Search

Introduction: Musculoskeletal injuries (MSIs) have direct impact on occupational readiness and task performance in military populations. Until this date, no epidemiologic data have been published concerning MSI incidence in the Netherlands Armed Forces (NAF). The aim of this study was to assess the MSI incidence and related costs in the NAF.Methods: In this descriptive epidemiologic study, we collected injury surveillance data from the electronic patient records of multiple military units of the NAF. Using data of all new consultations with a military physician from January 1, 2014 to December 31, 2016, we calculated MSI incidence rates per 100 person-years, with a 95% confidence interval (CI). Physician care costs were determined based on the number of physician consults and the charge per appointment. We used two methods to determine productivity costs; the top-down microcosting method and the friction cost method.Results: Our study sample included 22% (n = 8,847) of the total NAF population of 2016 (n =40,178). In this sample, consultations of MSIs accounted for 23.2% (n = 7,815) of all new consultations (n = 33,666). MSI incidence rates per unit ranged from 12.5 to53.3 per 100 person-years. In the total sample, MSI incidence rates were highest in the back (6.73, 95% CI 6.39-7.10), knee (5.04, 95% CI 4.74-5.35), and foot (4.79, 95% CI 4.50-5.10). The estimated costs for physician visits for MSIs in our sample were €0.69 million. Limited duty days accounted for €1.10 million productivity costs using top-down microcosting method.Conclusion: Our study provided evidence that MSIs result in substantial financial burden. Injuries of the back, knee, and foot account for the majority of demands on curative care for MSIs. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop and describe a wheelchair mobility performance test in wheelchair basketball and to assess its construct validity and reliability. To mimic mobility performance of wheelchair basketball matches in a standardised manner, a test was designed based on observation of wheelchair basketball matches and expert judgement. Forty-six players performed the test to determine its validity and 23 players performed the test twice for reliability. Independent-samplest-tests were used to assess whether the times needed to complete the test were different for classifications, playing standards and sex. Intraclass correlation coefficients (ICC) were calculated to quantify reliability of performance times. Males performed better than females (P < 0.001, effect size [ES] = −1.26) and international men performed better than national men (P < 0.001, ES = −1.62). Performance time of low (≤2.5) and high (≥3.0) classification players was borderline not significant with a moderate ES (P = 0.06, ES = 0.58). The reliability was excellent for overall performance time (ICC = 0.95). These results show that the test can be used as a standardised mobility performance test to validly and reliably assess the capacity in mobility performance of elite wheelchair basketball athletes. Furthermore, the described methodology of development is recommended for use in other sports to develop sport-specific tests. [ABSTRACT FROM AUTHOR]

Background Doctor-patient communication is an essential component of general practice. Improvement of GPs' communication patterns is an important target of training programmes. Available studies have so far failed to provide conclusive evidence of the effectiveness of educational interventions to improve doctor-patient communication. Aim To examine the effectiveness of a learner-centred approach that focuses on actual needs, to improve GPs' communication with patients. Design of study Randomised controlled trial. Setting One hundred volunteer GPs in the Netherlands. Method The intervention identified individual GPs' deficiencies in communication skills by observing authentic consultations in their own surgery. This performance assessment was followed by structured activities in small group meetings, aimed at remedying the identified shortcomings. Outcomes were measured using videotaped consultations in the GPs' own surgery before and after the intervention. Communication skills were rated using the MAAS-Global, a validated checklist. Results The scores in the intervention group demonstrated a significant improvement compared with those of the control group (95% confidence interval = 0.04 to 0.75). The effect size was moderate to large (d-value = 0.66). The level of participation significantly contributed to the effectiveness. Largest improvement was found on patient-centred communication skills. Conclusion The approach of structured individual improvement activities based on performance assessment is more effective in improving communication skills than current educational activities. [ABSTRACT FROM AUTHOR]

Background: The effect of three-dimensional (3D) vs. two-dimensional (2D) video on performance of a spatially complex procedure and perceived cognitive load were examined among residents in relation to their visual-spatial abilities (VSA)., Methods: In a randomized controlled trial, 108 surgical residents performed a 5-Flap Z-plasty on a simulation model after watching the instructional video either in a 3D or 2D mode. Outcomes included perceived cognitive load measured by NASA-TLX questionnaire, task performance assessed using Observational Clinical Human Reliability Analysis and the percentage of achieved safe lengthening of the scar., Results: No significant differences were found between groups. However, when accounted for VSA, safe lengthening was achieved significantly more often in the 3D group and only among individuals with high VSA (OR = 6.67, 95%CI: 1.23-35.9, p = .027)., Conclusions: Overall, 3D instructional videos are as effective as 2D videos. However, they can be effectively used to enhance learning in high VSA residents., Competing Interests: Declaration of competing interest None., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The field of obstetrics and gynecology requires complex decision-making and skills because of unexpected high-risk situations. These skills are influenced by alertness, reaction time, and concentration. Night shifts result in sleep deprivation, which might impair these functions, although it is still unclear to what extent., Objective: This study aimed to investigate whether a night shift routinely impairs the obstetrics and gynecology consultants' and residents' fitness to perform and whether this reaches a critical limit compared with relevant frames of reference., Study Design: Residents (n=33) and consultants (n=46) in obstetrics and gynecology conducted multiple measurements (n=415) at precall, postcall, and noncall moments with the fitness to perform self-test. The self-test consists of an adaptive pursuit tracking task that is able to objectively measure alertness, reaction time, concentration, and hand-eye coordination and Visual Analog Scale tests to subjectively score alertness. The test is validated with a sociolegal reference of a 0.06% ethanol blood concentration (the peak level after 2 units of alcohol, the legal driving limit). This equals -1.37% on the objective score and -8.17 points on subjective alertness. Linear mixed models were used to analyze the difference within subjects over a night shift, integrating repeated measures over time., Results: The overnight objective difference between postcall and precall measurements was -0.62 (P<.05) for residents and 0.28 (P=NS) for consultants, both not exceeding the sociolegal reference as a group. Objective impairment exceeded the reference for 31% of the residents and 28% of the consultants. Subjective alertness decreased in residents (-18.26; P<.001) and consultants (-10.85; P<.001), both exceeding the reference. No residents had to continue work postcall versus 7.8% of the consultants. None of the consultants that had to continue work were in an objective critically impaired state., Conclusion: This study provides insight and awareness of individual performance after night shifts with clear frames of reference. The performance of residents is negatively and significantly affected by night shifts; therefore, a scheduled day off after a night shift is justified. Consultants showed no overall impairment; however, a quarter did exceed the alcohol limit reference after their night shift. If not logistically feasible to schedule a protected day off after a night shift, our group recommends safe shift scheduling, including options to transfer care after a demanding night shift to prevent working in a compromised state., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Throughout the day, we may sometimes catch ourselves in patterns of thought that we experience as rigid and difficult to disengage from. Such "sticky" thinking can be highly disruptive to ongoing tasks, and when it turns into rumination constitutes a vulnerability for mental disorders such as depression and anxiety. The main goal of the present study was to explore the stickiness dimension of thought, by investigating how stickiness is reflected in task performance and pupil size. To measure spontaneous thought processes, we asked participants to perform a sustained attention to response task (SART), in which we embedded the participant's concerns to potentially increase the probability of observing sticky thinking. The results indicated that sticky thinking was most frequently experienced when participants were disengaged from the task. Such episodes of sticky thought could be discriminated from neutral and non-sticky thought by an increase in errors on infrequent no-go trials. Furthermore, we found that sticky thought was associated with smaller pupil responses during correct responding. These results demonstrate that participants can report on the stickiness of their thought, and that stickiness can be investigated using pupillometry. In addition, the results suggest that sticky thought may limit attention and exertion of cognitive control to the task., Competing Interests: The authors have declared that no competing interests exist.

