Research Projects

"Interventions to Improve Clinical Decision Making and Outcomes for Unstable Angina"

Academic Medicine and Managed Care Forum; Schering Plough; 1999-2004

Principal Investigator: Valerie Reyna

Project Coordinator: Jayni Parikh

Executive Summary:

More than 6 million patients present to emergency rooms with chest pain each year in the U.S. Considerable effort and expense have been invested in the development of clinical guidelines to improve quality of care for such patients. However, providing clinical information in guidelines is often insufficient to change provider behavior. Therefore, the aims of the proposed research are to assess deviations of current practice from recommended guidelines for acute cardiac ischemia, characterize the nature of those deviations, relate the deviations to medical outcomes and costs, and design interventions that will improve adherence to recommendations. 5000 patients who present to the emergency room with chest pain will be enrolled in a prospective cohort study. Multiple regression models will be used to link initial evaluation and management of these patients to subsequent events such as prescribed medications, hospital admissions, outpatient visits, revascularization procedures, myocardial infarction, cardiac death, and functional status as assessed by the SF36 medical outcomes questionnaire. Logistic regression analyses will identify the patient characteristics that clinicians use in decision making, in order to determine how these differ from guideline recommendations and outcome prediction rules. Based on these analyses and prior research on clinical decision making, we will develop Web-based tools and software to bridge the gap between guideline recommendations and clinical implementation. The effectiveness of these tools will be evaluated using a randomized control trial design in which physicians will be randomized to either a tools-intervention or a control group. Interventions will be judged on the basis of physicians’ ability to classify and manage patients so as to maximize therapeutic benefits for patients with symptoms suggestive of acute cardiac ischemia.


"Interventions for Risk Reduction and Avoidance in Youth"

National Institute of Health; 2001-2006

Principal Investigator: Valerie Reyna

Project Coordinators: Kristin Poirier, Kirsten Metz, Jennifer Roberts

Executive Summary:

Three million new cases of sexually transmitted diseases (STD) are identified in adolescents every year. The proposed research applies recent advances in cognitive-behavioral theory to increase the effectiveness and durability of multicomponent interventions that promote risk reduction and avoidance in adolescents. In Phase I, we investigate adolescents’ psychological representations of decision options (i.e. abstinence vs. risk taking), risk estimates of problem behaviors, and relevant beliefs and attitudes. Specifically, 200 adolescents will be surveyed, presented with realistic sexual decision-making scenarios, and questioned in-depth concerning their perceptions of important risks and consequences (e.g., the cumulative risk of contracting a STD). Hispanics will be oversampled to provide sufficient statistical power to evaluate ethnic differences. In Phase II, 800 adolescents will be randomly assigned to one of three groups: a standard multicomponent intervention (Reducing the Risk), a gist-based enhancement of the standard intervention, or a control group receiving an unrelated intervention. The enhanced intervention will be based on cognitive behavioral theory (e.g., Reyna & Ellis, 1994), as well as on differences identified in Phase I between adolescents engaging versus not engaging in risky behaviors. Pre- and post-intervention surveys will assess such outcomes as self-reports of risky behaviors, and STD treatment, with follow-up surveys at 3, 6, and 12 months. Multivariate analyses of variance (followed by univariate tests) controlling for background and baseline characteristics, will be used to compare differences among standard, enhanced, and control groups. Logistic regression will be used for categorical outcome measures, such as initiation of intercourse. Thus, the proposed research will provide evidence concerning sexual decision processes in Hispanic and non-Hispanic adolescents, and evaluate a theory-based intervention that focuses on specific behaviors and addresses both social (e.g., refusal skills) and cognitive-developmental factors using a randomized assignment design. We will also compare our survey data to results of a statewide evaluation of abstinence-only programs using the same survey instrument. By emphasizing gist representations, which are well preserved over long time periods and are key memories used in decision making, the enhanced intervention should produce larger and more sustained effects on risk reduction and avoidance.


"Children's Spontaneous False Memories for Traumatic Medical Events"

National Science Foundation; 1998-2002

Principal Investigator: Valerie Reyna

Executive Summary:

Children's spontaneous false memories for doctor visits that were accompanied by trauma were studied to answer several questions that bear on the accuracy of children's testimony. Prior research has produced a theoretical framework (fuzzy-trace theory) that makes counterintuitive predictions about such important issues as: age variability in spontaneous memory falsification, age variability in the effects of delay on memory falsification, the persistence of false memories over time, the tendency of mere memory tests to falsify the contents of memory, and the features of experienced events that are most prone to memory falsification. To date, however, research on these predictions, as well as research on other aspects of the theoretical framework, has not involved either forensically-relevant materials or forensically-appropriate time scales. Three experiments are proposed in which these limitations are removed.

