Disrupted social perception in frontotemporal dementia and Alzheimer's disease - Associated cognitive processes and clinical implications.

BACKGROUND: Social perception refers to the ability to adapt and update one's behaviour in accordance with the current context and provides the foundation for many complex social and emotional interactions. Alterations in social cognition are a hallmark of the behavioural variant of frontotemporal dementia (bvFTD), yet the capacity for social perception in this syndrome remains unclear. METHODS: We examined social perception in 18 bvFTD and 13 Alzheimer's disease (AD) patients, in comparison with 17 healthy older controls, using a social perception task derived from the Dewey Story Test. Participants also completed a comprehensive neuropsychological battery and carers provided ratings of behavioural and neuropsychiatric changes. RESULTS: Overall, bvFTD and AD performance diverged significantly from control ratings on the social perception task, however, no significant difference was found between patient groups. Standardised values relative to the mean control rating revealed considerable variability within the patient groups in terms of the direction of deviation, i.e., over- or under-rating the vignettes relative to healthy controls (range z-scores = -1.79 to +1.63). Greater deviation from control ratings was associated with more pronounced memory (p = .007) and behavioural (p = .009) disturbances in bvFTD; whilst social perception performance correlated exclusively with verbal fluency in AD (p = .003). CONCLUSIONS: Social perception is comparably disrupted in bvFTD and AD, yet likely reflects the differential breakdown of distinct cognitive processes in each dementia syndrome. Our findings have important clinical implications for the development of targeted interventions to manage disease-specific changes in social perception in dementia.

Contrasting social knowledge and theory of mind patterns in adults with personality disorders, schizophrenia spectrum disorders, and healthy controls.

INTRODUCTION: Personality disorders (PD) and schizophrenia spectrum disorders (SSD) are distinct conditions displaying common symptoms, like impairments in social cognition, that make them hard to distinguish, especially in severe cases. To date, few studies have compared theory of mind skills in these two disorders, and none have compared social knowledge skills. This study aims to compare the social cognitive abilities of patients with these conditions. METHOD: Non-parametric analyses of covariance were used to compare severe PD patients (n = 37), SSD patients (n = 44), and healthy controls (HC; n = 49) on the Social Knowledge Test and two measures of theory of mind: the Reading the Mind in the Eyes Test and the Combined Stories Test, which incorporates items from various widely used tests. RESULTS: While no significant group differences were found on the Social Knowledge Test, SSD patients performed lower than the HC group on both theory of mind tests. PD patients only had lower performance than the HC group on specific items from the Combined Stories Test. CONCLUSIONS: PD and SSD patients demonstrated distinctive patterns of social cognitive impairments, with items of greater complexity or with an affective orientation being the most discriminant for PD.

Social Knowledge & Performance in Autism: A Critical Review & Recommendations.

Autistic social challenges have long been assumed to arise from a lack of social knowledge ("not knowing what to do"), which has undergirded theory and practice in assessment, treatment, and education. However, emerging evidence suggests these differences may be better accounted for by difficulties with social performance ("doing what they may know"). This distinction has important implications for research, practice, policy, and community support of autistic people. This review examines the theoretical and clinical implications and empirical status of the knowledge-performance distinction in autism. Current evidence suggests that social knowledge deficits are neither definitional nor reliably related to outcomes in autism. Prioritizing social knowledge, then, may produce unanticipated, problematic consequences in terms of accuracy of assessment, intervention effectiveness, and promotion of stigma. It may also yield unrealistic expectations around the value of knowledge for autistic people and their families, yielding important ethical considerations. Conversely, recent evidence highlights performance-related factors as being especially promising for better modeling and addressing social challenges in autism. Prioritizing performance, then, may offer new directions for assessment, substantially different intervention opportunities, and novel methods of inclusion and affirmation. This review touches upon each of these domains and implications, integrates these developments with broader models of social competence in youth, and provides direction for future research and practice regarding social competence in autism.

Specialized Networks for Social Cognition in the Primate Brain.