Based on the work-home resources model, the present study aims to investigate the family-to-work enrichment process. Specifically, we theorize that positive child-related events and capitalizing on these events with significant others may facilitate employees' functioning at work. To test this enrichment process, we collected daily diary data from 112 Dutch working parents at 2 time points per day for 5 consecutive workdays. Specifically, we tested a mediated moderation model in which previous day positive child-related events were hypothesized to moderate the relationship between daily job demands and daily task performance through capitalization during the previous evening. As predicted, results of multilevel analyses revealed that the relationship between job demands and task performance was positive when employees had a resourceful home life, that is, experienced a high (vs. low) level of positive child-related events. In addition, sharing these positive events with significant others at home facilitated employees' functioning in dealing with job demands and further improved task performance during the subsequent workday. Finally, the moderating effect of previous day positive child-related events was mediated by capitalization at home during the previous evening. These findings suggest that capitalization is an important behavioral mechanism that prolongs the resourceful experiences in the family domain and benefits the work domain. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Purpose: Medical residents are valuable sources of information about the quality of frontline service delivery, but if they do not speak up, their ideas, opinions, and suggestions for improving their work practices cannot be considered. However, speaking up can be difficult for residents. Therefore, the authors have explored both what helps residents speak up about organizational barriers and opportunities to improve the quality of their work and what hinders them from doing so., Method: The authors conducted an exploratory qualitative interview study with 27 Dutch medical residents in the Netherlands in 2016. They used the critical incident technique for data collection and the constant comparison method of the Qualitative Analysis Guide of Leuven for data analysis., Results: Three types of incidents in which residents considered speaking up are described. The authors identified 2 main considerations that influenced residents' decisions about speaking up: Is it safe to speak up, and is speaking up likely to be effective? Residents' decisions were influenced by personal, team, and organizational aspects of their situations, such as supervisors' open attitudes, hierarchy, duration of clinical rotations, organization size, and experiences (either vicarious or their own)., Conclusions: Findings from this study indicate that residents tend to be silent when they encounter organizational barriers or opportunities to improve the quality of their work. Perceived effectiveness and safety are important forces that drive and constrain speaking up. The authors provide important starting points to empower medical residents to speak up about their suggestions for change.

Background: Surgical skills and decision making are influenced by alertness, reaction time, eye-hand coordination, and concentration. Night shift might impair these functions but it is unclear to what extent. The aim of this study was to investigate whether a night shift routinely impairs the surgeon's fitness to perform and whether this reaches a critical limit as compared to relevant frames of reference., Methods: Consultants (n = 59) and residents (n = 103) conducted fitness to perform measurements at precall, postcall, and noncall moments. This validated self-test consists of an adaptive tracker that is able to objectively measure alertness, reaction time, concentration, and eye-hand coordination, and multiple visual analog scales to subjectively score alertness. Results are compared to sociolegal (ethanol) and professional (operative skills) frames of reference that refer to a decrease under the influence of 0.06% ethanol., Results: Residents spent 1.7 call hours asleep on average as compared to 5.4 for consultants. Subjective alertness decreased in residents after night shifts (-13, P < 0.001) but not in consultants (-1.2, P = NS). The overnight difference in tracker score was -1.17 (P < 0.001) for residents and 0.46 (P = NS) for surgeons. Postcall subjective alertness only correlated to objective alertness in consultants. For residents, hours slept on-call correlated to objective alertness. For consultants, subsequent night calls significantly correlated to objective alertness, with the third subsequent call related to performance below the reference., Conclusions: Consultants remain fit to perform after night call, but subsequent calls may compromise clinical activities. This study provides insight and awareness of individual performance with clear frames of reference.

Purpose: The authors evaluate whether supplemental training for radiologists improves their breast screening performance and how this is measured., Methods: A systematic search was conducted in PubMed on August 3, 2017. Articles were included if they described supplemental training for radiologists reading mammograms to improve their breast screening performance and at least one outcome measure was reported. Study quality was assessed using the Medical Education Research Study Quality Instrument., Results: Of 2,199 identified articles, 18 were included, of which 17 showed improvement on at least one of the outcome measures, for at least one training activity or subgroup. Two measurement approaches were found. For the first approach, measuring performance on test sets, sensitivity, and specificity were the most reported outcomes (8 of 11 studies). Recall rate is the most reported outcome (6 of 7 studies) for the second approach, which measures performance in actual screening practice. The studies were mainly of moderate quality (Medical Education Research Study Quality Instrument score 11.7 ± 1.7), caused by small sample sizes and the lack of a control group., Conclusions: Supplemental training helps radiologists improve their screening performance, despite the mainly moderate quality of the studies. There is a need for better designed studies. Future studies should focus on performance in actual screening practice and should look for methods to isolate the training effect. If test sets are used, focus should be on knowledge about correlation between performance on test sets and actual screening practice., (Copyright © 2019 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Emotional intelligence (EI) contributes to good performance and well-being in jobs that involve frequent interpersonal contact. However, as EI is composed of self- and other-focused dimensions, it remains unclear which dimensions are responsible for better performance and well-being. We hypothesized that other-focused EI dimensions in particular relate to task performance, whereas self-focused EI dimensions relate to employees' subjective stress and physiological responses to emotional job demands. We asked Dutch secretaries ( N = 110) to professionally respond to five emotionally demanding work-related phone calls. The secretaries' skin conductance levels were recorded during the calls, and the secretaries had to indicate their stress levels after each call. Two independent raters coded the secretaries' effectiveness and the number of emotion regulation attempts during the phone calls. The results showed that other-focused emotion regulation was positively related to only one of the task performance indicators during three phone calls. In line with the hypotheses, self-focused emotion appraisal was negatively related to the secretaries' subjective stress levels after all the phone calls. Self-focused emotion regulation was positively related to the secretaries' skin conductance levels during all but one of the phone calls. This outcome suggests that self-focused EI dimensions decrease the subjective experience of stress but are accompanied by physiological costs, whereas other-focused emotion regulation may be positively but weakly related to task performance in emotionally demanding contexts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mind wandering is associated with worse performance on cognitively demanding tasks, but this concept is largely unexplored in typically developing children and little is known about the relation between mind wandering and specific executive functions (EFs). This study aimed, first, to measure and compare children's mind wandering in controlled computerized tasks as well as in an educational setting and, second, to examine the association between mind wandering and the three core EFs, namely inhibition, working memory, and set shifting/switching. A total of 52 children aged 9-11 years performed a classroom listening task and a computerized EF battery consisting of flanker, running span, and attention switching tasks. Mind wandering was measured using online probed and/or retrospective self-reports of task-unrelated thoughts (TUTs) during task performance. Children reported TUTs on 20-25% of the thought probes, which did not differ between classroom and EF tasks. Regression models, hierarchically adding the three core EFs, accounted for a small but significant portion of variance in TUT frequency when measured in class and retrospectively after EF tasks, but not when measured online in EF tasks. Children with worse inhibition were more prone to mind wander during classroom and EF tasks. Lower attention switching accuracy also explained variation in retrospectively reported TUTs during EF tasks. Working memory was not a significant predictor. These results suggest that mind wandering is common and reliably measurable in children in controlled computerized and educational tasks. Lower executive control abilities predict more frequent mind wandering, although different EFs are related to mind wandering in diverse tasks/measures., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Surgery has greatly benefited from various technologic advancements over the past decades. Surgery remains, however, mostly manual labor performed by well-trained surgeons. Little research has focused on improving osseous drilling techniques. The objective of this study was to compare the accuracy and precision of different orthopaedic drilling techniques involving the use of both index fingers., Questions/purposes: (1) Does the shooting grip technique and aiming at the contralateral index finger improve accuracy and precision in drilling? (2) Is the effect of drilling technique on accuracy and precision affected by the experience level of the performer?, Methods: This study included 36 participants from two Dutch training hospitals who were subdivided into three groups (N = 12 per group) based on their surgical experience (that is, no experience, residents, and surgeons). The participants had no further experience with drilling outside the hospital nor were there other potential confounding variables that could influence the test outcomes. Participants were instructed to drill toward a target exit point on a synthetic bone model. There were four conditions: (1) clenched grip without aiming; (2) shooting grip without aiming; (3) clenched grip with aiming at the contralateral index finger; and (4) shooting grip aiming at the contralateral index finger. Participants were only used to a clenched grip without aiming in clinical practice. Each participant had to drill five times per technique per test, and the test was repeated after 4 weeks. Accuracy was defined as the systematic error of all measurements and was calculated as the mean of the five distances between the five exit points and the target exit point, whereas precision was defined as the random error of all measurements and calculated as the SD of those five distances. Accuracy and precision were analyzed using mixed-design analyses of variance., Results: Accuracy was highest when using a clenched grip with aiming at the index finger (mean 4.0 mm, SD 1.1) compared with a clenched grip without aiming (mean 5.0 mm, SD 1.2, p = 0.004) and a shooting grip without aiming (mean 4.9 mm, SD 1.4, p = 0.015). The shooting grip with aiming at the index finger (mean 4.1 mm, SD 1.2) was also more accurate than a clenched grip without aiming (p = 0.006) and a shooting grip without aiming (p = 0.014). Shooting grip with aiming at the opposite index finger (median 2.0 mm, interquartile range [IQR] 1.2) showed the best precision and outperformed a clenched grip without aiming (median 2.9 mm, IQR 1.1, p = 0.016), but was not different than the shooting grip without aiming (median 2.2 mm, IQR 1.4) or the clenched grip with aiming (median 2.4 mm, IQR 1.3). The accuracy of surgeons (mean 4.1 mm, SD 1.1) was higher than the inexperienced group (mean 5.0 mm, SD 1.1, p = 0.012). The same applied for precision (median 2.2 mm, IQR 1.0 versus median 2.8 mm, IQR 1.4, p = 0.008)., Conclusions: A shooting grip combined with aiming toward the index finger of the opposite hand had better accuracy and precision compared with a clenched grip alone. Based on this study, experience does matter, because the orthopaedic surgeons outperformed the less experienced participants. Based on our study, we advise surgeons to aim at the index finger of the opposite hand when possible and to align the ipsilateral index finger to the drill bit., Level of Evidence: Level II, therapeutic study.

