Origins and development of representational systems in early childhood

It is argued in Chapters 1 to 4 that in cognitive psychology in general, and in the disciplines of language acquisition and cognitive development in particular, there is substantial benefit to be derived from distinguishing between two representational systems, one system being deployed in long-established or highly-practiced functions, and the second deployed in novel tasks, or where difficulties interrupt the first system. It is also argued that the proper subject of cognitive development is the second of these systems. Chapters 5 and 6 are concerned in different ways with the origins of language in the individual, in particular with the question of what innate knowledge of language might be justified. It is concluded that many questions regarding innate knowledge remain open, and that a source in human evolution for knowledge of language is no more likely than sources in individual or social development. In Chapter 7 it is argued that representational drawing emerges late in the 4th year of life, and some new techniques are described for studying early representational drawing. Following these treatments of external systems of representation, Chapter 8 offers a general developmental theory of forms of representation, extending Piaget's insight that mental representation is co-extensive with thought, and that the main axis of cognitive development is the content of thought and representation. Chapters 9 to 12 apply this theory to the representation of belief and desire, and of extrinsic and intrinsic qualities of objects, by 11/2 to 4 year-old children. Chapter 13 introduces a new method for analyzing the free classification task, a task sometimes used to assess children's ability to think about intrinsic qualities, and applies this method to various data sets. Chapter 14 applies these insights and results to the problem of characterizing concepts and concept development and favourably discusses the idea that more precise knowledge of this aspect of development may help to explain certain features of early language acquisition

Inhibitory control and children's mathematical ability

Following recent research linking executive functioning to children 's skills, this thesis explores the relationship between children's inhibition effciency and mathematical ability. This relationship was initially explored using six Stroop task variants containing verbal, numerical or pictorial stimuli. The results indicated that, in the numerical variants only, children of lower mathematical abilty possess less effcient inhibition mechanisms, compared to children of higher mathematical ability. Thus, it is proposed that low-abilty mathematicians may possess a domain-specifc problem with the inhibition of numerical information. The increased interference scores of the lowability mathematicians, however, were only evident under those conditions which also required a degree of switching between temporary strategies. A series of experiments also examined children's ability to inhibit prepotent responses and switch between strategies whilst performing mental arithmetic. The aim of these experiments was to provide a more naturalistic and appropriate exploration of the hypothesized relationship between mathematical abilty and inhibition effciency. These results also indicated that low-ability mathematicians possess fewer executive resources to cope with increased inhibition demands. A further systematic manipulation of switching and inhibition demands revealed that the low-abilty mathematicians experienced a particular difculty when both types of inhibitory demands (i.e. inhibiting a prepotent response and inhibiting an established strategy)were present. This suggests that their reduction in inhibition effciency stems from the amount of demands, rather than the type of demands placed on the executive system. Furthermore, the results indicated that inhibition effciency may be a specifc element of mathematical ability rather than an element of intellectual ability in general. The final study involved a group of low-abilty mathematicians and examined the disturbing impact of irrelevant information on their arithmetic word problem solving abilty. This study revealed that irrelevant numerical (IN) information has a more detrimental impact on performance than irrelevant verbal (IV) information. It is proposed that it is more difcult to inhibit IN information, as it appears more relevant to intentions, and thus, enters WM with a higher level of activations. In sum, the results indicate that low-abilty mathematicians have a reduced domainspecific working memory capacity, characterized by ineffcient inhibition mechanisms.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Young children’s understanding of line of sight