Primates have evolved diverse cognitive capabilities to navigate their complex social world. To understand how the brain implements critical social cognitive abilities, we describe functional specialization in the domains of face processing, social interaction understanding, and mental state attribution. Systems for face processing are specialized from the level of single cells to populations of neurons within brain regions to hierarchically organized networks that extract and represent abstract social information. Such functional specialization is not confined to the sensorimotor periphery but appears to be a pervasive theme of primate brain organization all the way to the apex regions of cortical hierarchies. Circuits processing social information are juxtaposed with parallel systems involved in processing nonsocial information, suggesting common computations applied to different domains. The emerging picture of the neural basis of social cognition is a set of distinct but interacting subnetworks involved in component processes such as face perception and social reasoning, traversing large parts of the primate brain.

Impact of social knowledge about the speaker on irony understanding: Evidence from neural oscillations.

The aim of the present study was to explore neuronal oscillatory activity during a task of irony understanding. In this task, we manipulated implicit information about the speaker such as occupation stereotypes (i.e., sarcastic versus non-sarcastic). These stereotypes are social knowledge that influence the extent to which the speaker's ironic intent is understood. Time-frequency analyses revealed an early effect of speaker occupation stereotypes, as evidenced by greater synchronization in the upper gamma band (in the 150-250 ms time window) when the speaker had a sarcastic occupation, by a greater desynchronization for ironic context compared to literal context in the alpha1 band and by a greater synchronization in the theta band when the speaker had a non-sarcastic occupation. When the speaker occupation did not constrain the ironic interpretation, the interpretation of the sentence as ironic was revealed as resource-demanding and requiring pragmatic reanalysis, as shown mainly by the synchronization in the theta band and the desynchronization in the alpha1 band (in the 500-800 ms time window). These results support predictions of the constraint satisfaction model suggesting that during irony understanding, extra-linguistic information such as information on the speaker is used as soon as it is available, in the early stage of processing.

UniSKGRep: A unified representation learning framework of social network and knowledge graph.

The human-oriented applications aim to exploit behaviors of people, which impose challenges on user modeling of integrating social network (SN) with knowledge graph (KG), and jointly analyzing two types of graph data. However, existing graph representation learning methods merely represent one of two graphs alone, and hence are unable to comprehensively consider features of both SN and KG with profiling the correlation between them, resulting in unsatisfied performance in downstream tasks. Considering the diverse gap of features and the difficulty of associating of the two graph data, we introduce a Unified Social Knowledge Graph Representation learning framework (UniSKGRep), with the goal to leverage the multi-view information inherent in the SN and KG for improving the downstream tasks of user modeling. To the best of our knowledge, we are the first to present a unified representation learning framework for SN and KG. Concretely, the SN and KG are organized as the Social Knowledge Graph (SKG), a unified representation of SN and KG. For the representation learning of SKG, first, two separate encoders in the Intra-graph model capture both the social-view and knowledge-view in two embedding spaces, respectively. Then the Inter-graph model is learned to associate the two separate spaces via bridging the semantics of overlapping node pairs. In addition, the overlapping node enhancement module is designed to effectively align two spaces with the consideration of a relatively small number of overlapping nodes. The two spaces are gradually unified by continuously iterating the joint training procedure. Extensive experiments on two real-world SKG datasets have proved the effectiveness of UniSKGRep in yielding general and substantial performance improvement compared with the strong baselines in various downstream tasks.

Oxytocin and social gaze during a dominance categorization task in tufted capuchin monkeys.

Visual attention to facial features is an important way that group-living primate species gain knowledge about others. However, where this attention is focused on the face is influenced by contextual and social features, and emerging evidence in Pan species suggests that oxytocin, a hormone involved in forming and maintaining affiliative bonds among members of the same group, influences social attention as measured by eye gaze. Specifically, bonobos tend to focus on conspecifics' eyes when viewing two-dimensional images, whereas chimpanzees focus more on the edges of the face. Moreover, exogenous oxytocin, which was hypothesized to increase eye contact in both species, instead enhanced this existing difference. We follow up on this to (1) determine the degree to which this Pan pattern generalizes across highly social, cooperative non-ape primates and (2) explore the impact of exogenously administered vs. endogenously released oxytocin in impacting this behavior. To do so, we tracked gaze direction on a computerized social categorization task using conspecific faces in tufted capuchin monkeys (Sapajus [Cebus] apella) after (1) exogenously administering intranasal oxytocin using a nebulizer or (2) inducing an endogenous increase in oxytocin using fur-rubbing, previously validated to increase oxytocin in capuchins. Overall, we did not find a general tendency in the capuchins to look toward the eyes or mouth, but we found that oxytocin was related to looking behavior toward these regions, albeit not in a straightforward way. Considering frequency of looking per trial, monkeys were more likely to look at the eye region in the fur-rubbing condition as compared to either the saline or exogenous oxytocin conditions. However, in terms of duration of looking during trials in which they did look at the eye region, monkeys spent significantly less time looking at the eyes in both oxytocin conditions as compared to the saline condition. These results suggest that oxytocin did not necessarily enhance eye looking in capuchins, which is consistent with the results from Pan species, and that endogenous and exogenous oxytocin may behave differently in their effect on how social attention is allocated.

