Meaningful Communication but not Superficial Anthropomorphism Facilitates Human-Automation Trust Calibration: The Human-Automation Trust Expectation Model (HATEM).

OBJECTIVE: The objective was to demonstrate anthropomorphism needs to communicate contextually useful information to increase user confidence and accurately calibrate human trust in automation. BACKGROUND: Anthropomorphism is believed to improve human-automation trust but supporting evidence remains equivocal. We test the Human-Automation Trust Expectation Model (HATEM) that predicts improvements to trust calibration and confidence in accepted advice arising from anthropomorphism will be weak unless it aids naturalistic communication of contextually useful information to facilitate prediction of automation failures. METHOD: Ninety-eight undergraduates used a submarine periscope simulator to classify ships, aided by the Ship Automated Modelling (SAM) system that was 50% reliable. A between-subjects 2 × 3 design compared SAM appearance (anthropomorphic avatar vs. camera eye) and voice inflection (monotone vs. meaningless vs. meaningful), with the meaningful inflections communicating contextually useful information about automated advice regarding certainty and uncertainty. RESULTS: Avatar SAM appearance was rated as more anthropomorphic than camera eye, and meaningless and meaningful inflections were both rated more anthropomorphic than monotone. However, for subjective trust, trust calibration, and confidence in accepting SAM advice, there was no evidence of anthropomorphic appearance having any impact, while there was decisive evidence that meaningful inflections yielded better outcomes on these trust measures than monotone and meaningless inflections. CONCLUSION: Anthropomorphism had negligible impact on human-automation trust unless its execution enhanced communication of relevant information that allowed participants to better calibrate expectations of automation performance. APPLICATION: Designers using anthropomorphism to calibrate trust need to consider what contextually useful information will be communicated via anthropomorphic features.

Testing children's ability to correctly use the "Shadow Rule" for sun protection.

INTRODUCTION: The "Shadow Rule" (SR) is a useful, immediate indicator of sunburn risk following the mnemonic "Short shadow? Seek shade!" However, some question people's ability to discern when their shadows are shorter or longer than them. METHODS: N = 76 10-year-old children were taught the SR and then asked to estimate their sun-cast shadow length relative to their height and whether this meant they should seek shade. Children were then asked to estimate a doll's shadow length at 10 systematically randomised angles. RESULTS: Children experienced greatest difficulty judging their shadows' lengths when they were equal to their height. At all other angles, they demonstrated high accuracy and 92 % of the time on average could correctly interpret the SR. CONCLUSIONS: Ten-year-old children appear capable, and by extension adults too, of applying the SR. Future research is now required to establish if education about the SR will translate into sun protection behaviour change.

Discriminant validity of the Hospital Anxiety and Depression Scale, Beck Depression Inventory (II) and Beck Anxiety Inventory to confirmed clinical diagnosis of depression and anxiety in patients with chronic obstructive pulmonary disease.

The objective of this study was to investigate the discriminant validity of commonly used depression and anxiety screening tools in order to determine the most suitable tool for patients with chronic obstructive pulmonary disease (COPD). COPD patients (n = 56) completed the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). These scores were compared to confirmed clinical diagnoses of depression and anxiety using the Mini Neuropsychiatric Interview. HADS depression subscale (HADS-D) sensitivity/specificity was 78/81%; BDI-II 89/77%; HADS anxiety subscale (HADS-A) 71/81%; and BAI 89/62%. HADS-D sensitivity/specificity was improved (100/83%) with the removal of Q4 'I feel as if I am slowed down' and adjusted cut-off (≥5). Removal of BDI-II Q21 'Loss of interest in sex' with adjusted cut-off ≥12 resulted in similar improvement (100/79%). No problematic items were identified for HADS-A or BAI. Previously reported low sensitivity/specificity of the HADS for COPD patients was not replicated. Furthermore, simple modifications of the HADS-D markedly improved sensitivity/specificity for depression.BDI-II, HADS-A and BAI produced acceptable sensitivity/specificity unmodified. Pending further research for COPD patients we recommend continued use of the HADS-A with standard cut-off (≥8) and removal of Q4 of the HADS-D with lower cut-off ≥5.

Impact of a point-of-sale tobacco display ban on smokers' spontaneous purchases: comparisons from postpurchase interviews before and after the ban in Western Australia.

