A Comparison of Test-Retest Reliability and Practice Effects of Short Portable Mental State Questionnaire and Montreal Cognitive Assessment in Patients with Stroke.

OBJECTIVE: To compare the test-retest reliabilities and minimal detectable change (MDC) of the Short Portable Mental State Questionnaire (SPMSQ) and the Montreal Cognitive Assessment (MoCA) in patients with stroke. METHODS: 63 patients were recruited from 1 medical center. The SPMSQ and MoCA were administered twice, 2 weeks apart. RESULTS: Both measures showed high intraclass correlation coefficients (SPMSQ: 0.87; MoCA: 0.89) and acceptable MDC%s (SPMSQ: 14.8%; MoCA: 19.6%). A small correlation (r = 0.30) was found between the absolute difference and average in each pair of assessments in the SPMSQ, which was close to the criterion of heteroscedasticity. A small practice effect was observed in the MoCA (Cohen's d = 0.30). CONCLUSION: The SPMSQ demonstrated smaller random measurement error and an absence of practice effect. When comparing the psychometric properties of the SPMSQ and MoCA as outcome measures for assessing cognitive function in patients with stroke, the SPMSQ appears to be a more suitable choice than the MoCA.

Practice-induced SNARC: evidence from a null-SNARC sample.

The mental representation of numbers inherently involves a spatial organization, often positioning smaller numbers to the left and larger numbers to the right. The SNARC effect, characterized by faster responses to small numbers using the left hand and vice versa for large numbers, is typically attributed to this left-to-right oriented mental number line (MNL). However, the direction of the SNARC effect seems to rely on reading direction, with most research exploring these mechanisms conducted within left-to-right reading cultures where the SNARC effect is prevalent. This study takes advantage of a sample from a left-to-right reading culture that does not exhibit the SNARC effect, allowing us to isolate and elucidate the stand-alone effects of recent experiences on SNARC. Therefore, the current study aims to investigate how MNL-compatible and MNL-incompatible practices induce an effect within a sample lacking the SNARC effect. To accomplish this, we reinvited the individuals from the sample which had previously shown no SNARC, and retested those who agreed to take part in the current study after an MNL-compatible or MNL-incompatible practice manipulation. The findings revealed an absence of the SNARC effect with MNL-compatible practices. Conversely, MNL-incompatible practices yielded a reverse SNARC effect. These results prompt a discussion on SNARC mechanisms within the framework of practice effects.

Acute Effects of Post-activation Performance Enhancement Exercises on Army Combat Fitness Test Performance in Male ROTC Cadets.

The purpose of this study was to evaluate the effectiveness of implementing task-specific, post-activation performance enhancement (PAPE) strategies, to acutely improve Army Combat Fitness Test (ACFT) performance. Nineteen ROTC cadets completed two ACFTs, separated by 72 hours. Approximately half (n = 10) completed the traditional "Preparation Drill" as their warm-up prior to the first session and added PAPE warm-up strategies as part of their second session. The other group (n = 9) completed the treatments in the opposite order to facilitate a repeated-measures, crossover design. The participants' composite ACFT score was used as the primary outcome measure of interest to explore mean difference in a two-way (Time x Treatment), repeated measures ANOVA. There was no interaction [F(1,8) = 0.075, p = 0.79] nor main effect of treatment [F(1,8) = 0.084, p = 0.78]. However, there was a main effect of Time [F(1,8) = 58.87, p < 0.001, d = 0.25] (mean ACFT score ± SD: Session 1 = 527 ± 43, Session 2 = 537 ± 39). The results of this study did not support the use of additional PAPE strategies to improve ACFT performance. However, there was a practice effect when the test was completed twice, separated by 72 hours in those with ACFT experience. The effect of Time was present for ACFT cumulative score, as well as event-level differences in three out of six events. Further research should implement familiarization sessions to minimize a practice effect from influencing results.

Adherence to the MIND diet and the odds of mild cognitive impairment in generally healthy older adults: The 3-year DO-HEALTH study.

