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What's new in healthcare communication?

  
  
  

Mother child waiting roomA novel coding scheme

A recent study (Zhou et al.) focuses on the development and validation of St Andrews Behavioural Interaction Coding Scheme (SABICS). SABICS deliberately aims on gathering both verbal and non-verbal behavioral data. To be able to test SABICS, video recordings were used to capture both verbal and non-verbal aspects of communication. Zhou et al. conclude that “Implemented easily on The Observer XT system, the scheme is capable of recoding and displaying complex interaction processes and demonstrates satisfactory inter- and intra-coder reliability”.

A development stage in which field observations and an extensive literature study were performed to select and define relevant behaviors provides a solid base for this coding scheme.

Zhou et al. is an Article in Press and will be assigned to an issue of the journal Patient Education and Counseling.

How to develop a coding scheme
Developing a relevant behavioral coding scheme is the first step in setting up research, meaning that researchers determine the significance of certain behaviors in contrast to other behaviors. Zhou et al. tell us that to come to effective communication in a clinical context, nurse behavior could include behaviors that reduce anxiety and bring about cooperation related behaviors in children. SABICS enables the inclusion of behaviors specific to a clinical context and communication content.

What is effective communication
Zhou et al. were primarily searching for a coding scheme that reflects focus on the dental staff’s encouragement- centered interaction approach. The scheme supports the effective communication in pediatric dentistry, and at the same time, enables inclusion of novel behavioral codes that are specific to a clinical context and communication content. Researchers looking into nurse-child interaction in elderly homes or doctor-child interaction in a hospital might also benefit from this novel coding scheme.

Focus on verbal and non-verbal behavior
Compared to RIAS (the widely used Roter Interaction Analysis System), Zhou et al. indicate that SABICS allows researchers to study the duration of the turn and that RIAS is mainly concerned with speech. Moreover, Zhou et al. point out that when working with SABICS, silences are coded and can thus be taken into account when reflecting on their roles in the interaction process. Often the importance of silences or hesitations in conversations are heavily underestimated.

SABICS deliberately focuses on both verbal and non-verbal behavior. The researchers explain that sequence and timing of behaviors can be analyzed using SABICS in combination with the video software system.

Clinician-child behavior in other clinical interventions
Zhou et al. are convinced that with minimal modifications, this coding scheme could be applied to the study of clinician-child behavior in other clinical situations.

Clinical interviews – analyzing verbal and non-verbal behavior

  
  
  

Doctor patient interactionIn general, researchers choose the methods and techniques that best suit their research objectives. That’s no different when researching doctor-patient communication or any other clinical interview setting. Some researchers use audio recordings to study verbal behavior while others try to get more insight in non-verbal behavior by recording behavior on video. Both of these techniques are aimed at studying the interaction process between clinician and patient. For each research question a different approach can be selected. Let’s have a look at two different approaches. In communication verbal and non-verbal behaviors can both be essential to understand the meaning of an utterance or statement. However, in these cases researchers have chosen to study either verbal utterances or non-verbal behavior.   

Non-verbal behavior
Montague et al. presented a study in which they analyzed non-verbal behavior in clinical interactions, specifically, looking into eye gaze behavior patterns (eye gaze behavior is considered an important aspect of doctor-patient interaction). They introduced a new method to evaluate gaze behavior patterns in doctor-patient interaction based on a lag sequential analysis for the description of eye gaze orientation between clinicians and patients. Video coding of behaviors of the clinician and the patient (using a coding scheme developed by Krippendorff, 2004) has allowed them to analyze non-verbal behavior patterns and draw conclusions: ‘the clinician’s gaze significantly affects the medical encounter but the converse is not true’ (Montague et al. 2011).

Verbal behavior
Then, Heyn et al. looked into verbal responses. A total of 193 consultations were analyzed. They made audio recordings and coded the conversations using task-focused categories of the Roter Interaction Analysis System (Roter and Larson, 2002). Heyn et al. coded the initiation of symptoms by applying criteria from the Verona coding definitions of emotional sequences (VR-CoDES, Zimmerman, 2011). As a result, they gained insight in the interaction between clinician and patient. A different kind of interaction when compared to what is presented by Montague et al. The background to Heyn et al.’s research falls back on a wish to test Choice, an interactive tailored patient assessment tool. The consultations coded in The Observer XT gave them insight in the effectiveness of Choice.

