Actions chains and intention understanding in 3- to 6-year-old children.

In intentional behavior, the final goal of an action is crucial in determining the entire sequence of motor acts. Neurons have been described in the inferior parietal lobule of monkeys, which besides encoding a specific motor act (e.g., grasping), have their discharge modulated by the final goal of the intended action (e.g., grasping-to-eat). Many of these "action-constrained" neurons have mirror properties responding to the observation of the motor act they encode, provided that this is embedded in a specific action. Thanks to this mechanism, the observers have an internal copy of the whole action before its execution and may, in this way, understand the agent's intention. The chained organization of motor acts has been demonstrated in schoolchildren. Here, we examined whether this organization is already present in very young children. To this purpose, we recorded EMG from the mylohyoid (MH) muscle in the children aged 3 to 6 y. The results showed that preschoolers, like older children, possess the chained organization of motor acts in execution. Interestingly, in comparison to older children, they have a delayed ability to use this mechanism to infer others' intentions by observation. Finally, we found a significant negative association between the children's age and the activation of the MH muscle during the grasp-to-eat phase in the observation condition. We, tentatively, interpreted it as a sign of an immature control of motor acts.

The debate over understanding in AI's large language models.

We survey a current, heated debate in the artificial intelligence (AI) research community on whether large pretrained language models can be said to understand language-and the physical and social situations language encodes-in any humanlike sense. We describe arguments that have been made for and against such understanding and key questions for the broader sciences of intelligence that have arisen in light of these arguments. We contend that an extended science of intelligence can be developed that will provide insight into distinct modes of understanding, their strengths and limitations, and the challenge of integrating diverse forms of cognition.

Human-like scene interpretation by a guided counterstream processing.

In modeling vision, there has been a remarkable progress in recognizing a range of scene components, but the problem of analyzing full scenes, an ultimate goal of visual perception, is still largely open. To deal with complete scenes, recent work focused on the training of models for extracting the full graph-like structure of a scene. In contrast with scene graphs, humans' scene perception focuses on selected structures in the scene, starting with a limited interpretation and evolving sequentially in a goal-directed manner [G. L. Malcolm, I. I. A. Groen, C. I. Baker, Trends. Cogn. Sci. 20, 843-856 (2016)]. Guidance is crucial throughout scene interpretation since the extraction of full scene representation is often infeasible. Here, we present a model that performs human-like guided scene interpretation, using an iterative bottom-up, top-down processing, in a "counterstream" structure motivated by cortical circuitry. The process proceeds by the sequential application of top-down instructions that guide the interpretation process. The results show how scene structures of interest to the viewer are extracted by an automatically selected sequence of top-down instructions. The model shows two further benefits. One is an inherent capability to deal well with the problem of combinatorial generalization-generalizing broadly to unseen scene configurations, which is limited in current network models [B. Lake, M. Baroni, 35th International Conference on Machine Learning, ICML 2018 (2018)]. The second is the ability to combine visual with nonvisual information at each cycle of the interpretation process, which is a key aspect for modeling human perception as well as advancing AI vision systems.

Widespread use of National Academies consensus reports by the American public.

In seeking to understand how to protect the public information sphere from corruption, researchers understandably focus on dysfunction. However, parts of the public information ecosystem function very well, and understanding this as well will help in protecting and developing existing strengths. Here, we address this gap, focusing on public engagement with high-quality science-based information, consensus reports of the National Academies of Science, Engineering, and Medicine (NASEM). Attending to public use is important to justify public investment in producing and making freely available high-quality, scientifically based reports. We deploy Bidirectional Encoder Representations from Transformers (BERT), a high-performing, supervised machine learning model, to classify 1.6 million comments left by US downloaders of National Academies reports responding to a prompt asking how they intended to use the report. The results provide detailed, nationwide evidence of how the public uses open access scientifically based information. We find half of reported use to be academic-research, teaching, or studying. The other half reveals adults across the country seeking the highest-quality information to improve how they do their job, to help family members, to satisfy their curiosity, and to learn. Our results establish the existence of demand for high-quality information by the public and that such knowledge is widely deployed to improve provision of services. Knowing the importance of such information, policy makers can be encouraged to protect it.

