Evaluating the Impact of Performance Improvement Initiatives on Transplant Center Reporting Compliance and Patient Follow-Up After Living Kidney Donation.

With the changing demographics of the living donor population and increased regulatory oversight, it is important that transplant centers report outcomes accurately. The aim of our retrospective cohort study of 312 living donors who underwent nephrectomy between 2008 and 2013 was to evaluate the impact of living donor program performance improvement initiatives on: (i) transplant center program reporting compliance; (ii) patient compliance with postdonation follow-up and its associated factors; and (iii) overall financial costs to the transplant center. The effect of the initiatives (donation eras 2008-2010 and 2011-2013) on compliance at key reporting points (6 months, 1 year, 2 years) was analyzed using correlation coefficients, χ(2) and Fisher's exact tests. Multivariable logistic regression models tested the initiatives' effect on the likelihood of patient follow-up. The initiatives were associated with significant improvement in form reporting compliance (r ≥ 0.862, p ≤ 0.027; 1 and 2 year Fisher's Exact p ≤ 0.002) and patient follow-up (χ(2) p ≤ 0.009) with acceptable transplant center costs. Multivariable analyses demonstrated that donation era was consistently and significantly (p < 0.001) associated with increased likelihood of postdonation patient follow-up. Institution of performance improvement initiatives with dedicated program resources is financially feasible and leads to more accurate and complete form reporting and improved patient follow-up after nephrectomy.

Delay of gratification in chimpanzees (Pan troglodytes).

Delay of gratification in 3 chimpanzees (Pan troglodytes) was examined by using a paradigm based on research with children. The chimpanzees either pressed a door-bell button during a trial and received one reward (the immediate reward) or did not press the doorbell and received another reward (the delayed reward). Two chimpanzees were language-trained, and a 3rd was non-language-trained. Foods (one more-preferred and one less-preferred), photographs of those foods, or lexigrams representing those foods were presented to the chimpanzees. All 3 chimpanzees delayed gratification when foods were physically present. One language-trained chimpanzee also delayed gratification with lexigrams present, and the 2nd language-trained chimpanzee delayed gratification in all three conditions. Language competence and early rearing are proposed as explanations for the different performances of these chimpanzees.

Toward a new outlook on primate learning and behavior: complex learning and emergent processes in comparative perspective.

Primate research of the 20th century has established the validity of Darwin's postulation of psychological as well as biological continuity between humans and other primates, notably the great apes. Its data make clear that Descartes' view of animals as unfeeling "beast-machines" is invalid and should be discarded. Traditional behavioristic frameworks--that emphasize the concepts of stimulus, response, and reinforcement and an "empty-organism" psychology--are in need of major revisions. Revised frameworks should incorporate the fact that, in contrast to the lifeless databases of the "hard" sciences, the database of psychology entails properties novel to life and its attendant phenomena. The contributions of research this century, achieved by field and laboratory researchers from around the world, have been substantial--indeed revolutionary. It is time to celebrate the progress of our field, to anticipate its significance, and to emphasize conservation of primates in their natural habitats.

Comparing communicative competence in child and chimp: the pragmatics of repetition.

Through an analysis of chimpanzee-human discourse, we show that two Pan troglodytes chimpanzees and two Pan paniscus chimpanzees (bonobos) exposed to a humanly devised symbol system use partial or complete repetition of others' symbols, as children do: they do not produce rote imitations, but instead use repetition to fulfil a variety of pragmatic functions in discourse. These functions include agreement, request, promise, excitement, and selection from alternatives. In so doing, the chimpanzees demonstrate contingent turn-taking and the use of simple devices for lexical cohesion. In short, they demonstrate conversational competence. Because of the presence of this conversational competence in three sibling species, chimpanzees, bonobos, and humans, it is concluded that the potential to express pragmatic functions through repetition was part of the evolutionary history of human language, present in our common ancestor before the phylogenetic divergence of hominids and chimpanzees. In the context of these similarities, two interesting differences appeared: (I) Human children sometimes used repetition to stimulate more talk in their conversational partner; the chimpanzees, in contrast, use repetition exclusively to forward the non-verbal action. This difference may illuminate a unique feature of human linguistic communication, or it may simply reflect a modality difference (visual symbols used by the chimpanzees, speech used by the children) in the symbol systems considered in this research. A second difference seems likely to reflect a true species difference: utterance length. The one- and two-symbol repetitions used by the chimpanzees to fulfil a variety of pragmatic functions were less than half the maximum length found in either the visual symbol combinations addressed to them by their adult human caregivers or the oral repetitions of two-year-old children. This species difference probably reflects the evolution of increased brain size and consequent increased memory capacity that has occurred since the phylogenetic divergence of hominids and chimpanzees four to seven million years ago.