BACKGROUND: The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet may slow cognitive decline in older adults. A potential mechanism could be possible anti-inflammatory properties of the MIND-diet. OBJECTIVE: To examine whether adherence to the MIND diet at baseline is associated with the odds of mild cognitive impairment (MCI) and changes in biomarkers of inflammation (High-sensitivity C-reactive Protein(hsCRP), interleukin-6(IL-6)) over three years in adults ≥70 years. METHODS: Adherence to the MIND diet was assessed by food frequency questionnaire (FFQ) at baseline and after three years. Presence of MCI based on the Montreal Cognitive Assessment (MoCA) was defined as <26 (MCI26), or <24 (MCI24). We performed a minimally adjusted model controlling for sex, prior fall, linear spline at age 85, time, treatment and study site. The fully adjusted model also adjusted for education, BMI, physical activity, depression score, daily energy intake, and comorbidity score. To assess the change in inflammatory markers from baseline, we used linear-mixed-effect models adjusted for the same variables plus the respective baseline concentrations. Sensitivity analyses accounting for practice effects of repeated cognitive tests using the reliable change index for both MoCA cut-offs were done. RESULTS: We included 2028 of 2157 DO-HEALTH participants (60.5% women; mean age 74.88 years) with complete data. Adherence to the MIND diet at baseline was not associated with cognitive decline over three years, neither at MoCA < 26 (OR (95%CI) = 0.99 (0.94-1.04)) nor at MoCA < 24 (OR (95%CI) = 1.03 (0.96-1.1)). Applying the reliable change index to the two cut-offs confirmed the findings. Further, the MIND diet adherence was not associated with the change in MoCA score from baseline in DO-HEALTH. For inflammatory biomarkers MIND-diet baseline adherence was not associated with changes in hsCRP or IL-6. CONCLUSION: Adherence to the MIND-diet was neither associated with the odds of MCI, nor with hsCRP or IL-6 at baseline. Moreover, change in MIND-diet over three years was not associated with changes in hsCRP or IL-6.

Mid-term changes in cognitive functions in patients with atrial fibrillation: a longitudinal analysis of the Swiss-AF cohort.

Background: Longitudinal association studies of atrial fibrillation (AF) and cognitive functions have shown an unclear role of AF-type and often differ in methodological aspects. We therefore aim to investigate longitudinal changes in cognitive functions in association with AF-type (non-paroxysmal vs. paroxysmal) and comorbidities in the Swiss-AF cohort. Methods: Seven cognitive measures were administered up to five times between 2014 and 2022. Age-education standardized scores were calculated and association between longitudinal change in scores and baseline AF-type investigated using linear mixed-effects models. Associations between AF-type and time to cognitive drop, an observed score of at least one standard deviation below individual's age-education standardized cognitive scores at baseline, were studied using Cox proportional hazard models of each cognitive test, censoring patients at their last measurement. Models were adjusted for baseline covariates. Results: 2,415 AF patients (mean age 73.2 years; 1,080 paroxysmal, 1,335 non-paroxysmal AF) participated in this Swiss multicenter prospective cohort study. Mean cognitive scores increased longitudinally (median follow-up 3.97 years). Non-paroxysmal AF patients showed smaller longitudinal increases in Digit Symbol Substitution Test (DSST), Cognitive Construct Score (CoCo)and Trail Making Test part B (TMT-B) scores vs. paroxysmal AF patients. Diabetes, history of stroke/TIA and depression were associated with worse performance on all cognitive tests. No differences in time to cognitive drop were observed between AF-types in any cognitive test. Conclusion: This study indicated preserved cognitive functioning in AF patients, best explained by practice effects. Smaller practice effects were found in non-paroxysmal AF patients in the DSST, TMT-B and the CoCo and could indicate a marker of subtle cognitive decline. As diabetes, history of stroke/TIA and depression-but not AF-type-were associated with cognitive drop, more attention should be given to risk factors and underlying mechanisms of AF.

Effects of a 10-week musical instrument training on cognitive function in healthy older adults: implications for desirable tests and period of training.