Predicting and coding sound into action translation in spinal cord injured people.

Motor activation in response to perception of action-related stimuli may depend on a resonance mechanism subserving action understanding. The extent to which this mechanism is innate or learned from sensorimotor experience is still unclear. Here, we recorded EEG while people with paraplegia or tetraplegia consequent to spinal cord injury (SCI) and healthy control participants were presented with action sounds produced by body parts (mouth, hands or feet) that were or were not affected by SCI. Non-action sounds were used as further control. We observed reduced brain activation in subjects affected by SCI at both pre- and post-stimulus latencies specifically for those actions whose effector was disconnected by the spinal lesion (i.e., hand sound for tetraplegia and leg sound for both paraplegia and tetraplegia). Correlation analyses showed that these modulations were functionally linked with the chronicity of the lesion, indicating that the longer the time the lesion- EEG data acquisition interval and/or the more the lesion occurred at a young age, the weaker was the cortical activity in response to these action sounds. Tellingly, source estimations confirmed that these modulations originated from a deficit in the motor resonance mechanism, by showing diminished activity in premotor (during prediction and perception) and near the primary motor (during perception) areas. Such dissociation along the cortical hierarchy is consistent with both previous reports in healthy subjects and with hierarchical predictive coding accounts. Overall, these data expand on the notion that sensorimotor experience maintains the cortical representations relevant to anticipate and perceive action-related stimuli.

What do women undergoing in vitro fertilization (IVF) understand about their chance of IVF success?

STUDY QUESTION: How well informed are Australian women who undergo IVF about their chances of having a baby? SUMMARY ANSWER: Only one in four women estimated their individual chance of success with IVF accurately, with most women overestimating their chance. WHAT IS KNOWN ALREADY: Limited knowledge about infertility and infertility treatment in the general population is well-documented. The few studies that have investigated patients' knowledge about the chance of IVF success suggest that while IVF patients are aware of average success rates, they tend to be unrealistic about their own chance of success. STUDY DESIGN, SIZE, DURATION: We conducted an anonymous online survey of 217 women who had started IVF since 2018 in Australia. The survey was advertised on social media, enabling women from across Australia to participate. Responses were collected in June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: The survey included questions on demographic characteristics and IVF history. It asked what participants thought their chance of having a baby from one IVF treatment cycle was, how they rated their knowledge about chance of success, and about their experience of receiving IVF-related information. Participants' estimations of their chance of success were compared with their chance as calculated by the Society for Assisted Reproductive Technology's (SART) online calculator. Responses to a free-text question about what information women wished they had been given when they started treatment were analysed thematically. MAIN RESULTS AND THE ROLE OF CHANCE: Only about a quarter (58/217, 27%) of participants accurately estimated their chance of having a baby within 20% relative to their SART calculated chance, with more than half (118/217, 54%) overestimating their chance. Ninety percent of women indicated that their preferred source of treatment information was a consultation with their doctor, despite less than half (44%) reporting that doctors explained the probability of having a baby with IVF well (mean 5.9/10). In free-text responses, many women also reported that they wished they had been given more realistic information about IVF and their chance of success. LIMITATIONS, REASONS FOR CAUTION: The dissemination method precludes calculation of response rate, and it is not possible to know if participants are representative of all women undergoing IVF. Additionally, we only surveyed women undergoing IVF, while those who decided not to have IVF were not included. Therefore, women who overestimated their chance may have been overrepresented. There is also inherent imprecision in the way understanding of chance of success was estimated. The potential impact of recall bias could neither be quantified nor excluded. It is difficult to determine to what extent women's lack of understanding of what is possible with IVF is due to poor information-provision by clinicians and the clinic, and how much can be explained by optimism bias. WIDER IMPLICATIONS OF THE FINDINGS: The finding of poor understanding of personal chance of success amongst women undergoing IVF in Australia requires further investigation to determine potential reasons for this. The findings can be used by clinics to develop strategies for improvement in the information-provision process to ensure that women can make informed decisions about their fertility treatment. STUDY FUNDING/COMPETING INTEREST(S): This study received no external funding. S.L. is supported by a NHMRC Investigator Grant (APP1195189). R.W. is supported by a NHMRC Investigator Grant (APP2009767). B.W.M. is supported by a NHMRC Investigator Grant (GNT1176437). B.W.M. reports consultancy for Merck and ObsEva and has received research funding and travel funding from Merck. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

Communication, understanding and engagement of patients with pancreatic cancer at time of diagnosis.