The Type of Information People with Schizophrenia Use in Ambiguous Social Situations.

BACKGROUND AND OBJECTIVES: Rather than focusing on the extensively studied social perception and recognition impairments in people with schizophrenia, this study focuses on the type of social information considered relevant by people with schizophrenia, and how they use it to arrive at conclusions about social situations. METHODS: Participants included 50 outpatients with schizophrenia from the Hospital del Salvador at Valparaíso, Chile, and 50 healthy comparators matched by age and gender. Subjects completed the Social Information Preference Test (SIPT), which presents scenes depicting ambiguous social situations with faces, thoughts, and facts about the scene hidden from view. Participants were required to select a limited number of these items and then choose between possible interpretations of the scene (positive, neutral, or negative). Additionally, they are asked to provide a feeling of certainty in their answers, using a 7-point visual analogue scale. RESULTS: People with schizophrenia, as well as controls had a strong preference for knowing the thoughts of the characters. Both groups were least likely to choose emotional expressions. Patients were significantly less likely to choose object/information than controls. Both groups showed a high certainty in their responses and no tendency to choose negative interpretations. LIMITATIONS: compensated clinical status of the patients may have influenced the results. CONCLUSIONS: The results of this study suggest that, despite difficulties perceiving clues about the mental state of others, people with schizophrenia use this information to make sense of social situations, and apparently, they do not have problems in understanding social interactions.

The Type of Information People with Schizophrenia Use in Ambiguous Social Situations / ¿Qué tipo de información usan las personas con esquizofrenia en situaciones sociales ambiguas?

ABSTRACT Background and objectives: Rather than focusing on the extensively studied social perception and recognition impairments in people with schizophrenia, this study focuses on the type of social information considered relevant by people with schizophrenia, and how they use it to arrive at conclusions about social situations. Methods: Participants included 50 outpatients with schizophrenia from the Hospital del Salvador at Valparaíso, Chile, and 50 healthy comparators matched by age and gender. Subjects completed the Social Information Preference Test (SIPT), which presents scenes depicting ambiguous social situations with faces, thoughts, and facts about the scene hidden from view. Participants were required to select a limited number of these items and then choose between possible interpretations of the scene (positive, neutral, or negative). Additionally, they are asked to provide a feeling of certainty in their answers, using a 7-point visual analogue scale. Results: People with schizophrenia, as well as controls had a strong preference for knowing the thoughts of the characters. Both groups were least likely to choose emotional expressions. Patients were significantly less likely to choose object/information than controls. Both groups showed a high certainty in their responses and no tendency to choose negative interpretations. Limitations: compensated clinical status of the patients may have influenced the results. Conclusions: The results of this study suggest that, despite difficulties perceiving clues about the mental state of others, people with schizophrenia use this information to make sense of social situations, and apparently, they do not have problems in understanding social interactions.