Introduction: Previous studies have shown that musical instrument training programs of 16 or more weeks improve verbal memory (Logical Memory Test delayed recall), processing speed (Digit Symbol Coding Test), and executive function (Trail Making Test Part B) of musically untrained healthy older adults. However, it is unclear whether shorter-period instrument training can yield similar effects. We sought to (1) verify those results and (2) clarify if intervention effects could be detected using other measures such as reaction time. Methods: Healthy older adults (mean age = 73.28 years) were pseudo-randomly assigned to an untrained control group (n = 30) or an intervention group (n = 30) that received a weekly 10-session musical instrument training program (using melodica). We conducted neuropsychological tests on which intervention effects or association with musical training were reported in previous studies. We newly included two reaction time tasks to assess verbal working memory (Sternberg task) and rhythm entrainment (timing task). Intervention effects were determined using a "group × time" analysis of variance (ANOVA). Results: The intervention effects were detected on the reaction time in Sternberg task and phonological verbal fluency. Although intervention effects had been reported on Logical Memory test, Digit Symbol Coding Test and Trail Making Test in previous studies with longer training periods, the present study did not show such effects. Instead, the test-retest practice effect, indicated by significant improvement in the control group, was significant on these tests. Discussion: The present results indicated the usefulness of working memory assessments (Verbal Fluency Test and Sternberg task) in detecting the effects of short-term melodica training in healthy older adults. The practice effect detected on those three tasks may be due to the shorter interval between pre- and post-intervention assessments and may have obscured intervention effects. Additionally, the findings suggested the requirement for an extended interval between pre- and post-tests to capture rigorous intervention effects, although this should be justified by a manipulation of training period.

The alternate-form reliability study of six variants of the Brief Visual-Spatial Memory Test-Revised and the Hopkins Verbal Learning Test-Revised.

Introduction: The revised Hopkins Verbal Learning Test-Revised (HVLT-R) and the Brief Visual-Spatial Memory Test-Revised (BVMT-R) are two widely used test involving verbal and visual learning and memory. In the two tests, six different versions are assembled, respectively, to prevent learning effects. Currently, no researchers have compared the six versions of the two tests. Thus, their usefulness in clinical studies requiring multiple follow-ups is limited. In this work, we confirm the equivalence of six HVLT-R and BVMT-R versions. Methods: 20 people completed all six HVLT-R and BVMT-R versions, while 120 people were randomly assigned to complete one of the six versions of each test. The Intelligence Quotient (IQ) level is measured using the short version of the Wechsler Adult Intelligence test. R4.2.0 is used for statistical analysis. The K-Related sample test (a non-parametric test) is used to observe the differences in test scores among the 20 subjects. The one-way Analysis of Variance (ANOVA) test is utilized to analyze the differences in test scores among the 120 subjects. The scores on different versions are compared using two similar sample tests. The HVLT-R Total Learning, the HVLT-R Delayed Recall, the BVMT-R Total Learning, and the BVMT-R Delayed Recall are indexes for comparison. Version and test scores are used as research factors, while different versions are used as research levels. Results: The results suggest that HVLT-R and BVMT-R versions 3, 5 and 6 are equally difficult, and relatively easy compared to versions 1, 2 and 4. HVLT-R versions 3, 5, and 6 show good reliability and can be used interchangeably when testing word learning ability or short-term memory; BVMT-R Versions 3, 5, and 6 show acceptable reliability and can be can be used interchangeably. Discussion: In the study of multiple follow-ups, it is a must to avoid discrepant versions and choose other equivalent versions. The results from this study could be used as a guide for upcoming studies and clinical applications in China.

Practice effect and test-retest reliability of the Wechsler Memory Scale-Fourth Edition in people with dementia.

BACKGROUND: The Wechsler Memory Scale-Fourth Edition (WMS-IV) has been widely used to assess memory function in people with dementia. The older adult battery of the WMS-IV includes four indices and seven subtests. The aims of this study were to examine the practice effect and test-retest reliability and calculate the reliable change index modified for practice (RCIp) for the indices and subtests of the older adult battery of the WMS-IV for people with dementia. METHODS: Fifty-six participants completed the WMS-IV twice, two weeks apart. The practice effect was investigated using effect size (Cohen's d) and bootstrapping mixed design analysis of variance while considering the severity of dementia. The test-retest reliability was estimated using intraclass correlation coefficient (ICC). RESULTS: The results showed non-significant practice effects with Cohen's d < 0.20 in different severities of dementia on two indices and five subtests. The ICC values of these indices and subtests were 0.82-0.85 and 0.57-1.00, respectively. The other two indices (i.e., auditory memory and immediate memory) and two subtests (i.e., logical memory delayed recall and visual reproduction immediate recall) demonstrated small to moderate practice effect (d = 0.46-0.74) for people with mild severity of dementia. CONCLUSION: On the whole, the WMS-IV has no to moderate practice effects and moderate to excellent test-retest reliability in people with dementia. The values of the RCIp with 95% confidence interval for the indices and subtests were provided in this study, which are useful to clinicians and researchers for interpreting the real score change in persons with dementia. The two indices (i.e., auditory memory and immediate memory) and two subtests (i.e., logical memory delayed recall and visual reproduction immediate recall) with noticeable practice effect should be used with caution when assessing memory function repeatedly in people with mild severity of dementia.

