Sustained Implementation of an Evidence-Based Extubation Checklist Reduced Extubation Failure in Trauma Patients.

Extubation failure remains a challenge in the perioperative setting. The aim of this intervention was to decrease the rate of perioperative extubation failure through the utilization of an extubation checklist. A five-item evidence-based extubation readiness checklist was implemented at a level I trauma center on all patients who were electively extubated in the operating room (OR). Extubation failure rates before and after implementation of the checklist were compared. Of 26,867 trauma patients extubated in the OR after the intervention, 84 cases (0.31%) failed extubation in the immediate postoperative period. A significant and sustained decrease in extubation failure rate per case performed was observed between the pre- and post-checklist period (OR, 0.33; 95% CI, 0.19, 0.56; P < 0.001). Partial (vs full) checklist completion, higher ASA physical status score, advanced age, and longer case length were independently associated with increased odds of extubation failure in the postintervention period.

Research focused doctoral nursing education in the 21st century: Curriculum, evaluation, and postdoctoral considerations.

The AACN position statement on The Research-Focused Doctoral Program in Nursing: Pathways to Excellence was revised in 2022 by an AACN Task Force charged with creating a new vision for the PhD and similar programs in nursing. This document, which was informed by hundreds of academic nursing stakeholders, yields expectations and recommendations for PhD program curriculum, program evaluation, post-doctoral competencies, and resources. Results of an AACN 2021 survey indicated increased enrollment in PhD programs 2017-2000. Fifteen percent of students were enrolled in BSN-PhD, programs, 70 % of schools reported external review, and overall average time to degree completion was 5 years. Considerations for the education for the research doctorate include development of curriculum that fosters the scholarship of discovery and scientific inquiry and implements systematic evaluation of program outcomes while advancing postdoctoral competencies and resources, including the post-doctoral fellowship. Comprehensive assessment of the PhD program promotes ongoing program analysis and quality. Postdoctoral fellowships advance the science of nursing via the creation of a culture and workforce for nursing research. Successful postdoctoral programs have mentors, resources, and infrastructure to adequately enable the fellow to progress in their line of inquiry and develop as an investigator.

Anesthesia-Related Malpractice Claims in Maryland 1994-2017.

This article presents data on anesthesia cases filed with the Maryland Health Claims Alternative Dispute Office between 1994 and 2017, a publicly available resource that includes all anesthesia-related claims filed in Maryland, regardless of whether they were reported to any national claims repository. Analysis of anesthesia malpractice claims offers critical information that can both decrease legal liability and improve patient outcomes for those receiving anesthesia. A total of 276 claims were filed. Variables under investigation included venue, types of surgery, legal cause of action, trends, and outcomes. Types of anesthesia-related claims included the administration of general anesthesia (59.8%), monitored anesthesia care (14.9%), pain management (10.9%), epidural/spinal anesthesia (9%), nerve blocks (2.9%), and local anesthesia infiltration (2.6%). Most cases (39.5%) involved failure to adequately monitor the patient. Inadequate perioperative care was alleged as the cause of action in 68.8% of cases. Major adverse patient outcomes were death (38.8%), brain damage (21%), and permanent nerve damage (14.9%). Understanding the events that lead to legal action can assist anesthesia providers to focus on ways to improve their practice.

Embodied object concepts: The contribution of structural and functional manipulability depends on available visual information.

Object identification is driven, in part, by the extent to which we have sensorimotor experience with the object. Importantly, the activation of embodied object representations depends on contextual information. In the present study, we use a visual masking paradigm to investigate how the availability of visual information modulates the role of manipulability in the representation of object concepts. Using both an object naming task (i.e., linguistic response) and a picture-word matching task (i.e., manual response), we provide evidence that structural manipulability (the ability to pick up an object with one hand) and functional manipulability (the action information that pertains to the ultimate use of the object) have dissociable effects on object identification. In both tasks, the effects of structural manipulability were greater when structural information was available in the image (i.e., when the objects were unmasked); in contrast, the effects of functional manipulability were greater when the objects were masked. Importantly, these effects were not due to object familiarity or the age at which the name of the objects was acquired. Our results are consistent with the activation of the two pathways within the dorsal visual stream that are part of a distributed neural network that represents embodied action information. We extend previous research by showing that visual information determines which type of embodied information drives object identification. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Ethical Issues Encountered by Military Nurses During Wartime.

Military nurses encounter similar issues as civilian nurses in daily practice situations; however, wartime and humanitarian missions may bring unique and difficult ethical dilemmas. While nursing has the American Nurses Association code of ethics to provide a framework to guide ethical practice decisions, conflicts may arise from the unique aspects of nursing within a wartime environment. Understanding those conflicts occuring within the military wartime scenario can provide nurses with experiential examples from which to derive strategies for personal coping and professional behavior and decision making. This chapter describes the research that has focused upon the identification of these issues, the effects from uresolved issues, and those directions for future research to better prepare miltiary nurses before and during deployment.