RESUMEN Objetivos: En lugar de los impedimentos en la percepción social, ampliamente estudiada en personas con esquizofrenia, centramos nuestra investigación en el tipo de información social considerada relevante por las personas con esquizofrenia y cómo la usan para llegar a conclusiones sobre situaciones sociales. Métodos: Se incluyó a 50 pacientes ambulatorios con esquizofrenia del Hospital del Salvador en Valparaíso, Chile, y 50 comparadores sanos, emparejados por edad y sexo. Los sujetos completaron la Prueba de Preferencia de Información Social (SIPT), que presenta escenas con situaciones sociales ambiguas en las que rostros, pensamientos y hechos sobre la escena están ocultos a la vista. Los participantes deben seleccionar un pequeño número de estos elementos y luego elegir entre posibles interpretaciones (positiva, neutral o negativa). Además, se les pide que proporcionen una sensación de certeza en sus respuestas, utilizando una escala analógica visual de 7 puntos. Resultados: Tanto las personas con esquizofrenia como los comparadores mostraron una fuerte preferencia por conocer los pensamientos de los personajes. La opción menos preferida por ambos grupos fue las expresiones emocionales, mientras que los pacientes escogieron menos objeto/información que los controles. Ambos grupos mostraron una alta certeza en sus respuestas y no se observó una tendencia a elegir interpretaciones negativas. Limitaciones: el estado clínico compensado de los pacientes puede haber influido en los resultados. Conclusiones: Los resultados de este estudio indican que, a pesar de las dificultades para percibir pistas sobre el estado mental de los demás, las personas con esquizofrenia usan esta información para dar sentido a las situaciones sociales y, aparentemente, no presentan problemas para comprender las interacciones sociales.

Social perception and knowledge impairments in severe alcohol use disorder: Group and individual-level findings.

BACKGROUND: Consistent data highlight the presence and clinical significance of social cognition impairments in severe alcohol use disorder (SAUD). However, social perception and knowledge (i.e., the ability to interpret social situations and to identify latent social rules), an important social cognition component, has not yet been explored in this disorder. METHOD: 35 patients with SAUD and 35 healthy controls (HC) completed the Social Perception and Knowledge test (PerSo), an experimental task requiring participants to comprehensively describe social situations and to identify the social rules illustrated in 8 pictures. We performed group and single-case analyses. RESULTS: Patients with SAUD, as a group, spontaneously identified less relevant "where"/"who"/"what" aspects of the social situations (social perception) than HC. They were however able to provide these elements when explicitly asked to. They were also less able to identify the social rules that subtended the situations (social knowledge). Single-case analyses revealed that 23 % of patients were significantly impaired for social perception, and 34 % for social knowledge. DISCUSSION: We provide novel evidence that SAUD is associated with social perception and knowledge impairments at the group level, and that these impairments strongly vary across patients. Such results should lead to the integration of social perception and knowledge impairments in the conceptualization and treatment of socio-affective difficulties in SAUD.

Bilingual children judge moral, social, and language violations as less transgressive than monolingual children.

Learning the rules and expectations that govern our social interactions is one of the major challenges of development. The current study examined whether bilingualism is associated with differences in children's developing social knowledge. We presented 54 4- to 6-year-old monolingual and bilingual children with vignettes of moral transgressions (e.g., hitting), social transgressions (e.g., wearing pants on one's head), and language transgressions (e.g., calling a common object by a nonsense word) and asked about their permissibility. In line with previous research findings, results demonstrate that all children evaluated moral violations more harshly than conventional violations. Notably, however, bilingual children were more permissive of violations across moral, social, and language domains than monolingual children. These findings yield new insights into the role of early experience in the development of social knowledge. We propose that bilinguals' unique linguistic and social experiences influence their understanding of moral and conventional rules.

O que pensam alunos do ensino fundamental de escolas públicas de Londrina a cerca da pobreza? / What do elementary school students from Londrina think about poverty?

A perspectiva piagetiana foi tomada como referência neste artigo que constituiu-se em estudo descritivo de abordagem qualitativa e objetivou investigar os níveis de evolução do conhecimento social por meio da noção de pobreza, em 24 estudantes do Ensino Fundamental, sendo 8 alunos dos anos iniciais (3º e 5º Anos) e 16 estudantes dos anos finais do Ensino Fundamental (7º e 9º Anos), de duas escolas públicas da cidade de Londrina, PR, uma delas com IDEB3.8 e outra com nota 5.6. Os procedimentos utilizados foram ancorados no método clínico crítico piagetiano. Como instrumentos, foram empregados: entrevista, produção de desenhos e legendas pelos participantes. Os resultados indicaram níveis distintos de compreensão da noção de pobreza: dos 24 alunos participantes do estudo, com idades compreendidas entre 6;0 e 15;03, 16 se enquadraram no nível I,8 se enquadraram no nível II e nenhum participante atingiu o nível III de compreensão da realidade social, que supõe maior elaboração, abstração e reflexão. Os resultados ressaltam a escola como espaço de reflexão e promoção de desenvolvimento cognitivo a oportunizar noções pertinentes ao domínio social, leitura e atuação mais crítica dos sujeitos transformadores da realidade em que vivem.