The experiments made use of false-recognition procedures that have been thoroughly piloted in prior research. Each experiment consisted of four sessions, all the participants were 180 children between the ages of 3 and 8. Session 1 was a visit to an urgent-care facility or pediatrician's office that participating children make for treatment of traumatic complaints that do not require general anesthetic or hospitalization (e.g., animal bites, cuts, and bruises, minor burns, sprains and broken bones). Children's experiences during such visits were the focus of subsequent memory interviews. The remaining three sessions were memory interviews conducted 1-3 days after the doctor visit (Session 2), 6 months after the doctor visit (Session 3), and 1 year after the doctor visit (Session 4). These memory interviews queried both events that the child experienced (targets) and events that did not happen (distractors). The false-recognition effect (the tendency for distractors that preserve the meaning of children's experience to be falsely accepted at higher rates than unrelated distractors) were used to measure spontaneous memory falsification. Differences in levels of spontaneous memory falsification were tracked as a function of several variables that are significant in forensic analysis of testimony (e.g., frequency of experience with events, amount of prior interviewing, whether interferences have been made about events, whether inconsistent versions of events have been experienced).

This project advanced forensic theory and practice by resolving two types of uncertainties in current scientific knowledge about children's false memories. The first uncertainty is that prior studies have produced inconsistent findings on the following key questions: Do spontaneous false memories become more or less frequent with age? Do children's spontaneous false memories increase with delay between exposure to events and memory tests? Do children's spontaneous false memories increase as the semantic overlap between nonexperienced events and experienced events increases? The other uncertainty is that recent studies have produced two new findings with potentially broad implications for children's testimony that have not yet been obtained with forensically-relevant procedures. Those findings are that mere memory tests can create false memories and that children's spontaneous false memories can be more stable over time than their true memories.


"Development of Memory in Children and Adults"

Principal Investigator: Valerie Reyna

Project Coordinator: Emily Bleyl


Executive Summary:

Recent research has demonstrated that false memories---memories that are consistent with the interpreted gist of experience but not the verbatim facts----are remarkably easy to induce in adults using simple verbal and pictorial materials. These effects have troubling counterparts in real-world settings, such as psychotherapy and eyewitness testimony. An often-used paradigm with adults involves presenting semantically associated words in a list at study, and later asking for free recall or recognition of those words. Adults show levels of false recall for some semantically associated words that are similar to levels for actually presented words. Children, however, show failry good memory for presented words, but virtually no false memory, using this paradigm. My collegues and I have developed a theory (which has been instantiated in a mathematical model) that explains and predicts differences between children's and adults' memories. The proposed research tests mechanisms assumed in that model by experimentally varying factors, such as overt semantic cues to the category structure of lists that are predicted to determine levels of false memory. Approximately 500 children and adults will participate, ranging from preschoolers (two years or older) to older adults including the elderly. Children and adults who are fluent speakers of English without significant developmental disabilities that would preclude understanding of the study materials will be recruited (and verbal material will be modified to reflect age-appropriate vocabulary levels.) The rationale for including both children and adults is to investigate developmental changes in memory mechanics.



"Memory in Neuroscience"

Principal Investigator: Valerie Reyna

Project Coordinator: Sarah Carter

Executive Summary:

Alzheimer's disease is the leading neurological disorder in aging individuals and is defined by prominent memory loss and malfucntion. Several previous studies on memory impairment in aging and neurologically-impaired individuals have used neuro-imaging methods and neuropsychological tools to identify characteristics of memory processes. Fuzzy Trace Theory (FTT) suggests that human memory is comprised of several components, namely gist and verbatim processes, which operate independently of each other in memory storage and retrieval. In light of FTT, the study will research patterns of memory recall in normal subjects as compared to patients with abnormal neurological diagnoses. Using the Rey-Auditory-Verbal Learning test (RAVLT), a recently developed method of researching memory retrieval, the study will measure gist and verbatim memory processes through word list recall. The RAVLT was prepared in order to assess cognitive functions such as immediate memory span, new learning, susceptibility to interference, and recognition memory. Data provided from researchers at the University of Oklahoma using this form of memory testing on neurologically impaired patients was previously analyzed using the FTT mathematical model and a notably decreased recall was found in patients with Alzheimer's disease. By applying this test to 500 subjects with either normal or abnormal memory function, the study will further examine and expand upon the role of gist and verbatim processes in aging individuals.



