At what point in reading development does literacy impact object recognition and orientation processing? Is it specific to mirror images? To answer these questions, forty-six 5- to 7-year-old preschoolers and first graders performed two same-different tasks differing in the matching criterion-orientation-based versus shape-based (orientation independent)-on geometric shapes and letters. On orientation-based judgments, first graders outperformed preschoolers who had the strongest difficulty with mirrored pairs. On shape-based judgments, first graders were slower for mirrored than identical pairs, and even slower than preschoolers. This mirror cost emerged with letter knowledge. Only first graders presented worse shape-based judgments for mirrored and rotated pairs of reversible (e.g., b-d; b-q) than nonreversible (e.g., e-ә) letters, indicating readers' difficulty in ignoring orientation contrasts relevant to letters.

ObjectiveThe objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies.DesignA cross-sectional, multilevel study design that surveyed quality managers and department heads and data from an organizational audit.SettingRandomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey).ParticipantsHospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012.Main Outcome MeasuresFour items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level.ResultsCurrent levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies.ConclusionsThere is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect.

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Prior studies have shown that words show a composite effect: When readers perform a same-different matching task on a target-part of a word, performance is affected by the irrelevant part, whose influence is severely reduced when the two parts are misaligned. However, the locus of this word composite effect is largely unknown. To enlighten it, in two experiments, Portuguese readers performed the composite task on letter strings: in Experiment 1, in written words varying in surface features (between-participants: courier, notera, alternating-cAsE), and in Experiment 2 in pseudowords. The word composite effect, signaled by a significant interaction between alignment of the two word parts and congruence between parts was found in the three conditions of Experiment 1, being unaffected by NoVeLtY of the configuration or by handwritten form. This effect seems to have a lexical locus, given that in Experiment 2 only the main effect of congruence between parts was significant and was not modulated by alignment. Indeed, the cross-experiment analysis showed that words presented stronger congruence effects than pseudowords only in the aligned condition, because when misaligned the whole lexical item configuration was disrupted. Therefore, the word composite effect strongly depends on abstract lexical representations, as it is unaffected by surface features and is specific to lexical items.

The composite paradigm is widely used to quantify holistic processing (HP) of faces: participants perform a sequential same-different task on one half (e.g., top) of a test-face relative to the corresponding half of a study-face. There is, however, debate regarding the appropriate design in this task. In the partial design, the irrelevant halves (e.g., bottom) of test- and study-faces are always different; an alignment effect indexes HP. In the complete design, besides alignment, congruency between the irrelevant and critical halves of the test-face is manipulated regarding the same/different response status of the study-face. The HP indexed in the complete design does not confound congruency and alignment and has good construct and convergent validities. De Heering, Houthuys, & Rossion (2007) argued that HP is mature as early as 4-year-olds but employed the partial design. Here we revisit this claim, testing four groups of 4- to 9/10 year-old children and two groups of adults. We found evidence of HP only from 6-year-olds on when considering the complete design, whereas significant alignment effects were found in the index adopted in the partial design already in 4-year-olds but which we demonstrate that reflects other factors besides HP, including response bias associated with congruency.

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