Asynchronous development of memory integration and differentiation influences temporal memory organization.

Adults remember items with shared contexts as occurring closer in time to one another than those associated with different contexts, even when their objective temporal distance is fixed. Such temporal memory biases are thought to reflect within-event integration and between-event differentiation processes that organize events according to their contextual similarities and differences, respectively. Within-event integration and between-event differentiation are hypothesized to differentially rely on binding and control processes, which may develop at different ages. To test this hypothesis, 5- to 12-year-olds and adults (N = 134) studied quartets of image pairs that contained either the same scene (same-context) or different scenes (different-context). Participants remembered same-context items as occurring closer in time by older childhood (7-9 years), whereas different-context items were remembered as occurring farther apart by early adolescence (10-12 years). The differential emergence of these temporal memory biases suggests within-event integration and between-event differentiation emerge at different ages. RESEARCH HIGHLIGHTS: Children are less likely than adults to use contextual information (e.g., location) to organize their continuous experience in memory, as indicated by temporal memory biases. Biases reflecting within-event integration (i.e., remembering elements with a shared context as occurring closer together in time) emerged in late childhood. Biases reflecting between-event differentiation (i.e., remembering elements from different contexts as occurring farther apart in time) emerged in early adolescence. The differential emergence of biases reflecting within-event integration and between-event differentiation suggests they are distinct, yet complementary, processes that support developmental improvements in event memory organization.

Dobbs, the Intrusive State, and the Future of Solidarity.

The intrusive state has long viewed women as fetal containers. The Dobbs decision goes further, essentially causing women to vanish when fetuses are abstracted from their relationships to pregnant persons. The ways in which women are first controlled and then made invisible are clearly connected with the move from obedience to omission that has historically affected black Americans. When personal decisionmaking and participation in democracy are regarded as threats, those threatened restrict decisional freedom and political power, deepening structural injustices relating to sex, race, and poverty. Fear of Dobbs has health effects on conditions unrelated to pregnancy and connects with erasures of human value that are not health-related. We reaffirm solidarity as a countering influence. Taking account of the richly relational context in which issues like abortion and political representation arise should lead to better, more meaningful policies, making so many people impossible to unsee.

Contextual features in the developing hippocampus: A representational similarity analysis.

Functional divisions of labor in support of memory have been reported along the anterior-posterior axis of the hippocampus. However, little is known about how the developing hippocampus represents associative memories along this axis. The present research employed representational similarity analysis to ask whether developmental differences exist in the extent to which the anterior versus the posterior hippocampus represent features of the context and associative memories. Functional magnetic resonance imaging data were collected during the retrieval phase of an associative recognition task from 8-year-olds, 10-year-olds, and adults (N = 58). Participants were asked to retrieve pairs of items, which were presented either in the same location as during encoding or in a flipped location. In the anterior hippocampus and only for adults, pattern similarity between the two studied pair conditions was greater than pattern similarity between studied pairs presented in the same location and novel pairs. In contrast, this difference was not significant in the posterior hippocampus. Older, but not younger, children showed a similar, albeit attenuated, similarity pattern to that of adults, but measures of patterns similarity predicted associative recognition across ages. In addition, exploratory analyses showed that similarity patterns in the adult posterior, but not anterior, hippocampus tracked the order of the runs. Overall, the results suggest functional and developmental dissociations in processing different contextual features, with the anterior hippocampus responding to salient and rapid-changing features and the posterior hippocampus responding to slower-changing features of the context.

Developmental differences in temporal schema acquisition impact reasoning decisions.

Schemas capture patterns across multiple experiences, accumulating information about common event structures that guide decision making in new contexts. Schemas are an important principle of leading theories of cognitive development; yet, we know little about how children and adolescents form schemas and use schematic knowledge to guide decisions. Here, we show that the ability to acquire schematic knowledge based on the temporal regularities of events increases during childhood and adolescence. Furthermore, we show that temporally mediated schematic knowledge biases reasoning decisions in an age-dependent manner. Participants with greater temporal schematic knowledge were more likely to infer that temporally related items shared other, non-temporal properties, with adults showing the greatest relationship between schema knowledge and reasoning choices. These data indicate that the mechanisms underlying schema formation and expression are not fully developed until adulthood and may reflect the ongoing maturation of hippocampus and prefrontal cortex through adolescence.

Ensuring Compliance With Quarantine by Undocumented Immigrants and Other Vulnerable Groups: Public Health Versus Politics.

A successful quarantine requires a high rate of compliance by individuals with potential exposure to a communicable disease.Many individuals would be reluctant to comply with a quarantine because they fear that contact with government officials will place them in legal, personal, or economic jeopardy. These include undocumented immigrants and individuals with a substance use disorder. For a quarantine to succeed, individuals must be granted temporary immunity from arrest, deportation, or similar adverse consequences, but doing so will be politically unpopular.We argue that public health considerations must take precedence over politics in protecting the health of the public.