Retrieval practice may not benefit mathematical word-problem solving.

The retrieval practice effect refers to the fact that one or even multiple retrievals of memory content during the same period are more effective than repeated studying to promote future memory retention. It is effective for numerous declarative knowledge learning materials. However, studies have demonstrated that retrieval practice does not benefit problem-solving skill learning. This study used worked examples from math word problem tasks as learning materials, considering the retrieval difficulty as the main factor. Experiment 1 explored the effect of retrieval practice on acquiring problem-solving skills under different initial testing difficulties. Experiment 2 manipulated the difficulty of materials as a variable to ascertain the effect of retrieval practice on problem-solving skills under different material difficulty levels. Experiment 3 introduced feedback variables to facilitate the generation of the retrieval practice effect and examined the effects of various difficulty feedback levels on problem-solving skills learning. Results showed that, compared with restudying examples (SSSS), the example-problem pairs (STST) did not promote delayed test performance. As for the retrieval practice effect, as no differences or advantages were found in the repeated study group on the immediate test, the retrieval practice group generally outperformed the repeated study group on the delayed test. However, across the three experiments, we found no evidence of retrieval practice affecting results during an enhanced delayed test. Therefore, there may be no retrieval practice effect on acquiring problem-solving skills from worked examples.

The benefit of retrieval practice on cued recall under stress depends on item difficulty.

Retrieval practice, the act of recalling previously studied information, yields greater memory retention than repeated studying (retrieval practice effect). Retrieval practice can also protect memories against the negative effects of stress at retrieval in free recall tests. In cued-recall tests, however, retrieval practice may not provide complete protection against stress-related memory impairments. Here we ask whether these conflicting results may be explained by the relative difficulty of the study materials. Participants (59 men) first studied 40 Swahili-Portuguese word pairs. Half of the pairs were then repeatedly studied while the other half were repeatedly recalled. In each condition, half of the pairs were easy to remember (high in memorability) while the other half were more difficult to remember (low in memorability). Participants returned 1 week later for a final cued-recall test. Half of the participants underwent a stress-induction protocol (modified Socially Evaluated Cold Pressor Test) 25 min before the final test for all 40-word pairs; the other half underwent a control condition. Salivary cortisol and questionnaire responses were used to assess the efficacy of stress induction. Participants recalled more word pairs learned via retrieval practice than via repeated study, replicating previous research. More importantly, the results revealed an interaction such that stress decreased recall for easy items, but increased recall for difficult items that had been successfully retrieved during encoding (conditional analysis). The results suggest that the impact of stress on cued recall depends both on the learning strategy and on the intrinsic difficulty of the to-be-learned materials.

Mayo-PACC: A parsimonious preclinical Alzheimer's disease cognitive composite comprised of public-domain measures to facilitate clinical translation.

INTRODUCTION: We aimed to define a Mayo Preclinical Alzheimer's disease Cognitive Composite (Mayo-PACC) that prioritizes parsimony and use of public domain measures to facilitate clinical translation. METHODS: Cognitively unimpaired participants aged 65 to 85 at baseline with amyloid PET imaging were included, yielding 428 amyloid negative (A-) and 186 amyloid positive (A+) individuals with 7 years mean follow-up. Sensitivity to amyloid-related cognitive decline was examined using slope estimates derived from linear mixed models (difference in annualized change across A+ and A- groups). We compared differences in rates of change between Mayo-PACC and other composites (A+ > A- indicating more significant decline in A+). RESULTS: All composites showed sensitivity to amyloid-related longitudinal cognitive decline (A+ > A- annualized change p < 0.05). Comparisons revealed that Mayo-PACC (AVLT sum of trials 1-5+6+delay, Trails B, animal fluency) showed comparable longitudinal sensitivity to other composites. DISCUSSION: Mayo-PACC performs similarly to other composites and can be directly translated to the clinic.