The DalHouses: 100 new photographs of houses with ratings of typicality, familiarity, and degree of similarity to faces.

Houses have often been used as comparison stimuli in face-processing studies because of the many attributes they share with faces (e.g., distinct members of a basic category, consistent internal features, mono-orientation, and relative familiarity). Despite this, no large, well-controlled databases of photographs of houses that have been developed for research use currently exist. To address this gap, we photographed 100 houses and carefully edited these images. We then asked 41 undergraduate students (18 to 31 years of age) to rate each house on three dimensions: typicality, likeability, and face-likeness. The ratings had a high degree of face validity, and analyses revealed a significant positive correlation between typicality and likeability. We anticipate that this stimulus set (i.e., the DalHouses) and the associated ratings will prove useful to face-processing researchers by minimizing the effort required to acquire stimuli and allowing for easier replication and extension of studies. The photographs of all 100 houses and their ratings data can be obtained at http://dx.doi.org/10.6084/m9.figshare.1279430.

Accessing embodied object representations from vision: A review.

Theories of embodied cognition (EC) propose that object concepts are represented by reactivations of sensorimotor experiences of different objects. Abundant research from linguistic paradigms provides support for the notion that sensorimotor simulations are involved in cognitive tasks like comprehension. However, it is unclear whether object concepts, as accessed from the visual presentation of objects, are embodied. In the present article we review a large body of visual cognitive research that addresses 5 main predictions of the theory of EC. First, EC accounts predict that visual presentation of manipulable objects, but not nonmanipulable objects, should activate motor representations. Second, EC predicts that sensorimotor activity is necessary to perform visual-cognitive tasks such as object naming. Third, EC posits the existence of distinct neural ensembles that integrate information from action and vision. Fourth, EC predicts that relationships between visual and motor activity change throughout development. Fifth, EC predicts that the visual presentation of objects or actions should prime performance cross-modally. We summarize findings from neuroimaging, neuropsychology, neurophysiology, development, and behavioral paradigms. We show that while much of the research published so far demonstrates that there is a relationship between visual and motoric representations, there is no evidence supporting a strong form of EC. We conclude that sensorimotor simulations may not be required to perform visual cognitive tasks and highlight a number of directions for future research that could provide strong support for EC in visual cognitive paradigms.

Photographs of manipulable objects are named more quickly than the same objects depicted as line-drawings: Evidence that photographs engage embodiment more than line-drawings.

Previous research has shown that photographs of manipulable objects (i.e., those that can be grasped for use with one hand) are named more quickly than non-manipulable objects when they have been matched for object familiarity and age of acquisition. The current study tested the hypothesis that the amount of visual detail present in object depictions moderates these "manipulability" effects on object naming. The same objects were presented as photographs and line-drawings during a speeded naming task. Forty-six participants named 222 objects depicted in both formats. A significant object depiction (photographs versus line drawing) by manipulability interaction confirmed our hypothesis that manipulable objects are identified more quickly when shown as photographs; whereas, non-manipulable objects are identified equally quickly when shown as photographs versus line-drawings. These results indicate that factors such as surface detail and texture moderate the role of "action" and/or "manipulability" effects during object identification tasks, and suggest that photographs of manipulable objects are associated with more embodied representations of those objects than when they are depicted as line-drawings.

Handles of manipulable objects attract covert visual attention: ERP evidence.

Previous research has demonstrated that people are faster at making a manual response with the hand that is aligned with the handle of a manipulable object compared to its functional end. According to theories of embodied cognition (ETC), the presentation of a manipulable object automatically elicits sensorimotor simulations of the respective hand and these simulations facilitate the response. However, an alternative interpretation of these data is that handles preferentially attract visual attention, since attended stimuli and locations typically elicit faster responses. We investigated attentional biases elicited by manipulable and non-manipulable objects using event-related-potentials (ERPs). On each trial, a picture of a manipulable object was followed by a target dot that participants had to make a button-press to. The dot was located at either the handle or functional end of the object. Consistent with previous attentional cuing paradigms, we showed that the P1 ERP component was greater in response to targets cued by handles than by functional ends. These results suggest that object handles automatically bias covert attentional processes. These attentional biases may account for earlier behavioural findings, without any recourse to ETC.

Testing the embodied account of object naming: a concurrent motor task affects naming artifacts and animals.

