The Large Allen Cognitive Level Screen as an indicator for medication adherence among adults accessing community mental health services

Background: Medication remains the cornerstone treatment for mental illness. Cognition is one of the strongest predictors of non-adherence. The aim of this preliminary investigation was to examine the association between the Large Allen Cognitive Level Screen (LACLS) and medication adherence among a small sample of mental health service users to determine whether the LACLS has potential as a screening tool for capacity to manage medication regimens. Method: Demographic and clinical information was collected from a small sample of people who had recently accessed community mental health services. Participants then completed the LACLS and the Medication Adherence Rating Scale (MARS) at a single time point. The strength of association between the LACLS and MARS was examined using Spearman rank-order correlation. Results: A strong positive correlation between the LACLS and medication adherence (r = 0.71, p = 0.01) was evident. No participants reported the use of medication aids despite evidence of impaired cognitive functioning. Conclusion: This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. While promising, this finding should be interpreted with caveats given its preliminary nature.

Residential dissonance and mode choice

Residential dissonance refers to the mismatch in land-use patterns between individuals’ preferred residential neighbourhood type and the type of neighbourhood in which they currently reside. Current knowledge regarding the impact of residential dissonance is limited to short-term travel behaviours in urban vs. suburban, and rural vs. urban areas. Although the prevailing view is that dissonants adjust their orientation and lifestyle around their surrounding land use over time, empirical evidence is lacking to support this proposition. This research identifies both short-term mode choice behaviour and medium-term mode shift behaviour of dissonants in transit oriented development (TODs) vs. non-TOD areas in Brisbane, Australia. Natural groupings of neighbourhood profiles (e.g. residential density, land use diversity, intersection density, cul-de-sac density, and public transport accessibility levels) of 3957 individuals were identified as living either in a TOD (510 individuals) or non-TOD (3447 individuals) areas in Brisbane using the TwoStep cluster analysis technique. Levels of dissonance were measured based on a factor analysis of 16 items representing the travel attitudes/preferences of individuals. Two multinomial logistic (MNL) regression models were estimated to understand mode choice behaviour of (1) TOD dissonants, and (2) non-TOD dissonants in 2009, controlling for socio-demographics and environmental characteristics. Two additional MNL regression models were estimated to investigate mode shift behaviour of (3) TOD dissonants, and (4) non-TOD dissonants between 2009 and 2011, also controlling for socio-demographic, changes in socio-demographic, and built environmental factors. The findings suggest that travel preference is relatively more influential in transport mode choice decisions compared with built environment features. Little behavioural evidence was found to support the adjustment of a dissonant orientation toward a particular land use feature and mode accessibility they represent (e.g. a modal shift to greater use of the car for non-TOD dissonants). TOD policies should focus on reducing the level of dissonance in TODs in order to enhance transit ridership.

Performance of a cognitive, but not visual, secondary task interacts with alcohol-induced balance impairment in novice and experienced motorcycle riders

The appropriateness of applying drink driving legislation to motorcycle riding has been questioned as there may be fundamental differences in the effects of alcohol on driving and motorcycling. It has been suggested that alcohol may redirect riders’ focus from higher-order cognitive skills such as cornering, judgement and hazard perception, to more physical skills such as maintaining balance. To test this hypothesis, the effects of low doses of alcohol on balance ability were investigated in a laboratory setting. The static balance of twenty experienced and twenty novice riders was measured while they performed either no secondary task, a visual (search) task, or a cognitive (arithmetic) task following the administration of alcohol (0%, 0.02%, and 0.05% BAC). Subjective ratings of intoxication and balance impairment increased in a dose-dependent manner in both novice and experienced motorcycle riders, while a BAC of 0.05%, but not 0.02%, was associated with impairments in static balance ability. This balance impairment was exacerbated when riders performed a cognitive, but not a visual, secondary task. Likewise, 0.05% BAC was associated with impairments in novice and experienced riders’ performance of a cognitive, but not a visual, secondary task, suggesting that interactive processes underlie balance and cognitive task performance. There were no observed differences between novice vs. experienced riders on static balance and secondary task performance, either alone or in combination. Implications for road safety and future ‘drink riding’ policy considerations are discussed.

Complex cognitive interactions in a badly designed world : Investigating the underlying causes of collisions between distinct road users

Collisions between distinct road users (e.g. drivers and riders, drivers and cyclists) make a substantial contribution to the road trauma burden. Although evidence suggests different road users interpret the same road situations contrarily, it is not clear how their situation awareness differs, nor is it clear which differences might lead to conflicts. This article presents the findings from an on-road study which was conducted to examine driver, cyclist and motorcyclist situation awareness in different road environments. The findings suggest that drivers, motorcyclists, and cyclists develop markedly different situational understandings even when operating in the same road environments. Examination of these differences indicate that they are likely to be compatible along arterial roads, shopping strips and at roundabouts, but that they may create conflicts between the different road users at intersections. The key role of road design in supporting compatible situation awareness and behaviour across different road users is discussed.