Practice effects in cognitive assessments three years later in non-carriers but not in symptom-free mutation carriers of autosomal-dominant Alzheimer's disease: Exemplifying procedural learning and memory?

Practice effects (PEs) defined as an improvement of performance in cognition due to repeated assessments between sessions are well known in unimpaired individuals, while less is known about impaired cognition and particularly in latent brain disease as autosomal-dominant Alzheimer's disease. The purpose was to evaluate the general (across tests/domains) and domain-specific PE calculated as the annual rate of change (ARC) in relation to years to the estimated disease onset (YECO) and in four groups of AD: asymptomatic mutation carriers (aAD, n = 19), prodromal, i.e., symptomatic mutation carriers, criteria for AD diagnosis not fulfilled (pAD, n = 4) and mutation carriers diagnosed with AD (dAD, n = 6) as well as mutation non-carriers from the AD families serving as a healthy comparison group (HC, n = 35). Cognition was assessed at baseline and follow-up about 3 years later by 12 tests covering six domains. The aAD and HC groups were comparable at baseline in demographic characteristics (age, gender, and education), when they were in their early forties, while the pAD and dAD groups were older and cognitively impaired. The results on mean ARC for the four groups were significantly different, small, positive, and age-insensitive in the HC group, while ARC was negative and declined with time/disease advancement in AD. The differences between HC and aAD groups in mean ARC and domain-specific ARC were not significant, indicating a subtle PE in aAD in the early preclinical stage of AD. In the symptomatic stages of AD, there was no PE probably due to cognitive disease-related progression. PEs were the largest in the verbal domain in both the HC and aAD groups, indicating a relationship with cognitive vulnerability. The group-related difference in mean ARC was predominant in timekeeping tests. To conclude, the practice effect in over 3 years was suggested to be linked to procedural learning and memory.

Investigating Students' Answering Behaviors in a Computer-Based Mathematics Algebra Test: A Cognitive-Load Perspective.

Computer-based testing is an emerging method to evaluate students' mathematics learning outcomes. However, algebra problems impose a high cognitive load due to requiring multiple calculation steps, which might reduce students' performance in computer-based testing. In order to understand students' cognitive load when answering algebra questions in a computer-based testing environment, three perspectives, element interactivity, practice effect, and individual differences, were investigated in this study. Seven levels of algebra exam questions were created using unary and simultaneous linear equations, and the inverse efficiency scores were employed as a measure of cognitive load in the study. Forty undergraduate and graduate students were tested. There were four findings: (1) As the element interactivity of test materials increased, the cognitive load increased rapidly. (2) The high-efficiency group had a lower cognitive load than the low-efficiency group, suggesting that the high-efficiency group had an advantage in a computer-based testing environment. (3) "Practice" has a considerable effect on reducing cognitive load, particularly in level 6 and 7 test items. (4) The low-efficiency group can reduce but not eliminate the gap with the high-efficiency group; they may require additional experience in a computer-based testing environment in order to improve reducing their cognitive load.

Practice Effect of Repeated Cognitive Tests Among Older Adults: Associations With Brain Amyloid Pathology and Other Influencing Factors.

Background: Practice effects (PE), after repeated cognitive measurements, may mask cognitive decline and represent a challenge in clinical and research settings. However, an attenuated practice effect may indicate the presence of brain pathologies. This study aimed to evaluate practice effects on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) scale, and their associations with brain amyloid status and other factors in a cohort of cognitively unimpaired older adults enrolled in the CHARIOT-PRO SubStudy. Materials and Methods: 502 cognitively unimpaired participants aged 60-85 years were assessed with RBANS in both screening and baseline clinic visits using alternate versions (median time gap of 3.5 months). We tested PE based on differences between test and retest scores in total scale and domain-specific indices. Multiple linear regressions were used to examine factors influencing PE, after adjusting for age, sex, education level, APOE-ε4 carriage and initial RBANS score. The latter and PE were also evaluated as predictors for amyloid positivity status based on defined thresholds, using logistic regression. Results: Participants' total scale, immediate memory and delayed memory indices were significantly higher in the second test than in the initial test (Cohen's dz = 0.48, 0.70 and 0.35, P < 0.001). On the immediate memory index, the PE was significantly lower in the amyloid positive group than the amyloid negative group (P = 0.022). Older participants (≥70 years), women, non-APOE-ε4 carriers, and those with worse initial RBANS test performance had larger PE. No associations were found between brain MRI parameters and PE. In addition, attenuated practice effects in immediate or delayed memory index were independent predictors for amyloid positivity (P < 0.05). Conclusion: Significant practice effects on RBANS total scale and memory indices were identified in cognitively unimpaired older adults. The association with amyloid status suggests that practice effects are not simply a source of measurement error but may be informative with regard to underlying neuropathology.