Language comprehension in ape and child.

Previous investigations of the linguistic capacities of apes have focused on the ape's ability to produce words, and there has been little concern for comprehension. By contrast, it is increasingly recognized that comprehension precedes production in the language development of normal human children, and it may indeed guide production. It has been demonstrated that some species can process speech sounds categorically in a manner similar to that observed in humans. Consequently, it should be possible for such species to comprehend language if they have the cognitive capacity to understand word-referent relations and syntactic structure. Popular theories of human language acquisition suggest that the ability to process syntactic information is unique to humans and reflects a novel biological adaptation not seen in other animals. The current report addresses this issue through systematic experimental comparisons of the language comprehension skills of a 2-year-old child and an 8 year-old bonobo (Pan paniscus) who was raised in a language environment similar to that in which children are raised but specifically modified to be appropriate for an ape. Both subjects (child and bonobo) were exposed to spoken English and lexigrams from infancy, and neither was trained to comprehend speech. A common caretaker participated in the rearing of both subjects. All language acquisition was through observational learning. Without prior training, subjects were asked to respond to the same 660 novel sentences. All responses were videotaped and scored for accuracy of comprehension of the English language. The results indicated that both subjects comprehended novel requests and simple syntactic devices. The bonobo decoded the syntactic device of word recursion with higher accuracy than the child; however, the child tended to do better than the bonobo on the conjunctive, a structure that places a greater burden on short-term memory. Both subjects performed as well on sentences that required the ability to reverse work order as they did on sentences that did not require this capacity. These results are discussed in light of a model of the evolution of language that suggests that the potential for language comprehension preceded the appearance of speech by several million years at minimum. The onset of speech is linked to the appearance of fully adapted bipedalism, which necessitated reorientation of the laryngeal tract and made closure of the soft palate possible. For the first time, such closure permitted mammals to easily produce sounds that could be interpreted by the mammalian auditory system in a categorical manner. When these sounds were paired with the previously extant capacity to produce vowels, it became possible to form "bounded vowels" or sound units that could readily be discriminated as units by the auditory system. It is suggested that this physical adaptation allowed the extant cognitive capacity of the hominids to embark on a speech-like mode of communication.

Hemispheric priming by meaningful and nonmeaningful symbols in language-trained chimpanzees (Pan troglodytes): further evidence of a left hemisphere advantage.

Hemispheric priming was examined in 3 language-trained chimpanzees (Pan troglodytes) using a simple reaction time paradigm. Subjects were required to hold down a response button until the occurrence of a response cue. A warning stimulus was presented to either the left visual field (LVF) or the right visual field (RVF) before the response cue occurred. No warning stimulus was presented on control trials. The warning stimuli were geometric communicative symbols from two semantic categories: foods and tools. A third set of warning stimuli were familiar geometric symbols. Dependent measures included reaction time and the number of false-positive responses. Reaction-time data indicated an RVF advantage in priming when the warning stimuli were food or tool symbols. No significant visual half-field differences were found for familiar symbols, but a trend toward an RVF advantage was observed. These effects were enhanced when subjects responded with their left hand. False-positive data also indicated an RVF advantage for the food and tool warning stimuli. The data indicate that hemispheric asymmetries for processing communicative symbols are present in language-trained chimpanzees.

Evidence for asymmetrical hemispheric priming using known and unknown warning stimuli in two language-trained chimpanzees (Pan troglodytes).

