Embracing Leadership: How Junior Medical Officers Shape the Future.

Transitioning from medical residency to an operational role challenges junior medical officers as their leadership skills are put to the test. In the multifaceted role of Military Medical Corps Officers, patient care remains paramount, and effective leadership hinges on core values. From clinical competence and mentorship to modeling behavior and fostering adaptability, this article underscores the importance of leadership development for junior officers as they transition from the training centers into the operational environment. Effective junior officer leaders become force multipliers, empowering their teams and cultivating future leaders to uphold the values essential to mission success.

Cognitive biases in internal medicine: a scoping review.

BACKGROUND: Medical errors account for up to 440,000 deaths annually, and cognitive errors outpace knowledge deficits as causes of error. Cognitive biases are predispositions to respond in predictable ways, and they don't always result in error. We conducted a scoping review exploring which biases are most prevalent in Internal Medicine (IM), if and how they influence patient outcomes, and what, if any, debiasing strategies are effective. CONTENT: We searched PubMed, OVID, ERIC, SCOPUS, PsychINFO, and CINAHL. Search terms included variations of "bias", "clinical reasoning", and IM subspecialties. Inclusion criteria were: discussing bias, clinical reasoning, and physician participants. SUMMARY: Fifteen of 334 identified papers were included. Two papers looked beyond general IM: one each in Infectious Diseases and Critical Care. Nine papers distinguished bias from error, whereas four referenced error in their definition of bias. The most commonly studied outcomes were diagnosis, treatment, and physician impact in 47 % (7), 33 % (5), and 27 % (4) of studies, respectively. Three studies directly assessed patient outcomes. The most commonly cited biases were availability bias (60 %, 9), confirmation bias (40 %, 6), anchoring (40 %, 6), and premature closure (33 %, 5). Proposed contributing features were years of practice, stressors, and practice setting. One study found that years of practice negatively correlated with susceptibility to bias. Ten studies discussed debiasing; all reported weak or equivocal efficacy. OUTLOOK: We found 41 biases in IM and 22 features that may predispose physicians to bias. We found little evidence directly linking biases to error, which could account for the weak evidence of bias countermeasure efficacy. Future study clearly delineating bias from error and directly assessing clinical outcomes would be insightful.

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.

Continuing Professional Development in Rheumatology for Primary Care Clinicians: A Systematic Review.

OBJECTIVE: To determine the quality of published rheumatology-focused continuing professional development (CPD) for primary care clinicians (PCCs) for improving the care of patients with rheumatic diseases. METHODS: The authors conducted a systematic review of CPD focused on rheumatology topics for PCCs. A librarian systematically searched PubMed, Embase, Web of Science, ERIC, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Sinico. Studies were limited to those conducted in North America after 1993. An extraction form that included the Medical Education Research Study Quality Instrument and the Kirkpatrick levels of learning outcomes was created through an iterative process and applied to the included articles. RESULTS: In total, 725 articles were retrieved, of which 9 were included. Results showed that CPD was directed more at noninflammatory arthritis than inflammatory arthritis. Autoimmune diseases were underrepresented; 4 studies discussed rheumatoid arthritis, and 1 study examined rheumatologic topics broadly. Newer research tended to include multimodal approaches that combined didactic and active learning strategies, showing an evolution toward more active learning. Although online learning is increasingly popular, interventions were predominantly face-to-face, with only a single example of e-learning. Studies were predominantly of moderate quality. CONCLUSION: Published studies of rheumatology-focused CPD are moving toward more interactive teaching modalities and are typically conducted in person, although virtual options for rheumatology-focused CPD should be explored to improve access to CPD. Autoimmune disease is an uncommon topic in CPD and represents an area for future expansion. Efficacy was difficult to assess given that most of the studies assessed for learner satisfaction, knowledge acquisition, or behavior change, whereas only 1 study focused on patient outcomes.

Trainability of novel person recognition based on brief exposure to form and motion cues.

