Correction: Eyewitness accuracy and retrieval effort: Effects of time and repetition.

[This corrects the article DOI: 10.1371/journal.pone.0273455.].

Stress and work-related mental illness among working adults with ADHD: a qualitative study.

BACKGROUND: Though many adults with ADHD underperform professionally, are more stressed, and have more days of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related mental illness. METHODS: Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants' well-being, and the need for support and accommodation. Qualitative content analysis was used to explore verbatim transcripts from the interviews. RESULTS: The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities. CONCLUSION: Further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with great dilemma.

Eyewitness accuracy and retrieval effort: Effects of time and repetition.

An important task for the law enforcement is to assess the accuracy of eyewitness testimonies. Recent research show that indicators of effortful memory retrieval, such as pausing and hedging (e.g. "I think", "maybe"), are more common in incorrect recall. However, a limitation in these studies is that participants are interviewed shortly after witnessing an event, as opposed to after greater retention intervals. We set out to mitigate this shortcoming by investigating the retrieval effort-accuracy relationship over time. In this study, participants watched a staged crime and were interviewed directly afterwards, and two weeks later. Half the participants also carried out a repetition task during the two-week retention interval. Results showed that the retrieval-effort cues Delays and Hedges predicted accuracy at both sessions, including after repetition. We also measured confidence, and found that confidence also predicted accuracy over time, although repetition led to increased confidence for incorrect memories. Moreover, retrieval-effort cues partially mediated between accuracy and confidence.

Exposure-Bleeding Count Modeling of Emicizumab for the Prophylaxis of Bleeding in Persons with Hemophilia A with/Without Inhibitors Against Factor VIII.

BACKGROUND AND OBJECTIVE: Emicizumab is a monoclonal antibody that bridges activated coagulation factor IX and factor X to restore effective hemostasis in persons with hemophilia A. It is indicated for routine prophylaxis of bleeding episodes in persons with hemophilia A. The aim of the present study is to describe the exposure-response relationship between emicizumab concentrations and bleeding frequency, and to confirm adequate bleeding control of the investigated dosing regimens 1.5 mg/kg once weekly, 3 mg/kg every 2 weeks, and 6 mg/kg every 4 weeks. METHODS: Treated bleeding events were pooled from 445 persons with hemophilia A with and without inhibitors against factor VIII, participating in six clinical studies. Emicizumab concentrations were predicted using a previously developed population pharmacokinetic model. A count model was used to quantify the exposure-response relationship. These models were used to illustrate the relationship between emicizumab concentrations and cumulative count of bleeding over 1 year (annualized bleeding rate). RESULTS: The final exposure-response model, based on a generalized Poisson distribution and an inhibitory Emax relationship, adequately describes the relationship between daily emicizumab concentrations and daily bleed frequency. A significant effect of factor VIII prophylaxis among persons with hemophilia A without inhibitors was found. Annualized bleeding rate simulations show that the three emicizumab dosing regimens maintain the concentrations close to the plateau of the effect. At the average steady-state concentration across all regimens (53.5 µg/mL), the predicted mean annualized bleeding rate is 1.28, corresponding to a 94.0% reduction from baseline. CONCLUSIONS: These results confirm that average emicizumab concentrations achieved with all three emicizumab dosing regimens provide adequate bleeding control.

Putting action into testing: Enacted retrieval benefits long-term retention more than covert retrieval.

Retrieval practice improves long-term retention. However, it is currently debated if this testing effect can be further enhanced by overtly producing recalled responses. We addressed this issue using a standard cued-recall testing-effect paradigm with verb-noun action phrases (e.g., water the plant) to prompt motor actions as a specifically powerful response format of recall. We then tested whether motorically performing the recalled verb targets (e.g., ?-the plant) during an initial recall test (enacted retrieval) led to better long-term retention than silently retrieving them (covert retrieval) or restudying the complete verb-noun phrases (restudy). The results demonstrated a direct testing effect, in that long-term retention was enhanced for covert retrieval practice compared to restudy practice. Critically, enactment during retrieval further improved long-term retention beyond the effect of covert memory retrieval, both in a congruent noun-cued recall test after 1 week (Experiment 1) and in an incongruent verb-cued recall test of nouns after 2 weeks (Experiment 2). This finding suggests that successful memory retrieval and ensuing enactment contribute to future memory performance in parts via different mechanisms.

The reminiscence bump is blind to blindness: Evidence from sound- and odor-evoked autobiographical memory.

