Prevalence of frailty and pain in hospitalised cancer patients: implications for older adult care.

A hospital-wide point prevalence study investigated frailty and pain in patients with a cancer-related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty-eight patients (19%) with cancer-related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent among cancer-related admissions, reinforcing the need for frailty screening and importance of pain assessment for patients with cancer.

Frailty and pain in an acute private hospital: an observational point prevalence study.

Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency units) at an acute, private, 860-bed metropolitan hospital were eligible to participate. Frailty was assessed using the self-report modified Reported Edmonton Frail Scale. Current pain and worst pain in the last 24 h were self-reported using the standard 0-10 numeric rating scale. Pain scores were categorised by severity (none, mild, moderate, severe). Demographic and clinical information including admitting services (medical, mental health, rehabilitation, surgical) were collected. The STROBE checklist was followed. Data were collected from 251 participants (54.9% of eligible). The prevalence of frailty was 26.7%, prevalence of current pain was 68.1% and prevalence of pain in the last 24 h was 81.3%. After adjusting for age, sex, admitting service and pain severity, admitting services medical (AOR: 13.5 95% CI 5.7-32.8), mental health (AOR: 6.3, 95% CI 1. 9-20.9) and rehabilitation (AOR: 8.1, 95% CI 2.4-37.1) and moderate pain (AOR: 3.9, 95% CI 1. 6-9.8) were associated with increased frailty. The number of older patients identified in this study who were frail has implications for managing this group in a hospital setting. This indicates a need to focus on developing strategies including frailty assessment on admission, and the development of interventions to meet the care needs of these patients. The findings also highlight the need for increased pain assessment, particularly in those who are frail, for more effective pain management.Trial registration: The study was prospectively registered (ACTRN12620000904976; 14th September 2020).

Why the other-race effect matters: Poor recognition of other-race faces impacts everyday social interactions.

What happens to everyday social interactions when other-race recognition fails? Here, we provide the first formal investigation of this question. We gave East Asian international students (N = 89) a questionnaire concerning their experiences of the other-race effect (ORE) in Australia, and a laboratory test of their objective other-race face recognition deficit using the Cambridge Face Memory Test (CFMT). As a 'perpetrator' of the ORE, participants reported that their problems telling apart Caucasian people contributed significantly to difficulties socializing with them. Moreover, the severity of this problem correlated with their ORE on the CFMT. As a 'victim' of the ORE, participants reported that Caucasians' problems telling them apart also contributed to difficulties socializing. Further, 81% of participants had been confused with other Asians by a Caucasian authority figure (e.g., university tutor, workplace boss), resulting in varying levels of upset/difficulty. When compared to previously established contributors to international students' high rates of social isolation, ORE-related problems were perceived as equally important as the language barrier and only moderately less important than cultural differences. We conclude that the real-world impact of the ORE extends beyond previously identified specialized settings (eyewitness testimony, security), to common everyday situations experienced by all humans.

Nurses' perceptions of using volunteer support in health care settings: A systematic scoping review.

AIMS: To understand nurses' perceptions of volunteer support in health care settings. BACKGROUND: Increasingly, volunteers provide specialised support to health care service users, requiring volunteers and nurses to work closely together. However, little is known about nurses' perceptions of volunteer support. METHODS: A scoping review was conducted following the PRISMA-ScR checklist. A mixed-methods convergent integrative approach was taken guided by the JBI framework. Quantitative data were transformed into qualitative data for synthesis and descriptive thematic analysis. Six databases were searched (CINHAL+, EMBASE, PubMed, Scopus, PsycInfo, ProQuest Health and Medical Collection) on 24 January 2022 using terms related to nurses, perceptions, volunteers and care settings, followed by a manual search. The search was limited to English language articles published during 2000-2022. Studies were included if they reported nurses' perceptions of volunteers supporting care within any health care setting. RESULTS: Of the 943 records identified, 12 met the inclusion criteria. All 12 were included in the review following critical appraisal. Five themes were identified: perceived benefits for patients, volunteers providing support for nursing staff, nurses' valuing volunteer support, nurses' understanding of the volunteer role and nurses' understanding of recruitment and training of volunteers. CONCLUSION: Nurses generally viewed volunteer support positively and perceived that it benefitted patients and assisted nurses. Some nurses raised concerns about the burden of additional supervision of volunteers and lacked knowledge of the volunteer role, recruitment and training. Emerging innovative models of nurse-led volunteer support can maximise the contribution of volunteers and help overcome barriers to volunteer acceptance. IMPLICATIONS: These findings will inform volunteer policies and provide guidance in developing volunteer support programs.

