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The European Norm EN 16258 was published in 2012 to provide a common methodology for the calculation and declaration of energy consumption and greenhouse gas emissions related to any transport operation. The objective was to offer a pragmatic and scientifically-acceptable approach that allows a wide group of users to prepare standardized, accurate, credible, comparable, and verifiable energy consumption and emission declarations. However, in its current form, EN 16258 contains gaps and ambiguities, and leaves room for interpretation, which makes comparisons of supply chains difficult. This research aims to overcome the shortcomings in the domain of allocating emissions from road freight transport operations to single shipments. Based on a discussion of emission drivers and the results of numerical experiments comparing the allocation vectors created by the EN 16258 allocation rules with those generated by the Shapley value, which is claimed to be the benchmark, ‘distance’ is identified as the single most useful unit for bridging the trade-off between accuracy and simplicity better than the other recommended allocation schemes. Thus, this paper claims that future versions of EN 16258 should only allow the allocation unit ‘distance.’ This will promote the accurateness, simplicity, consistency, transparency, and comparability of emission declarations.
Online-Navigationsdienste ermöglichen die Planung einer Reise von einem Start- zu einem Ziel-Ort. Die Berechnung von Reisedauer und Streckenlänge erfolgt auf Grundlage eines detaillierten Straßennetzes und unter Berücksichtigung Orts- und Zeit-typischer Verkehrsaufkommen. Dieser Beitrag zeigt, inwiefern Online-Navigationsdienste die Planung und Analyse logistischer Systeme unterstützen können. Er thematisiert insbesondere die Qualität der zur Verfügung gestellten Verkehrsinfrastrukturdaten und hebt die komparativen Vorteile des Einsatzes von Online-Navigationsdiensten im Vergleich zu ‚herkömmlichen‘ Verkehrsinformationsquellen hervor. Ein Anwendungsfall, bei dem die durch Transportaktivitäten verursachten CO2-Emissionen eines Güternahverkehrsnetzes untersucht werden, verdeutlicht die gewonnenen Erkenntnisse.
Zehn neue p‐Dotanden für die Leitfähigkeitsdotierung von organischen Halbleitern wurden identifiziert. Der wesentliche Vorteil der elektrophilen Tris(carboxylato)‐Bismut(III)‐Verbindungen ist die niedrige Absorption der damit dotierten Schichten. Diese Eigenschaft zusammen mit ihren niedrigen Herstellungskosten sowie der guten Verdampfbarkeit und Stabilität macht diese Dotanden sehr attraktiv für Anwendungen in der organischen Elektronik.
Applications in engineering frequently require the adjustment of certain parameters. While the mathematical laws that determine these parameters often are well understood, due to time limitations in every day industrial life, it is typically not feasible to derive an explicit computational procedure for adjusting the parameters based on some given measurement data. This paper aims at showing that in such situations, direct optimization offers a very simple approach that can be of great help. More precisely, we present a numerical implementation for the local minimization of a smooth function f:Rn→R subject to upper and lower bounds without relying on the knowledge of the derivative of f. In contrast to other direct optimization approaches the algorithm assumes that the function evaluations are fairly cheap and that the rounding errors associated with the function evaluations are small. As an illustration, this algorithm is applied to approximate the solution of a calibration problem arising from an engineering application. The algorithm uses a Quasi-Newton trust region approach adjusting the trust region radius with a line search. The line search is based on a spline function which minimizes a weighted least squares sum of the jumps in its third derivative. The approximate gradients used in the Quasi-Newton approach are computed by central finite differences. A new randomized basis approach is considered to generate finite difference approximations of the gradient which also allow for a curvature correction of the Hessian in addition to the Quasi-Newton update. These concepts are combined with an active set strategy. The implementation is public domain; numerical experiments indicate that the algorithm is well suitable for the calibration problem of measuring instruments that prompted this research. Further preliminary numerical results suggest that an approximate local minimizer of a smooth non-convex function f depending on n≤300 variables can be computed with a number of iterations that grows moderately with n.
Background
Contemporary casemix systems for health services need to ensure that payment rates adequately account for actual resource consumption based on patients’ needs for services. It has been argued that functioning information, as one important determinant of health service provision and resource use, should be taken into account when developing casemix systems. However, there has to date been little systematic collation of the evidence on the extent to which the addition of functioning information into existing casemix systems adds value to those systems with regard to the predictive power and resource variation explained by the groupings of these systems. Thus, the objective of this research was to examine the value of adding functioning information into casemix systems with respect to the prediction of resource use as measured by costs and length of stay.