Local and global visual processing abilities and processing style were investigated in individuals with autism spectrum disorder (ASD) versus typically developing individuals, children versus adolescents and boys versus girls. Individuals with ASD displayed more attention to detail in daily life, while laboratory tasks showed slightly reduced global processing abilities, intact local processing abilities, and a more locally oriented processing style. However, the presence of these group differences depended on particular task and sample (i.e., age and gender) characteristics. Most measures of local and global processing did not correlate with each other and were not associated with processing style. Significant associations between local-global processing and ASD symptom severity were observed, but the causality of these associations remains unclear.

Purpose: To determine reliability of the ABILHAND-Kids, explore sources of variation associated with these measurement results, and generate repeatability coefficients., Method: A reliability study with a repeated measures design was performed in an ambulatory rehabilitation care department from a rehabilitation center, and a center for special education. A physician, an occupational therapist, and parents of 27 children with spastic cerebral palsy independently rated the children's manual capacity when performing 21 standardized tasks of the ABILHAND-Kids from video recordings twice with a three week time interval (27 first-, and 25 second video recordings available). Parents additionally rated their children's performance based on their own perception of their child's ability to perform manual activities in everyday life, resulting in eight ratings per child., Results: ABILHAND-Kids ratings were systematically different between observers, sessions, and rating method. Participant × observer interaction (66%) and residual variance (20%) contributed the most to error variance (9%). Test-retest reliability was 0.92. Repeatability coefficients (between 0.81 and 1.82 logit points) were largest for the parents' performance-based ratings., Conclusion: ABILHAND-Kids scores can be reliably used as a performance- and capacity-based rating method across different raters. Parents' performance-based ratings are less reliable than their capacity-based ratings. Resulting repeatability coefficients can be used to interpret ABILHAND-Kids ratings with more confidence. Implications for Rehabilitation The ABILHAND-Kids is a valuable tool to assess a child's unimanual and bimanual upper limb activities. The reliability of the ABILHANDS-Kids is good across different observers as a performance- and capacity-based rating method. Parents' performance-based ratings are less reliable than their capacity-based ones. This study has generated repeatability coefficients for clinical decision making.

Matcha tea is gaining popularity throughout the world in recent years and is frequently referred to as a mood-and-brain food. Previous research has demonstrated that three constituents present in matcha tea, l-theanine, epigallocatechin gallate (EGCG), and caffeine, affect mood and cognitive performance. However, to date there are no studies assessing the effect of matcha tea itself. The present study investigates these effects by means of a human intervention study administering matcha tea and a matcha containing product. Using a randomized, placebo-controlled, single-blind study, 23 consumers participated in four test sessions. In each session, participants consumed one of the four test products: matcha tea, matcha tea bar (each containing 4g matcha tea powder), placebo tea, or placebo bar. The assessment was performed at baseline and 60min post-treatment. The participants performed a set of cognitive tests assessing attention, information processing, working memory, and episodic memory. The mood state was measured by means of a Profile of Mood States (POMS). After consuming the matcha products compared to placebo versions, there were mainly significant improvements in tasks measuring basic attention abilities and psychomotor speed in response to stimuli over a defined period of time. In contrast to expectations, the effect was barely present in the other cognitive tasks. The POMS results revealed no significant changes in mood. The influence of the food matrix was demonstrated by the fact that on most cognitive performance measures the drink format outperformed the bar format, particularly in tasks measuring speed of spatial working memory and delayed picture recognition. This study suggests that matcha tea consumed in a realistic dose can induce slight effects on speed of attention and episodic secondary memory to a low degree. Further studies are required to elucidate the influences of the food matrix., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Earlier research has shown that laparoscopic skills are trained more efficiently on a spaced schedule compared to a massed schedule. The aim of the study was to estimate to what extent the spacing interval, naps, and fatigue influenced the effectiveness of spacing laparoscopy training., Methods: Overall 4 groups of trainees (aged 17-41y; 72% female; N massed = 40; N break = 35; N break-nap = 37; N spaced = 37) without prior experience were trained in 3 laparoscopic tasks using a physical box trainer with different scheduling interventions. The first (massed) group received three 100-minute training sessions consecutively on a single day. The second (break) group received the sessions interrupted with two 45-minute breaks. The third (break-nap) group had the same schedule as the second group, but had two 35-minute powernap intervals during the breaks. The fourth (spaced) group had the 3 sessions on 3 consecutive days. A retention session was organized approximately 3 months after training., Results: The results showed an overall pattern of superior performance at the end of training and at retention for the spaced group, followed by the break-nap, break, and massed group, respectively. The spaced and break-nap group significantly outperformed the break and massed group, with effect sizes ranging from 0.20 to 0.37., Conclusions: Spacing laparoscopic training over 3 consecutive days or weeks is superior to massed training, even if the massed training contains breaks. Breaks with sleep opportunity (i.e., lying, inactive, and muted sensory input) enhance performance over training with regular breaks and traditional massed training., (Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Although work and family are undoubtedly important life domains, individuals are also active in other life roles which are also important to them (like pursuing personal interests). Building on identity theory and the resource perspective on work-home interface, we examined whether there is an indirect effect of work-self conflict/facilitation on exhaustion and task performance over time through personal resources (i.e., self-efficacy and optimism). The sample was composed of 368 Dutch police officers. Results of the 3-wave longitudinal study confirmed that work-self conflict was related to lower levels of self-efficacy, whereas work-self facilitation was related to improved optimism over time. In turn, self-efficacy was related to higher task performance, whereas optimism was related to diminished levels of exhaustion over time. Further analysis supported the negative, indirect effect of work-self facilitation on exhaustion through optimism over time, and only a few reversed causal effects emerged. The study contributes to the literature on interrole management by showing the role of personal resources in the process of conflict or facilitation over time. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