BACKGROUND: Objectives: To investigate communication clarity and understanding at the time of pancreatic adenocarcinoma (PDAC) diagnosis and whether they can influence patient engagement and compliance. METHODS: Consecutive PDAC patients were enrolled at the time of diagnosis after obtaining informed consent in a single-center study. The patients completed a validated scale (PHE-s®), and the understanding rate was assessed using standardized tools. Patient compliance was evaluated, and the correlation between the PHE-s®, understanding, and compliance was calculated. RESULTS: Thirty patients were enrolled (15 female) with a mean age 64.4, 13 were metastatic. The mean visit time was 31 min, being longer if visiting doctor was an oncologist (p = 0.002). The engagement level was high in 70% of the patients, and all but one were compliant. The analysis of doctor-patient interactions showed a median of 121 conversational turns for doctors, 75 for patients, and 20 for caregivers (p < 0.0001), and the median percentage of speaking time was 77% for doctors, 13% for patients, and 2% for caregivers (p < 0.0001). Female caregivers spent more time speaking than did male caregivers (median 11.6% vs. 1.3%; p = 0.06). There were 290 instances of problematic understanding, most of which occurred during the taking of patients' personal medical history for doctors, while for patients and caregivers, these occurred mainly during the discussion of diagnosis/treatment (p < 0.0001). In a multivariable analysis, only origin from central or southern Italy was associated with high engagement (p = 0.0087). CONCLUSION: In this first attempt to measure clarity of communication and engagement in patients with PDAC, typical features of conversation and problematic understanding emerged, which deserves further investigation.

Insights into the current state of knowledge, practice, and attitudes of physicians regarding gastrointestinal motility disorders in Egypt.

BACKGROUND: Gastrointestinal (GI) motility disorders are common in clinical settings, but physicians still lack sufficient understanding and effective management of these conditions. METHODS: This research assessed Egyptian physicians' knowledge, practices, and attitudes towards GI motility disorders. A cross-sectional survey employing a self-administered questionnaire was carried out among physicians in Egypt. The questionnaire addressed various aspects of physicians' understanding, practices, and attitudes regarding GI motility disorders. Data analysis was conducted using descriptive statistics and presented as frequencies and percentages. RESULTS: A total of 462 physicians took part in the study. Although nearly two-thirds of them knew about GI motility studies, a notable proportion lacked adequate knowledge about GI motility disorders. Notably, 84.2% correctly identified dysphagia as a critical symptom suggestive of an upper GI motility disorder. However, 13.4% incorrectly linked hematemesis with an upper GI motility disorder, and 16.7% expressed uncertainty. In terms of practice, around half of the participants encountered a small number of patients with GI motility disorders (less than 5 per week or even fewer). Only 29.7% felt confident in managing patients with motility disorders. Most participating physicians expressed a willingness to participate in training programs focused on motility disorders. CONCLUSIONS: This study underscores a knowledge gap among Egyptian physicians concerning GI motility disorders. It suggests the necessity of tailored education and training programs to improve their competency and practice in this domain.

What is in an action? Preschool children predict that agents take previous paths and not previous goals.