In this article results are reported from 3 warning stimulus-priming experiments that assessed hemisphere-specific activation and lateralization in 2 language-trained chimpanzees (Pan troglodytes). Results from Experiment 1 indicated a right visual field advantage in priming for meaningful warning stimuli presented in blocks of 36 trials. In Experiments 2 and 3, randomized presentations of meaningful, familiar, and meaningless stimuli resulted in right visual field advantages for meaningful warning stimuli. No visual half-field differences were found for familiar or meaningless warning stimuli. The findings are similar to those found in human subjects using known-unknown symbol paradigms; they suggest that basic phylogenetic neuropsychological systems related to activation and priming processes may link nonhuman primate and human studies of lateralization.

Language acquisition in a nonhuman species: implications for the innateness debate.

This article approaches the linguistic innateness issue from the perspective of a nonhuman species, the bonobo, an ape which is generally taken to be the best living model for early hominids. Recent studies indicate that a bonobo reared with humans comes spontaneously to comprehend spoken words, to produce novel two word combinations, and to respond appropriately to syntactically ordered sentences. The difference between the use of word combinations to say what one word can accomplish and combinations that convey a novel idea not transmittable by a single word is emphasized. It is argued that the use of such novel combinations must have preceded the appearance of syntax in the evolution of language. The use of multiword novel combinations has not received sufficient attention in the literature because of the erroneous assumption that novel meanings could only be achieved through syntactical structure. Consequently the significance of the ape's linguistic competence has been severely undervalued.

The NASA/LRC Computerized Test System.

A new testing package, including apparatus and tasks, is described for the study of behavior of a variety of species in a variety of experiments. The package is described with respect to the kinds of comparative psychological investigations for which it is well suited. The preliminary data generated within this new testing paradigm demonstrate that the NASA/LRC Computerized Test System provides a flexible yet powerful environment for the investigation of behavioral and psychological processes.

Lana chimpanzee learns to count by "NUMATH": a summary of a videotaped experimental report.

This paper summarizes a videotaped presentation (Rumbaugh, Savage-Rumbaugh, Hopkins, Washburn, & Runfeldt, 1987) of computerized training programs whereby an adult female chimpanzee, Lana (Pan troglodytes), learned to use a joystick to remove from a screen the number of boxes appropriate to the value of a randomly selected Arabic numeral 1, 2, or 3. Initial training provided a variety of cues, both numeric and otherwise, to support correct performance. Across software programs, all cues other than numeric ones were deleted. In the final test, Lana was correct on over 80% of trials in which there was no residual feedback of intratrial events and where only her memory of those events could provide the cue to indicate that she had removed boxes in accordance with the value of the target numbers and should terminate the trial. The tape is narrated and consists of video recordings of Lana's performance on each software program.

Rhesus monkeys (Macaca mulatta), video tasks, and implications for stimulus-response spatial contiguity.

Recent reports (Iwai, Yaginuma, & Mishkin, 1986; Yaginuma & Iwai, 1986) have supported the earlier conclusion by Meyer, Treichler, and Meyer (1965) and by Stollnitz (1965) that the efficiency of primate learning is compromised to the degree that there is spatial discontiguity between discriminanda and the locus of response. The research reported in this article calls for a reconsideration of this conclusion. Two rhesus monkeys (Macaca mulatta) easily mastered precise control of a joystick to respond to a variety of computer-generated targets despite the fact that the joystick was located 9 to 18 cm from the video screen. We hold that stimulus-response contiguity is a significant parameter of learning only to the degree that the monkey visually attends to the directional movements of its hand in order to displace discriminanda as in the Wisconsin General Test Apparatus. If, instead, attention is focused on the effects of the hand's movement rather than on the hand itself, stimulus-response contiguity is no longer a primary parameter of learning. The implications of this work for mirror-guided studies are discussed.

Addendum to "Summation in the chimpanzee (Pan troglodytes)".

Rumbaugh, Savage-Rumbaugh, and Hegel (1987) reported that two chimpanzees (Pan troglodytes) could select, with better than 90% accuracy, the greater of two paired quantities of chocolate chips. In that study, no one quantity of chocolates (from 0 through 5) was used in both pairs on a given trial. We investigated the effect of having one quantity in common (CQ) in both pairs. Whether the other quantities (OQs) of chocolates were both less than or greater than the CQ, summation still occurred. Accuracy was primarily a function of the ratios of sums to be differentiated. This finding substantiated the earlier conclusion that summation was based on both quantities of each pair and not on some simpler process such as the avoidance of the tray with the smallest single amount or selection of the tray with the single largest amount.