Methods
A systematic literature review was performed. Peer-reviewed studies, published before May 2014 were retrieved from CINAHL, EconLit, Embase, JSTOR, PubMed and Sociological Abstracts using keywords related to functioning (‘Functioning’, ‘Functional status’, ‘Function*, ‘ICF’, ‘International Classification of Functioning, Disability and Health’, ‘Activities of Daily Living’ or ‘ADL’) and casemix systems (‘Casemix’, ‘case mix’, ‘Diagnosis Related Groups’, ‘Function Related Groups’, ‘Resource Utilization Groups’ or ‘AN-SNAP’). In addition, a hand search of reference lists of included articles was conducted. Information about study aims, design, country, setting, methods, outcome variables, study results, and information regarding the authors’ discussion of results, study limitations and implications was extracted.
Results
Ten included studies provided evidence demonstrating that adding functioning information into casemix systems improves predictive ability and fosters homogeneity in casemix groups with regard to costs and length of stay. Collection and integration of functioning information varied across studies. Results suggest that, in particular, DRG casemix systems can be improved in predicting resource use and capturing outcomes for frail elderly or severely functioning-impaired patients.
Conclusion
Further exploration of the value of adding functioning information into casemix systems is one promising approach to improve casemix systems ability to adequately capture the differences in patient’s needs for services and to better predict resource use.
In two experiments, we examined the competition dependence of retrieval-induced forgetting (RIF) in motor memory. Participants learned sequential finger movements as responses to letter stimuli. The learning phase comprised two parts. In both parts, half of the motor sequences were to be executed at one of two locations (the left or right side of a keyboard) by pressing the corresponding response keys. Retrieval practice of half of the motor sequences at one location induced forgetting of the nonpracticed motor sequences at that location. However, RIF was prevented in Experiment 1 when retrieval practice took place before the nonpracticed items had even been encoded. In Experiment 2, RIF was prevented by intentionally forgetting the nonpracticed motor sequences prior to retrieval practice. These results suggest that precluding competition by related items during retrieval practice precluded them from being affected by RIF. The present findings support an inhibitory account and speak against the alternative assumptions that associative blocking or a mental context change causes RIF.
This research quantifies the impact that regular road traffic congestion has on the CO2 emissions of a real-world distribution network, and it studies the consequences when the number of distribution centers changes. For this purpose, this study makes use of a network model allowing for a detailed representation of all relevant transport operations, including production flows between factories and distribution centers, line haul shipments between distribution centers and customers, and round/delivery trips between transshipment points and retailer locations for the last mile. The processed trip and traffic information does not rely on standard traffic data collection approaches, such as interviews, in situ technologies, or floating car data, but the road traffic data are retrieved from an online navigation service, such as Bing Maps, Google Maps, Inrix, Here, and TomTom. This study proves that online navigation services may considerably contribute to future research projects analyzing CO2 sensitivities and greenhouse gas cutting opportunities in logistics networks.
Objective
Our aim was to specify the requirements of an architecture to serve as the foundation for standardized reporting of health information and to provide an exemplary application of this architecture.
Methods
The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) served as the conceptual framework. Methods to establish content comparability were the ICF Linking Rules. The Rasch measurement model, as a special case of additive conjoint measurement, which satisfies the required criteria for fundamental measurement, allowed for the development of a common metric foundation for measurement unit conversion. Secondary analysis of data from the North Yorkshire Survey was used to illustrate these methods. Patients completed three instruments and the items were linked to the ICF. The Rasch measurement model was applied, first to each scale, and then to items across scales which were linked to a common domain.
Results
Based on the linking of items to the ICF, the majority of items were grouped into two domains, Mobility and Self-care. Analysis of the individual scales and of items linked to a common domain across scales satisfied the requirements of the Rasch measurement model. The measurement unit conversion between items from the three instruments linked to the Mobility and Self-care domains, respectively, was demonstrated.