The trade-off between feasibility and accuracy of measurements of physical exposure at the workplace has often been discussed, but is unsufficiently understood. We therefore explored the effect of two low-back loading measurement tools with different accuracies on exposure estimates and their associations with low-back pain (LBP). Low-back moments of 93 workers were obtained using two methods: a moderately accurate observation-based method and a relatively more accurate video-analysis method. Group-based exposure metrics were assigned to a total of 1131 workers who reported on their LBP status during three follow-up years. The two methods were compared regarding individual and group-based moments and their predictive value for LBP. Differences between the two methods for peak moments were high at the individual level and remained substantial at group level. For cumulative moments, differences between the two methods were attenuated as random inaccuracies cancelled out. Peak moments were not predictive for LBP in any method while cumulative moments were, suggesting comparable predictive values of the two methods. While assessment of low-back load improves from investing in collecting relatively more accurate individual-based data, this does not necessarily lead to better predictive values on a group level, especially not for cumulative loads., (Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

The present study addressed employee job crafting behaviors (i.e., seeking resources, seeking challenges, and reducing demands) in the context of organizational change. We examined predictors of job crafting both at the organizational level (i.e., perceived impact of the implemented changes on the working life of employees) and the individual level (i.e., employee willingness to follow the changes). Job crafting behaviors were expected to predict task performance and exhaustion. Two-wave longitudinal data from 580 police officers undergoing organizational changes were analyzed with structural equation modeling. Findings showed that the degree to which changes influence employees' daily work was linked to reducing demands and exhaustion, whereas employee willingness to change was linked to seeking resources and seeking challenges. Furthermore, while seeking resources and seeking challenges were associated with high task performance and low exhaustion respectively, reducing demands seemed to predict exhaustion positively. Our findings suggest that job crafting can act as a strategy of employees to respond to organizational change. While seeking resources and seeking challenges enhance employee adjustment and should be encouraged by managers, reducing demands seems to have unfavorable implications for employees., ((c) 2015 APA, all rights reserved).)

Aims: Educating physicians in the procedural as well as cognitive skills of information technology (IT)-mediated medication management could be one of the missing links for the improvement of patient safety. We aimed to compose a framework of tasks that need to be addressed to optimize medication management in outpatient care., Methods: Formal task analysis: decomposition of a complex task into a set of subtasks. First, we obtained a general description of the medication management process from exploratory interviews. Secondly, we interviewed experts in-depth to further define tasks and subtasks., Setting: Outpatient care in different fields of medicine in six teaching and academic medical centres in the Netherlands and the United States., Participants: 20 experts. Tasks were divided up into procedural, cognitive and macrocognitive tasks and categorized into the three components of dynamic decision making., Results: The medication management process consists of three components: (i) reviewing the medication situation; (ii) composing a treatment plan; and (iii) accomplishing and communicating a treatment and surveillance plan. Subtasks include multiple cognitive tasks such as composing a list of current medications and evaluating the reliability of sources, and procedural tasks such as documenting current medication. The identified macrocognitive tasks were: planning, integration of IT in workflow, managing uncertainties and responsibilities, and problem detection., Conclusions: All identified procedural, cognitive and macrocognitive skills should be included when designing education for IT-mediated medication management. The resulting framework supports the design of educational interventions to improve IT-mediated medication management in outpatient care., (© 2015 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of The British Pharmacological Society.)

Objective: To investigate the current performance of urological residents regarding basic urological procedures in relation to patient safety issues and the identification of specific training needs., Design: Observational data of 146 urethrocystoscopies (UCSs), 27 transrectal ultrasounds of the prostate (TRUSs), 38 transrectal ultrasound-guided prostatic biopsies (TRUSPs), and 30 transurethral resections of bladder tumor (TURBTs) were collected. Performance was evaluated using scoring lists including details on completeness of procedural steps, level of independence, time, and the incidence of unintended events. The causal factors contributing to the unintended events were identified by 2 expert urologists and classified according to the recognized PRISMA method., Setting: This study was performed in 5 teaching hospitals in the Netherlands., Participants: We included 11 junior residents and 5 senior residents in urology in the final study cohort., Results: Senior residents showed a lower degree of completeness in material usage than junior residents did during UCS (p < 0.01) and in preparation, material usage, and procedure during TRUSP (all p < 0.05). In UCS and TURBT, senior residents received significantly less feedback than junior residents did (both p < 0.01). Incidence of unintended events for junior vs senior residents was 11% and 4% in UCS, 0% and 7% in transrectal ultrasound of the prostate, 36% and 62% in TRUSP, and 41% and 23% in TURBT, respectively. Overall, unintended events were mainly caused by human factors, in particular, verification and skills-based issues., Conclusion: Present performance of basic urological procedures involves a high percentage of unintended events, especially in TRUSP and TURBT, which are mainly caused by human factors and are a potential threat for patient safety. Junior residents are less independent but more thorough in the performance of UCS and TRUSP than senior residents are. Targeted skills training including assessment should be implemented before privileges for independent practice are granted to reduce the incidence of unintended events and optimize patient safety., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

The literature on relative age position effects is rather inconsistent. In this study we examined intra-classroom age position (or relative age) effects on Dutch adolescents' school progress and performance (as rated by teachers), physical development, temperamental development (fear and frustration), and depressive symptoms, all adjusted for age at the time of measurement. Data were derived from three waves of Tracking Adolescents' Individuals Lives Survey (TRAILS) of 2230 Dutch adolescents (baseline mean age 11.1, SD = 0.6, 51% girls). Albeit relative age predicted school progress (grade retention ORs = 0.83 for each month, skipped grade OR = 1.47, both p<.001), our key observation is the absence of substantial developmental differences as a result of relative age position in Dutch adolescents with a normative school trajectory, in contrast to most literature. For adolescents who had repeated a grade inverse relative age effects were observed, in terms of physical development and school performance, as well as on depressive symptoms, favoring the relatively young. Cross-cultural differences in relative age effect may be partly explained by the decision threshold for grade retention.

Background: Intermanual transfer implies that motor skills learned on one side of the body transfer to the untrained side. This effect was previously noted in adults practicing with a prosthesis simulator., Objective: The study objective was to determine whether intermanual transfer is present in children practicing prosthetic handling., Design: A mechanistic, pseudorandomized, pretest-posttest design was used., Setting: The study was conducted in a primary school in the Netherlands., Participants: The participants were children who were able-bodied (N=48; 25 boys, 23 girls; mean age=5.1 years) and randomly assigned to an experimental group or a control group., Intervention: The experimental group performed 5 training sessions using a prosthesis simulator on the training arm. Before (pretest), immediately after (posttest), and 6 days after (retention test) the training program, their ability to handle the prosthesis with the contralateral (test) arm was measured. The control group only performed the tests. Half of the children performed the tests with the dominant hand, and the other half performed the tests with the nondominant hand., Measurements: During the tests, movement time and control of force were measured., Results: An interaction effect of group by test was found for movement time. Post hoc tests revealed significant improvement in the experimental group between the posttest and the retention test. No force control effect was found., Limitations: Only children who were able-bodied were included. Measurements should have been masked and obtained without tester interference. The fact that 4 children whose results were slower than the mean result discontinued training may have biased the findings., Conclusions: The intermanual transfer effect was present in 5-year-old children undergoing training in prosthetic handling. After training of one hand, children's movement times for the other, untrained hand improved. This finding may be helpful for training children who are novice users of a prosthesis., (© 2015 American Physical Therapy Association.)