Fast and accurate recognition of teammates is crucial in contexts as varied as fast-moving sports, the military, and law enforcement engagements; misrecognition can result in lost scoring opportunities in sport or friendly fire in combat contexts. Initial studies on teammate recognition in sport suggests that athletes are adept at this perceptual ability but still susceptible to errors. The purpose of the current proof-of-concept study was to explore the trainability of teammate recognition from very brief exposure to vision of the whole-body form and motion of a previously unknown individual. Participants were divided into three groups: a 4-week training group who were also the actors for the test and training footage, a 2-week training group, and a no-training group. Findings revealed significant differences between the training groups and their improvement from the pre-to post-test on Response Accuracy and Movement Time. The current study found the best performance in the 4-week Training group. The biggest improvement was found in the 2-week training group, whilst no significant improvement was made in the Control group. These results suggest that training was effective, but also indicate that having initially performed the movements as actors may have led to improvements in baseline testing and ultimately the best results, thus physical performance of skills combined with video-based training may reduce the amount of time needed to improve teammate identification.

Welfare Assessment Tools in Zoos: From Theory to Practice.

Zoos are increasingly implementing formalized animal welfare assessment programs to allow monitoring of welfare over time, as well as to aid in resource prioritization. These programs tend to rely on assessment tools that incorporate resource-based and observational animal-focused measures. A narrative review of the literature was conducted to bring together recent studies examining welfare assessment methods in zoo animals. A summary of these methods is provided, with advantages and limitations of the approaches presented. We then highlight practical considerations with respect to implementation of these tools into practice, for example scoring schemes, weighting of criteria, and innate animal factors for consideration. It is concluded that there would be value in standardizing guidelines for development of welfare assessment tools since zoo accreditation bodies rarely prescribe these. There is also a need to develop taxon or species-specific assessment tools to complement more generic processes and more directly inform welfare management.

Management of Chronic Multisymptom Illness: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline.

In 2019, senior leaders within the US Department of Veterans Affairs and the US Department of Defense commissioned the update of a clinical practice guideline for managing chronic multisymptom illness. Clinical experts were assembled across both agencies to systematically review evidence and to develop treatment recommendations based on that evidence. This effort resulted in the development of 29 evidence-based recommendations for providing care for individuals with chronic multisymptom illness.

Making heads or tails of body inversion effects: Do heads matter?

Observers are better at discriminating upright bodies than inverted bodies, and this body inversion effect (BIE) is reliable with whole figures (bodies with heads), but not with bodies presented without heads or the heads occluded suggesting that heads may be key to BIEs. Some studies present whole figures and bodies without heads between groups, and BIEs are not found for bodies without heads [1]. Other studies present whole figures and bodies without heads in the same blocks and BIEs are found with bodies without heads [2]. Does seeing the heads of whole figures induce BIEs in bodies without heads? Here, participants discriminated bodies with either whole figures and bodies without heads presented within blocks, or in separate blocks with bodies without heads presented first. We tested body identity and posture discrimination and measured participants' gaze. BIEs were found with whole figures and bodies without heads in both identity and posture discrimination, and in both study designs. However, efficiency scores were better for the whole figures than the bodies without heads, but only when whole figures appeared in separate blocks. The magnitude of the BIE was overall stronger for whole figures compared to bodies without heads, but only in identity discrimination. BIE magnitudes were similar in the identity and posture tasks. Participants were better at identity discrimination, yet, there was greater looking at heads and less at bodies. During posture discrimination, greater looking at bodies and less at heads was associated with better performance. Faces might influence BIEs but are not essential. Configural representations of bodies without heads are sufficient for BIEs in posture and identity discrimination.

Amplified inversion effects for moving biological stimuli remain largest for faces and bodies.