Conclusions
The realization of an ICF-based architecture for information on patients’ functioning enables harmonization of health information while allowing clinicians and researchers to continue using their existing instruments. This architecture will facilitate access to comprehensive and consistently reported health information to serve as the foundation for informed decision-making.
Health is a complex process with potentially interacting components from the molecular to the societal and environmental level. Adequate research designs and data analysis methods are needed to improve our understanding of this complexity, to ultimately derive high quality evidence to inform patients, health professionals, and health policy decision makers. Also, effective patient-centred health care has to address the complexity of health, functioning, and disability, not only by implementing interventions, but also by using information technologythatrepresentsthecomplexityofhealthcaretoinformallactors. Given this background, we developed the concept of our conference HEC2016 as an interdisciplinary European event in beautiful Bavaria, in the city of Mu ¨nchen. Quite ironically this is the place, where William of Ockham, whose ideas of parsimony are the very opposite of complexity, accused of heresy, spent 17 years under the protection of the Bavarian King Ludwig IV. Furthermore, our local public health hero Max von Pettenkofer (1818–1901) contributed a lot to the basic systemic understanding of health, especially the relevance of a healthy environment. Under the joint theme of health as a complex system we joined the activities of five scientific disciplines: Medical Informatics, Medical Biometry, Bioinformatics, Epidemiology and Health Data Management. The mission behind this interdisciplinary effort was to serve as an important scientific forum for the exchange of new ideas and applications to strengthen health sciences on a national and international level. The analysis of health as a complex system opens needed perspectives on a challenging reality: filtering current hypotheses, resolving controversies, and tailoring interventions to the need of the individual within a health system environment. The conference encouraged the dialogue of the disciplines in order to advance our understanding of health and to decrease burden of disease. HEC2016 brought together the annual conferences of the German Association for Medical Informatics, Biometry and Epidemiology (GMDS), the German Society for Epidemiology (DGEpi), the International Epidemiological Association- European Region (IEA-EEF) and the European Federation for Medical Informatics Association
(EFMI, MIE 2016). HEC2016 took place in Mu ¨nchen, Germany, in the main building of the Ludwig-Maximilians-Universita ¨t (LMU) from 28 August to 2 September 2016 under the auspices of the Institute for MedicalInformationProcessing,BiometryandEpidemiologyofLMU. The conference received 832 contributions for oral and poster presentation (Table 1). Fourteen percent of them were from outside Europe with the largest group of 10 % from Asia (Table 2). Scientific program committees and reviewers selected 408 submissions as oral contributions and 303 for poster presentations. The program was surrounded by twelve tutorials held by international renowned scientists and covered a broad spectrum from innovative biostatistical and epidemiological methods to tutorials in application of innovative software, scientific writing and data protection issues. Over 50 panel discussions and workshops allowed in-depth exchange of ideas on specific topics and underscored the interactive nature of HEC2016. A special focus of HEC2016 was on the promotion of young scientists from all disciplines whose participation was supported by numerous travel grants. We would like to express our deepest gratitude to all the colleagues who supported us as speakers, committee members and reviewers, lent us a hand before, during and after the conference, gave critical but friendly comments at all stages of the preparations, supported us by providing coffee, audience or Butterbrezen, and specifically to those who submitted contributions to the conference and attended the conference and its many tutorials, lectures and sessions. We extend our gratitude to the Deutsche Forschungsgemeinschaft for generous financial support (grant no. GR 3608/4-1). Last not least we would like to thank our families who allowed us to spend most of our weekends with organizing this conference, to William of Ockham for lending us his razor (from time to time) and to Max von Pettenkofer for guidance.
Growing evidence shows interrelations of psychological factors, neurological and immunological processes. Therefore, constructs like a balance of activities, the so called “occupational balance”, could also have biological correlates. The aim of this study was to investigate potential associations between occupational balance, functioning, cytokines and C-reactive protein (CRP) in patients suffering from a chronic inflammatory disease like rheumatoid arthritis (RA) and healthy people. Moreover, we wanted to explore potential differences in gender and employment status.
A descriptive study in patients with RA and healthy people was conducted using the Occupational Balance-Questionnaire (OB-Quest) and the Short-Form 36 Health Survey (SF-36). Serum levels of cytokines, such as interleukin 6 (IL-6) and 8 (IL-8), interferon alpha (INFα), tumour necrosis factor alpha (TNFα), rheumatoid factor (RF) and of CRP were measured. Descriptive statistics, as well as Mann-Whitney U tests and Spearmen's rank correlation coefficients (rs) were calculated.