This article, that used a piagetian perspective as reference, was settled with a qualitative approach descriptive study having agoalin research social knowledge development levels through the notion of poverty, with 24 students, being 8 students of 3rd and 5th grades, and 16 students of 7th and 9th grades, in two public schools of Londrina, PR. The procedures used were anchored in piagetian critical clinical method. Interview and the drawings and subtitles production by participants were the instruments used. The results denoted understanding different levels of the poverty meaning. 24 students participated in the study, aged between 6;0 and 15;03. 16 students were fitin leve lI, 8 students were fitin level II and no one participant reached level III of social reality understanding, supposedly the most elaborated abstraction and reflection level. The results emphasize the school as aspace for reflection and promotion cognitive development, as to provide meanings pertinent to social domain, reading and more critical performance of subjects transformers in the reality they live.

The Type of Information People with Schizophrenia Use in Ambiguous Social Situations.

BACKGROUND AND OBJECTIVES: Rather than focusing on the extensively studied social perception and recognition impairments in people with schizophrenia, this study focuses on the type of social information considered relevant by people with schizophrenia, and how they use it to arrive at conclusions about social situations. METHODS: Participants included 50 outpatients with schizophrenia from the Hospital del Salvador at Valparaíso, Chile, and 50 healthy comparators matched by age and gender. Subjects completed the Social Information Preference Test (SIPT), which presents scenes depicting ambiguous social situations with faces, thoughts, and facts about the scene hidden from view. Participants were required to select a limited number of these items and then choose between possible interpretations of the scene (positive, neutral, or negative). Additionally, they are asked to provide a feeling of certainty in their answers, using a 7-point visual analogue scale. RESULTS: People with schizophrenia, as well as controls had a strong preference for knowing the thoughts of the characters. Both groups were least likely to choose emotional expressions. Patients were significantly less likely to choose object/information than controls. Both groups showed a high certainty in their responses and no tendency to choose negative interpretations. LIMITATIONS: compensated clinical status of the patients may have influenced the results. CONCLUSIONS: The results of this study suggest that, despite difficulties perceiving clues about the mental state of others, people with schizophrenia use this information to make sense of social situations, and apparently, they do not have problems in understanding social interactions.

A Health System's Pilot Experience with Using Social Knowledge Networking (SKN) Technology to Enable Meaningful Use of EHR Medication Reconciliation Technology.

Similar to issues faced in health systems across USA, AU Health, based in Augusta, Georgia, faced a scenario of low physician engagement in, and limited-use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which translated to high rates of medication discrepancies and low accuracy of the patient's active medication list, during transitions of care. In fall 2016, a two-year grant was secured from the U.S. Agency for Healthcare Research and Quality (AHRQ), to pilot a Social Knowledge Networking (SKN) system pertaining to "EHR-MedRec," to enable AU Health to progress from "limited use" of EHR MedRec technology, to "meaningful use." The rationale behind an SKN system, is that it could provide a platform for inter-professional knowledge exchange on practice issues related to EHR MedRec, across diverse provider subgroups and care settings, to highlight adverse consequences of gaps in practice for patient safety, and emphasize the value of adhering to best-practices in EHR MedRec. This, in turn, is expected to increase provider engagement in addressing issues related to EHR MedRec, and promote inter-professional learning of best-practices, to create a foundation for practice change or improvement (e.g., Meaningful Use of EHR MedRec technology). This Case Report describes AU Health's experiences with this novel initiative to pilot an SKN system for enabling Meaningful Use of EHR MedRec technology. It also discusses lessons learned in regard to the potential of an SKN system to enable inter-professional learning and practice improvement in the context of EHR MedRec, which, in turn, helps identify strategies and practice implications for healthcare managers.

Social performance-based interventions promote gains in social knowledge in the absence of explicit training for youth with autism spectrum disorder.