OBJECTIVE: To assess the impact of the Western Australian tobacco point-of-sale display ban on spontaneous purchase behaviours. METHODS: Daily adult smokers (n=402) observed purchasing cigarettes were recruited via exit interviews either 2 months before or after the implementation of the display ban. Smokers were asked if they had intended to purchase cigarettes before entering the store to assess spontaneous purchase behaviours. Whether smokers had noticed the displays before their purchase and the extent to which this influenced their purchase decision was also assessed via non-prompting questions. RESULTS: When compared with before the ban, fewer smokers after the ban noticed the displays (27.1% vs 1.1%, p<0.001), fewer reported making spontaneous purchases (28.2% vs 19.8%, p<0.05) and fewer claimed the displays influenced their purchase decisions (free recall 5.0% vs 1.1%, p<0.05; cued recall 22.1% vs 3.8%, p<0.001). Before the ban, spontaneous purchasers were more likely than planned purchasers to suggest the displays influenced their purchase decisions (free recall 9.7% vs 3.2%, p<0.05; cued recall 40.0% vs 17.9%, p<0.01). After the ban, spontaneous purchasers nominating the influence of displays fell substantially (free recall 9.7% vs 5.6%, p=NS; cued recall 40.0% vs 11.1%, p<0.01) as it did for planned purchasers (free recall 3.2% vs 0.0%, p<0.05; cued recall 17.9% vs 2.1%, p<0.01). CONCLUSIONS: We observed a 30% reduction in smokers making spontaneous tobacco purchases after implementation of the Western Australian tobacco display ban and between a fivefold and sixfold reduction in the proportion suggesting displays influenced their decision to purchase cigarettes. These data are consistent with previous research suggesting tobacco displays encourage spontaneous purchases and their removal corresponds to reductions in the same.

Internet-based photoaging within Australian pharmacies to promote smoking cessation: randomized controlled trial.

BACKGROUND: Tobacco smoking leads to death or disability and a drain on national resources. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18-30 years are relatively resistant to antismoking messages due to their widely held belief that they will not be lifelong smokers. OBJECTIVE: To conduct a randomized controlled trial (RCT) of a computer-generated photoaging intervention to promote smoking cessation among young adult smokers within a community pharmacy setting. METHODS: A trial was designed with 80% power based on the effect size observed in a published pilot study; 160 subjects were recruited (80 allocated to the control group and 80 to the intervention group) from 8 metropolitan community pharmacies located around Perth city center in Western Australia. All participants received standardized smoking cessation advice. The intervention group participants were also digitally photoaged by using the Internet-based APRIL Face Aging software so they could preview images of themselves as a lifelong smoker and as a nonsmoker. Due to the nature of the intervention, the participants and researcher could not be blinded to the study. The main outcome measure was quit attempts at 6-month follow-up, both self-reported and biochemically validated through testing for carbon monoxide (CO), and nicotine dependence assessed via the Fagerström scale. RESULTS: At 6-month follow-up, 5 of 80 control group participants (6.3%) suggested they had quit smoking, but only 1 of 80 control group participants (1.3%) consented to, and was confirmed by, CO validation. In the intervention group, 22 of 80 participants (27.5%) reported quitting, with 11 of 80 participants (13.8%) confirmed by CO testing. This difference in biochemically confirmed quit attempts was statistically significant (χ(2) 1=9.0, P=.003). A repeated measures analysis suggested the average intervention group smoking dependence score had also significantly dropped compared to control participants (P<.001). These differences remained statistically significant after adjustment for small differences in gender distribution and nicotine dependence between the groups. The mean cost of implementing the intervention was estimated at AU $5.79 per participant. The incremental cost-effectiveness ratio was AU $46 per additional quitter. The mean cost that participants indicated they were willing to pay for the digital aging service was AU $20.25 (SD 15.32). CONCLUSIONS: Demonstrating the detrimental effects on facial physical appearance by using a computer-generated simulation may be both effective and cost-effective at persuading young adult smokers to quit. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12609000885291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000885291 (Archived by WebCite at http://www.webcitation.org/6F2kMt3kC).

Measuring the effect of cigarette plain packaging on transaction times and selection errors in a simulation experiment.