Turning an object upside-down disrupts our ability to perceive it accurately, and this inversion effect is disproportionately larger for faces and whole bodies than most other objects. This disproportionate inversion effect is taken as an indicator of holistic processing for these stimuli. Large inversion effects are also found when viewing motion-only information from faces and bodies; however, these have not been compared to other moving objects in an identity task so it is unclear whether inversion effects remain disproportionately larger for faces and bodies when they are engaged in motion. The current study investigated the effect of inversion on static and moving unfamiliar faces, human bodies, and German Shepherd dogs in an old-new recognition memory task. Sensitivity and baseline corrected reaction time (RT) results revealed that inversion effects for faces and whole-bodies remained disproportionately larger than those for German Shepherd dogs, regardless of presentation type, suggesting that both static and moving faces and bodies are processed holistically.

Factors affecting infant toy preferences: Age, gender, experience, motor development, and parental attitude.

In contrast to the anecdotal claim that "male infants like cars and female infants like dolls," previous studies have reported mixed findings for gender-related toy preferences in infancy. In Experiment 1, we explored the emergence of gender-related preferences using face-car pairs (Experiment 1a, n = 51, 6-20 months) or face-stove pairs (Experiment 1b, n = 54, 6-20 months). In Experiment 2 (n = 42, 14-16 months), we explore the effect of toy properties, infants' past toy exposure, activity levels, and parental attitudes on such preferences using a wider range of toys. For both studies, infants demonstrated a general preference for faced stimuli over other objects, except for male infants who showed no preference between dolls and cars at around 15 months. Infants' prior experience participating in motor-intensive activities, with wheeled toys and parental attitudes appeared to relate to female infants' preferences for dynamic toys. These results indicate a range of factors influence gendered toy preferences and suggest that nurture plays an important role.

Learning from domestic homicide reviews in England and Wales.

This paper aims to contribute to the prevention of future domestic homicide by analysing 141 domestic homicide reviews (DHRs) in England and Wales. All publicly available DHRs (n = 141) were retrieved from Community Safety Partnership websites in England and Wales in June 2016. Utilising a mixed methods approach, we designed templates to extract quantitative and qualitative data from DHRs. Descriptive statistics were generated by SPSS. 54 DHRs were analysed qualitatively, using N-Vivo for data management. The findings revealed that perpetrators were aged: 16-82 years; with a mean average age of 41 years. Victims' ages ranged from 17 to 91 years old; with a mean average age: 45 years. Perpetrators' mental health was mentioned in 65% of DHRs; 49% of perpetrators had a mental health diagnosis. Healthcare services, in particular, mental health services, were most likely to be involved with perpetrators. 'Movement' was identified as a key contextual feature of the 54 DHRs analysed qualitatively and this was found to interact with risk assessment, language barriers and housing problems. In conclusion, domestic violence and abuse risk assessments need to be informed by the knowledge that domestic abuse occurs across the age span. Mental health settings offer an opportunity for intervention to prevent domestic homicide. Domestic Homicide Reviews can provide valuable material for training practitioners.

Body Inversion Effects With Photographic Images of Body Postures: Is It About Faces?

As with faces, participants are better at discriminating upright bodies than inverted bodies. This inversion effect is reliable for whole figures, namely, bodies with heads, but it is less reliable for headless bodies. This suggests that removal of the head disrupts typical processing of human figures, and raises questions about the role of faces in efficient body discrimination. In most studies, faces are occluded, but the aim here was to exclude faces in a more ecologically valid way by presenting photographic images of human figures from behind (about-facing), as well as measuring gaze to different parts of the figures. Participants determined whether pairs of sequentially presented body postures were the same or different for whole and headless figures. Presenting about-facing figures (heads seen from behind) and forward-facing figures with faces enabled a comparison of the effect of the presence or absence of faces. Replicating previous findings, there were inversion effects for forward-facing whole figures, but less reliable effects for headless images. There were also inversion effects for about-facing whole figures, but not about-facing headless figures. Accuracy was higher in the forward- compared to the about-facing conditions, but proportional dwell time was greater to bodies in about-facing images. Likewise, despite better discrimination of forward-facing upright compared to inverted whole figures, participants focused more on the heads and less on the bodies in upright compared to inverted images. However, there was no clear relationship between performance and dwell time proportions to heads. Body inversion effects (BIEs) were found with about-facing whole figures and headless forward-facing figures, despite the absence of faces. With inverted whole figures, there was a significant relationship between performance and greater looking at bodies, and less at heads suggesting that in more difficult conditions a focus on bodies is associated with better discrimination. Overall, the findings suggest that the visual system has greater sensitivity to bodies in their most experienced form, which is typically upright and with a head. Otherwise, the more a face is implied by the context, as in whole figures or forward- rather than about-facing headless bodies, the better the performance as holistic/configural processing is likely stronger.