Effectiveness of nurse-led volunteer support and technology-driven pain assessment in improving the outcomes of hospitalised older adults: protocol for a cluster randomised controlled trial.

INTRODUCTION: Hospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain. METHODS AND ANALYSIS: This single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted. ETHICS AND DISSEMINATION: Ethical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER: ACTRN12620001173987.

Prevalence of frailty and pain in hospitalised adult patients in an acute hospital: a protocol for a point prevalence observational study.

INTRODUCTION: Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia. METHODS AND ANALYSIS: A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the sample (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission. ETHICS AND DISSEMINATION: Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020-02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER: ACTRN12620000904976.

Perceptual Oscillations in Gender Classification of Faces, Contingent on Stimulus History.

Perception is a proactive ''predictive'' process, in which the brain takes advantage of past experience to make informed guesses about the world to test against sensory data. Here we demonstrate that in the judgment of the gender of faces, beta rhythms play an important role in communicating perceptual experience. Observers classified in forced choice as male or female, a sequence of face stimuli, which were physically constructed to be male or female or androgynous (equal morph). Classification of the androgynous stimuli oscillated rhythmically between male and female, following a complex waveform comprising 13.5 and 17 Hz. Parsing the trials based on the preceding stimulus showed that responses to androgynous stimuli preceded by male stimuli oscillated reliably at 17 Hz, whereas those preceded by female stimuli oscillated at 13.5 Hz. These results suggest that perceptual priors for face perception from recent perceptual memory are communicated through frequency-coded beta rhythms.

A critical period for faces: Other-race face recognition is improved by childhood but not adult social contact.

Poor recognition of other-race faces is ubiquitous around the world. We resolve a longstanding contradiction in the literature concerning whether interracial social contact improves the other-race effect. For the first time, we measure the age at which contact was experienced. Taking advantage of unusual demographics allowing dissociation of childhood from adult contact, results show sufficient childhood contact eliminated poor other-race recognition altogether (confirming inter-country adoption studies). Critically, however, the developmental window for easy acquisition of other-race faces closed by approximately 12 years of age and social contact as an adult - even over several years and involving many other-race friends - produced no improvement. Theoretically, this pattern of developmental change in plasticity mirrors that found in language, suggesting a shared origin grounded in the functional importance of both skills to social communication. Practically, results imply that, where parents wish to ensure their offspring develop the perceptual skills needed to recognise other-race people easily, childhood experience should be encouraged: just as an English-speaking person who moves to France as a child (but not an adult) can easily become a native speaker of French, we can easily become "native recognisers" of other-race faces via natural social exposure obtained in childhood, but not later.

Caricaturing can improve facial expression recognition in low-resolution images and age-related macular degeneration.

Previous studies of age-related macular degeneration (AMD) report impaired facial expression recognition even with enlarged face images. Here, we test potential benefits of caricaturing (exaggerating how the expression's shape differs from neutral) as an image enhancement procedure targeted at mid- to high-level cortical vision. Experiment 1 provides proof-of-concept using normal vision observers shown blurred images as a partial simulation of AMD. Caricaturing significantly improved expression recognition (happy, sad, anger, disgust, fear, surprise) by ∼4%-5% across young adults and older adults (mean age 73 years); two different severities of blur; high, medium, and low intensity of the original expression; and all intermediate accuracy levels (impaired but still above chance). Experiment 2 tested AMD patients, running 19 eyes monocularly (from 12 patients, 67-94 years) covering a wide range of vision loss (acuities 6/7.5 to poorer than 6/360). With faces pre-enlarged, recognition approached ceiling and was only slightly worse than matched controls for high- and medium-intensity expressions. For low-intensity expressions, recognition of veridical expressions remained impaired and was significantly improved with caricaturing across all levels of vision loss by 5.8%. Overall, caricaturing benefits emerged when improvement was most needed, that is, when initial recognition of uncaricatured expressions was impaired.

Perceptual experience shapes our ability to categorize faces by national origin: A new other-race effect.