INTRODUCTION: Australia has introduced legislation to force all cigarette packaging to be generic from 2012 onwards. The tobacco retail industry estimates this will result in transaction times increasing by 15-45 s per pack and is spending at least $A10 million of tobacco industry funds on an advertising campaigns claiming that the increased time and errors associated with plain packaging will ultimately cost small businesses $A 461 million per annum and endanger 15,000 jobs. We undertook an objective experiment to test these claims. METHODOLOGY: Participants (n=52) were randomly assigned to stand in front of a display of either 50 plain or coloured cigarette packets and then were read a randomly ordered list of cigarette brands. The time participants took to locate each packet was recorded and all selection errors were noted. After 50 'transactions', participants repeated the entire experiment with the alternative plain/coloured packs. Afterwards, participants were asked in an open-ended manner whether plain or coloured packaging was easier to locate and why. RESULTS: The average transaction was significantly quicker for plain compared with coloured packs (2.92 vs 3.17 s; p=0.040). One or more mistakes were made by 40.4% of participants when selecting coloured packaging compared with only 17.3% for plain packaging (p=0.011). Qualitative results suggested that the colours and inconsistent location of brand names often served to distract when participants scanned for brands. CONCLUSION: Rather than plain packaging requiring an additional 45 s per transaction, our results suggest that it will, if anything, modestly decrease transaction times and selection errors.

'We're not told why--we're just told': qualitative reflections about the Western Australian Go for 2&5® fruit and vegetable campaign.

OBJECTIVE: To explore why there is a lack of acceptance among Western Australian (WA) adults of the Go for 2&5® fruit and vegetable social marketing message to consume at least five servings of vegetables per day. DESIGN: A series of focus group discussions comprised of homogeneous groups varied by sex and age, until saturation of themes was achieved, followed by thematic analysis. SETTING: Part of qualitative research for the Go for 2&5® fruit and vegetable social marketing campaign in WA (2009 population: 2.2 million). SUBJECTS: WA adults stratified by sex and age groups (18-29 and 30-55 years) drawn from the second and third quartiles of socio-economic disadvantage. RESULTS: Familiarity with the Go for 2&5® message was excellent. Understanding of what constitutes 'two servings of fruit' was excellent and regarded by participants as highly achievable. Understanding of what constitutes 'five servings of vegetables' was suboptimal with widespread overestimation contributing to the belief that it is unrealistic. Participants did not know how the 2&5 recommendation was formulated and believed that daily consumption of two servings of fruit and five of vegetables would confer no greater health benefit than one of fruit and three of vegetables. Participants assumed that the 2&5 recommendation was 'aspirational' in the sense that it was purposely exaggerated to simply encourage greater overall consumption. CONCLUSIONS: A convincing case needs to be presented to WA adults as to why they should consume five servings of vegetables per day. Continuing efforts to educate incorporating what constitutes a serving will assist perceptions that the recommendation is realistic.

Using viral e-mails to distribute tobacco control advertisements: an experimental investigation.

The authors' objective was to conduct a trial of viral e-mail marketing as a distribution method for tobacco control advertisements. University students (n = 200) in the state of Western Australia were randomly allocated to receive 1 of 2 e-mails with hyperlinks to tobacco control advertisements ("Toilet" and "Rubbish") emphasizing the disgusting nature of smoking. Recipients followed a hyperlink to a Web page playing Toilet or Rubbish on endless loop. Viewers were encouraged to forward the e-mail to their friends and invited to complete an online survey about the advertisement. Unique downloads for each advertisement were identified by internet provider (IP) location and tallied by date and geographical location to assess subsequent dissemination beyond the initial 200 students. There were 826 unique viewings of the advertisements averaging 26.9 viewings per day for the first fortnight, followed by a lower average of 4.1 hits per day for the next 3.5 months. IP addresses identified hits from 3 other Australian states and 7 other countries. Online surveys were completed by 103 respondents (12.5% of total hits) but included few smokers (n = 9). Significantly more respondents rated Toilet as "funny" compared with Rubbish (40% vs. 11%; p < .05), likely explaining why the former accounted for significantly more viewings than the latter (487 vs. 339; p < .001). There was a greater than fourfold return in dissemination for each initial e-mail sent but daily hits rapidly deteriorated over time. Entertainment appears to facilitate viral e-mails being forwarded onwards but only exceptionally compelling tobacco control materials are ever likely to become self-perpetuating.

An independent assessment of the Australian food industry's Daily Intake Guide 'Energy Alone' label.