Motivation during videogame play : analysing player experience in terms of cognitive action

This paper describes a method for analysing videogames based on game activities. It examines the impact of these activities on the player experience. The research approach applies heuristic checklists that deconstruct games in terms of cognitive processes that players engage in during gameplay (e.g., addressing goals, interpreting feedback). For this study we examined three puzzle games, Portal 2, I-Fluid and Braid. The Player Experience of Need Satisfaction (PENS) survey is used to measure player experience following gameplay. Cognitive action provided within games is examined in light of reported player experiences to determine the extent to which these activities influence players’ feelings of competence, autonomy, intuitive control and presence. Findings indicate that the positive experiences are directly influenced by game activity design. Our study also demonstrates the value of expert review in deconstructing gameplay activity as a means of providing direction for game design that enhances the player experience.

Towards modelling web search behaviour : integrating users’ cognitive styles

With the rapid growth of information on the Web, the study of information searching has let to an increased interest. Information behaviour (IB) researchers and information systems (IS) developers are continuously exploring user - Web search interactions to understand and to help users to provide assistance with their information searching. In attempting to develop models of IB, several studies have identified various factors that govern user's information searching and information retrieval (IR), such as age, gender, prior knowledge and task complexity. However, how users' contextual factors, such as cognitive styles, affect Web search interactions has not been clearly explained by the current models of Web Searching and IR. This study explores the influence of users' cognitive styles on their Web search behaviour. The main goal of the study is to enhance Web search models with a better understanding of how these cognitive styles affect Web searching. Modelling Web search behaviour with a greater understanding of user's cognitive styles can help information science researchers and IS designers to bridge the semantic gap between the user and the IS. To achieve the aims of the study, a user study with 50 participants was conducted. The study adopted a mixed method approach incorporating several data collection strategies to gather a range of qualitative and quantitative data. The study utilised pre-search and post-search questionnaires to collect the participants' demographic information and their level of satisfaction about the search interactions. Riding's (1991) Cognitive Style Analysis (CSA) test was used to assess the participants' cognitive styles. Participants completed three predesigned search tasks and the whole user - web search interactions, including thinkaloud, were captured using a monitoring program. Data analysis involved several qualitative and quantitative techniques: the quantitative data gave raise to detailed findings about users' Web searching and cognitive styles, the qualitative data enriched the findings with illustrative examples. The study results provide valuable insights into Web searching behaviour among different cognitive style users. The findings of the study extend our understanding of Web search behaviour and how users search information on the Web. Three key study findings emerged: • Users' Web search behaviour was demonstrated through information searching strategies, Web navigation styles, query reformulation behaviour and information processing approaches while performing Web searches. The manner in which these Web search patterns were demonstrated varied among the users with different cognitive style groups. • Users' cognitive styles influenced their information searching strategies, query reformulation behaviour, Web navigational styles and information processing approaches. Users with particular cognitive styles followed certain Web search patterns. • Fundamental relationships were evident between users' cognitive styles and their Web search behaviours; and these relationships can be illustrated through modelling Web search behaviour. Two models that depict the associations between Web search interactions, user characteristics and users' cognitive styles were developed. These models provide a greater understanding of Web search behaviour from the user perspective, particularly how users' cognitive styles influence their Web search behaviour. The significance of this research is twofold: it will provide insights for information science researchers, information system designers, academics, educators, trainers and librarians who want to better understand how users with different cognitive styles perform information searching on the Web; at the same time, it will provide assistance and support to the users. The major outcomes of this study are 1) a comprehensive analysis of how users search the Web; 2) extensive discussion on the implications of the models developed in this study for future work; and 3) a theoretical framework to bridge high-level search models and cognitive models.

The impact of a social-cognitive teaching strategy on students with learning difficulties

This study examined the impact of a social-cognitive teaching strategy, the community of inquiry, on the functioning of six Year 4 students with learning difficulties. Results indicated that the students became more self-regulated in their learning and developed greater academic self-efficacy and stronger reading comprehension skills. Although the degree of development varied across the group, the results indicated that all six students (in addition to their class peers) benefited from actively engaging in scaffolded opportunities for intellectual and social exchange in a whole class setting. Accordingly, the findings of this study have implications for approaches to supporting the development and learning of students with learning difficulties.