Division of Learning, Technology, and Assessment of the Arizona Research Laboratories

Director: Valerie Reyna

Project Coordinator: Kira Moore-Rendon


Division of Learning, Technology, and Assessment Website


Executive Summary:

Technology-infused instructional environments (e.g., electronic interactive-learning systems, real-time video conferencing) have evolved at a much more rapid pace than the scientific study of how and what people learn in those environments. Consequently, new instructional technologies are proliferating in classrooms, but little is know about their effects on learning. Because technologies' effects on instructional outcomes are poorly understood, decisions as to when to implement them and how to implement them are rarely based on research findings.

The faculty of the Division of Learning, Technology, and Assessment of the Arizona Research Laboratories have developed four instruments. The first is the Cognitive Questionnaire, which measure students' critical thinking skills (e.g., accurate use of part-whole relations, statistical relations, cause-effect relations). The second is the Meta-Cognitive Questionnaire, which measures key components of problem solving ability (e.g., brainstorming, generating alternative formulations of problems, persistence, distinguishing premises from conclusions). The third is the Technological Interventions Questionnaire, which measure four types of technological supports that are available in specific courses (the Web, simulation, electronic interaction, and video-delivered distance learning), the frequency with which students use those supports, and frequency with which students engage in other types of computer activities (e.g., word processing, spreadsheets, computer games). The fourth is the Survey: Attitudes Toward Using Computers, which measures students' comfort and confidence levels using technological supports.

The research will link students' critical thinking skills and problems-solving skills to their use of learning technologies and to their course performance. The research will focus on learning outcomes and processes that are relevant to preparing students for a complex global economy, such as the ability to transfer learning to new, changing situations. The goal is to validate an evaluation model that incorporates the latest research on learning and assessment, and includes such factors as culture, individual differences, group processes, learning processes, and learning outcomes. The model can then be used formatively to ensure that proposed innovations conform to sound principles of human learning and memory. It will also provide a scientific basis for broader policy recommendations.


"Placebo and Suggestibility in Memory for Medical Outcomes"

National Institutes of Health; Pediatrics Research Center
Biopsychosocial Core; 1998-2003

Core Director: Valerie Reyna

Project Coordinator: Kira Moore-Rendon

Executive Summary:

Research on human memory indicates that patients and practitioners may over- or under-estimate the effectiveness of treatments, based on inaccurate memories for relevant medical outcomes. Memory for the frequency of outcomes, and for associations between putative causes and effects, is subject to biases and distortion. Factors known to influence the accuracy of memory include prior beliefs, individual differences in suggestibility, and short-term enhancement of actual or perceived well-being (so-called placebo effects). The history of medicine includes many examples of the irrational persistence of belief in the effectiveness of treatments despite disconfirmatory personal experiences (and vice versa i.e., irrational resistance to effective new treatments despite confirmatory evidence). The proposed research examines factors that determine patients' and practitioners' ability to learn from experience through accurate memory for associations between treatments and outcomes.

The purpose of this research is to investigate the effects of (1) patients' and practitioners' belief in the effectiveness of traditional and alternative therapeutic modalities, (2) individual differences in suggestibility, and (3) actual therapeutic modality (i.e., actual membership in double-blinded standard treatment or alternative treatment groups) on memory for medical outcomes. The first study in the series will focus on parents' memory for the frequency of episodes of otitis media in their children during three-month blocks of standard or alternative treatments. The total treatment phase will consist of six months and parents will be asked to estimate the frequency of otitis media during the first and the last three months of "treatment." The objective of this research is to understand patients' memory for the effectiveness of treatments, and the influence that prior belief and suggestibility might have on the accuracy of memory for medical outcomes. Subjects' responses will be verified with medical records previously obtained from the NIH Otitis Media Study.


