14 results
12 - Plea Bargaining
- from Part II - Pretrial Phase Decision-Making
- Edited by Monica K. Miller, University of Nevada, Reno, Logan A. Yelderman, Prairie View A & M University, Texas, Matthew T. Huss, Creighton University, Omaha, Jason A. Cantone, George Mason University, Virginia
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- Book:
- The Cambridge Handbook of Psychology and Legal Decision-Making
- Published online:
- 22 February 2024
- Print publication:
- 29 February 2024, pp 178-192
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Summary
Plea bargaining does not occur in a vacuum. There are several actors (e.g., prosecutors, defense attorneys, defendants) directly involved with plea negotiations and plea decisions. As approximately 95 percent of state and federal convictions result from guilty pleas, the decision-making process that defendants and other actors undergo during plea negotiations is important to understand. This chapter will address the unique and overlapping theoretical, practical, cognitive, and social influence factors that underlie the plea negotiation process and ultimate plea decision. Specifically, this chapter will focus on negotiations – particularly how attorneys approach negotiation ideologically and practically – and the power dynamics present when two or more actors attempt to influence each other. Furthermore, we will discuss the basic social (e.g., obedience to authority) and cognitive (e.g., heuristics) processes that drive defendant decision-making when interacting with prosecutors and defense attorneys. Finally, policy implications and future directions for research will be discussed throughout the chapter.
90 Feasibility of Repeated Remote Memory Assessment with Mobile Devices to Detect Subtle Cognitive Decline in Older Adults
- Lindsay R Clark, David Berron, Amanda J Peterson, Kristin Basche, Samantha Allison, Sterling C Johnson, Emrah Duzel
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 492-493
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Objective:
Frequent and remote cognitive assessment may improve sensitivity to subtle cognitive decline associated with preclinical Alzheimer’s disease (AD). The objective of this study was to evaluate the feasibility and acceptability of repeated remote memory assessment in late middle-aged and older adults.
Participants and Methods:We recruited participants from a longitudinal aging cohort to complete three medial temporal lobe-based memory paradigms (Object-In-Room Recall [ORR], Mnemonic Discrimination for Objects and Scenes [MDT-OS], Complex Scene Recognition [CSR]) using the neotiv application at repeated intervals over one year. We conducted initial telephone calls to perform screening, consent, and download instructions. Participants were assigned 24 remote sessions on a smartphone or tablet and were alerted via push notification when an assignment was ready to complete. Participants were randomly assigned to: (1) complete memory tests every other week or (2) complete memory tests for multiple days within one week every other month. Each remote session lasts approximately 10 minutes and includes one memory paradigm and brief usability/acceptability questionnaires followed by a delayed retrieval session 90 minutes later. Feasibility metrics examined included participation, retention, compliance, and usability/acceptability.
Results:Of 150 participants recruited, 113 consented and were enrolled into the study (participation rate = 75%). Current retention rate is 75%, with 85/113 currently active (n=73) or completed (n=12). Of the 85 active or completed participants, the mean age is 68.7 (range = 4882), 64% are women, 70% used a smartphone (30% tablet), 84 are cognitively unimpaired and 1 has mild cognitive impairment. The primary threat to retention was participants consenting into the study but never registering in the app or completing their first scheduled assignment. After enrollment, 130 telephone calls were made by study staff to facilitate registration into the app or to remind participants to complete tasks. 74-80% of participants completed delayed retrieval tasks within 30 minutes of push notification, but average retrieval time was 125137 minutes post-learning trials. Regarding acceptability/usability, 94% agreed the application was easy to use, 56% enjoyed completing the mobile memory tests (36% felt neutral), 40% prefer remote mobile memory tests to standard in-person paper and pencil tests, and 50% understood the test instructions. 87% felt the frequency of tests assigned was “just right” (13% “too often”) and 90% felt the test length was “just right” (7% too short, 3% too long). Participants who completed all 24 sessions to date (n=12) all endorsed being “satisfied” or “very satisfied” with the platform and visit schedule, as well as recommended continued use of this type of cognitive testing.