One-hundred-thirty-two patients with RA and 76 healthy people participated. Occupational balance was associated with functioning, cytokines and CRP. The strongest associations were identified in the unemployed healthy-people sample with cytokines and CRP being within the normal range. For example, the OB-Quest item challenging activities was associated with IL-8 (rs = − 0.63, p = 0.04) and the SF-36 sub-scale bodily pain was associated with IFNα (rs = − 0.69, p = 0.02). The items rest and sleep (rs = − 0.71, p = 0.01) and variety of different activities (rs = − 0.74, p < 0.01) correlated with the SF-36 sub-scale social functioning. Employed and unemployed people differed in their age and CRP levels. Additionally, gender differences were found in two OB-Quest items in that fewer women were able to adapt their activities to changing living conditions and fewer men were overstressed. In conclusion, we found preliminary biological evidence for the link between occupation and health in that the concepts encompassed in the construct of occupational balance were associated with functioning, cytokines and CRP.
Purpose
The purpose of this paper is to propose a comprehensive methodology and a problem-specific model for the configuration of the optimal strategic supplier portfolio in terms of traditional, performance-related objectives and sustainability targets.
Design/methodology/approach
To bridge the research gap, i.e., to align strategic supplier portfolio selection with corporate sustainability targets, a hybrid model of the analytic network process (ANP) and goal programming (GP) is developed. To validate the model, a case example is presented and managerial feedback is collected.
Findings
By enabling the integration of sustainability targets into strategic supplier portfolio configuration, the hybrid ANP-GP model contributes to research in the area of sustainable supply chain management. Results indicate that simplifying the model by omitting one or more details may lead to unfortunate actions.
Research limitations/implications
The model has been applied using a case example in the automotive industry. To strengthen the findings, it should be examined under other terms as well.
Practical implications
Integrating economic, environmental, and social targets into strategic supplier portfolio configuration reduces supply risks and promotes the achievement of the sustainability goals of the purchasing company.
Social implications
Strategic supplier selection counts among the decisions that have an impact on the environment and society for several years. Configuring economically rational, environmentally friendly, and socially responsible supplier bases supports worldwide efforts towards sustainable development.
Originality/value
Although sustainable supplier selection has gained importance in recent years, this is the first time that a comprehensive model for the determination of the optimal strategic supplier portfolio in terms of performance-related objectives and sustainability targets has been proposed.
Metric properties of the Spinal Cord Independence Measure - Self Report in a community survey
(2016)
Objective: The Spinal Cord Independence Measure – Self Report (SCIM-SR) is a self-report instrument for assessing functional independence of persons with spinal cord injury. This study examined the internal construct validity and reliability of the SCIM-SR, when administered in a community survey, using the Rasch measurement model.
Methods: Rasch analysis of data from 1,549 individuals with spinal cord injury who completed the SCIM-SR.
Results: In the initial analysis no fit to the Rasch model was achieved. Items were grouped into testlets to accommodate the substantial local dependency. Due to the differential item functioning for lesion level and degree, spinal cord injury-specific sub-group analyses were conducted. Fit to the Rasch model was then achieved for individuals with tetraplegia and complete paraplegia, but not for those with incomplete paraplegia. Comparability of ability estimates across sub-groups was attained by anchoring all sub-groups on a testlet.
Conclusion: The SCIM-SR violates certain assumptions of the Rasch measurement model, as shown by the local dependency and differential item functioning. However, an intermediate solution to achieve fit in 3 out of 4 spinal cord injury sub-groups was found. For the time being, therefore, it advisable to use this approach to compute Rasch-transformed SCIM-SR scores.
Background: Joint contractures are a common health problem in older persons with significant impact on activities of daily living. We aimed to retrieve outcome measures applied in studies on older persons with joint contractures and to identify and categorise the concepts contained in these outcome measures using the ICF (International Classification of Functioning, Disability and Health) as a reference.
Methods: Electronic searches of Medline, EMBASE, CINAHL, Pedro and the Cochrane Library were conducted (1/2002-8/2012). We included studies in the geriatric rehabilitation and nursing home settings with participants aged ≥ 65 years and with acquired joint contractures. Two independent reviewers extracted the outcome measures and transferred them to concepts using predefined conceptual frameworks. Concepts were subsequently linked to the ICF categories.