The reminiscence bump is the disproportionally high reporting of autobiographical memories from adolescence and early adulthood and is typically observed when memories are evoked by cues, such as words, pictures, and sounds. However, when odors are used the bump shifts to early childhood. Although these findings indicate that sensory modality affects the bump, the influence of the individual's sensory function on the reminiscence bumps is unknown. We examined the reminiscence bumps of sound- and odor-evoked autobiographical memories of early blind and sighted individuals, since early blindness implies considerable effects on sensory experience. Despite differences in sensory experience between blind and sighted individuals, the groups displayed similar age distributions of both sound- and odor-evoked memories. The auditory bump spanned the first two decades of life, whereas the olfactory bump was once again found in early childhood. These results demonstrate that the reminiscence bumps are robust to fundamental differences in sensory experience.

Perceived enabling factors and barriers for the implementation of improvements in health care in order to achieve patient-centred care: A case report from Sweden.

RATIONALE, AIM, AND OBJECTIVES: More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient-centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them. METHODS: Using a mixed method design, data were gathered via a questionnaire and individual interviews with health care personnel, clinic managers, and first-line managers. The data collection and analyses were based on the framework for Promoting Action on Research Implementation in Health Services (PARiHS). Correlations between PCC improvements and preconditions for improvements were performed. RESULTS: A high level of involvement, knowledge, and adequate resources were considered important to achieve an implementation of PCC with joint responsibility. Leadership and management need to be explicit and promote continuous follow-up and feedback. Preconditions for improvement had a linear correlation with the perceived level of implementation. Knowledge-related preconditions had greatest impact on implementation. CONCLUSIONS: The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence-based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care.

Predicting Accuracy in Eyewitness Testimonies With Memory Retrieval Effort and Confidence.

Evaluating eyewitness testimonies has proven a difficult task. Recent research, however, suggests that incorrect memories are more effortful to retrieve than correct memories, and confidence in a memory is based on retrieval effort. We aimed to replicate and extend these findings, adding retrieval latency as a predictor of memory accuracy. Participants watched a film sequence with a staged crime and were interviewed about its content. We then analyzed retrieval effort cues in witness responses. Results showed that incorrect memories included more "effort cues" than correct memories. While correct responses were produced faster than incorrect responses, delays in responses proved a better predictor of accuracy than response latency. Furthermore, participants were more confident in correct than incorrect responses, and the effort cues partially mediated this confidence-accuracy relation. In sum, the results support previous findings of a relationship between memory accuracy and objectively verifiable cues to retrieval effort.

Multimedia learning trumps retrieval practice in psychology teaching.

It is well established that studying with (vs. without) visual illustrations as well as taking tests (vs. restudying) is beneficial for learning, but on which strategy should one put the efforts, or should they be combined for best learning? Eighty-eight upper secondary school students were given a brief lecture presented verbally (6 classes) or with the aid of a visual illustration (visuoverbal, 6 classes). The information was processed again by taking a memory test or by restudying. Recall and transfer tests were conducted after some few minutes and again after one week. The visuoverbal lecture resulted in better learning than verbal presentation only. A significant study strategy by retention interval interaction was found. However, this interaction was not qualified by a testing effect. Hence, taking tests (retrieval practice) did not lead to better learning than restudying. It was concluded that it is worthwhile to use visual illustrations in teaching. However, the present study did not reveal any synergistic effects from the combination of visuoverbal presentation and retrieval practice.

The Direct Testing Effect Is Pervasive in Action Memory: Analyses of Recall Accuracy and Recall Speed.

Successful retrieval from memory is a desirably difficult learning event that reduces the recall decrement of studied materials over longer delays more than restudying does. The present study was the first to test this direct testing effect for performed and read action events (e.g., "light a candle") in terms of both recall accuracy and recall speed. To this end, subjects initially encoded action phrases by either enacting them or reading them aloud (i.e., encoding type). After this initial study phase, they received two practice phases, in which the same number of action phrases were restudied or retrieval-practiced (Exp. 1-3), or not further processed (Exp. 3; i.e., practice type). This learning session was ensued by a final cued-recall test both after a short delay (2 min) and after a long delay (1 week: Exp. 1 and 2; 2 weeks: Exp. 3). To test the generality of the results, subjects retrieval practiced with either noun-cued recall of verbs (Exp. 1 and 3) or verb-cued recall of nouns (Exp. 2) during the intermediate and final tests (i.e., test type). We demonstrated direct benefits of testing on both recall accuracy and recall speed. Repeated retrieval practice, relative to repeated restudy and study-only practice, reduced the recall decrement over the long delay, and enhanced phrases' recall speed already after 2 min, and this independently of type of encoding and recall test. However, a benefit of testing on long-term retention only emerged (Exp. 3), when prolonging the recall delay from 1 to 2 weeks, and using different sets of phrases for the immediate and delayed final tests. Thus, the direct testing benefit appears to be highly generalizable even with more complex, action-oriented stimulus materials, and encoding manipulations. We discuss these results in terms of the distribution-based bifurcation model.