Conclusions:Remote memory assessment using smartphones and tablets is feasible and acceptable for cognitively unimpaired late middle-aged and older adults. Follow-up by study staff was needed to ensure adequate retention. Comprehension of instructions and compliance with completing delayed retrieval tasks within the expected timeframe was lower than expected. These feedback will be incorporated into an updated version of the app to improve compliance and retention. Longitudinal data collection is ongoing and results will be updated with a larger sample. Results will be compared across frequency schedule groups.
50 Self-Reported Everyday Cognition Scale Memory, Attention, and Spatial Navigation Subsections Demonstrated Significant, but Limited, Diagnostic Accuracy in Identifying Preclinical Alzheimer Disease
- Taylor F Levine, Samantha L Allison, Denise Head
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 257-258
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Objective:
Preclinical Alzheimer disease (AD) has been associated with subtle deficits in memory, attention, and spatial navigation (Allison et al., 2019; Aschenbrenner et al., 2015; Hedden et al., 2013). There is a need for a widely distributable screening measure for detecting preclinical AD. The goal of this study was to examine whether self- and informant-reported change in the relevant cognitive domains, measured by the Everyday Cognition Scale (ECog; Farias et al., 2008), could represent robust clinical tools sensitive to preclinical AD.
Participants and Methods:Clinically normal adults aged 56-93 (n=371) and their informants (n=366) completed memory, divided attention, and visuospatial abilities (which assesses spatial navigation) subsections of the ECog. Reliability and validity of these subsections were examined using Cronbach’s alpha and confirmatory factor analyses (CFA). The hypothesized CFA assumed a three-factor structure with each subsection representing a separate latent construct. Receiver operating characteristics (ROC) and area under the curve (AUC) analyses were used to determine the diagnostic accuracy of the ECog subsections in detecting preclinical AD, either defined by cerebrospinal fluid (CSF) ptau181/Aß42 ratio >0.0198 or hippocampal volume in the bottom tertial of the sample. Hierarchical linear regression was used to examine whether ECog subsections predicted continuous AD biomarker burden when controlling for depressive symptomatology, which has been previously associated with subjective cognition (Zlatar et al., 2018). Lastly, we compared the diagnostic accuracy of ECog subsections and neuropsychological composites assessing the same or similar cognitive domains (memory, executive function, and visuospatial ability) in identifying preclinical AD.
Results:All self- and informant-reported subsections demonstrated appropriate reliability (a range=.71-.89). The three-factor CFA models were an adequate fit to the data and were significantly better than one-factor models (self-report x2(3)=129.511, p<.001; informant-report X2(3)=145.347, p<.001), suggesting that the subsections measured distinct constructs. Self-reported memory (AUC=.582, p=.007) and attention (AUC=.564, p=.036) were significant predictors of preclinical AD defined by CSF ptau181/Aß42 ratio. Self-reported spatial navigation (AUC=.592, p=.022) was a significant predictor of preclinical AD defined by hippocampal volume. Additionally, self-reported attention was a significant predictor of the CSF ptau181/Aß42 ratio (p<.001) and self-reported memory was a significant predictor of hippocampal volume (p=.024) when controlling for depressive symptoms. Informant-reports were not significant predictors of preclinical AD (all ps>.074).
There was a nonsignificant trend for the objectively measured executive function AUC to be higher than for self-reported attention in detecting preclinical AD defined by CSF ptau181/Aß42 ratio and was significantly higher than self-reported attention in detecting preclinical AD defined by hippocampal volume (p=.084 and p<.001, respectively). For memory and spatial navigation/visuospatial domains, the AUCs for self-reported and objective measures did not differ in detecting preclinical AD defined by either CSF ptau181/Aß42 ratio or hippocampal volume (ps>.129).
Conclusions:Although the self-reported subsections produced significant AUCs, these were not high enough to indicate clinical utility based on existing recommendations (all AUCs<.60; Mandrekar, 2010). Nonetheless, there was evidence that self-reported cognitive change has promise as a screening tool for preclinical AD but there is a need to develop questionnaires with greater sensitivity to subtle cognitive change associated with preclinical AD.
