Shaping the Sensory–Motor Network by Short-Term Unresolvable Sensory–Motor Mismatch

Learning from errors as the main mechanism for motor adaptation has two fundamental prerequisites: a mismatch between the intended and performed movement and the ability to adapt motor actions. Many neurological patients are limited in their ability to transfer an altered motor representation into motor action due to a compromised motor pathway. Studies that have investigated the effects of a sustained and unresolvable mismatch over multiple days found changes in brain processing that seem to optimize the potential for motor learning (increased drive for motor adaptation and a weakening of the current implementation of motor programs). However, it remains unclear whether the observed effects can be induced experimentally and more important after shorter periods. Here, we used task-based and resting-state fMRI to investigate whether the known pattern of cortical adaptations due to a sustained mismatch can be induced experimentally by a short (20 min), but unresolvable, sensory–motor mismatch by impaired facial movements in healthy participants by transient facial tapping. Similar to long-term mismatch, we found plastic changes in a network that includes the striatal, cerebellar and somatosensory brain areas. However, in contrast to long-term mismatch, we did not find the involvement of the cerebral motor cortex. The lack of the involvement of the motor cortex can be interpreted both as an effect of time and also as an effect of the lack of a reduction in the motor error. The similar effects of long-term and short-term mismatch on other parts of the sensory–motor network suggest that the brain-state caused by long-term mismatch can be (at least partly) induced by short-term mismatch. Further studies should investigate whether short-term mismatch interventions can be used as therapeutic strategy to induce an altered brain-state that increase the potential for motor learning.

Prediction errors disrupt hippocampal representations and update episodic memories

The brain supports adaptive behavior by generating predictions, learning from errors, and updating memories to incorporate new information. Prediction error, or surprise, triggers learning when reality contradicts expectations. Prior studies have shown that the hippocampus signals prediction errors, but the hypothesized link to memory updating has not been demonstrated. In a human functional MRI study, we elicited mnemonic prediction errors by interrupting familiar narrative videos immediately before the expected endings. We found that prediction errors reversed the relationship between univariate hippocampal activation and memory: greater hippocampal activation predicted memory preservation after expected endings, but memory updating after surprising endings. In contrast to previous studies, we show that univariate activation was insufficient for understanding hippocampal prediction error signals. We explain this surprising finding by tracking both the evolution of hippocampal activation patterns and the connectivity between the hippocampus and neuromodulatory regions. We found that hippocampal activation patterns stabilized as each narrative episode unfolded, suggesting sustained episodic representations. Prediction errors disrupted these sustained representations and the degree of disruption predicted memory updating. The relationship between hippocampal activation and subsequent memory depended on concurrent basal forebrain activation, supporting the idea that cholinergic modulation regulates attention and memory. We conclude that prediction errors create conditions that favor memory updating, prompting the hippocampus to abandon ongoing predictions and make memories malleable.

Learning From Errors: Exploring the Effectiveness of Enhanced Error Messages in Learning to Program

Error messages provided by the programming environments are often cryptic and confusing to learners. This study explored the effectiveness of enhanced programming error messages (EPEMs) in a Python-based introductory programming course. Participants were two groups of middle school students. The control group only received raw programming error messages (RPEMs) and had 35 students. The treatment group received EPEMs and had 33 students. During the class, students used an automated assessment tool called Mulberry to practice their programming skill. Mulberry automatically collected all the solutions students submitted when solving programming problems. Data analysis was based on 6339 student solutions collected by Mulberry. Our results showed that EPEMs did not help to reduce student errors or improve students’ performance in debugging. The ineffectiveness of EPEMs may result from reasons such as the inaccuracy of the interpreter’s error messages or students not reading the EPEMs. However, the viewpoint of productive failure may provide a better explanation of the ineffectiveness of EPEMs. The failures in coding and difficulties in debugging can be resources for learning. We recommend that researchers reconsider the role of errors in code and investigate whether and how failures and debugging contribute to the learning of programming.

Assessment of a safe environment in the Samsmu clinics departments in the part of fall prevention

At the present stage of the development of society, the problem of falls on a global scale has become a significant public health problem. WHO has declared the fall “the second leading cause of death from unintentional injury after road traffic injuries” and has identified patient safety as “continuous improvement of practice based on learning from errors and adverse events”. The main principle of ensuring the safety of medical care is the ability to predict the possible consequences that may arise in the process of implementing medical activities.

Video Reflexive Ethnography Methodology to Explore the Use of Variable Rate Intravenous Insulin Infusions

Background: The use of variable rate intravenous insulin infusion (VRIII) is a complex process that has consistently been implicated in reports of error and consequent harm. Investment in patient safety has focused mainly on learning from errors, though this has yet to be proved to reduce error rates. The Resilient Health Care approach advocates learning from everyday practices. Video reflexive ethnography (VRE) is an innovative methodology used to capture, reflect on and thereby improve these. This study set out to explore the use of VRIII with VRE, a secondary aim being to describe VRE’s feasibility and acceptability. Methods: This study was conducted in a Vascular Surgery Unit. Quantitative data (e.g. blood glucose measurements) were collected from electronic patient records. Qualitative data were collected using VRE methodology. The latter involved videoing healthcare practitioners caring for patients treated with VRIII and discussing the resulting video-clips with participants in reflexive meetings. Transcripts of these were subjected to thematic analysis and the quantitative data used to judge the outcomes of the video-observed tasks. Feasibility in relation to recruitment and data collection, as well as the acceptability of using VRE, were assessed based on participant responses during the study.Results: The use of VRE in conjunction with quantitative data revealed that context-dependent adaptations (seeking verbal orders to treat hypoglycaemia) and standardised practices (using VRIII guidelines) were strategies used in everyday work. Reflexive meetings highlighted the challenges faced while using VRIII (lack of knowledge of the appropriate medications to be prescribed with VRIII) and encouraged participants to suggest solutions (face-to-face, VRIII-focused training). The use of VRE was judged acceptable, based on the researcher’s interpretation of participants’ willingness to participate, and feasible, since all patients and 83% of the healthcare practitioners who were approached to participate agreed to do so. Conclusions: VRE deepened understanding of VRIII by shedding light on its essential tasks and the challenges and adaptations entailed by its use. The use of VRE to explore VRIII in a single unit was judged feasible and acceptable. However, future research might focus on collecting data across various units and hospitals to develop a full picture of the use of VRIIIs.

