When routine becomes stressful: A qualitative study into resuscitation team members' perception of stress and performance.

Interprofessional teamwork is of high importance during stressful situations such as CPR. Stress can potentially influence team performance. This study explores the perception of stress and its stressors during performance under pressure, to be able to further adjust or develop training. Healthcare professionals, who are part of the resuscitation team in a large Dutch university medical center, discussed their experiences in homogeneous focus groups. Nine focus groups and one individual interview were conducted and analyzed thematically, in order to deepen our understanding of their experiences. Thematic analysis resulted in two scenarios, routine and stress and an analysis of accompanying team processes. Routine refers to a setting perceived as straightforward. Stress develops in the presence of a combination of stressors such as a lack of clarity in roles and a lack of knowledge on fellow team members. Participants reported that stress affects the team, specifically through an altering of communication, a decrease in situational awareness, and formation of subgroups. This may lead to a further increase in stress, and potentially result in a vicious cycle. Team processes in a stressful situation like CPR can be disrupted by different stressors, and might affect the team and their performance. Improved knowledge about the stressors and their effects might be used to design a training environment representative for the performance setting healthcare professionals work in. Further research on the impact of representative training with team-level stressors and the development of a "team brain" might be worthwhile.

Novelty processing depends on medial temporal lobe structures.

OBJECTIVES: The goal of the present study was to identify the role of the medial temporal lobe (MTL) in the detection and later processing of novelty. METHODS: Twenty-one epilepsy patients with unilateral MTL resection (10 left-sided; 11 right-sided) and 26 matched healthy controls performed an adapted visual novelty oddball task. In this task two streams of stimuli were presented on the left and right of fixation while the patients' electroencephalogram was measured. The participants had to respond to infrequent target stimuli, while ignoring frequent standard, and infrequent novel stimuli that were presented to the left or right, appearing either contra- or ipsilateral to the patients' resections. RESULTS: Novelty detection, as indexed by the N2 ERP component elicited by novels, was reduced by the MTL resections, as evidenced by a smaller N2 for patients than healthy controls. Later processing of novels, as indexed by the novelty P3 ERP component, was reduced for novels presented contra- versus ipsilateral to the resected side. Moreover, at a frontal electrode site, the N2-P3 complex showed reduced novelty processing in patients with MTL resections compared to healthy controls. The ERP differences were specific for the novel stimuli, as target processing, as indexed by the P3b, was unaffected in the patients: No P3b differences were found between targets presented ipsi- or contralaterally to the resected side, nor between patients and healthy controls. CONCLUSIONS: The current results suggest that MTL structures play a role in novelty processing. In contrast, target processing was unaffected by MTL resections.

Appreciating small-group active learning: What do medical students want, and why? A Q-methodology study.

INTRODUCTION: For Small-Group Active Learning (SMAL) to be effective, students need to engage meaningfully in learning activities to construct their knowledge. Teachers can have difficulty engaging their students in this process. To improve engagement, we aimed to identify the diversity in medical students' appreciation of SMAL, using the concepts of epistemic beliefs and approaches to learning. METHOD: Q-methodology is a mixed-method research design used for the systematic study of subjectivity. We developed a set of 54 statements on active learning methods. In individual interviews, first-year medical students rank ordered their agreement with these statements and explained their reasons. Data were analyzed using a by-person factor analysis to group participants with shared viewpoints. RESULTS: A four-factor solution (i.e. profiles) fit the data collected from 52 students best and explained 52% of the variance. Each profile describes a shared viewpoint on SMAL. We characterized the profiles as 'understanding-oriented', 'assessment-oriented', 'group-oriented', and 'practice-oriented'. DISCUSSION: The four profiles describe how and why students differ in their appreciation of SMAL. Teachers can use the profiles to make better-informed decisions when designing and teaching their SMAL classes, by relating to students' epistemic beliefs, and approaches to learning. This may improve student motivation and engagement for SMAL.

Predicting the unknown: Novelty processing depends on expectations.