Developmental science has experienced a vivid debate on whether young children prioritize goals over means in their prediction of others' actions. Influential developmental theories highlight the role of goal objects for action understanding. Yet, recent infant studies report evidence for the opposite. The empirical evidence is therefore inconclusive. The current study advanced this debate by assessing preschool children's verbal predictions of others' actions. In five experiments (N = 302), we investigated whether preschool children and adults predict agents to move towards their previous goal (that is, show goal-related predictions) or predict agents to move along the same movement path that they pursued before. While Experiments 1a, 1b and 1c presented young children and adults with animated agents, Experiments 2a and 2b presented participants with human grasping action. An integrative analysis across experiments revealed that children were more likely to predict the agent to move along the same movement path, Z = -4.574, p ≤ 0.0001 (r = 0.304). That is, preschool children were more likely to predict that agents would move along the same trajectory even though this action would lead to a new goal object. Thus, our findings suggest that young children's action prediction relies on the detection of spatial and movement information. Overall, we discuss our findings in terms of theoretical frameworks that conceive of action understanding as an umbrella term that comprises different forms and facets in which humans understand others' actions. RESEARCH HIGHLIGHTS: We investigated whether preschool children predict agents to move towards their previous goal or to move along the same movement path that they pursued before. Unlike adults, preschool children predicted that agents would move along the same trajectory even though this action would lead to a new goal. Adults' goal-based predictions were affected from contextual details, whereas children systematically made path-based predictions. Young children's action prediction relies on the detection of spatial and movement information.

Infants rationally infer the goals of other people's reaches in the absence of first-person experience with reaching actions.

Does knowledge of other people's minds grow from concrete experience to abstract concepts? Cognitive scientists have hypothesized that infants' first-person experience, acting on their own goals, leads them to understand others' actions and goals. Indeed, classic developmental research suggests that before infants reach for objects, they do not see others' reaches as goal-directed. In five experiments (N = 117), we test an alternative hypothesis: Young infants view reaching as undertaken for a purpose but are open-minded about the specific goals that reaching actions are aimed to achieve. We first show that 3-month-old infants, who cannot reach for objects, lack the expectation that observed acts of reaching will be directed to objects rather than to places. Infants at the same age learned rapidly, however, that a specific agent's reaching action was directed either to an object or to a place, after seeing the agent reach for the same object regardless of where it was, or to the same place regardless of what was there. In a further experiment, 3-month-old infants did not demonstrate such inferences when they observed an actor engaging in passive movements. Thus, before infants have learned to reach and manipulate objects themselves, they infer that reaching actions are goal-directed, and they are open to learning that the goal of an action is either an object or a place. RESEARCH HIGHLIGHTS: In the present experiments, 3-month-old prereaching infants learned to attribute either object goals or place goals to other people's reaching actions. Prereaching infants view agents' actions as goal-directed, but do not expect these acts to be directed to specific objects, rather than to specific places. Prereaching infants are open-minded about the specific goal states that reaching actions aim to achieve.

Three-stage Dynamic Brain-cognitive Model of Understanding Action Intention Displayed by Human Body Movements.

The ability to comprehend the intention conveyed through human body movements is crucial for effective interpersonal interactions. If people can't understand the intention behind other individuals' isolated or interactive actions, their actions will become meaningless. Psychologists have investigated the cognitive processes and neural representations involved in understanding action intention, yet a cohesive theoretical explanation remains elusive. Hence, we mainly review existing literature related to neural correlates of action intention, and primarily propose a putative Three-stage Dynamic Brain-cognitive Model of understanding action intention, which involves body perception, action identification and intention understanding. Specifically, at the first stage, body parts/shapes are processed by those brain regions such as extrastriate and fusiform body areas; During the second stage, differentiating observed actions relies on configuring relationships between body parts, facilitated by the activation of the Mirror Neuron System; The last stage involves identifying various intention categories, utilizing the Mentalizing System for recruitment, and different activation patterns concerning the nature of the intentions participants dealing with. Finally, we delves into the clinical practice, like intervention training based on a theoretical model for individuals with autism spectrum disorders who encounter difficulties in interpersonal communication.

Speech Comprehension by Cochlear Implant Users Assessed with Evoked Potentials and Response Times.