Is There a Doctors' Effect on Patients' Physical Health, Beyond the Intervention and All Known Factors? A Systematic Review.

Purpose: Despite billions of doctor visits worldwide each year, little is known on whether doctors themselves affect patients' physical health after accounting for intervention and confounders such as patients' and doctors' data, hospital effects, nor how strong that doctors' effect is. Knowledge of surgeons' and psychotherapists' effects exists, but not for 102 other medical specialties notwithstanding the importance of such knowledge. Methods: Eligibility Criteria: Randomized controlled trials (RCTs), case-control, and cohort studies including medical doctors except surgeons for any intervention, reporting the proportion of variance in patients' outcomes owing to the doctors (random effects), or the fixed effects of grading doctors by outcomes, after multivariate adjustment. Exclusions: studies of <15 doctors or solely reporting doctors' effects for known variables. Sources: Medline, Embase, PsycINFO, inception to June 2020. Manual search for papers referring/referred to by resulting studies. Risk of Bias: Using Newcastle-Ottawa scale. Results: Despite all medical interventions bar surgery being eligible, only thirty cohort papers were found, covering 36,239 doctors, with 10 specialties, 21 interventions, 60 outcomes (17 unique). Studies reported doctors' effects by grading doctors from best to worst, or by diversely calculating the doctor-attributed percentage of patients' outcome variation, ie the intra-class correlation coefficient (ICC). Sixteen studies presented fixed effects, 18 random effects, and 3 another approach. No RCTs found. Thirteen studies reported exceptionally good and/or poor performers with confidence intervals wholly outside the average performance. ICC range 0 to 33%, mean 3.9%. Highly diverse reporting, meta-analysis therefore not applicable. Conclusion: Doctors, on their own, can affect patients' physical health for many interventions and outcomes. Effects range from negligible to substantial, even after accounting for all known variables. Many published cohorts may reveal valuable information by reanalyzing their data for doctors' effects. Positive and negative doctor outliers appear regularly. Therefore, it can matter which doctor is chosen.

Is There a Surgeons' Effect on Patients' Physical Health, Beyond the Intervention, That Requires Further Investigation? A Systematic Review.

Objective: To find and review published papers researching surgeons' effects on patients' physical health. Clinical outcomes of surgery patients with similar prognoses cannot be fully explained by surgeon skill or experience. Just as there are "hospital" and "psychotherapist" effects, there may be "surgeons" effects that persist after controlling for known variables like patient health and operation riskiness. Methods: Cohort studies and randomized controlled trials (RCTs) of any surgical intervention, which, after multivariate adjustment, either showed proportion of variance in patients' physical health outcomes due to surgeons (random effects) or graded surgeons from best to worst (fixed effects). Studies with <15 surgeons or only ascribing surgeons' effects to known variables excluded. Medline, PubMed, Embase, and PsycINFO were used for search until June 2020. Manual search for papers referring/referred by resulting studies. Risk of bias assessed by Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Results: Included studies: 52 cohort studies and three RCTs of 52,436+ surgeons covering 102 outcomes (33 unique). Studies either graded surgeons from best to worst or calculated the intra-class correlation coefficient (ICC), the percentage of patients' variation due to surgeons, in diverse ways. Sixteen studies showed exceptionally good and/or bad performers with confidence intervals wholly above or below the average performance. ICCs ranged from 0 to 47%, median 4.0%. There are no well-established reporting standards; highly heterogeneous reporting, therefore no meta-analysis. Discussion: Interpretation: There is a surgeons' effect on patients' physical health for many types of surgeries and outcomes, ranging from small to substantial. Surgeons with exceptional patient outcomes appear regularly even after accounting for all known confounding variables. Many existing cohort studies and RCTs could be reanalyzed for surgeons' effects especially after methodological reporting guidelines are published. Conclusion: In terms of patient outcomes, it can matter which surgeon is chosen. Surgeons with exceptional patient outcomes are worth studying further.