This report provides a detailed analysis of incorrect responses from an open-set spoken word-repetition task which is part of a Dutch speech audiometric test battery. Single-consonant confusions were analyzed from 230 normal hearing participants in terms of the probability of choice of a particular response on the basis of acoustic-phonetic, lexical, and frequency variables. The results indicate that consonant confusions are better predicted by lexical knowledge than by acoustic properties of the stimulus word. A detailed analysis of the transmission of phonetic features indicates that "voicing" is best preserved whereas "manner of articulation" yields most perception errors. As consonant confusion matrices are often used to determine the degree and type of a patient's hearing impairment, to predict a patient's gain in hearing performance with hearing devices and to optimize the device settings in view of maximum output, the observed findings are highly relevant for the audiological practice. Based on our findings, speech audiometric outcomes provide a combined auditory-linguistic profile of the patient. The use of confusion matrices might therefore not be the method best suited to measure hearing performance. Ideally, they should be complemented by other listening task types that are known to have less linguistic bias, such as phonemic discrimination.

Context: Medical schools in Western societies seek measures to increase the diversity of their student bodies with respect to ethnicity and social background. Currently, little is known about the effects of different selection procedures on student diversity., Objectives: This prospective cohort study aimed to determine performance differences between traditional and non-traditional (i.e. ethnic minority and first-generation university candidates) medical school applicants in academic and non-academic selection criteria., Methods: Applicants in 2013 (n = 703) were assessed on academic and non-academic selection criteria. They also completed a questionnaire on ethnicity and social background. Main outcome measures were 'not selected' (i.e. failure on any criteria), 'failure on academic criteria' and 'failure on non-academic criteria'. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by logistic regression analysis for ethnic subgroups (Surinamese/Antillean, Turkish/Moroccan/African, Asian, Western) compared with Dutch applicants, adjusted for age, gender, additional socio-demographic variables (first-generation immigrant, first-generation university applicant, first language, medical doctor as parent) and pre-university grade point average (pu-GPA). Similar analyses were performed for first-generation university applicants., Results: Compared with Dutch applicants, Surinamese/Antillean applicants underperformed in the selection procedure (failure rate: 78% versus 57%; adjusted OR 2.52, 95% CI 1.07-5.94), in particular on academic criteria (failure rate: 66% versus 34%; adjusted OR 3.00, 95% CI 1.41-6.41). The higher failure rate of first-generation university applicants on academic criteria (50% versus 37%; unadjusted OR 1.66, 95% CI 1.18-2.33) was partly explained by additional socio-demographic variables and pu-GPA. The outcome measure 'failure on non-academic criteria' showed no significant differences among the ethnic or social subgroups., Conclusions: The absence of differences on non-academic criteria was promising with reference to increasing social and ethnic diversity; however, the possibility that self-selection instigated by the selection procedure is stronger in applicants from non-traditional backgrounds cannot be ruled out. Further research should also focus on why cognitive tests might favour traditional applicants., (© 2014 John Wiley & Sons Ltd.)

Objectives: Deficits in response inhibition have been associated with attention-deficit/hyperactivity disorder (ADHD). Given the role of serotonin in ADHD and impulsivity, we postulated that genetic variants within the serotonin pathway might influence response inhibition., Methods: We measured neural activation during stop-signal task performance in adolescents with ADHD (N = 185), their unaffected siblings (N = 111), and healthy controls (N = 124), and investigated the relationship of two serotonin gene polymorphisms (the rs6296 SNP of the HTR1B gene and HTTLPR variants of the 5-HTT gene) with the neural correlates of response inhibition., Results: The whole-brain analyses demonstrated large scale neural activation differences in the inferior and medial frontal and temporal/parietal regions of the response inhibition network between the different variants of both the HTR1B and 5HTT genes. Activation in these regions was significantly associated with stop-task performance, but not with ADHD diagnosis or severity. No associations were found between HTR1B and 5HTT variants and ADHD or ADHD-related neural activation., Conclusions: These results provide novel evidence that serotonin may play an important role in the neurobiology of response inhibition. Although response inhibition is strongly linked to ADHD, serotonin linked genetic variants associated with response inhibition and its neural correlates do not explain variance of the ADHD phenotype.

This article describes the development of the Writing Readiness Inventory Tool in Context (WRITIC), a measurement evaluating writing readiness in Dutch kindergarten children (5 and 6 years old). Content validity was established through 10 expert evaluations in three rounds. Construct validity was established with 251 children following regular education. To identify scale constructs, factor analysis was performed. Discriminative validity was established by examining contrast groups with good (n = 142) and poor (n = 109) performers in paper-and-pencil tasks. Content validity was high with 94.4% agreement among the experts. Two reliable factors were found in the performance of paper-and-pencil tasks with Cronbach's alphas of 0.82 and 0.69 respectively. The contrast groups differed significantly in two WRITIC subdomains: "Sustained attention" and "Task performance". Our findings indicated that the WRITIC is feasible for use in the classroom.

The alleged association between the serotonin-transporter-linked polymorphic region (5-HTTLPR) and amygdala activation forms a cornerstone of the common view that carrying the short allele of this polymorphism is a potential risk factor for affective disorders. The authors of a recent meta-analysis showed that this association is statistically significant (Hedges's g = 0.35) but warned that estimates might be distorted because of publication bias. Here, we report a replication study of this relationship in 120 participants. We failed to find an association of 5-HTTLPR variation with amygdala activation during a widely used emotional-face-matching paradigm. Moreover, when we conducted a meta-analysis that included unpublished studies and data from the current study, the pooled meta-analytic effect size was no longer significant (g = 0.20, p = .06). These findings cast doubt on previously reported substantial effects, suggesting that the 5-HTTLPR-amygdala association is either much smaller than previously thought, conditional on other factors, or nonexistent., (© The Author(s) 2014.)

Objective: The Southampton Hand Assessment Procedure (SHAP) evaluates the functionality of normal, injured or prosthetic hands. The aim was to evaluate the learning effects of SHAP tasks and the appropriateness of the time limits applied per task in novice prosthetic users., Methods: Right-handed unimpaired volunteers (n = 24, mean age 21.8 years) completed 8 SHAP sessions over 5 consecutive days using a prosthetic simulator. The execution times of SHAP tasks were transformed into 6 prehensile patterns, the functionality profile, and the index of function, a general functionality score. Learning effects in task times were analysed using multilevel analysis., Results: Learning effects occurred in all SHAP tasks. Tasks, sex, sessions, tasks-sessions interaction, and the first session of the day contributed (p < 0.01) to the execution times. Tasks were performed more slowly by females and more slowly on the first session of the day. In several tasks time limits were exceeded by > 25% of participants in at least the first 3 sessions, which affected the calculation of the functionality profile and index of function scores., Conclusion: The learning effects of SHAP in novice prosthetic users require consideration when conducting a reliability study. SHAP scores in novice prosthetic-hand users are confounded by learning effects and exceeded time limits.