Fulfilled predictions lead to neural suppression akin to repetition suppression, but it is currently unclear if such effects generalize to broader stimulus categories in the absence of exact expectations. In particular, does expecting novelty alter the way novel stimuli are processed? In the present study, the effects of expectations on novelty processing were investigated using event-related potentials, while controlling for the effect of repetition. Sequences of five stimuli were presented in a continuous way, such that the last stimulus of a 5-stimulus sequence was followed by the first stimulus of a new 5-stimulus sequence without interruption. The 5-stimulus sequence was predictable: the first three stimuli were preceded by a cue indicating that the next stimulus was likely to be a standard stimulus, and the last two by a cue indicating that the next stimulus was likely to be novel. On some trials a cue typically predicting a standard was in fact followed by an unexpected novel stimulus. This design allowed to investigate the independent effects of (violated) expectations and repetition on novelty processing. The initial detection of expected novels was enhanced compared to unexpected novels, as indexed by a larger anterior N2. In contrast, the orienting response, as reflected by a novelty P3, was reduced for expected compared to unexpected novels. Although the novel stimuli were never repeated themselves, they could be presented after one another in the sequence. Such a category repetition affected the processing of novelty, as evidenced by an enhanced anterior N2, and a reduced novelty P3 for novels preceded by other novels. Taken together, the current study shows that novelty processing is influenced by expectations.

Short- and long-lasting consequences of novelty, deviance and surprise on brain and cognition.

When one encounters a novel stimulus this sets off a cascade of brain responses, activating several neuromodulatory systems. As a consequence novelty has a wide range of effects on cognition; improving perception and action, increasing motivation, eliciting exploratory behavior, and promoting learning. Here, we review these benefits and how they may arise in the brain. We propose a framework that organizes novelty's effects on brain and cognition into three groups. First, novelty can transiently enhance perception. This effect is proposed to be mediated by novel stimuli activating the amygdala and enhancing early sensory processing. Second, novel stimuli can increase arousal, leading to short-lived effects on action in the first hundreds of milliseconds after presentation. We argue that these effects are related to deviance, rather than to novelty per se, and link them to activation of the locus-coeruleus norepinephrine system. Third, spatial novelty may trigger the dopaminergic mesolimbic system, promoting dopamine release in the hippocampus, having longer-lasting effects, up to tens of minutes, on motivation, reward processing, and learning and memory.

Novelty processing and memory formation in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is characterized by a degeneration of nigrostriatal dopaminergic cells, resulting in dopamine depletion. This depletion is counteracted through dopamine replacement therapy (DRT). Dopamine has been suggested to affect novelty processing and memory, which suggests that these processes are also implicated in PD and that DRT could affect them. OBJECTIVE: To investigate word learning and novelty processing in patients with PD as indexed by the P2 and P3 event-related potential components, and the role of DRT in these processes. METHODS: 21 patients with PD and 21 matched healthy controls were included. Patients with PD were tested on and off DRT in two sessions in a counterbalanced design, and healthy controls were tested twice without intervention. Electroencephalogram (EEG) was measured while participants performed a word learning Von Restorff task. RESULTS: Healthy controls showed the typical Von Restorff effect, with better memory for words that were presented in novel fonts, than for words presented in standard font. Surprisingly, this effect was reversed in the patients with PD. In line with the behavioral findings, the P3 was larger for novel than for standard font words in healthy controls, but not in patients with PD. For both groups the P2 and P3 event-related components were larger for recalled versus forgotten words. DRT did not affect these processes. CONCLUSIONS: Learning of novel information is compromised in patients with PD. Likewise, the P2 and P3 components that predict successful memory encoding are reduced in PD patients. This was true both on and off DRT, suggesting that these findings reflect abnormalities in learning and memory in PD that are not resolved by dopaminergic medication.

Facilitation of responses by task-irrelevant complex deviant stimuli.

Novel stimuli reliably attract attention, suggesting that novelty may disrupt performance when it is task-irrelevant. However, under certain circumstances novel stimuli can also elicit a general alerting response having beneficial effects on performance. In a series of experiments we investigated whether different aspects of novelty--stimulus novelty, contextual novelty, surprise, deviance, and relative complexity--lead to distraction or facilitation. We used a version of the visual oddball paradigm in which participants responded to an occasional auditory target. Participants responded faster to this auditory target when it occurred during the presentation of novel visual stimuli than of standard stimuli, especially at SOAs of 0 and 200 ms (Experiment 1). Facilitation was absent for both infrequent simple deviants and frequent complex images (Experiment 2). However, repeated complex deviant images did facilitate responses to the auditory target at the 200 ms SOA (Experiment 3). These findings suggest that task-irrelevant deviant visual stimuli can facilitate responses to an unrelated auditory target in a short 0-200 millisecond time-window after presentation. This only occurs when the deviant stimuli are complex relative to standard stimuli. We link our findings to the novelty P3, which is generated under the same circumstances, and to the adaptive gain theory of the locus coeruleus-norepinephrine system (Aston-Jones and Cohen, 2005), which may explain the timing of the effects.