Interested? Read more about clinical communication in a free case study "Clinical communication - Using The Observer XT in physician-patient interaction".


download-a-free-case-study
  • Heyn, L.; Finset, A.; Eide, H.; Ruland, C.M. (2011). Effects of an interactive tailored patient assessment on patient-clinician communication in cancer care. Psycho-Oncology, DOI: 10.1002/pon.2064.
  • Krippendorff, K. (2004). Content analysis: An introduction to its methodology. Thousand Oaks, CA: Sage.
  • Montague, E.; Xu, J.; Chen, P.; Asan, O.; Barrett, B.P.; Chewning, B. (2011). Modeling eye gaze patterns in clinician-patient interaction with lag sequential analysis. Human Factors, 53 (5), 502-516.
  • Roter D.; Larson S. (2002). The Roter interaction analysis system (RIAS): utility and flexibility for analysis of medical interactions. Patient Education and Counseling, 46, 243–251.
  • Zimmermann C.; Del Piccolo L.; Bensing, J. et al. (2011) Coding patient cues and concerns in medical consultations: the verona coding definitions of emotional sequences (VR-CoDES). Patient Education and Counseling, 82, 141–148.

Zebrafish research: growing demands in South America

  
  
  

Zebrafish Adult

Zebrafish earning their stripes in research

Recently I wrote about the growing presence of zebrafish related studies at big international conferences, like the Society for Neuroscience annual meeting. This general infiltration of zebrafish in behavioral and biological sciences as a whole has been significant enough that the demand for specialized zebrafish meetings continues to grow. Specialized meetings have been established for years and new ones continue to surface; from the 10th zebrafish genetics and development conference, to the 13th Australia and New Zealand zebrafish meeting, the 2nd European Zebrafish PI Meeting, and now the second Latin American Zebrafish Network (LAZEN) course.

It was at the Society for Neuroscience last November that I was invited to speak at the second annual LAZEN meeting held last December in Porto Alegre, Brazil. This opportunity not only offered a chance for me to speak on zebrafish, behavioral paradigms, and my own research but also gave me a new view and appreciation for the potential of this model.

Zebrafish use in research has been growing steadily on the world-stage, but in South America in particular this growth is unprecedented. LAZEN beautifully illustrated this, with nearly 100 participants from all over the continent where most attendants were researchers with beginner or intermediate experience. To help investigators expand on their expertise with this organism, mornings were filled with practical hands-on lab sessions and afternoons were populated with traditional talks. I had the pleasure of both giving a talk and leading a morning session on behavioral paradigms. Particularly during the morning sessions participants tended to be beginners armed with questions and enthusiasm, and topics ranged from husbandry and breeding to behavior and molecular assays like DNA injections, inflammation assays, transgenesis, and in situ hybridization. After my talk some of the discussions that came up centered around practical concerns, for example how to test how much alcohol enters the bloodstream in an alcohol paradigm. A discussion about potential factors that can affect zebrafish (and experiments) came up as well, after I brought up the situations I have faced in the past. For example, issues relating to differing PH and salinity conditions, water temperature, and even air pressure: One researcher from Ecuador voiced concerns of high mortality among zebrafish and the possibility that this might have something to do with the altitude and air pressure. What made the discussions interesting was the focus on local concerns and challenges unique to research in South America. This even went beyond the practical laboratory concerns, to import policies that affect zebrafish entering South America.

Interestingly, it is shocking to see the promise zebrafish hold in behavioral research, in particular in South America: thanks to the economy of the model (maintenance costs, low start-up costs) average laboratories are able to produce world-class research. Without too large an investment small research groups are able to compete with large laboratories in quantity and quality of publications. This is of course somewhat generalized, but realistically new research groups are able to produce high quality behavioral research with a very minimal investment. Publications and growing recognition can lead to increased funding, which in turn allows these same groups to continue expanding their resources and work on increasingly high caliber projects. The meeting illustrated how work that would require a prohibitive investment using a rat-model can be done at a fraction of the cost in zebrafish. This places previously quite unknown research groups on the world stage. The result has been an increasing number of publications coming from the southern hemisphere, and it will be interesting to keep an eye on this growing body of dedicated researchers.

