Bridging a Gap in Coherence: The Coordination of Comprehension Processes When Viewing Visual Narratives.

Scene Perception and Event Comprehension Theory (SPECT) posits that understanding picture stories depends upon a coordination of two processes: (1) integrating new information into the current event model that is coherent with it (i.e., mapping) and (2) segmenting experiences into distinct event models (i.e., shifting). In two experiments, we investigated competing hypotheses regarding how viewers coordinate the mapping process of bridging inference generation and the shifting process of event segmentation by manipulating the presence/absence of Bridging Action pictures (i.e., creating coherence gaps) in wordless picture stories. The Computational Effort Hypothesis says that experiencing a coherence gap prompts event segmentation and the additional computational effort to generate bridging inferences. Thus, it predicted a positive relationship between event segmentation and explanations when Bridging Actions were absent. Alternatively, the Coherence Gap Resolution Hypothesis says that experiencing a coherence gap prompt generating a bridging inference to close the gap, which obviates segmentation. Thus, it predicted a negative relationship between event segmentation and the production of explanations. Replicating prior work, viewers were more likely to segment and generate explanations when Bridging Action pictures were absent than when they were present. Crucially, the relationship between explanations and segmentation was negative when Bridging Action pictures were absent, consistent with the Coherence Gap Resolution Hypothesis. Unexpectedly, the relationship was positive when Bridging Actions were present. The results are consistent with SPECT's assumption that mapping and shifting processes are coordinated, but how they are coordinated depends upon the experience of a coherence gap.

Workforce shortages in breast imaging: impact on mammography utilization.

OBJECTIVE: The objective of this study was to develop reliable forecasts of the future supply of radiologists and radiologic technologists practicing mammography under different assumptions about future introduction of new practitioners. In addition, this article includes basic mammography workforce statistics to provide a context for the forecasts. MATERIALS AND METHODS: The forecasts were developed using an age cohort flow model based on data provided by the American College of Radiology (ACR) on the numbers and age distribution of radiologists and on data provided by the American Society of Radiologic Technologists (ASRT) on radiologic technologists providing mammography services. RESULTS: The forecasts show that the current rates of production of new mammography professionals will result in dramatic reductions in mammography professionals per woman age 40 years old and older over the next 15-20 years. CONCLUSION: Unless the number of new mammography professionals entering practice every year increases beyond the current levels, there will be a growing gap between the supply of and demand for mammography professionals over the next two decades.

Projections of the supply of and demand for podiatric physicians in the United States, 2005 to 2030.

BACKGROUND: An unanticipated decrease in applications to podiatric medical schools in the late 1990s has resulted in a decline in the number of podiatric physicians per capita in the United States. This study explores the implications of five possible scenarios for addressing this decline. METHODS: With the help of an advisory committee and data from the American Podiatric Medical Association, projections of the supply of podiatric physicians were developed using five different scenarios of the future. Projections of several factors related to the demand for podiatric physicians were also developed based on a review of the literature. RESULTS: The projections reveal that unless the number of graduations of new podiatric physicians increases dramatically, the supply will not keep up with the increasing demand for their services. CONCLUSION: The growing supply-demand gap revealed by this study will be an important challenge for the podiatric medical profession to overcome during the next couple of decades.

How trends shape the work force today and tomorrow.

What forces are propelling the healthcare industry's prolonged period of change? How are these forces shaping the future of HIM? In this article, investigators from the Center for Health Workforce Studies examine the roots of the work force shortage and reveal trends that will continue to influence the industry.

The changing professional practice of physician assistants: 1992 to 2000.

BACKGROUND: Substantial changes in professional practice for physician assistants (PAs) occurred between 1992 and 2000. This paper describes a new professional practice index for the PA profession for 2000 that reflects current practice environments more accurately than did an index developed to reflect practice environments in 1992. In addition, the paper examines the relationships among the profession, its professional environment, and physicians, as well as the relationship between the PA profession and access to care for underserved populations. RESULTS: Comparisons of the 1992 professional practice index for the PA profession and indices for 2000 indicate that, collectively, the scope of practice of PAs increased significantly across the United States over the 8-year period. Variation of the index scores narrowed over the same period, suggesting that the 1990s were a period of convergence of professional practice across the 50 states. During this period the numbers of practicing PAs nearly doubled between 1992 and 2000, and in 2000 there were 5.8 practicing PAs per 100 physicians in active patient care in the United States. The professional practice index for the profession is positively correlated with the numbers of PAs per capita across the 50 states for both 1992 and 2000. CONCLUSION: Enabling legislation for PAs has been enacted in all 50 states and the District of Columbia over a 3-decade period. A period of consolidation and convergence of statutes and policies over the 1990s suggests that American medicine has endorsed the role of PAs. In spite of these findings, almost one third of states continue to have limited or restricted statutes for PA practice, mostly in the area of reimbursement.

Toward a new method for identifying facilities and communities with critical shortages of nurses.

This article summarizes the key findings of a study designed to evaluate the effectiveness of different methods for assessing the severity of nursing shortages in four types of health care facilities in the United States (hospitals, long-term care facilities, home health agencies, and public health agencies). The study involves testing several statistical models using currently available data to assess their accuracy and ease of use as possible bases for estimating and predicting the severity of nursing shortages in individual health care facilities. The assessments are based on criteria developed with the advice of panels of experts knowledgeable about each of the four types of facilities. The results of a "preferred method" for rating the severity of nursing shortages in counties in the United States are presented, along with key findings based on a variety of other models and analyses. Although it requires some refinement and a systematic validation, this method holds promise as a possible basis for targeting federal resources to alleviate the most critical nursing shortages across the country.

A Dental Hygiene Professional Practice Index (DHPPI) and access to oral health status and service use in the United States.

PURPOSE: The purpose of this article is to summarize a larger study that developed a statistical index that defines the professional practice environment of dental hygienists (DHs) in the United States, and to determine the extent to which the index scores are related to the number of DHs and dentists, the utilization of dental services, and selected oral health outcomes across the 50 states. METHODS: A Dental Hygiene Professional Practice Index (DHPPI) defines the professional status, supervision requirements, tasks permitted, and reimbursement options for DHs in each of the 50 states and the District of Columbia, as of December 31, 2001. Spearman rank order correlations between the DHPPI and numbers of oral health professionals, utilization of oral health services, and oral health outcomes in the 50 states are also presented. RESULTS: The analyses revealed that: There are significant differences in the legal practice environments (as reflected in the DHPPI) across the 50 states and the District of Columbia. Between 1990 and 2001, the number of DHs per capita increased by 46% in the United States, while the number of dentists per 100,000 population increased by only 10%. The DHPPI was not significantly correlated with the number of DHs or dentists in the 50 states in 2001. The DHPPI was significantly positively correlated with the salaries of DHs in 2001. The DHPPI was also significantly and positively correlated with a number of indicators of utilization of oral health services and oral health outcomes. CONCLUSIONS: Both access to oral health services and oral health outcomes are positively correlated with the DHPPI. This suggests that states with low DHPPI scores would be logical candidates for revised DH practice statutes and regulations to accomplish these objectives.