INTRODUCTION: Cochlear implant (CI) users differ greatly in their rehabilitation outcomes, including speech understanding in noise. This variability may be related to brain changes associated with intact senses recruiting cortical areas from stimulation-deprived senses. Numerous studies have demonstrated such cross-modal reorganization in individuals with untreated hearing loss. How it is affected by regular use of hearing devices remains unclear, however. To shed light on this, the current study measured cortical responses reflecting comprehension abilities in experienced CI users and normal-hearing controls. METHODS: Using multichannel electroencephalography, we tested CI users who had used their devices for at least 12 months and closely matched controls (N = 2 × 13). Cortical responses reflecting comprehension abilities - the N400 and late positive complex (LPC) components - were evoked using congruent and incongruent digit-triplet stimuli. The participants' task was to assess digit-triplet congruency by means of timed button presses. All measurements were performed in speech-shaped noise 15 dB above individually measured speech recognition thresholds. Three stimulus presentation modes were used: auditory-only, visual-only, and visual-then-auditory. RESULTS: The analyses revealed no group differences in the N400 and LPC responses. In terms of response times, the CI users were slower and differentially affected by the three stimulus presentation modes relative to the controls. CONCLUSION: Compared to normal-hearing controls, experienced CI users may need more time to comprehend speech in noise. Response times can serve as a proxy for speech comprehension by CI users.

Task relevance alters the effect of emotion on congruency judgments during action understanding.

The congruency judgments in action understanding helps individuals make timely adjustments to unexpected occurrence, and this process may be influenced by emotion. Previous research has showed contradictory effect of emotion on conflict processing, possibly due to the degree of relevance between emotion and task. However, to date, no study has systematically manipulated the relevance to explore how emotion affects congruency judgments in action understanding. We employed a cue-target paradigm and controlled the way emotional stimuli were presented on the target interface, setting up three experiments: emotion served as task-irrelevant distractor, task-irrelevant target and task-relevant target. The results showed that when emotion was irrelevant to the task, it impaired congruency judgements performance, regardless of a distractor or a target, while task-relevant emotion facilitated this process. These findings indicate that the impact of emotion on congruency judgements during action understanding depends on the degree of emotion-task relevance.

Eating problems in people with dementia with Lewy bodies: Associations with various symptoms and the physician's understanding.

OBJECTIVES: Eating problems frequently occur in people with dementia with Lewy bodies (DLB), but few studies have investigated the clinical background of this phenomenon. This study examined the relationship between eating problems and various symptoms of DLB and the relation between the treatment needs for DLB people with eating problems and the understanding of their eating problems by caregivers and physicians. DESIGN, MEASUREMENTS, AND PARTICIPANTS: This was a subanalysis of a cross-sectional, questionnaire-based survey study. Two hundred sixty-one subjects with DLB were divided into subjects with or without eating problems. Logistic or linear regression analysis was used to investigate the factors influencing eating problems. The treatment needs of DLB people for their eating problems and the understanding of these needs by caregivers and physicians were calculated as participant-caregiver and participant-physician kappa coefficient. RESULTS: Of the 261 participants, 27% suffered from eating problems. The presence of eating problems in participants with DLB was related to depression (p = 0.01, OR : 2.19, 95% CI: 1.23-3.91) and apathy (p = 0.01, OR 2.15, 95% CI: 1.20-3.87), while the worsening of eating problems was related to dysphagia (ß = 0.24, p = 0.03), apathy (ß = 0.23, p = 0.05), and nighttime behavior (ß = 0.24, p = 0.04). The participant-physician kappa coefficient for physician understanding of constipation, weight loss, dysphagia, weight gain, and increase in appetite was significantly lower than the corresponding participant-caregiver kappa coefficient (p-value of five symptoms < 0.01). CONCLUSIONS: Physicians need to pay more attention to eating problems and their neuropsychiatric background in the long-term support and management of DLB subjects.

Continuity in false belief understanding from 33 to 52 months of age.