Novelty detection is enhanced when attention is otherwise engaged: an event-related potential study.

Novel stimuli are detected and evaluated quickly, suggesting that processing them is a priority for the brain. In the present study, the effects of attention on this early visual novelty processing were investigated in two experiments using the event-related potential (ERP) technique. In the first experiment, participants performed two tasks that varied in the amount of attention available for novel stimuli. In the Visual Oddball task, participants responded to an infrequent target presented among standard and novel stimuli. In the Working Memory task, participants saw the same stimuli, but they could ignore them. Instead, participants had to keep six letters in working memory and report one of these letters at the end of the trial; attention was thus maximally allocated away from the visual oddball stimuli. In line with attention being fully occupied in the Working Memory task, the P3a to the visual oddball stimuli was smaller in the Working Memory than in the Visual Oddball task. In contrast, the anterior N2 component to task-irrelevant stimuli was enhanced in the Working Memory task. These findings suggest that the initial detection of novel stimuli is enhanced (large anterior N2) when few attentional resources are available, which is inconsistent with earlier findings that if anything, the N2 is enhanced by attention. In a second experiment, a condition was added in which working memory load was low, but visual oddball stimuli were task-irrelevant. Results from this experiment showed that while the reduction in P3a amplitude was due to task irrelevance, the enhanced anterior N2 was linked to a high working memory load. This suggests that novelty detection is enhanced when attention is otherwise engaged.

Visual priming through a boost of the target signal: evidence from saccadic landing positions.

Searching for a target is slower when target features change from trial to trial than when they are repeated. Although heavily studied, it is still not wholly clear what process is influenced by such visual priming. Here, we introduce anew measure to study priming. When a target and distractor are in close proximity, fast saccades generally fall in between the two, a finding known as the global effect. We elicited global effect saccades to study the effects of repeating target or distractor colors on overt attention. Saccades landed closer to a target or distractor in the color of a previous target, suggesting that priming enhances target color signals. This was true even for the fastest eye movements, in the range of express saccades. Distractor color repetition, on the other hand, had no effect, at least in isolation. Visual priming is, we conclude, at least partly the result of boosting perceptual target signals [corrected].

Acquired equivalence changes stimulus representations.

Acquired equivalence is a paradigm in which generalization is increased between two superficially dissimilar stimuli (or antecedents) that have previously been associated with similar outcomes (or consequents). Several possible mechanisms have been proposed, including changes in stimulus representations, either in the form of added associations or a change of feature salience. A different way of conceptualizing acquired equivalence is in terms of strategic inference: Confronted with a choice on which it has no evidence, the organism may infer from its history of reinforcement what the best option is, and that inference is observed as acquired equivalence. To test this account, we combined an incremental learning task with an episodic memory test. Drawings of faces were made equivalent through acquired equivalence training, and then paired with words in a list learning paradigm. When participants were asked to recognize specific face-word pairings, they confused faces more often when they had been made equivalent. This suggests that prior acquired equivalence training does influence how memories are coded. We also tested whether this change in coding reflected acquisition of new associations, as suggested by the associative mediation account, or whether stimuli become more similar through a reweighting of stimulus features, as assumed by some categorization theories. Results supported the associative mediation view. We discuss similarities between this view and exemplar theories of categorization performance.

Probabilistic categorization: how do normal participants and amnesic patients do it?