In short, LAZEN created a scientific program to appeal to both beginners and advanced zebrafish researchers. The organization and quality of the course far exceeded the modest cost of and makes it a ‘must-attend’ for researchers beyond just South America.

free-case-study-zebrafish-larvae-activ

3 examples of swimming rats in traumatic brain injury research (TBI)

  
  
  

Studies with EthoVision XT and the Morris water maze test

The Morris water maze test is a well validated and often used tool to investigate learning and memory in rats and mice. This blog post elaborates on three studies from The Walter Reed Army Institute of Research in Silver Spring (Maryland, USA) that use the Morris water maze in combination with automated tracking software EthoVision XT.

At the Walter Reed Army Institute, scientists investigate TBI (a leading cause of death and disability in the USA), and established the PBBI model for TBI; penetrating ballistic-like brain injury in rodents.

In Shear et al. (2010) the focus is on advancing the test platform for longitudinal research on the PBBI model. When motor, sensory, and cognitive deficits are investigated, a Morris water maze test in combination with behavioral tracking software EthoVision XT is used for the latter.

PBBI rats showed thigmotaxic swim patterns, suggesting a general incapacity to switch to a good search pattern. After re-testing, they were able to find the platform increasingly faster, but they never made it up to the level of the control group.

When pre-trained in the Morris water maze before their surgery, PBBI rats performed as well as their control group following surgery. However, they remained behind again in a spatial reversal task when the platform was moved and they needed to learn the new location. In conclusion: PBBI rats show normal memory retention, but impaired spatial learning.

In 2011 Shear et al. the same PBBI model is used to assess the sensitivity of the testing platform across a range of trauma severity levels, ranging from 5% to 12.5% of the rat brain volume. The Morris water maze - EthoVision XT solution was again used to determine cognitive impairment.

The results of this study were directly ranked by the degree of injury severity. The rats with the 12.5% injury rate showed the greatest cognitive impairment.

In 2011, the same research group (Chen et al.) also proposes a new animal model of closed-head concussive-induced mild TBI; projectile concussive impact, or PCI. Using the same set-up, spatial learning and memory were tested. One hour after the PCI procedure, rats were given 12 consecutive trials and a probe trial. No differences were found between the test group and the control group.

Additionally, sensorimotor performance was tested using CatWalk, and here PCI induced gait abnormalities at 1 to 4 hours after PCI, some of which were still detectable a day later.

Read more about the use of EthoVision XT in water maze testing in this white paper.

  download-our-free-white-paper

References

  • Shear, D.A.; Lu, X.-C.M.; Bombard, M.C.; Pederson, R.; Chen, Z.; Davis, A.; Tortella, F.C. (2010). Longitudinal characterization of motor and cognitive deficits in a model of penetrating ballistic-like brain injury. Journal of Neurotrauma, 27, 1911-1923.
  • Shear, D.A.; Lu, X.-C.M.; Pederson, R.; Wei, G.; Chen, Z.; Davis, A.; Yao, C.; Dave, J.; Tortella, F.C. (2011). Severity profile of penetrating ballistic-like brain injury on neurofunctional outcome, blood-brain barrier permeability, and brain edema formation. Journal of Neurotrauma, 28, 2185-2195.
  • Chen, Z.; Leung, L.Y.; Mountney, A.; Liao, Z.; Yang, W.; Lu, X.-C.M.; Dave, J.; Deng-Bryant, Y.; Wei, G.; Schmid, K.; Shear, D.A.; Tortella, F.C. (2011). A novel animal model of closed-head concussive-induced mild traumatic brain injury: development, implementation, and characterization. Journal of Neurotrauma, doi: 10.1089/neu.2011.2057.

Behavior research methods - Search your way to knowledge and skills

  
  
  

Search your way to knowledge and skillsThese days, researchers need to acquire their knowledge and skills with maximum effectiveness and a minimal investment of time. In an increasingly digital and inter-connected global environment, more and more people have access to knowledge via the worldwide web. In the area of methods, tools, and techniques for behavioral research, a few examples of online resource lists are:


And that’s just naming a few.