Alzheimer disease biomarkers are associated with decline in subjective memory, attention, and spatial navigation ability in clinically normal adults
- Taylor F. Levine, Steven J. Dessenberger, Samantha L. Allison, Denise Head, the Alzheimer’s Disease Neuroimaging Initiative
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- Journal:
- Journal of the International Neuropsychological Society / Volume 30 / Issue 4 / May 2024
- Published online by Cambridge University Press:
- 28 November 2023, pp. 313-327
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Objective:
Subtle changes in memory, attention, and spatial navigation abilities have been associated with preclinical Alzheimer disease (AD). The current study examined whether baseline AD biomarkers are associated with self- and informant-reported decline in memory, attention, and spatial navigation.
Method:Clinically normal (Clinical Dementia Rating Scale (CDR®) = 0) adults aged 56–93 (N = 320) and their informants completed the memory, divided attention, and visuospatial abilities (which assesses spatial navigation) subsections of the Everyday Cognition Scale (ECog) annually for an average of 4 years. Biomarker data was collected within (±) 2 years of baseline (i.e., cerebrospinal fluid (CSF) p-tau181/Aβ42 ratio and hippocampal volume). Clinical progression was defined as CDR > 0 at time of final available ECog.
Results:Self- and informant-reported memory, attention, and spatial navigation significantly declined over time (ps < .001). Baseline AD biomarkers were significantly associated with self- and informant-reported decline in cognitive ability (ps < .030), with the exception of p-tau181/Aβ42 ratio and self-reported attention (p = .364). Clinical progression did not significantly moderate the relationship between AD biomarkers and decline in self- or informant-reported cognitive ability (ps > .062). Post-hoc analyses indicated that biomarker burden was also associated with self- and informant-reported decline in total ECog (ps < .002), and again clinical progression did not significantly moderate these relationships (ps > .299).
Conclusions:AD biomarkers at baseline may indicate risk of decline in self- and informant-reported change in memory, attention, and spatial navigation ability. As such, subjectively reported decline in these domains may have clinical utility in tracking the subtle cognitive changes associated with the earliest stages of AD.
Learning in real world practice: Identifying implementation strategies to integrate health-related social needs screening within a large health system
- Kevin Fiori, Samantha Levano, Jessica Haughton, Renee Whiskey-LaLanne, Andrew Telzak, Sybil Hodgson, Elizabeth Spurrell-Huss, Allison Stark
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- Journal:
- Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 16 October 2023, e229
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Introduction:
Health systems have many incentives to screen patients for health-related social needs (HRSNs) due to growing evidence that social determinants of health impact outcomes and a new regulatory context that requires health equity measures. This study describes the experience of one large urban health system in scaling HRSN screening by implementing improvement strategies over five years, from 2018 to 2023.
Methods:In 2018, the health system adapted a 10-item HRSN screening tool from a widely used, validated instrument. Implementation strategies aimed to foster screening were retrospectively reviewed and categorized according to the Expert Recommendations for Implementing Change (ERIC) study. Statistical process control methods were utilized to determine whether implementation strategies contributed to improvements in HRSN screening activities.
Results:There were 280,757 HRSN screens administered across 311 clinical teams in the health system between April 2018 and March 2023. Implementation strategies linked to increased screening included integrating screening within an online patient portal (ERIC strategy: involve patients/consumers and family members), expansion to discrete clinical teams (ERIC strategy: change service sites), providing data feedback loops (ERIC strategy: facilitate relay of clinical data to providers), and deploying Community Health Workers to address HRSNs (ERIC strategy: create new clinical teams).
Conclusion:Implementation strategies designed to promote efficiency, foster universal screening, link patients to resources, and provide clinical teams with an easy-to-integrate tool appear to have the greatest impact on HRSN screening uptake. Sustained increases in screening demonstrate the cumulative effects of implementation strategies and the health system’s commitment toward universal screening.