Embodied theories of object representation propose that the same neural networks are involved in encoding and retrieving object knowledge. In the present study, we investigated whether motor programs play a causal role in the retrieval of object names. Participants performed an object-naming task while squeezing a sponge with either their right or left hand. The objects were artifacts (e.g. hammer) or animals (e.g. giraffe) and were presented in an orientation that favored a grasp or not. We hypothesized that, if activation of motor programs is necessary to retrieve object knowledge, then concurrent motor activity would interfere with naming manipulable artifacts but not non-manipulable animals. In Experiment 1, we observed naming interference for all objects oriented towards the occupied hand. In Experiment 2, we presented the objects in more 'canonical orientations'. Participants named all objects more quickly when they were oriented towards the occupied hand. Together, these interference/facilitation effects suggest that concurrent motor activity affects naming for both categories. These results also suggest that picture-plane orientation interacts with an attentional bias that is elicited by the objects and their relationship to the occupied hand. These results may be more parsimoniously accounted for by a domain-general attentional effect, constraining the embodied theory of object representations. We suggest that researchers should scrutinize attentional accounts of other embodied cognitive effects.

A test of the embodied simulation theory of object perception: potentiation of responses to artifacts and animals.

Theories of embodied object representation predict a tight association between sensorimotor processes and visual processing of manipulable objects. Previous research has shown that object handles can 'potentiate' a manual response (i.e., button press) to a congruent location. This potentiation effect is taken as evidence that objects automatically evoke sensorimotor simulations in response to the visual presentation of manipulable objects. In the present series of experiments, we investigated a critical prediction of the theory of embodied object representations that potentiation effects should be observed with manipulable artifacts but not non-manipulable animals. In four experiments we show that (a) potentiation effects are observed with animals and artifacts; (b) potentiation effects depend on the absolute size of the objects and (c) task context influences the presence/absence of potentiation effects. We conclude that potentiation effects do not provide evidence for embodied object representations, but are suggestive of a more general stimulus-response compatibility effect that may depend on the distribution of attention to different object features.

A computer-generated face database with ratings on realism, masculinity, race, and stereotypy.

Ratings of realism, masculinity, race, and racial stereotypy were collected on a set of computer-generated faces representing European, South East Asian, and African American ethnicities. To determine if these faces are processed in the same way as photographs of real faces, we demonstrated with these faces superior memory performance for upright faces over inverted faces (the face inversion effect). Further, in observers of European decent, we found both superior memory for European faces and a larger inversion effect for European than African American faces. Based on these results, we believe that this set of faces may be of use in perceptual investigations in which race is a critical manipulation.

Neuropsychological dissociations between motion and form perception suggest functional organization in extrastriate cortical regions in the human brain.

In this review of neuropsychological case studies, a number of dissociations are shown between different visual abilities including low-level motion perception, static form perception, form-from-motion perception and biological motion perception. These dissociations reveal counter-intuitive results. Specifically, higher level form-from-motion perception can persist despite deficits in low-level motion perception and static form perception. To account for these dissociations, we present a model of functional organization and identify future directions for investigations of higher order form-from-motion perception.

A significant bilateral field advantage for shapes defined by static and motion cues.

Matching performance is better when pairs of visual stimuli are presented in bilateral conditions--in which one stimulus is presented to each side of the visual field--than in unilateral presentations-when both stimuli are presented to one side of the field. This is called the bilateral field advantage (BFA). The processing of visual motion has also been found to be more strongly integrated across the cerebral hemispheres than is processing of static cues. However, in these studies higher-order motion tasks, such as processing motion-defined form, have not been examined. To determine if the BFA generalises to such tasks, we measured the magnitude of the effect using a shape-matching task in which the stimuli were random polygons that were either in motion, motion-defined, or static. The polygon pairs were presented either: (i) bilaterally, one to either side of the vertical meridian; (ii) unilaterally, both to one side of the vertical meridian (left or right visual fields); or (iii) centrally, vertically separated across the horizontal meridian (a control condition). An equal advantage of bilateral conditions over unilateral ones was found for all three types of polygon shape cues, showing that the BFA generalises to conditions where shapes are in motion and where shape is defined by motion. These findings are compatible with the notion that motion processing is strongly integrated across the cerebral hemispheres, and with the idea that this integration manifests itself with simple motion information, rather than with higher-order motion processing such as matching shapes defined by motion.

Behavioral effects of visual field location on processing motion- and luminance-defined form.