Looking through these lists, browsing the internet pages, or watching webinars are the perfect ways to quickly learn what is happening and how you can use new tools or methods to your advantage.

Physiological measurements, behavioral observations, and more

  
  
  

Autism researchLooking back on 2011 - behavioral and autism research in the picture

Top 10 Autism Speaks
Autism Speaks recently looked back on 2011 and named the top 10 autism research achievements of the year. Not only were a wide variety of topics in research achievements mentioned, but also achievements from all around the world attracted the attention of Autism Speaks science news. For further information, please read the article and the list at autismspeaks.org.

A large number of other interesting studies in 2011
In addition to the top 10, there were a large number of other interesting studies in 2011. One that should be highlighted in this behavioral research blog is Lima et al’s study that aimed to assess the behavioral and physiological responsiveness of three children with profound intellectual and multiple disabilities (PIMD) to a set of sensory stimuli. It is fascinating to see how researchers continue to search for methods and techniques that will help in the future with the gathering of rich and meaningful data! When focusing on the findings of Lima et al. (2011), the title – Beyond Behavioral Observations – says it all. Lima et al. explored whether adding physiological measurements to behavioral observations would provide further insight in reactions from children with PIMD.

Their results show that, although there sometimes is no observable reaction, this does not mean there is no reaction at all. The participants reacted physiologically to most of the presented stimuli. Consequently, these researchers advocate for combining of physiological and behavioral measurements in order to assess actual responsiveness. They argue that the value of the information obtained through this method (measuring physiological responses) and the undeniable implications for the emotional well-being of people with PIMD, are such that they fully justify going through the ‘trouble’ of setting up the hardware and software. Fortunately, these tools are becoming more and more user-friendly. Lima et al. have used The Observer® XT to determine the frequency and duration of all the behaviors. This professional software can also be used to integrate and analyze different data streams, such as physiological data in relation to behavioral data, making data collection a manageable process.

  • Lima, M.; Silva, K.; Amaral, I.; Magalhaes, A.; Sousa, L. De (2011). Beyond behavioural observations: a deeper view through the sensory reactions of children with profound intellectual and multiple disabilities. Child: care, health, and development, doi:10.1111/j.1365-2214.2011.01334.x.

3 Examples of pattern detection research

  
  
  

pattern detectionPatterns in behavior are everywhere around us. Think about the sequence of behavior when you do the laundry, get ready in the morning, play a game of soccer, or drive your car to work. Many behavioral scientists focus on these highly structured phenomena. For instance,  researchers now closely examine social interactions or the execution of tasks. Many patterns are missed when observed with the naked eye. Fortunately, cameras and specialized software can be used to aid in the detection of interesting behavior patterns. Theme™ software (T-patterns, Magnusson, 2000) can detect which events and behaviors drive the behavior, which occur as a result, and which are just random. Additionally, Theme requires data such as time series of discrete and meaningful behaviors as input so the software can automatically detect patterns in behavior.

Gaming research
In gaming research, patterns in behavior can indicate specific ‘search behavior’ (i.e. if the gamer exhibits an overall offensive or defensive strategy). To gain further insight in behavior, Dixon (2011) developed two closed world games. Basically, game participants were asked to act either as potentially dishonest builders constructing part of an Olympic stadium or terrorists masquerading as builders with the aim of planting explosives. Researchers used Theme software for the detection and analysis of hidden patterns of behavior within game data. The software was programmed to recognized specific teams and, as a result, the researchers concluded that the outcome would be extremely significant in a more complex system outside the constraints of the game. Group identification by data would be very valuable for real-world analysis, especially when handling more complex datasets.

  • Dixon, S.; Guest, E.; Dixon, M.; Elliot, J.; Mullier, D. (2011) DScent Final Report. Leeds Metropolitan University (Faculty of Arts, Environment & Technology)

Emotional expression research
Pattern analysis can also provide insight in the organization of facial actions which together produce emotional expressions. Considering that people communicate more emotion through facial expressions than through words, it is very interesting to know more about the structure of expressions. Even the tiniest nuances can be communicated by using facial expressions in interpersonal communication. With and Kaiser (2011) present their research that focused on the production and perception of emotions in social interactions in the Swiss Journal of Psychology. They used the Theme software to detect patterns and found that expressive patterns are composed of facial actions. This study demonstrates that the display of specific emotions can be related to statistically verified and recurrent temporal patterns of behavioral events- composed of facial, gaze, and head actions.