Results: From the 1057 abstracts retrieved, 60 studies met the inclusion criteria. We identified 52 single outcome measures and 24 standardised assessment instruments. A total of 1353 concepts were revealed from the outcome measures; 96.2 % could be linked to 50 ICF categories in the 2nd level; 3.8 % were not categorised. Fourteen of the 50 categories (28 %) belonged to the component Body Functions, 4 (8 %) to the component Body Structures, 26 (52 %) to the component Activities and Participation, and 6 (12 %) to the component Environmental Factors.
Conclusions: The ICF is a valuable reference for identifying and quantifying the concepts of outcome measures on joint contractures in older people. The revealed ICF categories remain to be validated in populations with joint contractures in terms of clinical relevance and personal impact.
Based on numerous studies showing that testing studied material can improve long-term retention more than restudying the same material, it is often suggested that the number of tests in education should be increased to enhance knowledge acquisition. However, testing in real-life educational settings often entails a high degree of extrinsic motivation of learners due to the common practice of placing important consequences on the outcome of a test. Such an effect on the motivation of learners may undermine the beneficial effects of testing on long-term memory because it has been shown that extrinsic motivation can reduce the quality of learning. To examine this issue, participants learned foreign language vocabulary words, followed by an immediate test in which one-third of the words were tested and one-third restudied. To manipulate extrinsic motivation during immediate testing, participants received either monetary reward contingent on test performance or no reward. After 1 week, memory for all words was tested. In the immediate test, reward reduced correct recall and increased commission errors, indicating that reward reduced the number of items that can benefit from successful retrieval. The results in the delayed test revealed that reward additionally reduced the gain received from successful retrieval because memory for initially successfully retrieved words was lower in the reward condition. However, testing was still more effective than restudying under reward conditions because reward undermined long-term memory for concurrently restudied material as well. These findings indicate that providing performance–contingent reward in a test can undermine long-term knowledge acquisition.
Objective: To evaluate the metric properties of distinct measures of psychological personal factors comprising feelings, beliefs, motives, and patterns of experience and behaviour assessed in the Swiss Spinal Cord Injury Cohort Study (SwiSCI), using Rasch methodology.
Methods: SwiSCI Pathway 2 is a community-based, nationwide, cross-sectional survey for persons with spinal cord injury (SCI) (n = 511). The Rasch partial credit model was used for each subscale of the Positive Affect Negative Affect Scale (PANAS), Appraisal of Life Events Scale (ALE), Purpose in Life test – Short Form (PIL-SF), and the Big Five Inventory-K (BFI-K).
Results: The measures were unidimensional, with the exception of the positive affect items of the PANAS, where pairwise t-tests resulted in 10% significant cases, indicating multidimensionality. The BFI-K subscale agreeableness revealed low reliability (0.53). Other reliability estimates ranged between 0.61 and 0.89. Ceiling and floor effects were found for most measures. SCI-related differential item functioning (DIF) was rarely found. Language DIF was identified for several items of the BFI-K, PANAS and the ALE, but not for the PIL-SF.
Conclusion: A majority of the measures satisfy the assumptions of the Rasch model, including unidimensionality. Invariance across language versions still represents a major challenge.
Unternehmen sind häufig mit Situationen konfrontiert, in denen schnell Entscheidungen bezüglich der Auswahl mehrerer Handlungsalternativen gefunden werden müssen. Mathematische Verfahren können hierbei unterstützen, z. B. für die Ermittlung einer ersten Diskussionsbasis. Verfügbare Softwarelösungen errechnen zwar häufig optimale Ergebnisse, zeigen jedoch Schwächen bei der praktischen Anwendbarkeit. So ist eine Einarbeitung in komplexe Optimierungssoftware für die teilweise sporadisch auftretenden Probleme in der Regel für Unternehmen nicht möglich, unter anderem auch unter Anbetracht der teilweise hohen Kosten der Standardsoftware und dem benötigten hohen Einarbeitungsaufwand. Gerade Problemstellungen in Fachbereichen, die nicht auf mathematische Problemlösung spezialisiert sind, münden daher regelmäßig in Ineffizienzen. Basierend auf den in der Literatur diskutierten Lösungsansätzen wurde ein praxisorientierter Ansatz zur Entscheidungsunterstützung für Rucksackprobleme bzw. 0–1 Probleme mithilfe von Genetischen Algorithmen (GA) entwickelt und technisch in Microsoft Excel® umgesetzt. Ein Praxistest bei einem chinesischen Textilunternehmen belegt erhöhte Effektivität und Effizienz. Die Software kann kostenfrei nach MIT Lizenz unter http://www.solvega.de/ heruntergeladen werden.