Evidence for the safety and quality issues associated with the care of patients with cognitive impairment in acute care settings : a rapid review

The Australian Commission on Safety and Quality in Health Care commissioned this rapid review to identify recent evidence in relation to three key questions: 1. What is the current evidence of quality and safety issues regarding the hospital experience of people with cognitive impairment (dementia/delirium)? 2. What are the existing evidence-based pathways, best practice or guidelines for cognitive impairment in hospitals? 3. What are the key components of an ideal patient journey for a person with dementia and/or delirium? The purpose of this review is to identify best practice in caring for patients with cognitive impairment (CI) in acute hospital settings. CI refers to patients with dementia and delirium but can include other conditions. For the purposes of this report, ‘Hospitals’ is defined as acute care settings and includes care provided by acute care institutions in other settings (e.g. Multipurpose Services and Hospital in the Home). It does not include residential aged care settings nor palliative care services that are not part of a service provided by an acute care institution. Method Both peer-reviewed publications and the grey literature were comprehensively searched for recent (primarily post 2010) publications, reports and guidelines that addressed the three key questions. The literature was evaluated and graded according to the National Health and Medical Research Council (NHMRC) levels of criteria (see Evidence Summary – Appendix B). Results Thirty-one recent publications were retrieved in relation to quality and safety issues faced by people with CI in acute hospitals. The results indicate that CI is a common problem in hospitals (upwards of 30% - the rate increases with increasing patient age), although this is likely to be an underestimate, in part, due to numbers of patients without a formal dementia diagnosis. There is a large body of evidence showing that patients with CI have worse outcomes than patients without CI following hospitalisation including increased mortality, more complications, longer hospital stays, increased system costs as well as functional and cognitive decline. 4 To improve the care of patients with CI in hospital, best practice guidelines have been developed, of which sixteen recent guidelines/position statements/standards were identified in this review (Table 2). Four guidelines described standards or quality indicators for providing optimal care for the older person with CI in hospital, in general, while three focused on delirium diagnosis, prevention and management. The remaining guidelines/statements focused on specific issues in relation to the care of patients with CI in acute hospitals including hydration, nutrition, wandering and care in the Emergency Department (ED). A key message in several of the guidelines was that older patients should be assessed for CI at admission and this is particularly important in the case of delirium, which can indicate an emergency, in order to implement treatment. A second clear mess...

Validation of the interRAI Cognitive Performance Scale against independent clinical diagnosis and the Mini-Mental State Examination in older hospitalized patients

Objective To compare the diagnostic accuracy of the interRAI Acute Care (AC) Cognitive Performance Scale (CPS2) and the Mini-Mental State Examination (MMSE), against independent clinical diagnosis for detecting dementia in older hospitalized patients. Design, Setting, and Participants The study was part of a prospective observational cohort study of patients aged ≥70 years admitted to four acute hospitals in Queensland, Australia, between 2008 and 2010. Recruitment was consecutive and patients expected to remain in hospital for ≥48 hours were eligible to participate. Data for 462 patients were available for this study. Measurements Trained research nurses completed comprehensive geriatric assessments and administered the interRAI AC and MMSE to patients. Two physicians independently reviewed patients’ medical records and assessments to establish the diagnosis of dementia. Indicators of diagnostic accuracy included sensitivity, specificity, predictive values, likelihood ratios and areas under receiver (AUC) operating characteristic curves. Results 85 patients (18.4%) were considered to have dementia according to independent clinical diagnosis. The sensitivity of the CPS2 [0.68 (95%CI: 0.58–0.77)] was not statistically different to the MMSE [0.75 (0.64–0.83)] in predicting physician diagnosed dementia. The AUCs for the 2 instruments were also not statistically different: CPS2 AUC = 0.83 (95%CI: 0.78–0.89) and MMSE AUC = 0.87 (95%CI: 0.83–0.91), while the CPS2 demonstrated higher specificity [0.92 95%CI: 0.89–0.95)] than the MMSE [0.82 (0.77–0.85)]. Agreement between the CPS2 and clinical diagnosis was substantial (87.4%; κ=0.61). Conclusion The CPS2 appears to be a reliable screening tool for assessing cognitive impairment in acutely unwell older hospitalized patients. These findings add to the growing body of evidence supporting the utility of the interRAI AC, within which the CPS2 is embedded. The interRAI AC offers the advantage of being able to accurately screen for both dementia and delirium without the need to use additional assessments, thus increasing assessment efficiency.

Implementing cognitive remediation therapy : lessons from two public mental health services

Objective: Neurocognitive deficits are a core symptom domain of schizophrenia, occurring in 75 -90 % of people with this diagnosis and influencing long term functional outcomes. This article aims to describe the pilot implementation of cognitive remediation therapy (CRT) in two large public mental health services and detail changes made to the delivery of this therapy after this trial. Conclusions: CRT provides an evidence based approach to targeting cognitive deficits but the translation of this therapy from a research setting to clinical practice has not been well evaluated.