Retrieval effort cues predict eyewitness accuracy.

Previous research has documented that correct eyewitness memories are more rapidly recalled and recognized than are incorrect ones, suggesting that retrieval ease is diagnostic of memory accuracy. Building on these findings, the current research explores whether verbal and paraverbal cues to retrieval effort could be used to determine the accuracy of honestly reported eyewitness statements about a crime event. Moreover, we examine the relative role of such effort cues and witnesses' subjective confidence in predicting memory accuracy. The results of 2 studies demonstrate that objectively verifiable verbal and paraverbal cues to retrieval effort are strongly related to honest witnesses' memory accuracy and that several of these cues contribute uniquely to predict accuracy. Moreover, we show that subjective confidence in a memory rests on these effort cues and that the cues mediate the confidence-accuracy relation. Given research showing that most people have vast difficulties in judging the quality of others' memories, combined with the scarcity of research on predictors of genuinely reported memories, these initial findings suggest unexplored alternatives that may prove highly useful for improving accuracy judgments, with potentially far-reaching significance not the least in the legal context. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Ease-of-learning judgments are based on both processing fluency and beliefs.

Processing fluency influences many types of judgments. Some metacognitive research suggests that the influence of processing fluency may be mediated by participants' beliefs. The current study explores the influence of processing fluency and beliefs on ease-of-learning (EOL) judgments. In two experiments (Exp 1: n = 94; Exp 2: n = 146), participants made EOL judgments on 24 six-letter concrete nouns, presented in either a constant condition (high fluency) with upper-case letters (e.g., BUCKET) or an alternating condition (low fluency) with mixed upper- and lower-case letters (e.g., bUcKeT). After judging words individually, participants studied the words and completed a free recall test. Finally, participants indicated what condition they believed made the words more likely to be learned. Results show constant-condition words were judged as more likely to be learned than alternating condition words, but the difference varied with beliefs. Specifically, the difference was biggest when participants believed the constant condition made words more likely to be learned, followed by believing there was no difference, and then believing the alternating condition made words more likely to be learned. Thus, we showed that processing fluency has a direct effect on EOL judgments, but the effect is moderated by beliefs.

Assessing Boundary Conditions of the Testing Effect: On the Relative Efficacy of Covert vs. Overt Retrieval.

Repeated testing during learning often improves later memory, which is often referred to as the testing effect. To clarify its boundary conditions, we examined whether the testing effect was selectively affected by covert (retrieved but not articulated) or overt (retrieved and articulated) response format. In Experiments 1 and 2, we compared immediate (5 min) and delayed (1 week) cued recall for paired associates following study-only, covert, and overt conditions, including two types of overt articulation (typing and writing). A clear testing effect was observed in both experiments, but with no selective effects of response format. In Experiments 3 and 4, we compared covert and overt retrieval under blocked and random list orders. The effect sizes were small in both experiments, but there was a significant effect of response format, with overt retrieval showing better final recall performance than covert retrieval. There were no significant effects of blocked vs. random list orders with respect to the testing effect produced. Taken together, these findings suggest that, under specific circumstances, overt retrieval may lead to a greater testing effect than that of covert retrieval, but because of small effect sizes, it appears that the testing effect is mainly the result of retrieval processes and that articulation has fairly little to add to its magnitude in a paired-associates learning paradigm.

Group discussions and test-enhanced learning: individual learning outcomes and personality characteristics.

This paper focuses on the factors that are likely to play a role in individual learning outcomes from group discussions, and it includes a comparison featuring test-enhanced learning. A between-groups design (N = 98) was used to examine the learning effects of feedback if provided to discussion groups, and to examine whether group discussions benefit learning when compared to test-enhanced learning over time. The results showed that feedback does not seem to have any effect if provided to a discussion group, and that test-enhanced learning leads to better learning than the discussion groups, independent of retention interval. Moreover, we examined whether memory and learning might be influenced by the participants' need for cognition (NFC). The results showed that those scoring high on NFC remembered more than those who scored low. To conclude, testing trumps discussion groups from a learning perspective, and the discussion groups were also the least beneficial learning context for those scoring low on NFC.