ISSUES ADDRESSED: A single thumbnail variant of the food industry's voluntary front-of-package Daily Intake Guide (DIG)--called the 'Energy Alone' thumbnail (DIG kJ)--has recently appeared on many energy-dense, nutrient-poor foods and beverages, especially soft drinks and confectionery. However, there is no published data to date that has assessed its merit. METHOD: A quota sample of 58 Australian adults (50% female; 47% blue collar; mean age 35 years, range 18-59) was presented with photographs of three food packages alternatively labelled with DIG kJ, full DIG (five thumbnails) and Traffic Lights (TL) systems. Participants ranked each labelling system along seven-point scales for the following dimensions: 'interpretable, 'noticeable', 'useful' 'and' a deterrent to purchasing unhealthy snack foods: Participants were afterwards brought together in eight focus groups of 7-8 to discuss the merits of each system. RESULTS: Paired samples t-tests suggested the DIG kJ was rated significantly less "noticeable" ,'useful'or'a deterrent'than either the full DIG or TL systems. The TL system was also rated as significantly more'interpretable"and"a deterrent'than either variant of DIG. In the focus groups, participants described the DIG kJ as too small to be noticeable, too abstract to be meaningful, and of little practical use. Higher energy on food labels was also associated with positive health, rather than as a risk for overconsumption. CONCLUSION: The DIG kJ performed poorly against the TL and full DIG. Our results suggest it is an ineffective food labelling system, that is unlikely to affect consumer knowledge, awareness, attitudes, purchasing or consumption behaviours.

Playgroups as a setting for nutrition and physical activity interventions for mothers with young children: exploratory qualitative findings.

ISSUE ADDRESSED: The child bearing years are associated with increased risk of weight gain for many women. Little is known about the attitudes and preferences for nutrition and physical activity interventions in this population. This research investigated the barriers and facilitators of mothers with young children to engage in healthy physical activity and nutrition behaviours. METHODS: Eight focus groups were conducted with mothers (n = 65) who attended Perth, metropolitan playgroups. Transcriptions from the groups plus observer notes were used to conduct a thematic analysis. RESULTS: Participants were aware of the need for good nutrition and adequate physical activity but many failed to meet public health recommendations. Many participants were keen to improve their diet and increase their levels of physical activity. However, a major barrier to adopting and maintaining healthy diets and adequate physical activity levels was a shift in priorities from investing in their own health to investing in their children's. CONCLUSIONS: Interventions using a 'whole family' approach are more likely to be successful in engaging mothers. Interventions should focus on strengthening mothers' self efficacy surrounding eating and physical activity.

Determinants for concomitant anxiety and depression in people living with chronic obstructive pulmonary disease.

OBJECTIVE: Anxiety and depression are common comorbidities in people diagnosed with chronic obstructive pulmonary disease (COPD). Despite concomitant psychological symptomatology being reported in 22-48% of people with COPD, most literature focuses on identifying the risk factors for anxiety or depression separately. Therefore, our objective was to determine whether there is an association between people living with concomitant anxiety and depression and sociodemographic risk factors in people and living with COPD. METHODS: This was a cross-sectional study of 242 people living with COPD. Symptomatology of anxiety and depression were assessed using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-II). Univariate and multivariable logistic regression models were used to test the association between symptomatology and demographic predictor variables. Odds ratios and 95% confidence intervals were derived. RESULTS: Of the 242 people included, 48.8% (n = 118) had no symptoms of anxiety or depression and 33.5%% (n = 81) had symptomatology for both. Multivariable modelling suggested younger age, having a carer, having a previous psychological medical history, having a higher number of comorbidities and poorer quality of life were associated with concomitant anxiety and depression compared to those without symptomatology. CONCLUSION: Further work should be done to build upon our results which adds to the limited literature surrounding risk factors for concomitant psychological symptomatology to facilitate future discussion surrounding reducing these detrimental comorbidities in people with COPD.

Impact of smoking images in magazines on the smoking attitudes and intentions of youth: an experimental investigation.