Traditional theories posit a ventral cortical visual pathway subserving object recognition regardless of the information defining the contour. However, functional magnetic resonance imaging (fMRI) studies have shown dorsal cortical activity during visual processing of static luminance-defined (SL) and motion-defined form (MDF). It is unknown if this activity is supported behaviorally, or if it depends on central or peripheral vision. The present study compared behavioral performance with two types of MDF [one without translational motion (MDF) and another with (TM)] and SL shapes in a shape matching task where shape pairs appeared in the upper or lower visual fields or along the horizontal meridian of central or peripheral vision. MDF matching was superior to the other contour types regardless of location in central vision. Both MDF and TM matching was superior to SL matching for presentations in peripheral vision. Importantly, there was an advantage for MDF and TM matching in the lower peripheral visual field that was not present for SL forms. These results are consistent with previous behavioral findings that show no field advantage for static form processing and a lower field advantage for motion processing. They are also suggestive of more dorsal cortical involvement in the processing of shapes defined by motion than luminance.

A contextual effect of 2nd-order configural processing of non-face objects by non-experts.

We investigated here the detection of 2nd-order configural relations both in faces and in non-face objects. In experiment 1 it was shown that observers were more sensitive to feature displacements in upright faces and houses than in inverted faces and houses. The presence of an inversion effect in the house stimuli suggested that 2nd-order relational processing was applied to the non-face stimuli. In experiment 2, the inversion effect for houses was absent when only houses were presented. In experiment 3, face and house stimuli were once again presented in the same task and inversion effects were again seen for both types of stimuli. Together, these results suggest that 2nd-order relational processing can be flexibly applied to non-face objects when they are presented in the context of faces.

Living kidney organ donation: experiences of spousal support of donors.

AIM: The purpose of this study was to explore the process of living kidney donation as experienced by husbands of donors to aid nurses and all members of the health care team in promoting informed consent for those considering living donation and to promote the well being of spouses of living donors, donors and their families. BACKGROUND: The attitudes of husbands of living kidney donors may affect their decision to donate and satisfaction with recovery from donation surgery, thus it is critical to know how husbands of living kidney donors view kidney donation. METHODS: Eleven male spouses of living kidney donors were interviewed three months following their wife's donation. Grounded theory methodology was used to inaugurate a substantive theory that describes living kidney donation and its impact on the spousal relationship and family, as experienced by the husband of a donor. RESULTS: The result of the data analysis was a substantive theory pertaining strictly to the husbands' experiences as the spouse of the living kidney donor. The process commenced with scheduling of the living donation followed by the postoperative time frame, including bringing the donor wife home. The core variable, 'Fulfilling Your Vows', described attitudes, behaviours and actions that guided husbands in successfully and generously caring for their wives, their families, the recipients and themselves throughout the living kidney donation process and continuing 'to this day'. RELEVANCE TO CLINICAL PRACTICE: The substantive theory of 'Fulfilling Your Vows' will guide nurses and other transplant specialists in helping to improve fully informed consent of potential donors before surgery and in developing supportive strategies to maximize spouse, donor and family outcomes throughout the transplantation process.

Perceptual biases in processing facial identity and emotion.

Normal observers demonstrate a bias to process the left sides of faces during perceptual judgments about identity or emotion. This effect suggests a right cerebral hemisphere processing bias. To test the role of the right hemisphere and the involvement of configural processing underlying this effect, young and older control observers and patients with right hemisphere damage completed two chimeric faces tasks (emotion judgment and face identity matching) with both upright and inverted faces. For control observers, the emotion judgment task elicited a strong left-sided perceptual bias that was reduced in young controls and eliminated in older controls by face inversion. Right hemisphere damage reversed the bias, suggesting the right hemisphere was dominant for this task, but that the left hemisphere could be flexibly recruited when right hemisphere mechanisms are not available or dominant. In contrast, face identity judgments were associated most clearly with a vertical bias favouring the uppermost stimuli that was eliminated by face inversion and right hemisphere lesions. The results suggest these tasks involve different neurocognitive mechanisms. The role of the right hemisphere and ventral cortical stream involvement with configural processes in face processing is discussed.

Hierarchical attention in discriminating objects at different levels of specificity.

An implicit assumption of studies in the attentional literature has been that global and local levels of attention are involved in object recognition. To investigate this assumption, a divided attention task was used in which hierarchical figures were presented to prime the subsequent discrimination of target objects at different levels of category identity (basic and subordinate). Target objects were identified among distractor objects that varied in their degree of visual similarity to the targets. Hierarchical figures were also presented at different sizes and as individual global and local elements in order to investigate whether attention-priming effects on object discrimination were due to grouping/parsing operations or spatial extent. The results showed that local processing primed subordinate object discriminations when the objects were visually similar. Global processing primed basic object discriminations, regardless of the similarity of the distractors, and subordinate object discriminations when the objects were visually dissimilar. It was proposed that global and local processing aids the selection of perceptual attributes of objects that are diagnostic for recognition and that selection is based on two mechanisms: spatial extent and grouping/parsing operations.