Cortical paired associative stimulation shows impaired plasticity of inhibition networks as a function of chronic alcohol use
- Samantha N. Sallie, Saurabh Sonkusare, Alekhya Mandali, Violeta Casero, Hailun Cui, Natalie V. Guzman, Michael Allison, Valerie Voon
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- Journal:
- Psychological Medicine / Volume 54 / Issue 4 / March 2024
- Published online by Cambridge University Press:
- 15 September 2023, pp. 698-709
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Background
Response inhibition − or the ability to withhold a suboptimal response − relies on the efficacy of fronto-striatal networks, and is impaired in neuropsychiatric disorders including addiction. Cortical paired associative stimulation (cPAS) is a form of transcranial magnetic stimulation (TMS) which can strengthen neuronal connections via spike-timing-dependent plasticity mechanisms. Here, we used cPAS targeting the fronto-striatal inhibitory network to modulate performance on a response inhibition measure in chronic alcohol use.
MethodsFifty-five participants (20 patients with a formal alcohol use disorder (AUD) diagnosis (26–74 years, 6[30%] females) and 20 matched healthy controls (HCs) (27–73 years, 6[30%] females) within a larger sample of 35 HCs (23–84 years, 11[31.4%] females) underwent two randomized sessions of cPAS 1-week apart: right inferior frontal cortex stimulation preceding right presupplementary motor area stimulation by either 4 ms (excitation condition) or 100 ms (control condition), and were subsequently administered the Stop Signal Task (SST) in both sessions.
ResultsHCs showed decreased stop signal reaction time in the excitation condition (t(19) = −3.01, p = 0.007, [CIs]:−35.6 to −6.42); this facilitatory effect was not observed for AUD (F(1,31) = 9.57, p = 0.004, CIs: −68.64 to −14.11). Individually, rates of SST improvement were substantially higher for healthy (72%) relative to AUD (13.6%) groups (OR: 2.33, p = 0.006, CIs:−3.34 to −0.55).
ConclusionIn line with previous findings, cPAS improved response inhibition in healthy adults by strengthening the fronto-striatal network through putative long-term potentiation-like plasticity mechanisms. Furthermore, we identified a possible marker of impaired cortical excitability, and, thus, diminished capacity for cPAS-induced neuroplasticity in AUD with direct implications to a disorder-relevant cognitive process.
Clinical utility of self- and informant-reported memory, attention, and spatial navigation in detecting biomarkers associated with Alzheimer disease in clinically normal adults
- Taylor F. Levine, Samantha L. Allison, Steven J. Dessenberger, Denise Head, for the Alzheimer’s Disease Neuroimaging Initiative
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- Journal:
- Journal of the International Neuropsychological Society / Volume 30 / Issue 3 / March 2024
- Published online by Cambridge University Press:
- 29 August 2023, pp. 232-243
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Objective:
Preclinical Alzheimer disease (AD) has been associated with subtle changes in memory, attention, and spatial navigation abilities. The current study examined whether self- and informant-reported domain-specific cognitive changes are sensitive to AD-associated biomarkers.
Method:Clinically normal adults aged 56–93 and their informants completed the memory, divided attention, and visuospatial abilities (which assesses spatial navigation) subsections of the Everyday Cognition Scale (ECog). Reliability and validity of these subsections were examined using Cronbach’s alpha and confirmatory factor analysis. Logistic regression was used to examine the ability of ECog subsections to predict AD-related biomarkers (cerebrospinal fluid (CSF) ptau181/Aβ42 ratio (N = 371) or hippocampal volume (N = 313)). Hierarchical logistic regression was used to examine whether the self-reported subsections continued to predict biomarkers when controlling for depressive symptomatology if available (N = 197). Additionally, logistic regression was used to examine the ability of neuropsychological composites assessing the same or similar cognitive domains as the subsections (memory, executive function, and visuospatial abilities) to predict biomarkers to allow for comparison of the predictive ability of subjective and objective measures.