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.

Patellofemoral Pain Syndrome.

Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years. The incidence in the United States is between 3% and 6%. The cardinal feature of PFPS is pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities. The pain of PFPS often worsens with prolonged sitting or descending stairs. The most sensitive physical examination finding is pain with squatting. Examining a patient's gait, posture, and footwear can help identify contributing causes. Plain radiographs of the knee are not necessary for the diagnosis of PFPS but can exclude other diagnoses, such as osteoarthritis, patellar fracture, and osteochondritis. If conservative treatment measures are unsuccessful, plain radiography is recommended. Treatment of PFPS includes rest, a short course of nonsteroidal anti-inflammatory drugs, and physical therapy directed at strengthening the hip flexor, trunk, and knee muscle groups. Patellar kinesiotaping may provide additional short-term pain relief; however, evidence is insufficient to support its routine use. Surgery is considered a last resort.

Can we look past people's race? The effect of combining race and a non-racial group affiliation on holistic processing.

Face memory is worse for races other than one's own, in part because other-race faces are less holistically processed. Both experiential factors and social factors have been suggested as reasons for this other-race effect. Direct measures of holistic processing for race and a non-racial category in faces have never been employed, making it difficult to establish how experience and group membership interact. This study is the first to directly explore holistic processing of own-race and other-race faces, also classed by a non-racial category (university affiliation). Using a crossover design, White undergraduates (in Australia) completed the part-whole task for White (American) and Black South African faces attributed to the University of Western Sydney (own) and University of Sydney (other). Black South African undergraduates completed the same task for White and Black South African faces attributed to the University of Cape Town (own) and Stellenbosch University (other). It was hypothesised that own-race faces would be processed more holistically than other-race faces and that own-university faces would be processed more holistically than other-university faces. Results showed a significant effect of race for White participants (White faces were matched more accurately than Black faces), and wholes were matched more accurately than parts, suggesting holistic processing, but only for White faces. No effect of university was found. Black South African participants, who have more experience with other-race faces, processed wholes better than parts irrespective of race and university category. Overall, results suggest that experiential factors of race outweigh any effects of a non-racial shared group membership. The quality of experience for the named populations, stimuli presentation, and degree of individuation are discussed.

Caricaturing as a general method to improve poor face recognition: Evidence from low-resolution images, other-race faces, and older adults.

There are multiple well-established situations in which humans' face recognition performance is poor, including for low-resolution images, other-race faces, and in older adult observers. Here we show that caricaturing faces-that is, exaggerating their appearance away from an average face-can provide a useful applied method for improving face recognition across all these circumstances. We employ a face-name learning task offering a number of methodological advantages (e.g., valid comparison of the size of the caricature improvement across conditions differing in overall accuracy). Across six experiments, we (a) extend previous evidence that caricaturing can improve recognition of low-resolution (blurred) faces; (b) show for the first time that caricaturing improves recognition and perception of other-race faces; and (c) show for the first time that caricaturing improves recognition in observers across the whole adult life span (testing older adults, M age = 71 years). In size, caricature benefits were at least as large where natural face recognition is poor (other-race, low resolution, older adults) as for the naturally best situation (own-race high-resolution faces in young adults). We discuss potential for practical applicability to improving face recognition in low-vision patients (age-related macular degeneration, bionic eye), security settings (police, passport control), eyewitness testimony, and prosopagnosia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Caricaturing faces to improve identity recognition in low vision simulations: How effective is current-generation automatic assignment of landmark points?