  • With, S.; Kaiser, S. (2011). Sequential patterning of facial actions in the production and perception of emotional expressions. Swiss journal of psychology, 70 (4), 241-252.

Cat – owner interaction
In another blog post - Crossing the bridge between human and animal behavior research - research related to pattern detection was. Wedl et al. wrote about their study on forty cat-owning couples. Theme was used to detect hidden temporal patterns (T-patterns) in behaviors to shed light on the complexity of the interaction between the couples. In this blog entry, you can more closely investigate their results, giving you an idea of how pattern detection can aid your research.

  • Wedl, M.; Bauer, B.; Gracey, D.; Grabmayer, C.; Spielauer, E.; Day, J.; Kotrschal, K. (2011). Factors influencing the temporal patterns of dyadic behaviours and interactions between domestic cats and their owners. Behavioural Processes, 86, 58-67.

 

Observing behavior - Jury deliberations

  
  
  

Investigating group processes

Jury deliberations expected to begin today in Iredell murder trialJury deliberations in Whitehead trial continues WednesdayJurors continue deliberations in Padilla trial – These are just a few headlines that mention jury trials. Nowadays, researchers increasingly study this deliberation process, which goes on behind closed doors. Take for example Behind closed doors: the effect of pretrial publicity on jury deliberations (Ruva, 2011). The results of this study suggest that negative pretrial publicity (PTP) has a biasing effect on jury verdicts and that PTP exposure can influence juror’s interpretations and discussion of trial evidence.

Meeting

Christine Ruva et al. (2011) analyzed 30 mock-jury deliberations. One point of interest, which they explored, was the behavior of jurors who were asked to read actual negative pretrial publicity from the murder trail that they later viewed in comparison with jurors who read unrelated news articles. Researchers performed content analyses in order to discover what occurs during jury deliberations. The mock-jury deliberations were filmed and behaviors were then coded using The Observer software. The authors of this article prefer using this software package instead of transcribed deliberations or video observations, which use less sophisticated content analysis tools. The Observer software allows for more elaborate coding schemes and more accurate event timing. These elaborate coding schemes provide the user tools to more accurately analyze and even detect the most subtle differences in behavior.

Furthermore, evaluating group processes, such as jury deliberations, can be extremely valuable for many fields of research. Scientists are examining new methods and techniques that can help them gather relevant data. For example, Waller et al. (2011) studied how individuals contribute to a decision-making process. They hypothesized that individuals in large group settings do not always contribute equally to group decision making processes. Realizing it would be interesting to closely observe any group process, they examined roles such as influencers, deciders, listeners, and bystanders. In the end, Waller concluded that the data gathered did not demonstrate any effect of group size on actual participation during deliberations. What they measured was perceived participation. Not actual but perceived participation, because they used questionnaires to gather data. The results of both might be similar, however, it is still important to clarify how participants truly behaved, which can be done through the gathering of observational data.

  • Ruva, C.L.; LeVasseur, M.A. (2011). Behind closed doors: the effect of pretrial publicity on jury deliberations. Psychology, Crime & Law, DOI:10.1080/1068316X.2010.502120, 1-22.
  • Waller, B.M.; Hope, L.; Burrowes, N.; Morrison, E.R. (2011). Twelve (not so) angry men: managing conversational group size increases perceived contribution by decision makers. Group processes & intergroup relations, 14 (6), 835-843.

Behavioral neuroscience research at SfN Annual Meeting

  
  
  

What happened in Washington DC doesn’t stay in DC

SFN

More than 32,000 people attended this year’s Society for Neuroscience annual meeting in Washington D.C. With this many people it is no surprise the range of topics is as vast as you can wrap your brain around: from teaching neuroscience to addiction studies, sports neuroscience, and behavioral neuroscience, among many more.