Conceptual continuity in children's false belief understanding from toddlerhood to childhood was investigated in a longitudinal study of 75 children. Performance in a low-demands false belief task at 33 months of age was significantly correlated with performance in a content false belief task at 52 months independent of language ability and executive function. In contrast, there was no correlation with performance in a location false belief task, which differed from the "Sally-Anne" format of the low-demands task and was high in executive demands. These findings support the view that explicit false belief understanding may be continuous from toddlerhood to childhood and that developmental change may be characterized in terms of enrichment and increasing stability of core conceptual understanding rather than in terms of fundamental change.

Investigating belief understanding in children in a nonverbal ambiguous displacement and communication setting.

Finding ways to investigate false belief understanding nonverbally is not just important for preverbal children but also is the only way to assess theory of mind (ToM)-like abilities in nonhuman animals. In this preregistered study, we adapted the design from a previous study on pet dogs to investigate false belief understanding in children and to compare it with belief understanding of those previously tested dogs. A total of 32 preschool children (aged 5-6 years) saw the displacement of a reward and obtained nonverbal cueing of the empty container from an adult communicator holding either a true or false belief. In the false belief condition, when the communicator did not know the location of the reward, children picked the baited container, but not the cued container, more often than the empty one. In the true belief condition, when the communicator witnessed the displacement yet still cued the wrong container, children performed randomly. The children's behavior pattern was at odds with that of the dogs tested in a previous study, which picked the cued container more often when the human communicator held a false belief. In addition to species comparisons, because our task does not require verbal responses or relational sentence understanding, it can also be used in preverbal children. The children in our study behaved in line with the existing ToM literature, whereas most (but not all) dogs from the previously collected sample, although sensitive to differences between the belief conditions, deviated from the children. This difference suggests that using closely matched paradigms and experimental procedures can reveal decisive differences in belief processing between species. It also demonstrates the need for a more comprehensive exploration and direct comparison of the various aspects of false belief processing and ToM in different species to understand the evolution of social cognition.

Children's estimates of equivalent rational number magnitudes are not equal: Evidence from fractions, decimals, percentages, and whole numbers.

Integration of rational number knowledge with prior whole number knowledge has been theorized as critical for mathematical success. Fractions, decimals, and percentages are generally assumed to differ in difficulty based on the degree to which their structure is perceptually similar to whole numbers. Specifically, percentages are viewed as most similar to whole numbers with their fixed unstated denominator of 100. Decimals are often assumed to be easier than fractions because their place-value structure is an extension of the base-ten system for whole numbers, unlike fractions, which have a bipartite structure (i.e., a/b). However, there has been no comprehensive investigation of how fraction, decimal, and percentage knowledge compares with whole number knowledge. To assess understanding of the four notations, we measured within-participants number line estimation of equivalent fractions and decimals with shorter string lengths (e.g., 8/10 and 0.8) and longer string lengths (e.g., 80/100 and 0.80), percentages (e.g., 80%), and proportionally equivalent whole numbers on a 0-100 scale (e.g., 80.0). Middle school students (N = 65; 33 female) generally underestimated all formats relative to their actual values (whole numbers: 3% below; percentages: 2%; decimals: 17%; fractions: 5%). Shorter string-length decimals and fractions were estimated as smaller than equivalent longer string-length equivalents. Overall, percentages were estimated similarly to corresponding whole numbers, fractions had modest string-length effects, and decimals were the most underestimated, especially for single-digit decimals. These results highlight the strengths and weaknesses of children's understanding of each notation's magnitudes and challenge the assumption that decimals are easier than fractions.

Understanding of the functions of forgiveness among preschoolers.