PURPOSE: Previous behavioural studies demonstrate that face caricaturing can provide an effective image enhancement method for improving poor face identity perception in low vision simulations (e.g., age-related macular degeneration, bionic eye). To translate caricaturing usefully to patients, assignment of the multiple face landmark points needed to produce the caricatures needs to be fully automatised. Recent development in computer science allows automatic face landmark detection of 68 points in real time and in multiple viewpoints. However, previous demonstrations of the behavioural effectiveness of caricaturing have used higher-precision caricatures with 147 landmark points per face, assigned by hand. Here, we test the effectiveness of the auto-assigned 68-point caricatures. We also compare this to the hand-assigned 147-point caricatures. METHOD: We assessed human perception of how different in identity pairs of faces appear, when veridical (uncaricatured), caricatured with 68-points, and caricatured with 147-points. Across two experiments, we tested two types of low-vision images: a simulation of blur, as experienced in macular degeneration (testing two blur levels); and a simulation of the phosphenised images seen in prosthetic vision (at three resolutions). RESULTS: The 68-point caricatures produced significant improvements in identity discrimination relative to veridical. They were approximately 50% as effective as the 147-point caricatures. CONCLUSION: Realistic translation to patients (e.g., via real time caricaturing with the enhanced signal sent to smart glasses or visual prosthetic) is approaching feasibility. For maximum effectiveness software needs to be able to assign landmark points tracing out all details of feature and face shape, to produce high-precision caricatures.

Improving face identity perception in age-related macular degeneration via caricaturing.

Patients with age-related macular degeneration (AMD) have difficulty recognising people's faces. We tested whether this could be improved using caricaturing: an image enhancement procedure derived from cortical coding in a perceptual 'face-space'. Caricaturing exaggerates the distinctive ways in which an individual's face shape differs from the average. We tested 19 AMD-affected eyes (from 12 patients; ages 66-93 years) monocularly, selected to cover the full range of vision loss. Patients rated how different in identity people's faces appeared when compared in pairs (e.g., two young men, both Caucasian), at four caricature strengths (0, 20, 40, 60% exaggeration). This task gives data reliable enough to analyse statistically at the individual-eye level. All 9 eyes with mild vision loss (acuity ≥ 6/18) showed significant improvement in identity discrimination (higher dissimilarity ratings) with caricaturing. The size of improvement matched that in normal-vision young adults. The caricature benefit became less stable as visual acuity further decreased, but caricaturing was still effective in half the eyes with moderate and severe vision loss (significant improvement in 5 of 10 eyes; at acuities from 6/24 to poorer than <6/360). We conclude caricaturing has the potential to help many AMD patients recognise faces.

The relationship between discrimination and memory for spacing and feature changes in houses.

Adults need to discriminate between stimuli and recognize those previously seen. For faces, feature changes (e.g., different eyes) and spacing changes (e.g., distances between eyes) are important cues. In two experiments, we assessed the influence of these on discrimination and recognition of houses, a commonly used control in face studies. In both experiments, discrimination was better for feature than spacing changes. Memory for spacing changes was generally poor but aided by extra learning and intermixing change types. Conversely, memory for features was good, especially when there were few houses, and change type was blocked. Unexpectedly, memory was best for differences that might signal something about occupants (e.g., changes to garden or bins), perhaps akin to hairstyles for faces. Overall, results are consistent with previous work showing poor discrimination of spacing in non-face objects and extends them to show that, unlike for faces, spacing differences are also not well remembered.