Development of Episodic Prospection: Factors Underlying Improvements in Middle and Late Childhood.

Episodic prospection is the mental simulation of a personal future event in rich contextual detail. This study examined age-related differences in episodic prospection in 5- to 11-year-olds and adults (N = 157), as well as factors that may contribute to developmental improvements. Participants' narratives of past, future, and make-believe events were coded for episodic content, and self-concept coherence (i.e., how coherently an individual sees himself or herself) and narrative ability were tested as predictors of episodic prospection. Although all ages provided less episodic content for future event narratives, age-related improvements were observed across childhood, suggesting future event generation is particularly difficult for children. Self-concept coherence and narrative ability each independently predicted the episodic content of 5- and 7-year-olds' future event narratives.

Retrieval flexibility and reinstatement in the developing hippocampus.

Episodic memory improves during childhood and this improvement has been associated with age differences in hippocampal function, but previous research has not manipulated the possible underlying mechanisms. We tested the hypothesis that age-related differences in hippocampal activation may reflect changes in retrieval flexibility. We expected these activation differences to be observed most prominently in the anterior hippocampus. Functional magnetic resonance imaging (fMRI) data were collected from children ages 8 and 10, and adults (N = 63) during an associative recognition task that required participants to recognize pairs of pictures which either appeared in the same location as during encoding (Same location), or in a flipped location, such that each picture switched their location with the other member of the pair (Flipped location). Recognition of same-location pairs placed lower demands on flexible retrieval compared to recognition of flipped-location pairs. Behaviorally, 8-year-olds exhibited the strongest correct recognition gains for same-location compared to flipped-location pairs, and females unexpectedly outperformed males across all ages. When we examined correct recognition, adults recruited the hippocampal head more strongly for flipped- versus same-location pairs compared to both groups of children; in contrast both adults and 10-year-olds recruited the hippocampal tail more strongly for flipped- versus same-location pairs compared to 8-year-olds. This pattern was stronger in the left hippocampus and for females. Moreover hippocampal discrimination between recognized and forgotten items in the same-location condition was stronger in 8-year-olds compared to adults, and was stronger in the flipped-location condition in adults compared to 8-year-olds; this pattern was stronger in the left hippocampus. Individual differences in this discrimination contrast for flipped-location trials in the head and body predicted performance on an index of creative thinking. Overall, these results lend new support to the idea that hippocampal development may reflect change in retrieval flexibility with implications for additional forms of flexible cognition.

Introspection on uncertainty and judicious help-seeking during the preschool years.

Little is known about the mechanisms underlying a ubiquitous behavior in preschoolers, help-seeking. We tested the hypothesis that preschoolers' awareness of their own uncertainty is associated with help-seeking. Three-, 4-, and 5-year-olds (N = 125) completed a perceptual identification task twice: once independently and once when they could request help from a confederate whose competence level was manipulated. Consistent with our hypothesis, participants sought help more frequently on trials for which, when required to answer independently, they expressed lower confidence. Children in the bad-helper condition were slower to respond after receiving help than those in the good-helper condition. Finally, females and children with more advanced theory of mind were more likely to seek help, identifying additional factors that relate to help-seeking.

An ethnographic study of main events during hospitalisation: perceptions of nurses and patients.

AIM: To explore nurses' and patients' perceptions of care during main events of hospitalisation. BACKGROUND: Main events during hospitalisation such as admission, transfer to the operation room and preparation for discharge have been identified as times when there is significant patient-caregiver interaction. It is during these interactions that there is an opportunity for the nurse to have a positive influence on the patient's satisfaction with care. The patient's perception of care has been studied but not qualitatively. Perceptions of care from the nurses' perspectives have not been well studied. This study explored the patient's perception of care as well as the nurse's perception of the care he provided. DESIGN: This study used an ethnographic methodology that included participant observation and unstructured interviews. METHOD: The research was conducted in two phases. First, participant observation was chosen to observe and understand nurse-patient and nurse-family behaviour. The second phase was an unstructured interview to elicit both the patient's and the nurse's views about the care experience. RESULTS: Two major findings were the patient and the nurse had different perceptions of the care experience and the presence of family or a support person influenced the patient's perception of care. CONCLUSION: The use of ethnography proved to be a valuable methodology for studying the interactions of patients, families and nurses. Qualitative methods such as ethnography can yield significant findings on perceptions that are unable to be gleaned by traditional quantitative methods but can serve to provide hypotheses for further study. Relevance to clinical practice. This study suggests that to maintain quality and patient satisfaction scores, hospitals will need to focus on the difference between the perceived care given and the perceived care received particularly during main events. The role of families and visitors supports positive perceptions of care.

Interpersonal Family Dynamics Relate to Hippocampal CA Subfield Structure.