Results:All subsections demonstrated appropriate reliability and validity. Self-reported memory (with outliers removed) was the only significant predictor of AD biomarker positivity (i.e., CSF ptau181/Aβ42 ratio; p = .018) but was not significant when examined in the subsample with depressive symptomatology available (p = .517). Self-reported memory (with outliers removed) was a significant predictor of CSF ptau181/Aβ42 ratio biomarker positivity when the objective memory composite was included in the model.
Conclusions:ECog subsections were not robust predictors of AD biomarker positivity.
Use of clinical pathways integrated into the electronic health record to address the coronavirus disease 2019 (COVID-19) pandemic
- Part of
- Allison H. Bartlett, Sonya Makhni, Samantha Ruokis, Mary Kate Selling, Lauren Hall, Craig A. Umscheid, Cheng-Kai Kao
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 2 / February 2023
- Published online by Cambridge University Press:
- 22 March 2022, pp. 260-267
- Print publication:
- February 2023
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Background:
The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)–integrated clinical pathways (E-ICPs), which are easily understood care algorithms accessible at the point of care.
Objective:To describe our institution’s creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools.
Setting:Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices.
Methods:Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19–specific E-ICPs along with a process for frequent reassessment and updating. We examined the development and use of our COVID-19–specific pathways for a 6-month period (March 1–September 1, 2020), and we have described their impact using case studies.
Results:In total, 45 COVID-19–specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions, and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders were placed. Case studies demonstrate the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting.
Conclusions:E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and they continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and nonurgent clinical conditions.
Characterizing the Effects of Sex, APOE ɛ4, and Literacy on Mid-life Cognitive Trajectories: Application of Information-Theoretic Model Averaging and Multi-model Inference Techniques to the Wisconsin Registry for Alzheimer’s Prevention Study
- Rebecca L. Koscik, Derek L. Norton, Samantha L. Allison, Erin M. Jonaitis, Lindsay R. Clark, Kimberly D. Mueller, Bruce P. Hermann, Corinne D. Engelman, Carey E. Gleason, Mark A. Sager, Richard J. Chappell, Sterling C. Johnson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 25 / Issue 2 / February 2019
- Published online by Cambridge University Press:
- 07 December 2018, pp. 119-133
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Objectives: Prior research has identified numerous genetic (including sex), education, health, and lifestyle factors that predict cognitive decline. Traditional model selection approaches (e.g., backward or stepwise selection) attempt to find one model that best fits the observed data, risking interpretations that only the selected predictors are important. In reality, several predictor combinations may fit similarly well but result in different conclusions (e.g., about size and significance of parameter estimates). In this study, we describe an alternative method, Information-Theoretic (IT) model averaging, and apply it to characterize a set of complex interactions in a longitudinal study on cognitive decline. Methods: Here, we used longitudinal cognitive data from 1256 late–middle aged adults from the Wisconsin Registry for Alzheimer’s Prevention study to examine the effects of sex, apolipoprotein E (APOE) ɛ4 allele (non-modifiable factors), and literacy achievement (modifiable) on cognitive decline. For each outcome, we applied IT model averaging to a set of models with different combinations of interactions among sex, APOE, literacy, and age. Results: For a list-learning test, model-averaged results showed better performance for women versus men, with faster decline among men; increased literacy was associated with better performance, particularly among men. APOE had less of an association with cognitive performance in this age range (∼40–70 years). Conclusions: These results illustrate the utility of the IT approach and point to literacy as a potential modifier of cognitive decline. Whether the protective effect of literacy is due to educational attainment or intrinsic verbal intellectual ability is the topic of ongoing work. (JINS, 2019, 25, 119–133)
Longitudinal Standards for Mid-life Cognitive Performance: Identifying Abnormal Within-Person Changes in the Wisconsin Registry for Alzheimer’s Prevention
- Rebecca L. Koscik, Erin M. Jonaitis, Lindsay R. Clark, Kimberly D. Mueller, Samantha L. Allison, Carey E. Gleason, Richard J. Chappell, Bruce P. Hermann, Sterling C. Johnson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 25 / Issue 1 / January 2019
- Published online by Cambridge University Press:
- 28 November 2018, pp. 1-14