Objective: To examine the construct validity of the Individual Work Performance Questionnaire (IWPQ)., Methods: A total of 1424 Dutch workers from three occupational sectors (blue, pink, and white collar) participated in the study. First, IWPQ scores were correlated with related constructs (convergent validity). Second, differences between known groups were tested (discriminative validity)., Results: First, IWPQ scores correlated weakly to moderately with absolute and relative presenteeism, and work engagement. Second, significant differences in IWPQ scores were observed for workers differing in job satisfaction, and workers differing in health., Conclusion: Overall, the results indicate acceptable construct validity of the IWPQ. Researchers are provided with a reliable and valid instrument to measure individual work performance comprehensively and generically, among workers from different occupational sectors, with and without health problems.

Purpose: To gain insight into (1) the prevalence and incidence of common mental disorders (CMD) and low work ability among bricklayers and construction supervisors; (2) the impact of CMD on current work ability and work ability 1 year later and (3) the added value of job-specific questions about work ability for detecting signs of low work ability., Methods: We randomly selected 750 bricklayers and 750 supervisors. This sample was surveyed by means of a baseline questionnaire and a follow-up questionnaire 1 year later. Work ability was measured with the first three questions of the Work Ability Index and job-specific questions. Self-reported CMD were measured with instruments designed to detect a high need for recovery after work, distress and depression. We used univariate logistic regression to analyse the presence or absence of CMD as independent variable., Results: The prevalence and incidence of CMD among 199 bricklayers and 224 supervisors was 22 %/10 % and 32 %/15 %, respectively. The prevalence of low general work ability was comparable for both occupations (5 %). CMD were associated with low current work ability and low work ability at follow-up (ORs 4.3-22.4), but not with a reduction in work ability 1 year later. Questions on job-specific work ability resulted in more indications of low work ability among both occupations than did questions on general work ability., Conclusions: Regardless of occupation, workers who report CMD at baseline have a high likelihood of current low work ability and low work ability 1 year later.

Operational performance in military settings involves physical and mental skills that are generally investigated separately in lab settings, leading to reduced ecological validity. Therefore, we investigated the effects of anxiety and exercise-induced fatigue, separately and in combination, on cognitive and shooting performance of 22 soldiers in a real-world setting. Findings indicated that soldiers' shooting accuracy and decision-making and mathematical skills decreased significantly under anxiety. Whether exercise-induced fatigue was beneficial or detrimental to task performance depended on the task at hand. The increased arousal levels through exercise prevented shooting accuracy from deteriorating in the decision task. In contrast, cognitive performance suffered from the increased arousal: participants more often failed to shoot when being fired at by an opponent and also math performance seemed to decrease. We conclude that anxiety can deteriorate soldier performance and that exercise-induced fatigue may improve or deteriorate performance in combination with anxiety depending on the nature of the task., Practitioner Summary: Soldiers encounter anxiety and exercise-induced fatigue. We investigated to what degree these factors influence soldiers' shooting and cognitive performance. Experimental manipulation of anxiety and exercise during a representative field course indicated decreased performance under anxiety. Exercise prevented shooting accuracy from deteriorating under anxiety, although cognitive performance was negatively affected after exercise.

Walking speed is shown to be an important indicator of the health status and function in older adults and part of the comprehensive geriatric assessment in clinical practice. The present study aimed to assess the influence of different assessment methods on walking speed and its association with the key aspects of poor health status, i.e., the presence of low cognitive performance and cardiopulmonary disease. In 288 community-dwelling elderly (mean age 82.2 ± 7.1 years) referred to a geriatric outpatient clinic, walking speed was assessed with the 4-m, 10-m, and 6-min walking tests. The mean walking speed assessed with the 10-m walking test was higher compared to the 4-m and 6-min walking tests (mean difference (95% CI) 0.11 m/s (0.10; 0.13) and 0.08 m/s (0.04; 0.13), respectively). No significant difference was found in the walking speed assessed with the 4-m compared to the 6-min walking test (mean difference (95% CI) -0.03 m/s (-0.08; 0.03)). ICCs showed excellent agreement of the 4-m with the 10-m walking test and fair to good agreement of the 6-min with the 4-m as well as 10-m walking test. The presence of low cognitive performance was negatively associated with walking speed, with the highest effect size for the 4-m walking test. The presence of cardiopulmonary disease was negatively associated with walking speed as well, with the highest effect size for the 6-min walking test. In conclusion, in the clinically relevant population of elderly outpatients, walking speed and its interpretation depends on the assessment method, which therefore cannot be used interchangeably in clinical practice.

Objective: To explore the muscle activation patterns in relation to pain complaints in bassists studied during a musical task. This study was based on the assumption that pain complaints are caused by increased muscle activation during playing or relaxation and/or faster onset of fatigue of muscles., Design: Cross-sectional study., Setting: Nonclinical., Participants: Student bass guitarists (N=36) from conservatories in the Netherlands., Interventions: Not applicable., Main Outcome Measures: Bassists played a standard music piece for 30 minutes. Muscle activation levels and pain were recorded. Pain was registered with a Numeric Rating Scale (NRS 0-10). The muscle activation level of both the trapezius muscles and flexor carpi radialis was measured with sEMG: sEMG as the percentage of the maximal voluntary isometric contraction (%MVC) and the slope of the sEMG (slope of %MVC) were calculated. The %MVC as a function of time and the slope of %MVC were calculated during playing and for rest periods before and after playing. For statistic analysis, the Mann-Whitney U test and a multilevel multiregression analysis were used for comparing the sEMG data of bassists with and without pain., Results: No significant differences in %MVC or the slope of %MVC were between the bassists with and without pain complaints., Conclusions: The results surprisingly indicate that pain complaints of bassists may not be associated with another muscle activation pattern. It is, therefore, not likely that pain is caused by increased muscle activation during playing and/or relaxation, nor by faster onset of fatigue., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Internationally, postgraduate medical education (PGME) has shifted to competency-based training. To evaluate the effects of this shift on the outcomes of PGME appropriate instruments are needed., Aim: To provide an inventory of tasks specialists perform in practice, which can be used as an instrument to evaluate the outcomes of PGME across disciplines., Methods: Following methodology from job analysis in human resource management, we used document analyses, observations, interviews and questionnaires. Two thousand seven hundred and twenty eight specialists were then asked to indicate how frequently they performed each task in the inventory, and to suggest additional tasks. Face and content validity was evaluated using interviews and the questionnaire. Tasks with similar content were combined in a total of 12 clusters. Internal consistency was evaluated by calculating Cronbach's alpha. Construct validity was determined by examining predefined differences in task performance between medical, surgical and supportive disciplines., Results: Seven hundred and six specialists (36%) returned the questionnaire. The resulting inventory of 91 tasks showed adequate face and content validity. Internal consistency of clusters of tasks was adequate. Significant differences in task performance between medical, surgical and supportive disciplines indicated construct validity., Conclusion: We established a comprehensive, generic and valid inventory of tasks of specialists which appears to be applicable across medical, surgical and supportive disciplines.

Adolescents' risk-taking behavior has been linked to a maturational imbalance between reward ("go") and inhibitory-control ("stop")-related brain circuitry. This may drive adolescent drug-taking, such as cannabis use. In this study, we assessed the non-acute effects of adolescent cannabis use on reward-related brain function. We performed a two-site (United States and Netherlands; pooled data) functional magnetic resonance imaging (fMRI) study with a cross-sectional design. Twenty-one abstinent but frequent cannabis-using boys were compared with 24 non-using peers on reward-related brain function, using a monetary incentive delay task with fMRI. Focus was on anticipatory and response stages of reward and brain areas critically involved in reward processing like the striatum. Performance in users was normal. Region-of-interest analysis indicated striatal hyperactivity during anticipatory stages of reward in users. Intriguingly, this effect was most pronounced during non-rewarding events. Striatal hyperactivity in adolescent cannabis users may signify an overly sensitive motivational brain circuitry. Frequent cannabis use during adolescence may induce diminished ability to disengage the motivational circuit when no reward can be obtained. This could strengthen the search for reinforcements like drugs of abuse, even when facing the negative (non-rewarding) consequences.