Social environments that are extremely enriched or adverse can influence hippocampal volume. Though most individuals experience social environments that fall somewhere in between these extremes, substantially less is known about the influence of normative variation in social environments on hippocampal structure. Here, we examined whether hippocampal volume tracks normative variation in interpersonal family dynamics in 7- to 12-year-olds and adults recruited from the general population. We focused on interpersonal family dynamics as a prominent feature of one's social world. Given evidence that CA1 and CA2 play a key role in tracking social information, we related individual hippocampal subfield volumes to interpersonal family dynamics. More positive perceptions of interpersonal family dynamics were associated with greater CA1 and CA2/3 volume regardless of age and controlling for socioeconomic status. These data suggest that CA subfields are sensitive to normative variation in social environments and identify interpersonal family dynamics as an impactful environmental feature.

The impact of dementia and mild memory impairment (MMI) on intimacy and sexuality in spousal relationships.

BACKGROUND: Sexuality and intimacy in couples in which one partner is affected by dementia has been widely researched. Few studies have explored these issues in couples where one partner is affected by mild memory impairment (MMI) or mild cognitive impairment (MCI). The objectives of this study were to (1) identify and contrast issues of intimacy and sexuality that spousal caregivers of persons with MMI and dementia may experience, and (2) identify future lines of research in this population. METHODS: Fourteen dementia and nine MMI spousal caregivers participated in focus groups conducted between 2008 and 2009 at the Stanford/VA Alzheimer's Research Center. Content analyses were conducted to identify themes. RESULTS: Five themes emerged: communication, marital cohesion, affectional expression, caregiver burden, and ambiguity concerning the future of the relationship. Dementia caregivers reported more difficulties with communication, cohesion, and perceptions of increased burden than their MMI counterparts. Both groups indicated reduced sexual expression due to physical limitations; substitute activities including hand-holding, massaging, and hugging were noted. Both groups reported difficulty anticipating the future of the relationship due to present stressors. While dementia caregivers could consider future romantic relationships with others, MMI caregivers were primarily able to consider future relationships only for companionship and emotional intimacy. CONCLUSION: Early therapeutic interventions may assist couples in modifying activities, behaviors, and expectations about the future of the relationship. Such modifications may help maintain relationship satisfaction, decrease burden, preserve quality of life, and delay time-to-placement. Extending time-to-placement could have cost savings implications for families and the healthcare system.

Stuck in the Present? Constraints on Children's Episodic Prospection.

The examination of children's ability to simulate their future has gained increased attention, and recent discoveries highlight limitations in this ability that extend into adolescence. We propose an account for this protracted developmental trajectory, which encompasses consideration of retrieval flexibility across timescales and self-knowledge. We also identify avenues for future research.

Space and time in episodic memory: Effects of linearity and directionality on memory for spatial location and temporal order in children and adults.

Episodic memory is a critical capacity that involves remembering past events along with their spatial and temporal contexts. Relatively little is known about the relations between spatial and temporal information in long-term memory in children or adults. The present research examined the influence of the mental timeline (linear horizontal display extending from the left to right direction for English speakers) on memory for events and their spatial and temporal features in 7-year-olds, 9-year-olds, 11-year-olds and young adults (N = 146). During encoding, participants studied triplets of objects, varying on two dimensions of the mental timeline: linearity (whether objects were presented in linear succession or not) and direction (whether objects were presented from left-to-right or right-to-left). After a delay, during retrieval, participants were tested on their memory for individual objects, and either the spatial location or temporal order of the objects. We found that overall accuracy for spatial location was higher than accuracy for temporal order, and there was a parallel developmental trajectory for both these aspects of memory. Across age groups we found that memory for temporal order, but not spatial location, was influenced by linearity and direction (i.e., match to mental timeline). Thus, in both children and adults the spatiotemporal mental timeline supported memory for temporal order, converging with predictions generated within domains of language and thought and enhancing our understanding of how space and time are represented in the mind.

Development and implementation of a comprehensive strategic plan for medical education at an academic medical center.

Despite their vital contributions to the training of future physicians, many academic teaching hospitals have grown operationally and financially distinct from affiliated medical schools because of divergent missions, contributing to the erosion of clinical training. Some institutions have responded by building hybrid organizations; others by creating large health care networks with variable relationships with the affiliated medical school. In this case, the authors wished to establish the future educational mission of their medical center as a core element of the institution by creating data-driven recommendations for reorganization, programs, and financing. They conducted a self-study of all constituents, the results of which confirmed the importance of education at their institution but also revealed the insufficiency of incentives for teaching. They underwent an external review by a committee of prominent educators, and they involved administrators at the hospital and the medical school. Together, these inputs composed an informed assessment of medical education at their teaching hospital, from which they developed and actualized an institution-wide strategic plan for education. Over the course of three years, they centralized the administrative structure for education, implemented programs that cross departments and reinforce the UME-GME continuum, and created transparency in the financing of medical education. The plan was purposefully aligned with the clinical and research strategic plans by supporting patient safety in programs and the professional development of faculty. The application of a rigorous strategic planning process to medical education at an academic teaching hospital can focus the mission, invigorate faculty, and lead to innovative programs.