Objective: Cohort studies are an appropriate method for the collection of population-based longitudinal data to track people's health and functioning over time. However, describing and understanding functioning in its complexity with all its determinants is one of the biggest challenges faced by clinicians and researchers.
Design: This paper focuses on the development of a cohort study on functioning, outlining the relevant steps and related methods, and illustrating these with reference to the Swiss Spinal Cord Injury Cohort Study (SwiSCI).
Methods and results: In setting up a cohort study the initial step is to specify which variables are to be included, i.e. what to assess. The International Classification of Functioning, Disability and Health (ICF) is valuable in this process. The second step is to identify how to assess the specified ICF categories. Existing instruments and assessments can then be linked to the ICF.
Conclusion: The methods outlined here enable the development of a cohort study to be based on a comprehensive perspective of health, operationalized through functioning as conceptualized and classified in the ICF, yet to remain efficient and feasible to administer.
Quality issue
Responding to person's health and related needs requires the availability of health information that reflects relevant aspects of a health condition and how this health condition impacts on a person's daily life.
Initial assessment
Health information is routinely collected at different time points by diverse professionals, in different settings for various purposes with varying methods. Consequently, health information is not always comparable, posing a challenge to the regular monitoring of quality.
Choice of solution
The World Health Organization's (WHO) International Classification of Diseases (ICD), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI; under development) are complementary and serve as meaningful reference classifications for comparing data on persons’ health and related interventions across health systems.
Implementation
We developed a systematic approach of translating routinely collected information into a standardized report based on the three WHO reference classifications and the Rehab-Cycle®. Subsequently, we have demonstrated its application using five random case records of individuals attending a rehabilitation program.
Evaluation
All identified concepts were able to be linked to WHO's reference classifications. The ICF served as a tool to standardize information on rehabilitation goals and their achievement. The ICHI served as the basis for reporting the interventions that were documented in the case records, including the intervention targets that were derived from the ICF codes.
Lessons learned
Our experience shows that, it is possible to translate routinely collected information into standardized reports by linking existing narrative records with WHO's reference classifications.
Objective: To test subgroups of a community-based sample of individuals with spinal cord injury, categorized by the application of current recommendations by the International Spinal Cord Society.
Design: Community survey.
Participants: Individuals with traumatic and non-traumatic spinal cord injury residing in Switzerland.
Methods: Recommended subgroups of age, gender, years since injury, severity of injury and aetiology were tested against the following criteria: (i) distribution of participants across categories; (ii) within- and between-group variability with regard to selected outcomes of functioning and quality of life.
Results: Data-sets for 1,549 participants (28.5% women; mean age 52 ± 15 years) were available for analyses. There was a number of participants in every subgroup, yet numbers were relatively small in the group with the shortest time since injury (< 1 year; n = 23) and in the oldest age group (≥76; n = 94). A high variability in some outcomes was detected between categories. All variables were predictive for most of the endpoints investigated.
Conclusion: Recommended categorization could well fit the present sample. A minor concern was the low numbers of participants in some subgroups.
In adults, testing can enhance subsequent learning by reducing interference from the tested information. Here, we examined this forward effect of testing in children. Younger and older elementary school children and adult controls studied four lists of items in anticipation of a final cumulative recall test. Following presentation of each of the first three lists, participants were immediately tested on the respective list, or the list was re-presented for additional study. Results revealed that, compared to additional study, immediate testing of Lists 1–3 enhanced memory for the subsequently studied List 4 in adults and older elementary school children, but not in younger elementary school children. The findings indicate that the forward effect of testing is a relatively late-maturing phenomenon that develops over middle childhood and is still inefficient in the early elementary school years. Together with the results of other recent studies, these findings point to a more general problem in young children in combating interference.