OBJECTIVE: To determine the effect of magazine incidental smoking imagery on youths' smoking intentions. METHODS: A magazine was developed incorporating photographs of smokers (Smoking Magazine). A second version of the magazine (Non-smoking Magazine) included these photographs with the tobacco paraphernalia digitally erased. Equal numbers of smokers and non-smokers aged 14-17 years (n = 357) were randomly assigned to look through one version of the magazine and then asked a series of questions. RESULTS: Smokers made more unprompted mention of smoking imagery than non-smokers after viewing Smoking Magazine (52% vs 34%; p<0.05). Smokers viewing Smoking Magazine were more likely to report an urge to smoke (54% vs 40%; p<0.05). Female non-smokers who viewed Smoking Magazine were more likely than those who viewed Non-smoking Magazine to state a future intention to smoke (13% vs 0%; p<0.05). Female smokers were more attracted to the male models appearing in Smoking Magazine than Non-smoking Magazine (49% vs 24%; p<0.05) and the opposite was true for female non-smokers (28% vs 52%; p<0.05). Female smokers were also marginally more likely to desire looking like the female models in Smoking Magazine (64% vs 46%; p = 0.06) but no difference was observed in the non-smoking females (46% vs 46%). Male smokers and non-smokers did not differ in their responses by magazine type. CONCLUSIONS: Incidental positive smoking imagery in magazines can generate the same sorts of consumer effects attributed to advertising in general, including tobacco advertising. Sex specific results of our study may be explained by the choice of smoking images used.

The weighty issue of Australian television food advertising and childhood obesity.

ISSUE ADDRESSED: The aim of this paper is to provide an accessible overview of research literature on the link between childhood obesity and food advertising on Australian television. METHODS: A systematic review of current medical, public health, psychological and marketing research literature surrounding the topics of childhood obesity and television food advertising, with emphasis on Australian data. RESULTS: Childhood obesity rates have tripled since 1985, mirrored by increases in consumption of energy-dense foods. Energy-dense food advertising is ubiquitous in children's television programming, but children's ability to perceive the commercial intent of advertisements only emerges gradually as a function of age. Until such time, children are trusting, and hence vulnerable, to food advertising, influencing their desires and purchase requests to parents. There is robust evidence to suggest that television viewing and childhood obesity are related. However, the direction of causation and specific contribution of food advertising remains equivocal. Moreover, the link between television and childhood obesity is surprisingly weak, with only a small independent effect size (approximately 1%). CONCLUSIONS: Television food advertising seems to have only a very small, indirect link to childhood obesity.

An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students.

BACKGROUND: While numerous theoretical and conceptual models suggest social evaluation anxiety would likely influence performance in simulation-based learning environments, there has been surprisingly little research to investigate the extent to which this is true. METHODS: Final-year Bachelor of Science (Nursing) students (N=70) were randomly assigned to complete one of three clinically identical simulation-based scenarios designed to elicit varying levels of social evaluation anxiety by manipulating the number of other people present with the student during the simulation (1, 2 or 3 others). Rises in acute stress were measured via continuous heart-rate and salivary cortisol. Performance scores were derived from the average of two independent raters' using a structured clinical checklist (/16). RESULTS: Statistically different increases were found within the first minute of the simulation between those students with one versus three other people in the room (+4.13 vs. +14.01beats-per-minute respectively, p=0.01) and salivary cortisol measures suggested significantly different changes in anxiety between these groups (-0.05 vs. +0.11µg/dL respectively, p=0.02). Independent assessments suggested students with only one other person accompanying them in the simulation significantly outperformed those accompanied by three others (12.95 vs. 10.67 respectively, p=0.03). DISCUSSION: Students accompanied by greater numbers during simulations experienced measurably greater anxiety and measurably poorer performances. These results demonstrate the ability to manipulate social evaluation anxiety within high-fidelity simulation training of undergraduates in order to help students better acclimatise to stressful events prior to practising in real clinical settings.

Assessing simulation-based clinical training: comparing the concurrent validity of students' self-reported satisfaction and confidence measures against objective clinical examinations.

Introduction: Simulation-based education (SBE) literature is replete with student satisfaction and confidence measures to infer educational outcomes. This research aims to test how well students' satisfaction and confidence measures correlate with expert assessments of students' improvements in competence following SBE activities. Methods: N=85 paramedic students (mean age 23.7 years, SD=6.5; 48.2% female) undertook a 3-day SBE workshop. Students' baseline competence was assessed via practical scenario simulation assessments (PSSAs) administered by expert paramedics and confidence via a questionnaire. Postworkshop competence and confidence plus self-reported students' satisfaction were remeasured. Results: PSSA scores increased significantly between baseline and post workshop (35.7%→53.4%, p<0.001), as did students' confidence (55.7%→60.5%, p<0.001), and their workshop satisfaction was high (71.0%). Satisfaction and postworkshop confidence measures were moderately correlated (r=0.377, p=0.001). However, competence improvements were not significantly correlated with either satisfaction (r=-0.107 p=0.344) or change in confidence (r=-0.187 p=0.102). Discussion: Students' self-reported satisfaction and confidence measures bore little relation to expert paramedics' judgements of their educational improvements. Satisfaction and confidence measures appear to be dubious indicators of SBE learning outcomes.