Youth with autism spectrum disorder (ASD) experience deficits in social knowledge. It has long been theorized that these youth must learn these skills explicitly, and social skills interventions (SSIs) have followed suit. Recently, performance-based SSIs have emerged, which promote in vivo opportunities for social engagement without explicit instruction. Effects of performance-based SSIs on social knowledge have not been examined. This study employs two discrete samples (one lab-based, one community-based) of youth with ASD to examine the effects of performance-based interventions on social knowledge. Results largely support the efficacy and effectiveness of improving social knowledge by performance-based interventions without explicit teaching. This indicates that youth with ASD may be able to learn these aspects of social cognition implicitly, rather than exclusively explicitly. The results of the current study also suggest that SSI content, dosage, and intensity may relate to these outcomes, which are important considerations in clinical practice and future studies.

Social-Aware Driver Assistance Systems for City Traffic in Shared Spaces.

Shared spaces are gaining presence in cities, where a variety of players and mobility types (pedestrians, bicycles, motorcycles, and cars) move without specifically delimited areas. This makes the traffic they comprise challenging for automated systems. The information traditionally considered (e.g., streets, and obstacle positions and speeds) is not enough to build suitable models of the environment. The required explanatory and anticipation capabilities need additional information to improve them. Social aspects (e.g., goal of the displacement, companion, or available time) should be considered, as they have a strong influence on how people move and interact with the environment. This paper presents the Social-Aware Driver Assistance System (SADAS) approach to integrate this information into traffic systems. It relies on a domain-specific modelling language for social contexts and their changes. Specifications compliant with it describe social and system information, their links, and how to process them. Traffic social properties are the formalization within the language of relevant knowledge extracted from literature to interpret information. A multi-agent system architecture manages these specifications and additional processing resources. A SADAS can be connected to other parts of traffic systems by means of subscription-notification mechanisms. The case study to illustrate the approach applies social knowledge to predict people's movements. It considers a distributed system for obstacle detection and tracking, and the intelligent management of traffic signals.

Role of context in affective theory of mind in Alzheimer's disease.

Affective theory of mind (ToM) is defined as the ability to deal with affective mental states. Attributing an affective mental state from a facial expression relies mainly on processes that allow information in the environment to be perceived and decoded. Reasoning processes are required when information is not directly available in the environment (e.g., when making an affective mental state attribution in a social situation where there is no visible facial expression of emotion). Although facial emotion decoding deficits have been reported in Alzheimer's disease (AD), few studies have assessed emotional reasoning processes. Long-term social knowledge may also contribute to mental state attribution, given its involvement in social situations, but the links between these two domains have not yet been properly explored. The aim of the present study was therefore to assess both decoding and reasoning processes in AD, as well as the effect of context on emotion attribution (i.e., whether prior presentation of a congruent vs. noncongruent social situation influences emotion recognition from faces). We also aimed to improve current understanding of the relationship between ToM processes and social knowledge. Participants were 20 patients with AD, 20 healthy older individuals, and 20 healthy young individuals. They performed three tasks testing ToM: a context task (emotion attribution in a social situation); a face task (facial emotion recognition); and a context-face task (determining whether the facial emotion was consistent with the emotion inferred from the social situation, e.g., an embarrassing situation followed by a proud face). All participants underwent a neuropsychological battery that included an assessment of social norm knowledge (e.g., determining whether it is socially acceptable to phone in a church). Results showed deficits in the patients with AD for decoding emotions from faces and for reasoning about emotions inferred from a social context. Patients were found to consider contextual information in such a way that congruency either helped or hindered the decoding of stimuli in the environment. As expected, we found that ToM abilities were linked to social norm knowledge. Overall, our findings suggest that patients with AD have difficulty attributing emotional mental states, and deficits in social norm knowledge and the presence of incongruent information may heighten this difficulty.

Demographic and Clinical Correlates of Social Cognition in Schizophrenia: Observation from India.