SfN makes a point of relating neuroscience to many different disciplines, but the main theme does more and more relate back to behavior. The Dialogues lecture is the first big lecture kicking off the annual meeting. In recent years topics have ranged from neuroscience as it relates to magic, and mental illness and awareness. This year the topic was Economics and Behavior. Each year, this main lecture has touched back onto human behavior. Most likely, at least in part, fuelled by this being relatable to all attendees, but it also reminds us that behavioral research is at the core of understanding biological functions. Whether animal behavior, or human behavior, SfN underlines how we continue to deepen our understanding of both, and how much work still needs to be done in this realm.

Behavioral neuroscience is an increasingly growing topic of interest to many scientists. Over the years of attending this meeting, a steady increase in the number of zebrafish themed posters can be noticed. However, a considerable number of these relate to pure biological studies, but the interest in zebrafish behavior does continue to grow. I presented a poster myself on this topic, and every year the interest in our work has increased, particularly with regards to the underlying methodology for the studies. I found that I spent an equal amount of time discussing the actual research, as I do going over the logistics of obtaining my data and the tools I use for data analysis.

In general, ideas from the theoretical talks at SfN are taken back to labs worldwide. As far as methods go, zebrafish in particular are still very much in need of standardized procedures. SfN might generate great research questions and ideas, but when it comes to translating those to new paradigms, you can draw from the expertise that comes together at an event like Measuring Behavior where behavioral neuroscientists, behavioral ecologists, and ethologists or developmental psychologists meet, just to name a few.

Why behavioral data collection works

  
  
  

Infant behaviorUnderstanding development in infancy

How are scholars studying learning in infancy? How do they study parental influence? Which methods and techniques are useful and which aren’t? Below are several examples of methods and techniques used in infant behavior research.

  • Questionnaires or interviews can aid in the gathering of valuable data – particularly when the observations of the spectators (doctors, parents, nurses, etc.) are important. One must of course be cautious: when examined through rose-colored glasses, the child under observation could be described in glowing terms. On the other hand, comments could also be negative. Other research methods can help in the objectification of one’s research.
  • The Intermodal Preferential Looking (IPL) paradigm, a model for exploring language learning and development, is sometimes used in cognitive linguistics. The question, “When and how does language acquisition begin?” is tackled by observing behavior in a controlled environment using the IPL paradigm. A quiet room is of course necessary for proper examination. The IPL paradigm is based on the fact that children tend to look at scenes which correspond to sentences they hear. Employing this technique allows researchers to integrate a more implicit measure of sentence comprehension (eye gaze duration) compared to acting purely on linguistic stimuli. Consequently, researchers will be able to test much younger children. For more information, please read Styles and Plunkett 2009 to see how they explored word comprehension.
  • Eye tracking technology is often used in infant behavior research. In a study carried out by Daniel Yurovsky and colleagues (2010), eye trackers were used to attempt determine a link between learning and viewing. Preferential looking tests were used to determine whether infants had learned the correct pairings. Direction of gaze was recorded by a Tobii X60 eye-tracker as well as a camera oriented towards the child’s eyes. For more information about their results, please see their publication or or watch a Youtube video in which 5 month old infant is eye tracked using a Tobii Eye Tracker.
  • Cecchini (2011) tested if newborns prefer to look at a previously known communicative face compared to a new face. In addition, newborns’ strategies of gazing at a previously known communicative face compared to a previously known still-face were investigated. This study was conducted with all newborns lying flat in their cradles in a quiet room. The most important finding was that the newborns preferred to look at a new face rather than a previously known face only when the known face was previously seen in a motionless condition (still face situation). The recordings were coded using an Observer system. In this paper Cecchini et al. published 4 figures which demonstrate exactly how the experiment was carried out.
download-our-case-study-on-infant-behavi


Cecchini, M.; Baroni, E.; Di Vito, C.; Piccolo, F.; Lai, C. (2011). Newborn preference for a new face vs. previously seen communicative or motionless face. Infant Behavior and Development, 34 (3), 424-433.

Styles, S.; Plunkett, K. (2009). What is ‘word understanding’ for the parent of a one-year old? Matching the difficulty of a lexical comprehension task to parental CDI report. Journal of Child Language, 36 (4), 895-908.

Yurovsky, D.; Hidaka, S.; Yu, C.; Smith, L. B. (2010). Linking Learning to Looking: Habituation and Association in Infant Statistical Language Learning. In Proceedings of the 32nd Annual Conference of the Cognitive Science Society Austin, TX, 1589-1594.

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