Previous research into children’s understanding of line of sight has led to differing conclusions as to when and how children become able to appreciate that their view of an object will be different from another persons’ view of the same object. This is probably due to the diversity of response methods required from the children as well as different types of tasks and settings being used between the experiments. The aim of the present thesis is to investigate systematically how children will fare across various settings and whether their comprehension of line of sight can be biased by the task’s setting. The first experiment assessed children’s understanding of line of sight through a tube that was bent to varying degrees of curvature and whether their response pattern would change when feedback was provided. Results showed that children have great difficulty performing correctly on this task, especially when the degree of curvature is small. The older children corrected their response pattern when feedback was provided but the younger children tended to persevere in their response pattern regardless of contradictory feedback. The second experiment looked at children’s performance when walls were used - half the walls were smooth gradual curves while the other half was walls made up of two segments that met to form an angle. Again the children were asked to predict if two dolls placed at opposite ends of each wall would be able to see each other. Results showed that though even young children have no trouble in performing correctly on the “angled” walls, performance on the curved walls was significantly poorer with the older children performing better than the younger children. The third experiment sought to quantify the point at which children deemed line of sight became possible. To do this we used a single “U” shaped trench with the children being asked if one doll could see another in various configurations. The results showed a strong bias towards over estimating visibility. The fourth experiment repeated the second experiment but used wooden trenches instead of walls but also sought to quantify the “switchover” point at which the children deem vision becomes possible between the two dolls. The difference between angles and curves was once again replicated as was the age difference. The fifth experiment compared children’s appreciation of line of sight through/along tubes, trenches and walls. This performance level varied strongly depending on the type of task the child was asked to perform upon with the tube proving to be the most difficult and the angled trench the easiest. The overall findings of the experiment pointed to a context-dependent performance, implying a piece-meal development of childrens’ comprehension of line of sight.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A case-controlled study of relatives’ complaints concerning patients who died in hospital: the role of treatment escalation / limitation planning

Objectives To independently assess quality of care among patients who died in hospital and whose next-of-kin submitted a letter of complaint and make comparisons with matched controls. To identify whether use of a treatment escalation limitation plan (TELP) during the terminal illness was a relevant background factor. Design The study was an investigator-blinded retrospective case-note review of 42 complaints cases and 72 controls matched for age, sex, ward location and time of death. Setting The acute medical and surgical wards of three District General Hospitals administered by NHS Lanarkshire, Scotland. Participants None. Intervention None. Outcome measures Quality of care: Clinical ‘problems’, non-beneficial interventions (NBIs) and harms were evaluated using the Structured Judgment Review Method. Complaints were categorized using the Healthcare Complaints Analysis Tool. Results The event frequencies and rate ratios for clinical ‘problems’, NBIs and harms were consistently higher in complaint cases compared to controls. The difference was only significant for NBIs (P = 0.05). TELPs were used less frequently in complaint cases compared to controls (23.8 versus 47.2%, P = 0.013). The relationship between TELP use and the three key clinical outcomes was nonsignificant. Conclusions Care delivered to patients at end-of-life whose next-of-kin submitted a complaint was poorer overall than among control patients when assessed independently by blinded reviewers. Regular use of a TELP in acute clinical settings has the potential to influence complaints relating to end-of-life care, but this requires further prospective study

Quantifying the extent to which index event biases influence large genetic association studies

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.As genetic association studies increase in size to 100,000s of individuals, subtle biases may influence conclusions. One possible bias is "index event bias" (IEB) that appears due to the stratification by, or enrichment for, disease status when testing associations between genetic variants and a disease-associated trait. We aimed to test the extent to which IEB influences some known trait associations in a range of study designs and provide a statistical framework for assessing future associations. Analysing data from 113,203 non-diabetic UK Biobank participants, we observed three (near TCF7L2, CDKN2AB and CDKAL1) overestimated (BMI-decreasing) and one (near MTNR1B) underestimated (BMI-increasing) associations among 11 type 2 diabetes risk alleles (at P  500,000 if the prevalence of those diseases differs by > 10% from the background population. In conclusion, IEB may result in false positive or negative genetic associations in very large studies stratified or strongly enriched for/against disease cases.H.Y., A.R.W. and T.M.F. are supported by the European Research Council grant: 323195; SZ-245 50371-GLUCOSEGENES-FP7-IDEAS-ERC. S.E.J. is funded by the Medical Research Council (grant: MR/M005070/1). M.A.T., M.N.W. and A.M. are supported by the Wellcome Trust Institutional Strategic Support Award (WT097835MF). R.M.F. is a Sir Henry Dale Fellow (Wellcome Trust and Royal Society grant: 104150/Z/14/Z). R.B. is funded by the Wellcome Trust and Royal Society grant: 104150/Z/14/Z. J.T. is funded by a Diabetes Research and Wellness Foundation Fellowship. Z.K. received financial support from the Leenaards Foundation, the Swiss Institute of Bioinformatics and the Swiss National Science Foundation (31003A-143914) and SystemsX.ch (39). The work of M.P.B was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award no. T32HL007779. Generation Scotland received core support from the Chief Scientist Office of the Scottish Government Health Directorates [CZD/16/6] and the Scottish Funding Council [HR03006]. E.R.P. holds a WT New investigator award 102820/Z/13/Z

Genetic Evidence for a Link Between Favorable Adiposity and Lower Risk of Type 2 Diabetes, Hypertension, and Heart Disease.

