Sample records for structured clinical judgment

  1. Evaluation of a model of violence risk assessment among forensic psychiatric patients.

    PubMed

    Douglas, Kevin S; Ogloff, James R P; Hart, Stephen D

    2003-10-01

    This study tested the interrater reliability and criterion-related validity of structured violence risk judgments made by using one application of the structured professional judgment model of violence risk assessment, the HCR-20 violence risk assessment scheme, which assesses 20 key risk factors in three domains: historical, clinical, and risk management. The HCR-20 was completed for a sample of 100 forensic psychiatric patients who had been found not guilty by reason of a mental disorder and were subsequently released to the community. Violence in the community was determined from multiple file-based sources. Interrater reliability of structured final risk judgments of low, moderate, or high violence risk made on the basis of the structured professional judgment model was acceptable (weighted kappa=.61). Structured final risk judgments were significantly predictive of postrelease community violence, yielding moderate to large effect sizes. Event history analyses showed that final risk judgments made with the structured professional judgment model added incremental validity to the HCR-20 used in an actuarial (numerical) sense. The findings support the structured professional judgment model of risk assessment as well as the HCR-20 specifically and suggest that clinical judgment, if made within a structured context, can contribute in meaningful ways to the assessment of violence risk.

  2. Nurses’ Clinical Judgment Development: A Qualitative Research in Iran

    PubMed Central

    Seidi, Jamal; Alhani, Fatemeh; Salsali, Mahvash

    2015-01-01

    Background: Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion. Objectives: In this study we explored the process of Iranian nurses’ development in clinical judgment. Patients and Methods: This qualitative study was conducted in 2013 at hospitals of Kurdistan University of Medical Sciences, located in the Sanandaj city of Iran. The data were collected based on semi-structured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method. Results: The study participants’ main concern was ‘being non-professional in clinical judgment’. In response to this concern, they were struggling for gaining professional autonomy, striving for integrating clinical judgment skills, scrambling to make effective educational interventions and striving for professional and inter professional collaboration in clinical judgment. The core category was ‘struggling for becoming professional in clinical judgment development’. When nurses were supported professionally, they were able to develop their professional clinical judgment. Conclusions: The findings of this study provided critical information about nurses’ professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses’ clinical judgment ability. PMID:26473075

  3. A framework to support preceptors' evaluation and development of new nurses' clinical judgment.

    PubMed

    Nielsen, Ann; Lasater, Kathie; Stock, Mary

    2016-07-01

    In today's complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates' learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses' clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Clinical Interview Assessment of Financial Capacity in Older Adults with Mild Cognitive Impairment and Alzheimer’s Disease

    PubMed Central

    Marson, Daniel C.; Martin, Roy C.; Wadley, Virginia; Griffith, H. Randall; Snyder, Scott; Goode, Patricia S.; Kinney, F. Cleveland; Nicholas, Anthony P.; Steele, Terri; Anderson, Britt; Zamrini, Edward; Raman, Rema; Bartolucci, Alfred; Harrell, Lindy E.

    2009-01-01

    Objectives To investigate financial capacity in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) using a clinician interview approach. Design Cross-sectional. Setting Tertiary care medical center. Participants Healthy older adults (N=75), patients with amnestic MCI (N=58), mild AD (N=97), and moderate AD (N=31). Measurements The investigators and five study physicians developed a conceptually based, semi-structured clinical interview for evaluating seven core financial domains and overall financial capacity (Semi-Structured Clinical Interview for Financial Capacity; SCIFC). For each participant, a physician made capacity judgments (capable, marginally capable, or incapable) for each financial domain and for overall capacity. Results Study physicians made a total of over 11,000 capacity judgments across the study sample (N=261). Very good inter-rater agreement was obtained for the SCIFC judgments. Increasing proportions of marginal and incapable judgment ratings were associated with increasing disease severity across the four study groups. For overall financial capacity, 95 percent of physician judgments for older controls were rated as capable, as compared to only 82% for patients with MCI, 26% for patients with mild AD, and 4% for patients with moderate AD. Conclusion Financial capacity in cognitively impaired older adults can be reliably evaluated by physicians using a relatively brief, semi-structured clinical interview. Financial capacity shows mild impairment in MCI, emerging global impairment in mild AD, and advanced global impairment in moderate AD. MCI patients and their families should proactively engage in financial and legal planning given these patients’ risk of developing AD and accelerated loss of financial abilities. PMID:19453308

  5. The Impact of Critical Thinking on Clinical Judgment During Simulation With Senior Nursing Students.

    PubMed

    Cazzell, Mary; Anderson, Mindi

    2016-01-01

    The study examined the impact of critical thinking (CT) on clinical judgment (CJ) during a pediatric Objective Structured Clinical Evaluation (OSCE) with 160 pre-licensure nursing students. Educators are called to transform teaching strategies to develop CJ but confusion exists over definitions. A descriptive correlational design was used to examine demographics and Tower of Hanoi (TOH) and Health Science Reasoning Test (HSRT) scores. CJ was measured by scores on the Lasater Clinical Judgment Rubric (LCJR) from videotaped OSCEs. Participants were: 86 percent female, 42 percent Caucasian, median 23 years, with 49 percent having health care experience. Students averaged seven moves over minimum on the TOH. Average scores were: HSRT 25/38 and LCJR 31/44. Statistically significant predictors of CJ were gender, ethnicity, HSRT deduction, and analysis; 11 CT variables accounted for 17 percent of LCJR scores. Educators need to utilize/develop innovative teaching strategies addressing CJ predictors.