Effects of Low- Versus High-Fidelity Simulations on the Cognitive Burden and Performance of Entry-Level Paramedicine Students: A Mixed-Methods Comparison Trial Using Eye-Tracking, Continuous Heart Rate, Difficulty Rating Scales, Video Observation and Interviews.

INTRODUCTION: High-fidelity simulation-based training is often avoided for early-stage students because of the assumption that while practicing newly learned skills, they are ill suited to processing multiple demands, which can lead to "cognitive overload" and poorer learning outcomes. We tested this assumption using a mixed-methods experimental design manipulating psychological immersion. METHODS: Thirty-nine randomly assigned first-year paramedicine students completed low- or high-environmental fidelity simulations [low-environmental fidelity simulations (LF(en)S) vs. high-environmental fidelity simulation (HF(en)S)] involving a manikin with obstructed airway (SimMan3G). Psychological immersion and cognitive burden were determined via continuous heart rate, eye tracking, self-report questionnaire (National Aeronautics and Space Administration Task Load Index), independent observation, and postsimulation interviews. Performance was assessed by successful location of obstruction and time-to-termination. RESULTS: Eye tracking confirmed that students attended to multiple, concurrent stimuli in HF(en)S and interviews consistently suggested that they experienced greater psychological immersion and cognitive burden than their LF(en)S counterparts. This was confirmed by significantly higher mean heart rate (P < 0.001) and National Aeronautics and Space Administration Task Load Index mental demand (P < 0.05). Although group allocation did not influence the proportion of students who ultimately revived the patient (58% vs. 30%, P < 0.10), the HF(en)S students did so significantly more quickly (P < 0.01). The LF(en)S students had low immersion resulting in greater assessment anxiety. CONCLUSIONS: High-environmental fidelity simulation engendered immersion and a sense of urgency in students, whereas LF(en)S created assessment anxiety and slower performance. We conclude that once early-stage students have learned the basics of a clinical skill, throwing them in the "deep end" of high-fidelity simulation creates significant additional cognitive burden but this has considerable educational merit.

Western Australians' perceptions of the survivability of different cancers: implications for public education campaigns.

ISSUE ADDRESSED: People's decisions about whether to participate in cancer screening and to seek treatment are related to their perceptions of the survivability of cancer. However, there is little empirical evidence to suggest people's awareness of the survivability of different cancers. The object of the present study was to determine people's estimates of the survivability of 10 cancers. METHODS: In 2001, data were collected via computer-assisted telephone interviews with 1,501 randomly selected metropolitan and rural Western Australian adults. Participants were presented with a list of 10 cancers. Half the sample was asked to nominate the three most survivable, and half was asked to nominate the three least survivable cancers. RESULTS: Participants' rankings of the 10 cancers in terms of perceived survivability were consistent with cancer registry data, with the exception of bone cancer which was underrated. Respondents' average estimates of five-year survival rates were also accurate (+/- 2-6%) for cancers with relatively high survival rates such as breast, cervical, prostate, and other skin cancers, with the exception of melanoma, which was underestimated (20%). However, average estimated survival rates for cancers with low survivability, such as leukaemia, lung, and stomach cancers, were substantially overestimated, being 31%, 38% and 43% higher respectively. CONCLUSIONS: Western Australians appear to have a reasonable understanding of the relative survivability of various cancers but a poorer appreciation of actual survival rates.

Clinical Placement Before or After Simulated Learning Environments?: A Naturalistic Study of Clinical Skills Acquisition Among Early-Stage Paramedicine Students.