Recent genetic studies have identified some alleles that are associated with higher BMI but lower risk of type 2 diabetes, hypertension, and heart disease. These "favorable adiposity" alleles are collectively associated with lower insulin levels and higher subcutaneous-to-visceral adipose tissue ratio and may protect from disease through higher adipose storage capacity. We aimed to use data from 164,609 individuals from the UK Biobank and five other studies to replicate associations between a genetic score of 11 favorable adiposity variants and adiposity and risk of disease, to test for interactions between BMI and favorable adiposity genetics, and to test effects separately in men and women. In the UK Biobank, the 50% of individuals carrying the most favorable adiposity alleles had higher BMIs (0.120 kg/m(2) [95% CI 0.066, 0.174]; P = 1E-5) and higher body fat percentage (0.301% [0.230, 0.372]; P = 1E-16) compared with the 50% of individuals carrying the fewest alleles. For a given BMI, the 50% of individuals carrying the most favorable adiposity alleles were at lower risk of type 2 diabetes (odds ratio [OR] 0.837 [0.784, 0.894]; P = 1E-7), hypertension (OR 0.935 [0.911, 0.958]; P = 1E-7), and heart disease (OR 0.921 [0.872, 0.973]; P = 0.003) and had lower blood pressure (systolic -0.859 mmHg [-1.099, -0.618]; P = 3E-12 and diastolic -0.394 mmHg [-0.534, -0.254]; P = 4E-8). In women, these associations could be explained by the observation that the alleles associated with higher BMI but lower risk of disease were also associated with a favorable body fat distribution, with a lower waist-to-hip ratio (-0.004 cm [95% CI -0.005, -0.003] 50% vs. 50%; P = 3E-14), but in men, the favorable adiposity alleles were associated with higher waist circumference (0.454 cm [0.267, 0.641] 50% vs. 50%; P = 2E-6) and higher waist-to-hip ratio (0.0013 [0.0003, 0.0024] 50% vs. 50%; P = 0.01). Results were strengthened when a meta-analysis with five additional studies was conducted. There was no evidence of interaction between a genetic score consisting of known BMI variants and the favorable adiposity genetic score. In conclusion, different molecular mechanisms that lead to higher body fat percentage (with greater subcutaneous storage capacity) can have different impacts on cardiometabolic disease risk. Although higher BMI is associated with higher risk of diseases, better fat storage capacity could reduce the risk.This is the author accepted manuscript. The final version is available from the American Diabetes Association via http://dx.doi.org/10.2337/db15-167

Examining sustainability in a hospital setting: Case of smoking cessation

<p>Abstract</p> <p>Background</p> <p>The Ottawa Model of Smoking Cessation (OMSC) is a hospital-based smoking cessation program that is expanding across Canada. While the short-term effectiveness of hospital cessation programs has been documented, less is known about long-term sustainability. The purpose of this exploratory study was to understand how hospitals using the OMSC were addressing sustainability and determine if there were critical factors or issues that should be addressed as the program expanded.</p> <p>Methods</p> <p>Six hospitals that differed on OMSC program activities (identify and document smokers, advise quitting, provide medication, and offer follow-up) were intentionally selected, and two key informants per hospital were interviewed using a semi-structured interview guide. Key informants were asked to reflect on the initial decision to implement the OMSC, the current implementation process, and perceived sustainability of the program. Qualitative analysis of the interview transcripts was conducted and themes related to problem definition, stakeholder influence, and program features emerged.</p> <p>Results</p> <p>Sustainability was operationalized as higher performance of OMSC activities than at baseline. Factors identified in the literature as important for sustainability, such as program design, differences in implementation, organizational characteristics, and the community environment did not explain differences in program sustainability. Instead, key informants identified factors that reflected the interaction between how the health problem was defined by stakeholders, how priorities and concerns were addressed, features of the program itself, and fit within the hospital context and resources as being influential to the sustainability of the program.</p> <p>Conclusions</p> <p>Applying a sustainability model to a hospital smoking cessation program allowed for an examination of how decisions made during implementation may impact sustainability. Examining these factors during implementation may provide insight into issues affecting program sustainability, and foster development of a sustainability plan. Based on this study, we suggest that sustainability plans should focus on enhancing interactions between the health problem, program features, and stakeholder influence.</p