  6. The Clinical Threat Assessment of the Lone-Actor Terrorist.

    PubMed

    Meloy, J Reid; Genzman, Jacqueline

    2016-12-01

    The Terrorist Radicalization Assessment Protocol (TRAP-18) is a structured professional judgment instrument for the assessment of individuals who present a concern for lone-actor terrorism. It consists of eight proximal warning behaviors and 10 distal characteristics. Previous research has demonstrated its interrater reliability and some concurrent and postdictive validity. In this article, TRAP-18 is retrospectively applied to the case of US Army psychiatrist and jihadist Malik Nidal Hasan, who committed a mass murder at Fort Hood, Texas in 2009. The strengths and limitations of TRAP-18 as a structured professional judgment instrument for mental health clinicians are discussed, and clinical risk management suggestions are made. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. The Meta-Analysis of Clinical Judgment Project: Effects of Experience on Judgment Accuracy

    ERIC Educational Resources Information Center

    Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.; Anderson, Linda A.; Cook, Robert S.; Nichols, Cassandra N.; Lampropoulos, Georgios K.; Walker, Blain S.; Cohen, Genna R.; Rush, Jeffrey D.

    2009-01-01

    Clinical and educational experience is one of the most commonly studied variables in clinical judgment research. Contrary to clinicians' perceptions, clinical judgment researchers have generally concluded that accuracy does not improve with increased education, training, or clinical experience. In this meta-analysis, the authors synthesized…

  8. Electronic health record tools' support of nurses' clinical judgment and team communication.

    PubMed

    Kossman, Susan P; Bonney, Leigh Ann; Kim, Myoung Jin

    2013-11-01

    Nurses need to quickly process information to form clinical judgments, communicate with the healthcare team, and guide optimal patient care. Electronic health records not only offer potential for enhanced care but also introduce unintended consequences through changes in workflow, clinical judgment, and communication. We investigated nurses' use of improvised (self-made) and electronic health record-generated cognitive artifacts on clinical judgment and team communication. Tanner's Clinical Judgment Model provided a framework and basis for questions in an online survey and focus group interviews. Findings indicated that (1) nurses rated self-made work lists and medication administration records highest for both clinical judgment and communication, (2) tools aided different dimensions of clinical judgment, and (3) interdisciplinary tools enhance team communication. Implications are that electronic health record tool redesign could better support nursing work.

  9. A study to determine the difference in clinical judgment abilities between BSN and non-BSN graduates.

    PubMed

    Sanford, M; Genrich, S; Nowotny, M

    1992-02-01

    The purpose of this retrospective study is to determine the difference in clinical judgment abilities of recent baccalaureate nurses (BSN) seeking employment in a large metropolitan hospital and of nurses without a baccalaureate degree. Using an ex post facto design, the orientation records of 116 newly hired nurses were analyzed to determine the clinical judgment abilities using video vignettes produced by Medcom, Inc. Findings indicated that there was no difference in clinical judgment in newly hired BSN and non-BSN graduates. These findings indicate a need for more research studies to determine how clinical judgment is developed and to evaluate teaching strategies that facilitate clinical judgment.

  10. Construction and Validation of the Clinical Judgment Skill Inventory: Clinical Judgment Skill Competencies That Measure Counselor Debiasing Techniques

    ERIC Educational Resources Information Center

    Austin, Bryan S.; Leahy, Michael J.

    2015-01-01

    Purpose: To construct and validate a new self-report instrument, the Clinical Judgment Skill Inventory (CJSI), inclusive of clinical judgment skill competencies that address counselor biases and evidence-based strategies. Method: An Internet-based survey design was used and an exploratory factor analysis was performed on a sample of rehabilitation…

  11. Self-Reflection of Video-Recorded High-Fidelity Simulations and Development of Clinical Judgment.

    PubMed

    Bussard, Michelle E

    2016-09-01

    Nurse educators are increasingly using high-fidelity simulators to improve prelicensure nursing students' ability to develop clinical judgment. Traditionally, oral debriefing sessions have immediately followed the simulation scenarios as a method for students to connect theory to practice and therefore develop clinical judgment. Recently, video recording of the simulation scenarios is being incorporated. This qualitative, interpretive description study was conducted to identify whether self-reflection on video-recorded high-fidelity simulation (HFS) scenarios helped prelicensure nursing students to develop clinical judgment. Tanner's clinical judgment model was the framework for this study. Four themes emerged from this study: Confidence, Communication, Decision Making, and Change in Clinical Practice. This study indicated that self-reflection of video-recorded HFS scenarios is beneficial for prelicensure nursing students to develop clinical judgment. [J Nurs Educ. 2016;55(9):522-527.]. Copyright 2016, SLACK Incorporated.