People are better at recognizing own-race than other-race faces. This other-race effect has been argued to be the result of perceptual expertise, whereby face-specific perceptual mechanisms are tuned through experience. We designed new tasks to determine whether other-race effects extend to categorizing faces by national origin. We began by selecting sets of face stimuli for these tasks that are typical in appearance for each of six nations (three Caucasian, three Asian) according to people from those nations (Study 1). Caucasian and Asian participants then categorized these faces by national origin (Study 2). Own-race faces were categorized more accurately than other-race faces. In contrast, Asian American participants, with more extensive other-race experience than the first Asian group, categorized other-race faces better than own-race faces, demonstrating a reversal of the other-race effect. Therefore, other-race effects extend to the ability to categorize faces by national origin, but only if participants have greater perceptual experience with own-race, than other-race faces. Study 3 ruled out non-perceptual accounts by showing that Caucasian and Asian faces were sorted more accurately by own-race than other-race participants, even in a sorting task without any explicit labelling required. Together, our results demonstrate a new other-race effect in sensitivity to national origin of faces that is linked to perceptual expertise.

A new other-race effect for gaze perception.

The well-known other-race effect in face recognition has been widely studied, both for its theoretical insights into the nature of face expertise and because of its social and forensic importance. Here we demonstrate an other-race effect for the perception of a simple visual signal provided by the eyes, namely gaze direction. In Study 1, Caucasian and Asian participants living in Australia both showed greater perceptual sensitivity to detect direct gaze in own-race than other-race faces. In Study 2, Asian (Chinese) participants living in Australia and Asian (Chinese) participants living in Hong Kong both showed this other-race effect, but Caucasian participants did not. Despite this inconsistency, meta-analysis revealed a significant other-race effect when results for all 5 participant groups from corresponding conditions in the 2 studies were combined. These results demonstrate a new other-race effect for the perception of the simple, but socially potent, cue of direct gaze. When identical morphed-race eyes were inserted into the faces, removing race-specific eye cues, no other-race effect was found (with 1 exception). Thus, the balance of evidence implicated perceptual expertise, rather than social motivation, in the other-race effect for detecting direct gaze. (PsycINFO Database Record

Hidden Markov model analysis reveals the advantage of analytic eye movement patterns in face recognition across cultures.

It remains controversial whether culture modulates eye movement behavior in face recognition. Inconsistent results have been reported regarding whether cultural differences in eye movement patterns exist, whether these differences affect recognition performance, and whether participants use similar eye movement patterns when viewing faces from different ethnicities. These inconsistencies may be due to substantial individual differences in eye movement patterns within a cultural group. Here we addressed this issue by conducting individual-level eye movement data analysis using hidden Markov models (HMMs). Each individual's eye movements were modeled with an HMM. We clustered the individual HMMs according to their similarities and discovered three common patterns in both Asian and Caucasian participants: holistic (looking mostly at the face center), left-eye-biased analytic (looking mostly at the two individual eyes in addition to the face center with a slight bias to the left eye), and right-eye-based analytic (looking mostly at the right eye in addition to the face center). The frequency of participants adopting the three patterns did not differ significantly between Asians and Caucasians, suggesting little modulation from culture. Significantly more participants (75%) showed similar eye movement patterns when viewing own- and other-race faces than different patterns. Most importantly, participants with left-eye-biased analytic patterns performed significantly better than those using either holistic or right-eye-biased analytic patterns. These results suggest that active retrieval of facial feature information through an analytic eye movement pattern may be optimal for face recognition regardless of culture.

Diagnosing prosopagnosia in East Asian individuals: Norms for the Cambridge Face Memory Test-Chinese.

The Cambridge Face Memory Test (CFMT) is widely accepted as providing a valid and reliable tool in diagnosing prosopagnosia (inability to recognize people's faces). Previously, large-sample norms have been available only for Caucasian-face versions, suitable for diagnosis in Caucasian observers. These are invalid for observers of different races due to potentially severe other-race effects. Here, we provide large-sample norms (N = 306) for East Asian observers on an Asian-face version (CFMT-Chinese). We also demonstrate methodological suitability of the CFMT-Chinese for prosopagnosia diagnosis (high internal reliability, approximately normal distribution, norm-score range sufficiently far above chance). Additional findings were a female advantage on mean performance, plus a difference between participants living in the East (China) or the West (international students, second-generation children of immigrants), which we suggest might reflect personality differences associated with willingness to emigrate. Finally, we demonstrate suitability of the CFMT-Chinese for individual differences studies that use correlations within the normal range.