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Objectives: A major challenge in cognitive aging is differentiating preclinical disease-related cognitive decline from changes associated with normal aging. Neuropsychological test authors typically publish single time-point norms, referred to here as unconditional reference values. However, detecting significant change requires longitudinal, or conditional reference values, created by modeling cognition as a function of prior performance. Our objectives were to create, depict, and examine preliminary validity of unconditional and conditional reference values for ages 40–75 years on neuropsychological tests. Method: We used quantile regression to create growth-curve–like models of performance on tests of memory and executive function using participants from the Wisconsin Registry for Alzheimer’s Prevention. Unconditional and conditional models accounted for age, sex, education, and verbal ability/literacy; conditional models also included past performance on and number of prior exposures to the test. Models were then used to estimate individuals’ unconditional and conditional percentile ranks for each test. We examined how low performance on each test (operationalized as <7th percentile) related to consensus-conference–determined cognitive statuses and subjective impairment. Results: Participants with low performance were more likely to receive an abnormal cognitive diagnosis at the current visit (but not later visits). Low performance was also linked to subjective and informant reports of worsening memory function. Conclusions: The percentile-based methods and single-test results described here show potential for detecting troublesome within-person cognitive change. Development of reference values for additional cognitive measures, investigation of alternative thresholds for abnormality (including multi-test criteria), and validation in samples with more clinical endpoints are needed. (JINS, 2019, 25, 1–14)
Implementation of parental feeding practices: does parenting style matter?
- Allison Kiefner-Burmeister, Debra Hoffmann, Samantha Zbur, Dara Musher-Eizenman
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- Journal:
- Public Health Nutrition / Volume 19 / Issue 13 / September 2016
- Published online by Cambridge University Press:
- 15 March 2016, pp. 2410-2414
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Objectives
To combat childhood obesity, researchers have focused on parental feeding practices that promote child health. The current study investigated how parenting style relates to twelve parental feeding practices.
DesignData on parenting style and parental feeding practices were obtained for a correlational study from users of Amazon’s Mechanical Turk, an online survey system.
SettingUSA.
SubjectsMothers of children aged 7–11 years (n 193).
ResultsParenting style related differentially to eleven out of the twelve measured practices. Authoritative mothers displayed more feeding practices that promote child health and fewer practices that impede child health. Authoritarian and permissive mothers displayed more unhealthy practices than authoritative mothers, but differed from each other on the practices they employed.
ConclusionsParenting style may relate to more aspects of feeding than previously realized. The inclusion of numerous healthy feeding practices along with unhealthy practices in the current study provides suggestions for the application of healthy feeding behaviours. Instruction on feeding behaviours and parenting style should be a focus of future educational programmes.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. 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Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Contributors
- Edited by Joan Cangiarella, New York University School of Medicine, Aylin Simsir, New York University School of Medicine, Sana O. Tabbara
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- Breast Cytohistology
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- 05 June 2016
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- 05 August 2013, pp vi-vi
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Focus Group Study of Hand Hygiene Practice among Healthcare Workers in a Teaching Hospital in Toronto, Canada
- Ti-Hyun Jang, Samantha Wu, Debra Kirzner, Christine Moore, Gomana Youssef, Agnes Tong, Jenny Lourenco, Robyn B. Stewart, Liz J. McCreight, Karen Green, Allison McGeer
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- Infection Control & Hospital Epidemiology / Volume 31 / Issue 2 / February 2010
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- 02 January 2015, pp. 144-150
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- February 2010
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Objective.
To understand the behavioral determinants of hand hygiene in our hospital.
Design.Qualitative study based on 17 focus groups.
Setting.Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto.
Participants.We recruited 153 healthcare workers (HCWs) representing all major patient care job categories.
Methods.Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators.
Results.Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self-protection as the primary reason for the performance of hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection. Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs' adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such.
Conclusions.Our results confirm previous findings that hand hygiene is practiced for personal protection, that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing contaminated hospital equipment may improve compliance.