The current research examined how drivers handle task-demands induced by listening to the radio while driving. In particular, we explored the traces of a possible cognitive strategy that might be used by drivers to cope with task-demands, namely blocking-out auditory distracters. In Study 1 (N=15), participants listened to a radio-broadcast while watching traffic videos on a screen. Based on a recall task asking about what they had listened to, we created baseline scores reflecting the general levels of blocking-out of radio-content when there was no concurrent driving task accompanying the radio-listening. In Study 2 (N=46), participants were asked to complete two drives in the simulator: one drive in high-complexity traffic and another in low-complexity traffic. About half of the participants listened to a radio-broadcast while driving, and the other half drove in silence. The radio-listeners were given the same recall task that we had used in Study 1. The results revealed that the participants who drove while listening to the radio (Study 2) recalled less material from the radio-broadcast as compared to the participants who did not drive (Study 1). In addition, the participants who drove while listening to the radio recalled less talk-radio excerpts when driving in high-complexity traffic than when driving in low-complexity traffic. Importantly, listening to the radio did not impair driving performance. Together, these findings indicate that blocking-out radio-content might indeed be a strategy used by drivers to maintain their driving performance., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: Better understanding of critically reflective work behavior (CRWB), an approach for work-related informal learning, is important in order to gain more profound insight in the continuing development of health care professionals., Methods: A survey, developed to measure CRWB and its predictors, was distributed to veterinary professionals. The authors specified a model relating CRWB to a Perceived Need for Lifelong Learning, Perceived Workload, and Opportunities for Feedback. Furthermore, research utilization was added to the concept of CRWB. The model was tested against the data, using structural equation modeling (SEM)., Results: The model was well represented by the data. Four factors that reflect aspects of CRWB were distinguished: (1) individual CRWB; (2) being critical in interactions with others; (3) cross-checking of information; and (4) openness to new findings. The latter 2 originated from the factor research utilization in CRWB. The Perceived Need for Lifelong Learning predicts CRWB. Neither Perceived Workload nor Opportunities for Feedback of other practitioners was related to CRWB., Discussion: The results suggest that research utilization, such as cross-checking information and openness to new findings, is essential for CRWB. Furthermore, perceptions of the need for lifelong learning are more relevant for CRWB of health care professionals than qualities of the workplace., (Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.)

Objective: To estimate work loss days due to absenteeism and presenteeism associated with commonly occurring mental and physical disorders., Methods: In a nationally representative face-to-face survey (Netherlands Mental Health Survey and Incidence Study-2) including 4,715 workers, the presence of 13 mental and 10 chronic physical disorders was assessed using the Composite International Diagnostic Interview 3.0 and a physical disorder checklist. Questions about absent days due to illness and days of reduced quantitative and qualitative functioning while at work were based on the WHO Disability Assessment Schedule. Total work loss days were defined as the sum of the days of these three types of loss, where days of reduced functioning were counted as half. Both individual and population-level effects of disorders on work loss were studied, taking comorbidity into account., Results: Any mental disorder was associated with 10.5 additional absent days, 8.0 days of reduced-qualitative functioning and 12.0 total work loss days. For any physical disorder, the number of days was 10.7, 3.5 and 11.3, respectively. Adjusted for comorbidity, drug abuse, bipolar disorder, major depression, digestive disorders and panic disorder were associated with the highest number of additional total work loss days. At population-level, major depression, chronic back pain, respiratory disorders, drug abuse and digestive disorders contributed the most. Annual total work loss costs per million workers were estimated at 360 million for any mental disorder; and 706 million for any physical disorder., Conclusions: Policies designed to lessen the impact of commonly occurring disorders on workers will contribute to a reduction in absenteeism and presenteeism. As the indirect costs of (mental) disorders are much higher than their medical costs, prevention and treatment of these conditions may be cost-effective.

Objective: Haptic shared control was investigated as a human-machine interface that can intuitively share control between drivers and an automatic controller for curve negotiation., Background: As long as automation systems are not fully reliable, a role remains for the driver to be vigilant to the system and the environment to catch any automation errors. The conventional binary switches between supervisory and manual control has many known issues, and haptic shared control is a promising alternative., Method: A total of 42 respondents of varying age and driving experience participated in a driving experiment in a fixed-base simulator, in which curve negotiation behavior during shared control was compared to during manual control, as well as to three haptic tunings of an automatic controller without driver intervention., Results: Under the experimental conditions studied, the main beneficial effect of haptic shared control compared to manual control was that less control activity (16% in steering wheel reversal rate, 15% in standard deviation of steering wheel angle) was needed for realizing an improved safety performance (e.g., 11% in peak lateral error). Full automation removed the need for any human control activity and improved safety performance (e.g., 35% in peak lateral error) but put the human in a supervisory position., Conclusion: Haptic shared control kept the driver in the loop, with enhanced performance at reduced control activity, mitigating the known issues that plague full automation., Application: Haptic support for vehicular control ultimately seeks to intuitively combine human intelligence and creativity with the benefits of automation systems.

Background: In surgical education, there is a need for educational performance evaluation tools that yield reliable and valid data. This paper describes the development and validation of robust evaluation tools that provide surgeons with insight into their clinical teaching performance. We investigated (1) the reliability and validity of 2 tools for evaluating the teaching performance of attending surgeons in residency training programs, and (2) whether surgeons' self evaluation correlated with the residents' evaluation of those surgeons., Materials and Methods: We surveyed 343 surgeons and 320 residents as part of a multicenter prospective cohort study of faculty teaching performance in residency training programs. The reliability and validity of the SETQ (System for Evaluation Teaching Qualities) tools were studied using standard psychometric techniques. We then estimated the correlations between residents' and surgeons' evaluations., Results: The response rate was 87% among surgeons and 84% among residents, yielding 2625 residents' evaluations and 302 self evaluations. The SETQ tools yielded reliable and valid data on 5 domains of surgical teaching performance, namely, learning climate, professional attitude towards residents, communication of goals, evaluation of residents, and feedback. The correlations between surgeons' self and residents' evaluations were low, with coefficients ranging from 0.03 for evaluation of residents to 0.18 for communication of goals., Conclusions: The SETQ tools for the evaluation of surgeons' teaching performance appear to yield reliable and valid data. The lack of strong correlations between surgeons' self and residents' evaluations suggest the need for using external feedback sources in informed self evaluation of surgeons., (Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Previous research has demonstrated that stereotype threat induces a prevention focus and impairs central executive functions. The present research examines how these 2 consequences of stereotype threat are related. The authors argue that the prevention focus is responsible for the effects of stereotype threat on executive functions and cognitive performance. However, because the prevention focus is adapted to deal with threatening situations, the authors propose that it also leads to some beneficial responses to stereotype threat. Specifically, because stereotype threat signals a high risk of failure, a prevention focus initiates immediate recruitment of cognitive control resources. The authors further argue that this response initially facilitates cognitive performance but that the additional cognitive demands associated with working under threat lead to cognitive depletion over time. Study 1 demonstrates that stereotype threat (vs. control) facilitates immediate cognitive control capacity during a stereotype-relevant task. Study 2 experimentally demonstrates the process by showing that stereotype threat (vs. control) facilitates cognitive control as a default, as well as when a prevention focus has been experimentally induced, but not when a promotion focus has been induced. Study 3 shows that stereotype threat facilitates initial math performance under a prevention focus, whereas no effect is found under a promotion focus. Consistent with previous research, however, stereotype threat impaired math performance over time under a prevention focus, but not under a promotion focus., (2012 APA, all rights reserved)