Face-blind for other-race faces: Individual differences in other-race recognition impairments.

We report the existence of a previously undescribed group of people, namely individuals who are so poor at recognition of other-race faces that they meet criteria for clinical-level impairment (i.e., they are "face-blind" for other-race faces). Testing 550 participants, and using the well-validated Cambridge Face Memory Test for diagnosing face blindness, results show the rate of other-race face blindness to be nontrivial, specifically 8.1% of Caucasians and Asians raised in majority own-race countries. Results also show risk factors for other-race face blindness to include: a lack of interracial contact; and being at the lower end of the normal range of general face recognition ability (i.e., even for own-race faces); but not applying less individuating effort to other-race than own-race faces. Findings provide a potential resolution of contradictory evidence concerning the importance of the other-race effect (ORE), by explaining how it is possible for the mean ORE to be modest in size (suggesting a genuine but minor problem), and simultaneously for individuals to suffer major functional consequences in the real world (e.g., eyewitness misidentification of other-race offenders leading to wrongful imprisonment). Findings imply that, in legal settings, evaluating an eyewitness's chance of having made an other-race misidentification requires information about the underlying face recognition abilities of the individual witness. Additionally, analogy with prosopagnosia (inability to recognize even own-race faces) suggests everyday social interactions with other-race people, such as those between colleagues in the workplace, will be seriously impacted by the ORE in some people. (PsycINFO Database Record

Holistic processing of face configurations and components.

Although many researchers agree that faces are processed holistically, we know relatively little about what information holistic processing captures from a face. Most studies that assess the nature of holistic processing do so with changes to the face affecting many different aspects of face information (e.g., different identities). Does holistic processing affect every aspect of a face? We used the composite task, a common means of examining the strength of holistic processing, with participants making same-different judgments about configuration changes or component changes to 1 portion of a face. Configuration changes involved changes in spatial position of the eyes, whereas component changes involved lightening or darkening the eyebrows. Composites were either aligned or misaligned, and were presented either upright or inverted. Both configuration judgments and component judgments showed evidence of holistic processing, and in both cases it was strongest for upright face composites. These results suggest that holistic processing captures a broad range of information about the face, including both configuration-based and component-based information. (PsycINFO Database Record

How Well Do Computer-Generated Faces Tap Face Expertise?

The use of computer-generated (CG) stimuli in face processing research is proliferating due to the ease with which faces can be generated, standardised and manipulated. However there has been surprisingly little research into whether CG faces are processed in the same way as photographs of real faces. The present study assessed how well CG faces tap face identity expertise by investigating whether two indicators of face expertise are reduced for CG faces when compared to face photographs. These indicators were accuracy for identification of own-race faces and the other-race effect (ORE)-the well-established finding that own-race faces are recognised more accurately than other-race faces. In Experiment 1 Caucasian and Asian participants completed a recognition memory task for own- and other-race real and CG faces. Overall accuracy for own-race faces was dramatically reduced for CG compared to real faces and the ORE was significantly and substantially attenuated for CG faces. Experiment 2 investigated perceptual discrimination for own- and other-race real and CG faces with Caucasian and Asian participants. Here again, accuracy for own-race faces was significantly reduced for CG compared to real faces. However the ORE was not affected by format. Together these results signal that CG faces of the type tested here do not fully tap face expertise. Technological advancement may, in the future, produce CG faces that are equivalent to real photographs. Until then caution is advised when interpreting results obtained using CG faces.

A cultural setting where the other-race effect on face recognition has no social-motivational component and derives entirely from lifetime perceptual experience.

Competing approaches to the other-race effect (ORE) see its primary cause as either a lack of motivation to individuate social outgroup members, or a lack of perceptual experience with other-race faces. Here, we argue that the evidence supporting the social-motivational approach derives from a particular cultural setting: a high socio-economic status group (typically US Whites) looking at the faces of a lower status group (US Blacks) with whom observers typically have at least moderate perceptual experience. In contrast, we test motivation-to-individuate instructions across five studies covering an extremely wide range of perceptual experience, in a cultural setting of more equal socio-economic status, namely Asian and Caucasian participants (N = 480) tested on Asian and Caucasian faces. We find no social-motivational component at all to the ORE, specifically: no reduction in the ORE with motivation instructions, including for novel images of the faces, and at all experience levels; no increase in correlation between own- and other-race face recognition, implying no increase in shared processes; and greater (not the predicted less) effort applied to distinguishing other-race faces than own-race faces under normal ("no instructions") conditions. Instead, the ORE was predicted by level of contact with the other-race. Our results reject both pure social-motivational theories and also the recent Categorization-Individuation model of Hugenberg, Young, Bernstein, and Sacco (2010). We propose a new dual-route approach to the ORE, in which there are two causes of the ORE-lack of motivation, and lack of experience--that contribute differently across varying world locations and cultural settings.