Forgiveness plays an important role in restoring and maintaining cooperative relationships. Previous studies have demonstrated that young children could forgive transgressors both as a third party and as a victim. However, the research on young children's understanding of forgiveness is scant. This study focused on the two main functions of forgiveness-the restoration of a damaged relationship between the victim and the transgressor and the positive emotional change in the victim toward the transgressor. In this study, 48 4-year-olds (25 girls), 50 5-year-olds (21 girls), and 50 6-year-olds (21 girls) in Japan heard stories in which a victim either did or did not forgive a transgressor. They answered questions about the relationship between the victim and the transgressor and the victim's feelings toward the transgressor. Regarding the restoration of a damaged relationship, 4- to 6-year-olds understood that the restoration could occur in the presence of forgiveness. Yet, 6-year-olds showed more distinctive belief than 4- and 5-year-olds that the damaged relationship remains unrestored without forgiveness from the victim. For emotional changes, 6-year-olds understood that the forgiving victim would experience positive emotional changes, whereas the unforgiving victim would not. However, 4- and 5-year-olds expected positive emotional changes even without forgiveness, although they anticipated greater changes after forgiveness. The results show that the understanding of the important functions of forgiveness is present at 4 years of age and matures by 6 years of age. Children may develop a sophisticated understanding of the functions of forgiveness later than the actual forgiving behavior.

Building integrated number sense in adults and children: Comparing fractions-only training with cross-notation number line training.

Mounting evidence points to the predictive power of cross-notation rational number understanding (e.g., 2/5 vs. 0.25) relative to within-notation understanding (e.g., 2/5 vs. 1/4) in predicting math outcomes. Although correlational in nature, these studies suggest that number sense training emphasizing integrating across notations may have more positive outcomes than a within-notation focus. However, this idea has not been empirically tested. Thus, across two studies with undergraduate students (N = 183 and N = 181), we investigated the effects of a number line training program using a cross-notation approach (one that focused on connections among fractions, decimals, and percentages) and a within-notation approach (one that focused on fraction magnitude representation only). Both number line approaches produced positive effects, but those of the cross-notation approach were larger for fraction magnitude estimation and cross-notation comparison accuracy. In a third study (N = 63), we adapted the cross-notation number line training for use in place of typical classroom warm-up activities for middle school students. Similar to the results with undergraduate students, the cross-notation training program yielded positive benefits for middle school students over a typical warm-up activity (fraction arithmetic practice). Together, these results suggest the importance of an integrated approach to teaching rational number notations, an approach that appears to be uncommon in current curricula.

Identifying Facilitators and Inhibitors of Shared Understanding: An Ethnography of Diagnosis Communication in Acute Medical Settings.

BACKGROUND AND AIMS: Communication is important in determining how patients understand the diagnostic process. Empirical studies involving direct observation of communication within diagnostic processes are relatively limited. This ethnographic study aimed to identify communicative practices facilitating or inhibiting shared understanding between patients and doctors in UK acute secondary care settings. METHODS: Data were collected in acute medical sectors of three English hospitals. Researchers observed doctors as they assessed patients; semistructured interviews were undertaken with doctors and patients directly afterwards. Patients were also interviewed 2-4 weeks later. Case studies of individual encounters (consisting of these interviews and observational notes) were created, and were cross-examined by an interdisciplinary team to identify divergence and convergence between doctors' and patients' narratives. These data were analysed thematically. RESULTS: We conducted 228 h of observation, 24 doctor interviews, 32 patient interviews and 15 patient follow-up interviews. Doctors varied in their communication. Patient diagnostic understanding was sometimes misaligned with that of their doctors; interviews revealed that they often made incorrect assumptions to make sense of the fragmented information received. Thematic analysis identified communicative practices that seemed to facilitate, or inhibit, shared diagnostic understanding between patient and doctor, revealing three themes: (1) communicating what has been understood from the medical record, (2) sharing the thought process and diagnostic reasoning and (3) closing the loop and discharge communication. Shared understanding was best fostered by clear communication about the diagnostic process, what had already been done and what was achievable in acute settings. Written information presents an underutilised tool in such communication. CONCLUSIONS: In UK acute secondary settings, the provision of more information about the diagnostic process often fostered shared understanding between doctor and patient, helping to minimise the confusion and dissatisfaction that can result from misaligned expectations or conclusions about the diagnosis, and the uncertainty therein. PATIENT/PUBLIC CONTRIBUTION: A patient and public involvement group (of a range of ages and backgrounds) was consulted. They contributed to the design of the protocol, including the timing of interviews, the acceptability of a follow-up telephone interview, the development of the interview guides and the participant information sheets.