Cognitive remediation : the foundation of psychosocial treatment of schizophrenia

Despite advances in psychopharmacology, schizophrenia remains a severely disabling illness. It is now appreciated that cognitive impairment mediates the functional disability associated with the disorder. Cognitive remediation which is defined as “a behavioural training based intervention that aims to improve cognitive processes (attention, memory, executive functioning, social cognition or meta cognition) with the goal of durability and generalization” is a therapeutic approach that improves cognition and when combined with other rehabilitation strategies improves real world functioning (Wykes et al., 2011).

Modeling users’ web search behavior and their cognitive styles

Previous studies have shown that users’ cognitive styles play an important role during Web searching. However, only limited studies have showed the relationship between cognitive styles and Web search behavior. Most importantly, it is not clear which components of Web search behavior are influenced by cognitive styles. This paper examines the relationships between users’ cognitive styles and their Web searching and develops a model that portrays the relationship. The study uses qualitative and quantitative analyses to inform the study results based on data gathered from 50 participants. A questionnaire was utilised to collect participants’ demographic information, and Riding’s (1991) Cognitive Style Analysis (CSA) test to assess their cognitive styles. Results show that users’ cognitive styles influenced their information searching strategies, query reformulation behaviour, Web navigational styles and information processing approaches. The user model developed in this study depicts the fundamental relationships between users’ Web search behavior and their cognitive styles. Modeling Web search behavior with a greater understanding of user’s cognitive styles can help information science researchers and information systems designers to bridge the semantic gap between the user and the systems. Implications of the research for theory and practice, and future work are discussed.

Process model comprehension : the effects of cognitive abilities, learning style, and strategy

Process models are used to convey semantics about business operations that are to be supported by an information system. A wide variety of professionals is targeted to use such models, including people who have little modeling or domain expertise. We identify important user characteristics that influence the comprehension of process models. Through a free simulation experiment, we provide evidence that selected cognitive abilities, learning style, and learning strategy influence the development of process model comprehension. These insights draw attention to the importance of research that views process model comprehension as an emergent learning process rather than as an attribute of the models as objects. Based on our findings, we identify a set of organizational intervention strategies that can lead to more successful process modeling workshops.

What is the evidence to guide best practice for the management of older people with cognitive impairment presenting to emergency departments? A systematic review

The aim of this study was to conduct a systematic literature review of research-based studies to identify practices designed to meet the specific care needs of older cognitively impaired patients in emergency departments (ED). A systematic literature review of studies was completed using PRIMSA methodology. The search criteria included articles from both emergency and acute care settings. A total of 944 articles were screened, and a total of 43 articles were identified as eligible. The review found a number of intervention studies to improve quality of care for older persons with cognitive impairment carried out or commenced in emergency settings, including interventions to improve cognitive impairment recognition (n = 9) and clinical approaches to reduce falls (n = 1) and both delirium incidence and prevalence (n = 2). Relevant studies carried out in acute care settings regarding cognitive impairment recognition (n = 4) and primary and secondary prevention of delirium (n = 18) and intervention studies that reduced the prescription of deliriogenic drugs (n = 1), reduced behavioral symptoms and discomfort (n = 7), and improved nutritional intake (n = 1) in hospitalized older persons with dementia were also identified. There is limited research available that reports interventions that improve the quality of care of older ED patients with cognitive impairment. Although this review found evidence obtained from the acute care setting, additional research is needed to identify whether these interventions are beneficial in fast-paced emergency settings.

Theorizing why in e-learning – a frontier for cognitive engagement

Asking why is an important foundation of inquiry and fundamental to the development of reasoning skills and learning. Despite this, and despite the relentless and often disruptive nature of innovations in information and communications technology (ICT), sophisticated tools that directly support this basic act of learning appear to be undeveloped, not yet recognized, or in the very early stages of development. Why is this so? To this question, there is no single satisfactory answer; instead, numerous plausible explanations and related questions arise. After learning something, however, explaining why can be revealing of a person’s understanding (or lack of it). What then differentiates explanation from information; and, explanatory from descriptive content? What ICT scaffolding might support inquiry instigated by why-questioning? What is the role of reflective practice in inquiry-based learning? These and other questions have emerged from this investigation and underscore that why-questions often propagate further questions and are a catalyst for cognitive engagement and dialogue. This paper reports on a multi-disciplinary, theoretical investigation that informs the broad discourse on e-learning and points to a specific frontier for design and development of e-learning tools. Probing why reveals that versatile and ambiguous semantics present the core challenge – asking, learning, knowing, understanding, and explaining why.