Exposure-Response and Tumor Growth Inhibition Analyses of the Monovalent Anti-c-MET Antibody Onartuzumab (MetMAb) in the Second- and Third-Line Non-Small Cell Lung Cancer.

The phase III trial comparing onartuzumab + erlotinib vs. erlotinib in the second- and third-line non-small cell lung cancer (NSCLC) did not meet its primary endpoint of overall survival (OS). The objective was to assess whether doses higher than the phase III dose (15 mg/kg) might yield better efficacy without compromising the safety profile. Data were from 636 patients from the phase II and III NSCLC studies. Tumor growth inhibition (TGI) models were fit to longitudinal tumor size data to estimate individual TGI metrics including time to tumor re-growth (TTG). Cox regression models were developed for time-to-event endpoints (progression-free survival (PFS), OS, and TTG) to investigate relationships with baseline prognostic factors and onartuzumab exposure. Incidence of adverse events was modeled by logistic regression. In the final models, higher onartuzumab exposure was associated with longer PFS, but not with longer OS. Longer OS was associated with higher baseline albumin, longer TTG, smaller number of metastatic sites, female gender, lower ECOG score, and younger age. TTG was the only TGI metric retained in the final OS model. Onartuzumab exposure was not significantly associated with TTG after adjusting for prognostic factors. Higher Cmin was associated with increased incidence of infusion reactions and peripheral edema. Higher onartuzumab exposure was not significantly associated with improved OS after adjusting for prognostic factors and TTG, and there was a trend of unknown clinical significance toward increased incidence of infusion reactions and peripheral edema. These results did not support testing higher onartuzumab doses.

Population Pharmacokinetics and Exposure-Response Relationship of Carfilzomib in Patients With Multiple Myeloma.

A population pharmacokinetic (PK) model and exposure-response (E-R) analysis was developed using data collected from 5 phase 1b/2 and 2 phase 3 studies in subjects with multiple myeloma. Subjects receiving intravenous infusion on 2 consecutive days each week for 3 weeks (days 1, 2, 8, 9, 15, and 16) in each cycle at doses ranging from 15 to 20/56 mg/m2 (20 mg/m2 in cycle 1 and, if tolerated, escalated to 56 mg/m2 on day 8 of cycle 1). The population PK analysis indicated that among all the covariates tested, the only statistically significant covariate was body surface area on carfilzomib clearance; however, this covariate was unlikely to be clinically significant. Despite inclusion of different populations (relapsed or relapsed/refractory), treatments (carfilzomib monotherapy or combination therapy), infusion lengths (2 to 10 minutes or 30 minutes), and different doses, the E-R analysis of efficacy showed that after adjusting for baseline characteristics, higher area under the concentration-time curve was associated with improved overall response rate (ORR), from 15 to 20/56 mg/m2 . No positive relationships between maximum concentration and ORR were identified, indicating that ORR would not be expected to be impacted by infusion length. For safety end points, no statistically significant relationship between exposure and increasing risk of adverse events was identified. The results of an E-R analysis provided strong support for a carfilzomib dose at 20/56 mg/m2 as a 30-minute infusion for monotherapy and combination therapy. This article illustrates an example of application of E-R analysis to support labeling dose recommendation in the absence of extensive clinical data.

Coronary Artery Calcification Is Related to Inflammation in Rheumatoid Arthritis: A Long-Term Follow-Up Study.

Objective. A long-term follow-up of patients with rheumatoid arthritis (RA) to evaluate factors related to coronary artery calcification (CAC). Methods. All 22 eligible patients (4 males/18 females, mean age 65 years, and RA-duration 30-36 years) from the original (baseline; n = 39) study of atherosclerosis were included. Inflammation, cardiovascular risk factors, and biomarkers were measured at baseline. At follow-up 13 years later, CAC was assessed by computed tomography (CT) and the grade of inflammation was measured. Multivariate analysis of differences between patients with low (0-10) and high CAC (>10) was done by orthogonal projection to latent structures (OPLS). Results. Ten patients had CAC 0-10 and 12 had >10 (range 18-1700). Patients with high CAC had significantly higher ESR (24.3 versus 9.9 mm/h) and swollen joint count (2 versus 0). The OPLS models discriminated between patients having high or low CAC. With only baseline variables, the sensitivity was 73% and the specificity 82%. The model that also included inflammatory variables from follow-up had a sensitivity of 89% and a specificity of 85%. Exclusion of baseline intima media thickness and plaque from the latter model modestly reduced the accuracy (sensitivity 80% and specificity 83%). Conclusions. CAC is related to inflammation in patients with RA.