BACKGROUND: There is conflicting evidence surrounding the merit of clinical placements (CPs) for early-stage health-profession students. Some contend that early-stage CPs facilitate contextualization of a subsequently learned theory. Others argue that training in simulated-learning experiences (SLEs) should occur before CP to ensure that students possess at least basic competency. We sought to investigate both claims. METHODS: First-year paramedicine students (n = 85) undertook 3 days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating 2 groups (Clin → Sim/Sim → Clin). Clinical skills acquisition was measured via direct scenario-based clinical assessments with expert observers conducted at 4 intervals during the semester. Perceptions of difficulty of CP and SLE were measured via the National Aeronautics and Space Administration Task Load Index. RESULTS: Students' clinical assessment scores in both groups improved significantly from beginning to end of semester (P < 0.001). However, at semester's end, clinical assessment scores for the Sim → Clin group were statistically significantly greater than those of the Clin → Sim group (P = 0.021). Both groups found SLEs more demanding than CP (P < 0.001). However, compared with the Sim → Clin group, the Clin → Sim group rated SLE as substantially more time-demanding than CP (P = 0.003). CONCLUSIONS: Differences in temporal demand suggest that the Clin → Sim students had fewer opportunities to practice clinical skills during CP than the Sim → Clin students due to a more limited scope of practice. The Sim → Clin students contextualized SLE within subsequent CP resulting in greater improvement in clinical competency by semester's end in comparison with the Clin → Sim students who were forced to contextualize skills retrospectively.

Quantification of opportunities for early-stage paramedicine students to practice clinical skills during clinical placements compared with an equal dose of simulation-based workshops.

Introduction: A reported advantage of simulation-based learning environments (SLE) over clinical placements (CPs) is that the former can provide a greater number and breadth of opportunities to practice level-appropriate clinical skills compared with the random patient presentations provided during the latter. Although logical and widely accepted as fact, we find no published evidence to demonstrate the magnitude, nor indeed veracity, of this assumption. We therefore sought to quantify the clinical skills practiced by entry-level paramedicine students attending a well-selected CP compared with an equal dosage of SLE. Methods: N=37 first-year paramedicine students completed activity diaries during 3 days of CP and 3 days of SLE. Opportunities to practice clinical skills were quantified and coded as either: level-appropriate, beyond-level or of non-discipline relevance. Results: During SLE, the average student was exposed 226 times to 11 level-appropriate clinical procedures. During CP the average student was exposed 48 times to 24 clinical procedures, the majority relevant to paramedicine (63%), but a minority level-appropriate (38%). Students' opportunities for supervised, 'hands on' practice represented only 10% of exposures in either SLE or CP but in terms of raw numbers of level-appropriate opportunities, SLE provided more than CP (n=23 vs 2). Discussion: Our results confirm that SLE provides substantially more opportunities than CP for students to practice level-appropriate skills and is therefore more appropriate for repetitive practice. However, CP is likely to remain useful to students for practicing interpersonal skills and contextualisation of knowledge within the broader health system. Educators should therefore carefully articulate learning objectives before choosing between SLE and CP.

Children's understanding of the selling versus persuasive intent of junk food advertising: implications for regulation.

Evidence suggests that until 8 years of age most children are cognitively incapable of appreciating the commercial purpose of television advertising and are particularly vulnerable to its persuasive techniques. After this age most children begin to describe the 'selling' intent of advertising and it is widely assumed this equips them with sufficient cognitive defences to protect against advertisers' persuasion attempts. However, much of the previous literature has been criticised for failing to differentiate between children's awareness of 'selling' versus 'persuasive' intent, the latter representing a more sophisticated understanding and superior cognitive defence. Unfortunately there is little literature to suggest at what age awareness of 'persuasive intent' emerges; our aim was to address this important issue. Children (n = 594) were recruited from each grade from Pre-primary (4-5 years) to Grade 7 (11-12 years) from ten primary schools in Perth, Western Australia and exposed to a McDonald's television advertisement. Understanding the purpose of television advertising was assessed both nonverbally (picture indication) and verbally (small discussion groups of 3-4), with particular distinction made between selling versus persuasive intent. Consistent with previous literature, a majority of children described the 'selling' intent of television advertising by 7-8 years both nonverbally and verbally, increasing to 90% by 11-12 years. Awareness of 'persuasive' intent emerged slowly as a function of age but even by our oldest age-group was only 40%. Vulnerability to television advertising may persist until children are far older than previously thought. These findings have important implications regarding the debate surrounding regulation of junk food (and other) advertising aimed at children.