Beyond Psychological Safety – the Role of Direct Supervisor Behavior in Fostering Learning from Errors at the Workplace

This study explores how direct supervisors can hinder or enhance how professionals learn from their errors. Extant research has often focused on psychological safety as the main condition for this kind of learning to take place. We expand prior research by exploring which behaviors of direct supervisors effectively facilitate learning from errors in concert with psychological safety. We conducted semi-structured interviews among 23 professionals to gain detailed insights into their thoughts, needs, and the difficulties they encounter. Through content analysis, we identified four critical supervisor behaviors that participants viewed as facilitating learning from errors next to fostering a psychologically safe work environment: (1) providing timely feedback, (2) guidance and elaborate feedback, (3) being accessible and personally involved, (4) organizing joint evaluations. Based on our findings, recommendations are formulated for supervisors that aim to facilitate professionals’ learning from errors and their professional development.

Mesolimbic dopamine adapts the rate of learning from errors in performance

Recent success in training artificial agents and robots derives from a combination of direct learning of behavioral policies and indirect learning via value functions. Policy learning and value learning employ distinct algorithms that depend upon evaluation of errors in performance and reward prediction errors, respectively. In animals, behavioral learning and the role of mesolimbic dopamine signaling have been extensively evaluated with respect to reward prediction errors; however, to date there has been little consideration of how direct policy learning might inform our understanding. Here we used a comprehensive dataset of orofacial and body movements to reveal how behavioral policies evolve as naive, head-restrained mice learned a trace conditioning paradigm. Simultaneous multi-regional measurement of dopamine activity revealed that individual differences in initial reward responses robustly predicted behavioral policy hundreds of trials later, but not variation in reward prediction error encoding. These observations were remarkably well matched to the predictions of a neural network based model of behavioral policy learning. This work provides strong evidence that phasic dopamine activity regulates policy learning from performance errors in addition to its roles in value learning and further expands the explanatory power of reinforcement learning models for animal learning.

The contributions of entorhinal cortex and hippocampus to error driven learning

Computational models proposed that the medial temporal lobe (MTL) contributes importantly to error-driven learning, though little direct in-vivo evidence for this hypothesis exists. To test this, we recorded in the entorhinal cortex (EC) and hippocampus (HPC) as macaques performed an associative learning task using an error-driven learning strategy, defined as better performance after error relative to correct trials. Error-detection signals were more prominent in the EC relative to HPC. Early in learning hippocampal but not EC neurons signaled error-driven learning by increasing their population stimulus-selectivity following error trials. This same pattern was not seen in another task where error-driven learning was not used. After learning, different populations of cells in both the EC and HPC signaled long-term memory of newly learned associations with enhanced stimulus-selective responses. These results suggest prominent but differential contributions of EC and HPC to learning from errors and a particularly important role of the EC in error-detection.

Characterization of patient safety incidents reported by patients or families to the brazilian health regulatory system – 2014 – 2019

Patient safety incidents, especially adverse events (AEs), are a global public health issue. The objective of the study was to characterize patient safety incidents reported by patients or families to the Brazilian Health Regulatory System (SNVS). This is a descriptive, retrospective study with a quantitative approach, using a database from the Brazilian Health Regulatory Agency (ANVISA), NOTIVISA - Citizen module, 2014 to 2019. A total of 1355 safety incident were reported, a majority from the Southeast region (45.3%), occurred more frequently among women (58.0%) aged between 26 and 35 (16.7%) and 56 and 65 years (16.5%). Healthcare-associated infections (HAIs) (36.3%) were the most frequently notified event, followed by medication/intravenous fluid (IV) incident (36.2%). Injury was mostly classified as mild (32.0%) and moderate (23.7%). From a total of 33 deaths, the majority (51.5%) were due to HAI. There was a significant association between the proportion of deaths and age group (p-value = 0.032). Most notifications were related to HAIs, followed by drugs or IV fluids and most reported incidents resulting in death were due to HAIs, with a significant difference observed in the proportion of deaths in relation to age group. The study demonstrates the need for greater encouragement and participation of patients and family members in reporting incidents, valuing their experiences for continuous learning from errors in health services.

Is dealing with errors in the classroom specific for school subjects? A study of the error climate in mathematics, German, and English

A frequent observation in the school context is that opportunities to learn from errors are often missed. However, a positive error climate may support learning from errors. For the school subject of mathematics, some findings about characteristics of the error climate already exist. But, a comparison of the error climate between different school subjects is still pending. In the present study, it is analyzed whether the error climate differs in different school subjects and whether the same interrelations between the ways in which individuals deal with errors can be found in these different school subjects. In a study with 937 students from 48 classrooms from grades 5 to 7, in different secondary schools in Germany and Austria, we assessed the error climate and individual reactions following errors in mathematics, German, and English. Small mean differences between mathematics and the two language subjects were yielded. In addition, we found medium-sized correlations between the error climate measures in the three school subjects. However, the same pattern of interrelations between error climate and the way individuals deal with errors for all three school subjects could be shown. The results suggest that the perception of the error climate is rather similar in different school subjects. This has implications, for instance, for interventions that aim at fostering the error climate.