notes whilst suppressing the veridical color). This is the first empirical demonstration of synaesthesia for musical notation. The fact that synaesthetic color influences music playing/reading (a sensory-motor transformation) but not verbal color naming suggests that synaesthetic Stroop effects can arise from processing the meaning of a stimulus and not just as a result of verbal response interference. However, it is likely that the color associations themselves have a developmental origin in the names assigned to them. In all three cases, the colors of the written notes are related to the graphemes that arbitrarily denote them (e.g., 'A' may be "red" both as a letter and when written in musical notation). The results suggest that synaesthetic associations may migrate from one representational format (e.g., graphemes) to another (e.g., musical notation).

A recognized challenge in the field of augmentative and alternative communication (AAC) is the assessment of the individual skills and preferences of potential users of AAC. Particularly in cognitive assessment, many traditional methods are inappropriate because they require the participant to produce a verbal response and/or involve complex verbal instructions. For individuals with limited verbal forms of language, failure at such tasks is relatively uninstructive, either for revealing their functional intellectual status or for developing effective interventions. This paper presents a demonstration of a method developed to evaluate category structure and, thus, semantic organization in individuals with limited verbal skills concomitant to autism spectrum disorder. This method offers a promising tool for assessing clients for AAC. Further potential uses of this method, both clinically and in research, are discussed.

Studies on affordance perception commonly report systematic errors; a finding that is at odds with the observation that everyday motor behavior is accurate. The present study investigated whether the means by which perceptual performance is measured could explain the reported errors. Perception of overhead reachability and reaction time were measured using a verbal and an actual reaching response in a standing reach, and a reach-and-jump. Results show that participants accurately perceived their action boundaries for both tasks and in both response conditions. A simple reach, however, took less time to initiate (1,094 ms) than a reach-and jump (1,214 ms). Interestingly, the verbal response took considerably more time to initiate (1,424 ms) than the actual reach (1,154 ms). These results suggest that making verbal judgments about affordances is a different task than actually acting on them. It is therefore concluded that the use of conscious judgments to measure perceptual performance should be considered with care.

Background The accurate prediction of outcome after out-of-hospital cardiac arrest (OHCA) is of major importance. The recently described Full Outline of UnResponsiveness (FOUR) is well adapted to mechanically ventilated patients and does not depend on verbal response. Objective To evaluate the ability of FOUR assessed by intensivists to accurately predict outcome in OHCA. Methods We prospectively identified patients admitted for OHCA with a Glasgow Coma Scale below 8. Neurological assessment was performed daily. Outcome was evaluated at 6 months using Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC). Results Eighty-five patients were included. At 6 months, 19 patients (22%) had a favorable outcome, GP-CPC 1–2, and 66 (78%) had an unfavorable outcome, GP-CPC 3–5. Compared to both brainstem responses at day 3 and evolution of Glasgow Coma Scale, evolution of FOUR score over the three first days was able to predict unfavorable outcome more precisely. Thus, absence of improvement or worsening from day 1 to day 3 of FOUR had 0.88 (0.79–0.97) specificity, 0.71 (0.66–0.76) sensitivity, 0.94 (0.84–1.00) PPV and 0.54 (0.49–0.59) NPV to predict unfavorable outcome. Similarly, the brainstem response of FOUR score at 0 evaluated at day 3 had 0.94 (0.89–0.99) specificity, 0.60 (0.50–0.70) sensitivity, 0.96 (0.92–1.00) PPV and 0.47 (0.37–0.57) NPV to predict unfavorable outcome. Conclusion The absence of improvement or worsening from day 1 to day 3 of FOUR evaluated by intensivists provides an accurate prognosis of poor neurological outcome in OHCA.

Background The study of communication skills of Asian medical students during structured Problem-based Learning (PBL) seminars represented a unique opportunity to assess their critical thinking development. This study reports the first application of the health education technology, content analysis (CA), to a Japanese web-based seminar (webinar). Methods The authors assigned twelve randomly selected medical students from two universities and two clinical instructors to two virtual classrooms for four PBL structured tutoring sessions that were audio-video captured for CA. Both of the instructors were US-trained physicians. This analysis consisted of coding the students’ verbal comments into seven types, ranging from trivial to advanced knowledge integration comments that served as a proxy for clinical thinking. Results The most basic level of verbal simple responses accounted for a majority (85%) of the total students’ verbal comments. Only 15% of the students’ comments represented more advanced types of critical thinking. The male students responded more than the female students; male students attending University 2 responded more than male students from University 1. The total mean students’ verbal response time for the four sessions with the male instructor was 6.9%; total mean students’ verbal response time for the four sessions with the female instructor was 19% (p Conclusions This report is the first to describe the application of CA to a multi-university real time audio and video PBL medical student clinical training webinar in two Japanese medical schools. These results are preliminary, mostly limited by a small sample size (n = 12) and limited time frame (four sessions). CA technology has the potential to improve clinical thinking for medical students. This report may stimulate improvements for implementation.