Spacing learning units affects both learning and forgetting.

Spaced learning produces better learning performance than extended learning periods without or with little interruptions. This "spacing effect" exists on different time scales, ranging from seconds to months. We recently found large spacing effects with a hitherto rarely investigated 12-hours spacing interval. The present study tested for potentially larger learning effects in the temporal vicinity of 12 h and analyzed spacing effects separately for learning and forgetting. 102 participants learned 40 German-Japanese vocabulary pairs in separate conditions with 7.5 min and 4-, 8-, 12-, and 24-hours spacing intervals. Two final tests were executed after retention intervals of 24 h and 7 days. The 7.5-min spacing interval produced a steeper initial learning curve than all other spacing intervals. 24 h after the last learning unit, we found almost no forgetting in the 4-, 8- and 12-hours spacing conditions, but about 9.3% and 3.6% forgetting in the 7.5 min and 24 h spacing conditions. After 7 days, forgetting was in the range of 13% for all conditions between 4 and 24 h. The 7.5 min condition produced 34% forgetting. Our results indicate that spacing intervals in the range of 8 h ± 4 h provide high learning performance and can be easily integrated in our daily schedules.

Test-retest reliability and practice effect of the Leuven Perceptual Organisation Screening Test.

AbstractVisual diagnostic tests must have a high degree of consistency in their measurements (high reliability) to ensure accurate assessment of perceptual abilities. The current study assessed test-retest reliability and practice effects in the Leuven Perceptual Organisation Screening Test (L-POST) in 144 healthy volunteers, with time intervals between 0 and 756 days. We used Pearson's and intraclass correlation analysis, Bland-Altman analysis and multilevel modelling. Results from our analyses converged and supported an adequate reliability of the L-POST. Multilevel modelling demonstrated an absence of practice effect, suggesting that the L-POST is suitable for repeat administration. This study suggests that the L-POST has adequate reliability and is suitable for repeat administration even at short intervals. This study provides the basis for a more systematic evaluation for neuropsychological assessments, which can lead to the development of more reliable assessment batteries.

Practice effect and test-retest reliability of the Mini-Mental State Examination-2 in people with dementia.

BACKGROUND: The Mini-Mental State Examination-Second Edition (MMSE-2) consists of three visions: a brief version (MMSE-2:BV), a standard version (MMSE-2:SV), and an expanded version (MMSE-2: EV). Each version was equipped with alternate forms (blue and red). There was a lack of evidence on the practice effect and test-retest reliability of the three versions of the MMSE-2, limiting its utility in both clinical and research settings. The purpose of this study was to examine the practice effect and test-retest reliability of the MMSE-2 in people with dementia. METHODS: One hundred and twenty participants were enrolled, of which 60 were administered with the blue form twice (i.e., the same-form group, [SF group]) and 60 were administered with the blue form first and then the red form (alternate-form group, [AF group]). The practice effect was evaluated using a paired t-test and Cohen's d. The test-retest reliability was examined using the intraclass correlation coefficient (ICC). RESULTS: For the practice effects, in the SF group, no statistically significant differences were found for the MMSE-2:BV and MMSE-2: EV total scores and eight subtests (p = 0.061-1.000), except for the MMSE-2:SV total score (p = 0.029). In the AF group, no statistically significant differences were found for all three versions of the total scores and subtests (p = 0.106-1.000), except for the visual-constructional ability subtest (p = 0.010). Cohen's d of all three versions' total scores and subtests were 0.00-0.20 and 0.00-0.26 for SF group and AF group, respectively. For the test-retest reliability, ICC values for all three versions and eight subtests in SF and AF groups were 0.60-0.93 and 0.56-0.93, respectively. CONCLUSION: Our results demonstrated that the practice effect could be minimized when alternate forms of the MMSE-2 were used. The MMSE-2 had good to excellent test-retest reliability, except for three subtests (i.e., visual-constructional ability, registration, and recall). Caution should be taken when interpreting the results of visual-constructional ability, registration, and recall subtests of the MMSE-2.