"Arizona Hispanic Center of Excellence"

National Institutes of Health; 1999-2004

Key Personnel: Valerie Reyna

Executive Summary:

The Arizona Hispanic Center of Excellence (AHCOE) will integrate existing programs of the College of Medicine (COM) with the Mexican American Studies & Research Center (MASRC) in order to create a unique curricular and research unit. This unit will enhance the cultural competency of current medical students, and improve the COM's climate for recruitment, retention and promotion of Hispanic faculty. Unlike past efforts, this Hispanic Center of Excellence will work to change the fundamental COM organizational culture, where Hispanic faculty are isolated by discipline and department as opposed to unified in shared research.

Emerging Hispanic COM faculty will utilize the existing MASRC research platform to further cultivate their research interests, thereby enhancing their academic and professional development. By merging existing faculty and projects within both COM and MASRC, we will capitalize on the applied research base of Hispanic faculty and build a statewide foundation for Hispanic health services research and policy. This unique approach is possible because MASRC is the only applied Mexican American research center in the country with full time tenure track faculty dedicated to research on Hispanic health and education.

Based on a recent MASRC study of minority education in Arizona, it is clear that preparation for medical education must start in elementary school level, where academic progress for Hispanic students begins to falter. Another significant finding about the education of Hispanic students is that the starting point for postsecondary education is frequently the local community college, a historically understudied segment of the medical school pipeline. As a result, a central focus of the proposed AHCOE outreach activities includes interventions beginning at the 5th grade and continuing through higher education, with a special emphasis on community college outreach.


"The University of Arizona Initiative for Minority PhDs"

National Institutes of Health; IMSD Opportunities in Biomedical Research
Affecting Minorities; 2001-2006

Key Personnel: Valerie Reyna

Executive Summary:

The aim of this project is to implement a comprehensive program that will enhance our ability to increase the number of underrepresented minority students who obtain doctoral degrees in biomedical sciences.



"Processes that Control Children's False Memory Reports"

National Science Foundation; 2003-2006


Principal Investigator: Valerie Reyna

Project Coordinators: Rachel Brownstein, Jessica Haley

Executive Summary:

This is a renewal application to support continuation of the PI's program of research on children's false memories. That program of research is theory-driven, and to date, it has produced a number of few findings about false memories that were originally predicted on theoretical grounds. The new research that is proposed consists of three things large-scale developmental experiments. The experiments will focus on two cognitive operations that are believed to be key controlling factors in children's false-memory repports: recollection rejection and phantom recollection. The existence of both operations is predicted by the PI's theoretical account of false memory (fuzzy-trace theory), and evidence of the use of both operations by adults has been reported in previous experiments. Recollection rejection is an operation that suppresses the reporting of false events that are consistent with the gist of children's experience. Suppression is accomplished via the detection of mismatches between false-but-gist-consistent event and verbatim traces of actual events. For instance after hearing a narrative containing the statement "The bird is inside the cage" and "The cage is under the table," Children could reject the unpresented statement "The bird is under the table" by retrieving verbatim traces of either presented sentence and noticing that the words "bird" and "table" do not appear together in the sentence. Phantom recollection, on the other hand, is an operation that supports the reporting of false events that are consistent with the gist of children's experience by generating illusory vivid phenomenologies for those events. Fuzzy-trace theory posits that gist memories will sometimes cause false events to be accompanied by illusory vivid phenomenologies that are difficult to distinguish from the vivid phenomenologies that accompany true events. These phantom recollections cause things that were not experienced to be remembered as physical "occurences" (e.g, they are seen in the mind's eye or heard in the mind's ear). Fuzzy-trace theory predicts that phantom recollection can occur when two conditions are met: (a) Experienced events repeatedly cue some familiar meaning, so that gist memories of that meaning are very strong, and (b) the false events that provoke phantom recollection are especially good retrieval cues fron strong gist memories. The proposed experiments will implement a new paradigm, conjoint recognition, that was developed and tested in the PI's lab. This paradigm provides a reliable behavioral method of measuring recollection rejection and phantom recollection in children. Children respond to memory tests under three types of instructions (accept only experienced events, accept only nonexperienced events that are consistent with the gist of experience, and accept experienced events + nonexperienced events that are consistent with the gist of exeprience). Recollection rejection and phantom recollection are identified with distinct patterns of reponses across these different types of instructions. A mathematical model that is defined over the paradigm corrects raw response patterns for the influence of extraneous variables, which allows researchers to separate and quantify the effects of recollection rejection and phantom recollection. Implementation of this paradigm will generate detailed findings on how recollection rejection and phantom recollection affect false-memory reports, on how these operations change with age, and how they react to forensically-significant task variables.



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