No childhood development of viewpoint-invariant face recognition: evidence from 8-year-olds and adults.

Performance on laboratory face tasks improves across childhood, not reaching adult levels until adolescence. Debate surrounds the source of this development, with recent reviews suggesting that underlying face processing mechanisms are mature early in childhood and that the improvement seen on experimental tasks instead results from general cognitive/perceptual development. One face processing mechanism that has been argued to develop slowly is the ability to encode faces in a view-invariant manner (i.e., allowing recognition across changes in viewpoint). However, many previous studies have not controlled for general cognitive factors. In the current study, 8-year-olds and adults performed a recognition memory task with two study-test viewpoint conditions: same view (study front view, test front view) and change view (study front view, test three-quarter view). To allow quantitative comparison between children and adults, performance in the same view condition was matched across the groups by increasing the learning set size for adults. Results showed poorer memory in the change view condition than in the same view condition for both adults and children. Importantly, there was no quantitative difference between children and adults in the size of decrement in memory performance resulting from a change in viewpoint. This finding adds to growing evidence that face processing mechanisms are mature early in childhood.

Holistic processing for other-race faces in chinese participants occurs for upright but not inverted faces.

Recent evidence suggests stronger holistic processing for own-race faces may underlie the own-race advantage in face memory. In previous studies Caucasian participants have demonstrated larger holistic processing effects for Caucasian over Asian faces. However, Asian participants have consistently shown similar sized effects for both Asian and Caucasian faces. We investigated two proposed explanations for the holistic processing of other-race faces by Asian participants: (1) greater other-race exposure, (2) a general global processing bias. Holistic processing was tested using the part-whole task. Participants were living in predominantly own-race environments and other-race contact was evaluated. Despite reporting significantly greater contact with own-race than other-race people, Chinese participants displayed strong holistic processing for both Asian and Caucasian upright faces. In addition, Chinese participants showed no evidence of holistic processing for inverted faces arguing against a general global processing bias explanation. Caucasian participants, in line with previous studies, displayed stronger holistic processing for Caucasian than Asian upright faces. For inverted faces there were no race-of-face differences. These results are used to suggest that Asians may make more general use of face-specific mechanisms than Caucasians.

Importance of the inverted control in measuring holistic face processing with the composite effect and part-whole effect.

Holistic coding for faces is shown in several illusions that demonstrate integration of the percept across the entire face. The illusions occur upright but, crucially, not inverted. Converting the illusions into experimental tasks that measure their strength - and thus index degree of holistic coding - is often considered straightforward yet in fact relies on a hidden assumption, namely that there is no contribution to the experimental measure from secondary cognitive factors. For the composite effect, a relevant secondary factor is size of the "spotlight" of visuospatial attention. The composite task assumes this spotlight can be easily restricted to the target half (e.g., top-half) of the compound face stimulus. Yet, if this assumption were not true then a large spotlight, in the absence of holistic perception, could produce a false composite effect, present even for inverted faces and contributing partially to the score for upright faces. We review evidence that various factors can influence spotlight size: race/culture (Asians often prefer a more global distribution of attention than Caucasians); sex (females can be more global); appearance of the join or gap between face halves; and location of the eyes, which typically attract attention. Results from five experiments then show inverted faces can sometimes produce large false composite effects, and imply that whether this happens or not depends on complex interactions between causal factors. We also report, for both identity and expression, that only top-half face targets (containing eyes) produce valid composite measures. A sixth experiment demonstrates an example of a false inverted part-whole effect, where encoding-specificity is the secondary cognitive factor. We conclude the inverted face control should be tested in all composite and part-whole studies, and an effect for upright faces should be interpreted as a pure measure of holistic processing only when the experimental design produces no effect inverted.