Chimpanzee (Pan troglodytes) spatial problem solving with the use of mirrors and televised equivalents of mirrors.

Two adult male chimpanzees reached through a hole in the wall of their home cage and, by tracking the images of their hands and of an otherwise hidden target object in a mirror or closed-circuit television picture, moved their hands in whichever direction was necessary to make contact with the target object. They discriminated between live video images and tapes and performed effectively when the target objects were presented in novel locations and when the video picture was presented at random in different orientations. There was thus no consistent relation between the location of images on the monitor and the location of their real-world counterparts. Comparable performances in monkeys and nonprimates seem unlikely.

The capacity of animals to acquire language: do species differences have anything to say to us?

Following the Gardners' discovery that an ape named Washoe could learn to produce and combine a number of hand movements similar to those used by deaf human beings, a variety of 'ape-language projects' sprang up. Some projects used different symbol systems, others used different training techniques, and others used different species of apes. While debate still rages regarding the appropriate way to interpret the symbolic productions of apes, three species of great apes (gorilla, orangutan, and chimpanzee) have now been credited with this capacity while no lesser apes or monkeys have been reported, at present, to have acquired such communicative skills. Among all of the claims made for the various animal species, the philosophers have entered the fray attempting to define the essence of what it is about language that makes it 'human'. This paper will compare and contrast the above positions to arrive at behavioural definitions of symbolic usage that can be applied across species. It will then present new data on a fourth ape species Pan paniscus which is proving to be the first non-human species to acquire symbolic skills in a spontaneous manner.

Perceived variability and symbol use: a common language-cognition interface in children and chimpanzees (Pan troglodytes).

Analysis of two chimpanzees' conversations with their teacher during a tool-use training task demonstrated that chimps use lexigrams, a humanly devised visual symbol system, selectively to encode perceived variability; that is, they generally used their symbols to differentiate alternative possibilities or to represent change or novelty in a situation. In contrast, they tended to leave unsaid what was unchanging, repetitive, or the unique possibility in a situation. Perceived variability influenced not only which symbols were selected but also utterance length: A single dimension of variability in a situation leads to single-lexigram utterances; multiple dimensions are associated with multi-lexigram utterances. This pattern of results indicates that the absence of formal grammatical structure in chimp language does not imply that utterances beyond one word in length are either rote strings or imitations. The chimps' tendency to mention the variable while leaving the constant or redundant unsaid is, moreover, strong support for the position that their use of a humanly devised symbol system is more than a series of conditioned responses.

Verbal behavior at a procedural level in the chimpanzee.

Ape language research has typically employed cognitive descriptions of ape competencies. Recently, Epstein, Lanza, and Skinner (1980) attempted to simulate some of the ape findings with pigeons. They also used cognitive terms to describe their results, but with "tongue-in-cheek." In the hope of bringing about a better understanding of the ape research, this paper describes the main aspects of one ape language project, using a behavior-analytic framework. It then briefly compares and contrasts, from that perspective, the training programs used with pigeons and with apes. It is concluded that the behavior-analytic framework, and the procedures devised to produce language skills in apes, provide strong support for several of the major positions set forth in Skinner's (1957) Verbal Behavior.

Reference: the linguistic essential.

Three chimpanzees learned to label three edibles as "foods" and three inedibles as "tools". Two chimpanzees could then similarly categorize numerous objects during blind trial 1 tests when shown only objects' names. The language-like skills of the chimpanzee who failed (Lana) illustrates that apes can use symbols in ways that emulate human usage without comprehending their representational function.

Symbolic communication between two chimpanzees (Pan troglodytes).

Through use of learned symbols, two chimpanzees accurately specified 11 foods by name to one another when the food item's identity was known by only one. They could not do this when denied use of the symbols. The chimpanzees then spontaneously requested specific foods of one another by name. Requests resulted in cooperative and reciprocal symbolically mediated food exchange.