This study was conducted to enhance insight into the functionality, usability, and efficacy of two systematically selected Electronic Mobility Aids (EMA) aimed at obstacle detection and orientation. Eight persons who are visually impaired participated in a user evaluation of the UltraCane and the Miniguide. The participants' mobility performance was observed while completing a standardized indoor mobility course with their regular mobility aid, then with each EMA, and assessed in terms of speed, Percentage Preferred Walking Speed (PPWS), type and number of mobility incidents made. Interviews were administered to ascertain users' satisfaction with the functionality, effectiveness and specific features of the assistive devices. Walking speed and PPWS declined when using an EMA compared to the long cane. The mean total number of previously defined mobility incidents decreased significantly and also the type of mobility incidents changed. Generally, participants were quite satisfied with the use of the EMA, and detailed advantageous as well as disadvantageous aspects concerning functionality and certain features of both devices. The UltraCane and the Miniguide have proven to be effective on an indoor mobility course. Individual users' characteristics and preferences appear to be critical for their appraisal of the devices.

Objective: To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke., Design: Cohort study., Setting: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom., Participants: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age ± SD, 69.2±12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy-based start-and-stop rules was checked in a second group of patients (n=237; mean age ± SD, 60.0±11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke., Interventions: Not applicable., Main Outcome Measures: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules., Results: The RMI had good fit of the double monotonicity model (coefficient H(T)=.87). The interpretation of the total score improved. Item hierarchy-based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules., Conclusions: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Behavioral, psychophysiological, and neuropsychological studies have revealed large developmental differences in various learning paradigms where learning from positive and negative feedback is essential. The differences are possibly due to the use of distinct strategies that may be related to spatial working memory and attentional control. In this study, strategies in performing a discrimination learning task were distinguished in a cross-sectional sample of 302 children from 4 to 14 years of age. The trial-by-trial accuracy data were analyzed with mathematical learning models. The best-fitting model revealed three learning strategies: hypothesis testing, slow abrupt learning, and nonlearning. The proportion of hypothesis-testing children increased with age. Nonlearners were present only in the youngest age group. Feature preferences for the irrelevant dimension had a detrimental effect on performance in the youngest age group. The executive functions spatial working memory and attentional control significantly predicted posterior learning strategy probabilities after controlling for age., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Two methods of fine tuning the initial settings of hearing aids were compared: An audiologist-driven approach--using real ear measurements and a patient-driven fine-tuning approach--using feedback from real-life situations. The patient-driven fine tuning was conducted by employing the Amplifit(®) II system using audiovideo clips. The audiologist-driven fine tuning was based on the NAL-NL1 prescription rule. Both settings were compared using the same hearing aids in two 6-week trial periods following a randomized blinded cross-over design. After each trial period, the settings were evaluated by insertion-gain measurements. Performance was evaluated by speech tests in quiet, in noise, and in time-reversed speech, presented at 0° and with spatially separated sound sources. Subjective results were evaluated using extensive questionnaires and audiovisual video clips. A total of 73 participants were included. On average, higher gain values were found for the audiologist-driven settings than for the patient-driven settings, especially at 1000 and 2000 Hz. Better objective performance was obtained for the audiologist-driven settings for speech perception in quiet and in time-reversed speech. This was supported by better scores on a number of subjective judgments and in the subjective ratings of video clips. The perception of loud sounds scored higher than when patient-driven, but the overall preference was in favor of the audiologist-driven settings for 67% of the participants.

This study investigated the effects of non-obtrusive feedback on continuous lifted hand/finger behaviour, task performance and comfort. In an experiment with 24 participants the effects of two visual and two tactile feedback signals were compared to a no-feedback condition in a computer task. Results from the objective measures showed that all types of feedback were equally effective to reduce lifted hand/finger behaviour (effectiveness) compared to absence of feedback, while task performance was not affected (efficiency). In contrast to objective measures, subjective user experience was significantly different for the four types of feedback signals. Continuous tactile feedback appeared to be the best signal; not only the effectiveness and efficiency were rated reasonable, it also scored best on perceived match between signal and required action. This study shows the importance of including user experiences when investigating usability of feedback signals. Non-obtrusive feedback embedded in products and environments may successfully be used to support office workers to adopt healthy, productive and comfortable working behaviour., (Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Objectives: It has been postulated that prognostic models based on administrative data can provide valid adjusted mortality rates in specific patient populations. In this study we compared the performance and robustness of a model based on administrative data (customized hospital standardized mortality ratio) and a model based on clinical data (customized Simplified Acute Physiology Score II) in the Dutch intensive care unit population., Design: Cohort study of intensive care unit records from a national intensive care unit quality registry linked to administrative records from the Dutch National Medical Registration. The hospital standardized mortality ratio and Simplified Acute Physiology Score II models were first-level customized on the intensive care unit population., Setting: Fifty-five Dutch intensive care units., Patients: A total of 66,564 intensive care unit patients admitted from 2005 to 2008., Interventions: None., Measurements and Main Results: Performance expressed by measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve, Brier score, Hosmer-Lemeshow Ĉ-statistic, and calibration plots). Additionally, the robustness of the models was assessed by simulating changes in the population's severity of illness and analyzing the effect on the intensive care units' standardized mortality ratios.The area under the receiver operating characteristic curve and Brier score of the customized Simplified Acute Physiology Score II were significantly superior to that of the customized hospital standardized mortality ratio (0.85 and 0.11 vs. 0.77 and 0.13, respectively). Calibration plots showed good agreement between observed and predicted mortality for low-risk patients in both models, with more discrepancy in the high-risk patients when using the customized hospital standardized mortality ratio. Severity of illness had influence on the intensive care units' standardized mortality ratios in both models, but the customized Simplified Acute Physiology Score II showed more robustness., Conclusions: The customized Simplified Acute Physiology Score II outperforms the customized hospital standardized mortality ratio in the Dutch intensive care unit population. Comparing institutions based on standardized mortality ratios can be unfavorable for those with a more severely ill intensive care unit population, especially when using the customized hospital standardized mortality ratio.

It is unclear whether the maximum acceptable weight of lift (MAWL), a common psychophysical method, reflects joint kinetics when different lifting techniques are employed. In a within-participants study (n = 12), participants performed three lifting techniques--free style, stoop and squat lifting from knee to waist level--using the same dynamic functional capacity evaluation lifting test to assess MAWL and to calculate low back and knee kinetics. We assessed which knee and back kinetic parameters increased with the load mass lifted, and whether the magnitudes of the kinetic parameters were consistent across techniques when lifting MAWL. MAWL was significantly different between techniques (p = 0.03). The peak lumbosacral extension moment met both criteria: it had the highest association with the load masses lifted (r > 0.9) and was most consistent between the three techniques when lifting MAWL (ICC = 0.87). In conclusion, MAWL reflects the lumbosacral extension moment across free style, stoop and squat lifting in healthy young males, but the relation between the load mass lifted and lumbosacral extension moment is different between techniques., Practitioner Summary: Tests of maximum acceptable weight of lift (MAWL) from knee to waist height are used to assess work capacity of individuals with low-back disorders. This article shows that the MAWL reflects the lumbosacral extension moment across free style, stoop and squat lifting in healthy young males, but the relation between the load mass lifted and lumbosacral extension moment is different between techniques. This suggests that standardisation of lifting technique used in tests of the MAWL would be indicated if the aim is to assess the capacity of the low back.