PURPOSE: Although deficits in social cognition (SC) had been recognized as a hallmark of schizophrenia, quality data in Indian context were limited. The purpose of the current research was to determine the demographic and clinical correlates of SC in schizophrenia. METHODS: Between February 2014 and January 2015, a case-control study was conducted in Chhattisgarh, India, among 100 paranoid schizophrenia patients (ICD-10) from two psychiatric hospitals and 100 neighborhood-based healthy (28-item General Health Questionnaire) controls. After obtaining signed consent, SC was assessed among 20-35-year-old, high school or more educated subjects ensuring eligibility for appropriate scales. RESULTS: Patients had poorer social knowledge (adjusted-beta-coefficient [AC] = -4.89 [-6.32, -3.45]) and lower predicted mean score for internal attribution of negative event (AC: -0.72 [-1.17, -0.27]). Nonrecognition of facial expressions especially for anger (adjusted-odds-ratio [AOR] = 3.50 [1.17, 10.51]), surprise (AOR = 2.91 [1.36, 6.25]) and fear (AOR = 2.35 [1.11, 5.01]) was more common among cases. Wrong recognition of expressions was less likely among females (for surprise: AOR = 0.35 [0.13, 0.93]) and educated (for sadness: AOR = 0.11 [0.02, 0.58]) but more common among wealthy (for surprise: AOR = 4.58 [1.22, 17.19]) and urban (for fear: unadjusted odds ratios = 4.30 [1.53, 12.03]) subjects. If recognized expressions correctly, females were more likely to perceive higher intensity of anger (AOR = 4.30 [1.80, 10.29]) and happiness (AOR = 4.22 [1.66, 10.72]). Higher intensity was perceived by more educated subjects regarding anger (AOR = 2.57 [1.04, 6.34]) but not for happiness (AOR = 0.09 [0.01, 0.79]). Unmarried/divorced/separated perceived happiness (AOR = 2.86 [1.02, 7.97]) with more intensity while those in joint families perceived sadness (AOR = 2.80 [1.22, 6.41]) and fear (AOR = 2.28 [1.01, 5.16]) with more intensity. CONCLUSION: A significant impairment in SC was observed among paranoid schizophrenia cases in Chhattisgarh, India. Intervention and further research addressing identified issues of SC need to target specific subpopulations, among schizophrenia patients.

Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.

Background: In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from "limited use" of EHR Medication Reconciliation (MedRec) Technology, to "meaningful use." Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool, which, along with a Discussion Tool, was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1. Methods: Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health. Results: Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners' importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated "Important" or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6) Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI. Conclusion: There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation.

Implementing a Social Knowledge Networking (SKN) system to enable meaningful use of an EHR medication reconciliation system.

BACKGROUND: Despite the regulatory impetus toward meaningful use of electronic health record (EHR) Medication Reconciliation (MedRec) to prevent medication errors during care transitions, hospital adherence has lagged for one chief reason: low physician engagement, stemming from lack of consensus about which physician is responsible for managing a patient's medication list. In October 2016, Augusta University received a 2-year grant from the Agency for Healthcare Research and Quality to implement a Social Knowledge Networking (SKN) system for enabling its health system (AU Health) to progress from "limited use" of EHR MedRec technology to "meaningful use." The hypothesis is that SKN would bring together a diverse group of practitioners, to facilitate tacit knowledge exchange on issues related to EHR MedRec, which in turn is expected to increase practitioners' engagement in addressing those issues and enable meaningful use of EHR. The specific aims are to examine: 1) user-engagement in the SKN system, and 2) associations between "SKN use" and "meaningful use" of EHR. METHODS: The 2-year project uses an exploratory mixed-method design and consists of three phases: 1) development; 2) SKN implementation; and 3) analysis. Phase 1, completed in May 2017, sought to identify a comprehensive set of issues related to EHR MedRec from practitioners directly involved in the MedRec process. This process facilitated development of a "Reporting Tool" on issues related to EHR MedRec, which, along with an existing "SKN/Discussion Tool," was integrated into the EHR at AU Health. Phase 2 (launched in June 2017) involves implementing the EHR-integrated SKN system over a 52-week period in inpatient and outpatient medicine units. DISCUSSION: The prospective implementation design is expected to generate context-sensitive strategies for meaningful use and successful implementation of EHR MedRec and thereby make substantial contributions to the patient safety and risk management literature. From a health care policy perspective, if the hypothesis holds, federal vendors could be encouraged to incorporate SKN features into EHR systems.