Primary triage nurses do not divert patients away from the emergency department at times of high in-hospital bed occupancy - a retrospective cohort study.

BACKGROUND: Emergency department (ED) overcrowding is frequently described in terms of input- throughput and output. In order to reduce ED input, a concept called primary triage has been introduced in several Swedish EDs. In short, primary triage means that a nurse separately evaluates patients who present in the Emergency Department (ED) and either refers them to primary care or discharges them home, if their complaints are perceived as being of low acuity. The aim of the present study is to elucidate whether high levels of in-hospital bed occupancy are associated with decreased permeability in primary triage. The appropriateness of discharges from primary triage is assessed by 72-h revisits to the ED. METHODS: The study is a retrospective cohort study on administrative data from the ED at a 420-bed hospital in southern Sweden from 2011-2012. In addition to crude comparisons of proportions experiencing each outcome across strata of in-hospital bed occupancy, multivariate models are constructed in order to adjust for age, sex and other factors. RESULTS: A total of 37,129 visits to primary triage were included in the study. 53.4 % of these were admitted to the ED. Among the cases referred to another level of care, 8.8 % made an unplanned revisit to the ED within 72 h. The permeability of primary triage was not decreased at higher levels of in-hospital bed occupancy. Rather, the permeability was slightly higher at occupancy of 100-105 % compared to <95 % (OR 1.09 95 % CI 1.02-1.16). No significant association between in-hospital bed occupancy and the probability of 72-h revisits was observed. CONCLUSIONS: The absence of a decreased permeability of primary triage at times of high in-hospital bed occupancy is reassuring, as the opposite would have implied that patients might be denied entry not only to the hospital, but also to the ED, when in-hospital beds are scarce.

The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge--a retrospective cohort study.

BACKGROUND: Previous work has suggested that given a hospital's need to admit more patients from the emergency department (ED), high inpatient bed occupancy may encourage premature hospital discharges that favor the hospital's need for beds over patients' medical interests. We argue that the effects of such action would be measurable as a greater proportion of unplanned hospital readmissions among patients discharged when the hospital was full than when not. In response, the present study tested this hypothesis by investigating the association between inpatient bed occupancy at the time of hospital discharge and the 30-day readmission rate. METHODS: The sample included all inpatient admissions from the ED at a 420-bed emergency hospital in southern Sweden during 2011-2012 that resulted in discharge before 1 December 2012. The share of unplanned readmissions within 30 days was computed for levels of inpatient bed occupancy of <95%, 95-100%, 100-105% and >105% at the hour of discharge. A binary logistic regression model was constructed to adjust for age, time of discharge, and other factors that could affect the outcome. RESULTS: In all, 32,811 visits were included in the study, 9.9% of which resulted in an unplanned readmission within 30 days of discharge. The proportion of readmissions was 9.0% for occupancy levels of <95% at the patient's discharge, 10.2% for 95-100% occupancy, 10.8% for 100-105% occupancy, and 10.5% for >105% occupancy (p = 0.0001). Results from the multivariate models show that the OR (95% CI) of readmission was 1.11 (1.01-1.22) for patients discharged at 95-100% occupancy, 1.17 (1.06-1.29) at 100-105% occupancy, and 1.15 (0.99-1.34) at >105% occupancy. CONCLUSIONS: Results indicate that patients discharged from inpatient wards at times of high inpatient bed occupancy experience an increased risk of unplanned readmission within 30 days of discharge.

Effects of testing on subsequent re-encoding and long-term forgetting of action-relevant materials: On the influence of recall type.

Testing one's memory of previously studied information reduces the rate of forgetting, compared to restudy. However, little is known about how this direct testing effect applies to action phrases (e.g., "wash the car") - a learning material relevant to everyday memory. As action phrases consist of two different components, a verb (e.g., "wash") and a noun (e.g., "car"), testing can either be implemented as noun-cued recall of verbs or verb-cued recall of nouns, which may differently affect later memory performance. In the present study, we investigated the effect of testing for these two recall types, using verbally encoded action phrases as learning materials. Results showed that repeated study-test practice, compared to repeated study-restudy practice, decreased the forgetting rate across 1 week to a similar degree for both noun-cued and verb-cued recall types. However, noun-cued recall of verbs initiated more new subsequent learning during the first restudy, compared to verb-cued recall of nouns. The study provides evidence that testing has benefits on both subsequent restudy and long-term retention of action-relevant materials, but that these benefits are differently expressed with testing via noun-cued versus verb-cued recall.