In probabilistic categorization tasks, various cues are probabilistically (but not perfectly) predictive of class membership. This means that a given combination of cues sometimes belongs to one class and sometimes to another. It is not yet clear how categorizers approach such tasks. Here, we review evidence in favor of two alternative conceptualizations of learning in probabilistic categorization: as rule-based learning, or as incremental learning. Each conceptualization forms the basis of a way of analyzing performance: strategy analysis assumes rule-based learning, while rolling regression analysis assumes incremental learning. Here, we contrasted the ability of each to predict performance of normal categorizers. Both turned out to predict responses about equally well. We then reviewed performance of patients with damage to regions deemed important for either rule-based or incremental learning. Evidence was again about equally compatible with either alternative conceptualization of learning, although neither predicted an involvement of the medial temporal lobe. We suggest that a new way of conceptualizing probabilistic categorization might be fruitful, in which the medial temporal lobe help set up representations that are then used by other regions to assign patterns to categories.

Retrograde amnesia for autobiographical memories and public events in mild and moderate Alzheimer's disease.

Patients with mild to moderate Alzheimer's disease and normal controls were tested on two retrograde memory tests, one based on public events, and the other querying autobiographical memory. On both tests, patients showed strong decrements as compared to normal controls, pointing to retrograde amnesia. Evidence for a gradient in retrograde amnesia was conflicted, with analyses of variance revealing no gradient beyond the most recent period, and more sensitive analyses pointing to shallow Ribot gradients on both tests. A literature review shows that this is the case in most published studies. In autobiographical remote memory patients generated many incorrect answers, a tendency correlated with the number of false alarms on an anterograde memory test administered several months earlier. This suggests a stable, possibly executive, factor underlying memory errors.

Remembering the news: modeling retention data from a study with 14,000 participants.

A retention study is presented in which participants answered questions about news events, with a retention interval that varied within participants between 1 day and 2 years. The study involved more than 14,000 participants and around 500,000 data points. The data were analyzed separately for participants who answered questions in Dutch or in English, providing an opportunity for replication. We fitted models of varying complexity to the data in order to test several hypotheses concerning retention. Evidence for an asymptote in retention was found in only one data set, and participants with greater media exposure displayed a higher degree of learning but no difference in forgetting. Thus, forgetting was independent of initial learning. Older adults were found to have forgetting curves similar to those of younger adults.

Integrating incremental learning and episodic memory models of the hippocampal region.

By integrating previous computational models of corticohippocampal function, the authors develop and test a unified theory of the neural substrates of familiarity, recollection, and classical conditioning. This approach integrates models from 2 traditions of hippocampal modeling, those of episodic memory and incremental learning, by drawing on an earlier mathematical model of conditioning, SOP (A. Wagner, 1981). The model describes how a familiarity signal may arise from parahippocampal cortices, giving a novel explanation for the finding that the neural response to a stimulus in these regions decreases with increasing stimulus familiarity. Recollection is ascribed to the hippocampus proper. It is shown how the properties of episodic representations in the neocortex, parahippocampal gyrus, and hippocampus proper may explain phenomena in classical conditioning. The model reproduces the effects of hippocampal, septal, and broad hippocampal region lesions on contextual modulation of classical conditioning, blocking, learned irrelevance, and latent inhibition.

Mode shifting between storage and recall based on novelty detection in oscillating hippocampal circuits.

It has been suggested that hippocampal mode shifting between a storage and a retrieval state might be under the control of acetylcholine (ACh) levels, as set by an autoregulatory hippocampo-septo-hippocampal loop. The present study investigates how such a mechanism might operate in a large-scale connectionist model of this circuitry that takes into account the major hippocampal subdivisions, oscillatory population dynamics and the time scale on which ACh exerts its effects in the hippocampus. The model assumes that hippocampal mode shifting is regulated by a novelty signal generated in the hippocampus. The simulations suggest that this signal originates in the dentate. Novel patterns presented to this structure lead to brief periods of depressed firing in the hippocampal circuitry. During these periods, an inhibitory influence of the hippocampus on the septum is lifted, leading to increased firing of cholinergic neurons. The resulting increase in ACh release in the hippocampus produces network dynamics that favor learning over retrieval. Resumption of activity in the hippocampus leads to the reinstatement of inhibition. Despite theta-locked rhythmic firing of ACh neurons in the septum, ACh modulation in the model fluctuates smoothly on a time scale of seconds. It is shown that this is compatible with the time scale on which memory processes take place. A number of strong predictions regarding memory function are derived from the model.