  12. Thinking like a nurse: a research-based model of clinical judgment in nursing.

    PubMed

    Tanner, Christine A

    2006-06-01

    This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: (1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combination; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning. A model based on these general conclusions emphasizes the role of nurses' background, the context of the situation, and nurses' relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.

  13. Perception versus reality: a comparative study of the clinical judgment skills of nurses during a simulated activity.

    PubMed

    Fenske, Cynthia L; Harris, Margaret A; Aebersold, Michelle L; Hartman, Laurie S

    2013-09-01

    This study was conducted to determine how closely nurses' perceptions of their clinical judgment abilities matched their demonstrated clinical judgment skills during a simulation. Seventy-four registered nurses participated in a simulation using a video format. After the simulation, the nurses self-assessed their performance using the Lasater Clinical Judgment Rubric. This rubric was then used to rate the nurses' actual performance in the simulation activity. The study results showed a significant discrepancy between nurses' perceptions of their own clinical judgment abilities and their demonstrated clinical judgment skills. Age and length of nursing experience enhanced the difference between the findings of self-assessment and actual performance. Younger nurses and those with 1 year or less of nursing experience were significantly more likely to have self-assessed their abilities at a much higher level compared with their actual skills. Copyright 2013, SLACK Incorporated.

  14. Nursing student stories on learning how to think like a nurse.

    PubMed

    Di Vito-Thomas, Pam

    2005-01-01

    The ability to think critically, improve clinical systems, and decrease errors in clinical judgments are ever the vision of nursing practice. The author describes the thinking processes of nursing students as they make clinical judgments and the most important teaching/learning strategies that help develop their clinical judgment.

  15. Comparison of Decision Assist and Clinical Judgment of Experts for Prediction of Lifesaving Interventions

    DTIC Science & Technology

    2015-03-01

    min of pulse oximeter photopletysmograph waveforms and extracted features to predict LSIs. We compared this with clinical judgment of LSIs by...Curve (AUROC). We obtained clinical judgment of need for LSI from 405 expert clinicians in135 trauma patients. The pulse oximeter algorithm...15 min of pulse oximeter waveforms predicts the need for LSIs during initial trauma resuscitation as accurately as judgment of expert trauma

  16. Current status of clinical education in paramedic programs: a descriptive research project.

    PubMed

    Grubbs, K C

    1997-01-01

    Development of competence in exercising therapeutic judgment skills represents the goal of clinical education. Time (clock hours) is not a valid predictor of attainment of competence in paramedic clinical education. Quantity of patient contact experiences facilitates development of judgment skills, and offers a valid measure of progress toward competence. This project uses national survey data from accredited programs to describe the availability and accessibility of patient contact experiences within paramedic clinical education. Data from this local program supplements the national survey results. The components of clinical judgment are enumerated, and strategies to teach and evaluate clinical judgment skills are discussed.

  17. Clinical judgment, moral anxiety, and the limits of psychiatry.

    PubMed

    Murray, Bradley

    2017-12-01

    It is common for clinicians working in psychiatry and related clinical disciplines to be called on to make diagnostic clinical judgments concerning moral anxiety, which is a kind of anxiety that is closely bound up with decisions individuals face as moral agents. To make such a judgment, it is necessary to make a moral judgment. Although it has been common to acknowledge that there are ways in which moral and clinical judgment interact, this type of interaction has remained unacknowledged. This raises questions as to the nature and limits of psychiatry-particularly concerning the extent to which psychiatric discourse ought to incorporate moral discourse, and the role of the clinician as an expert in identifying problematic anxiety.

  18. Critical thinking versus clinical reasoning versus clinical judgment: differential diagnosis.

    PubMed

    Victor-Chmil, Joyce

    2013-01-01

    Concepts of critical thinking, clinical reasoning, and clinical judgment are often used interchangeably. However, they are not one and the same, and understanding subtle difference among them is important. Following a review of the literature for definitions and uses of the terms, the author provides a summary focused on similarities and differences in the processes of critical thinking, clinical reasoning, and clinical judgment and notes suggested methods of measuring each.

  19. Do clinicians decide relying primarily on Bayesians principles or on Gestalt perception? Some pearls and pitfalls of Gestalt perception in medicine.

    PubMed

    Cervellin, Gianfranco; Borghi, Loris; Lippi, Giuseppe

    2014-08-01

    Clinical judgment is a foundation of medical practice and lies at the heart of a physician's knowledge, expertise and skill. Although clinical judgment is an active part of all medical fields, thus including diagnosis and therapy, communication and decision making, it is still poorly defined. It can be considered a synthesis of intuition (mainly based on Gestalt principles) and an analytical approach. Gestalt perception finds its rationale in the evidence that perception of any given object or experience exhibits intrinsic qualities that cannot be completely reduced to visual, auditory, tactile, olfactory, or gustatory components. Thus, perceptions are not constructed in a "bottom-up" fashion from such elements, but are instead globally perceived, in a more "top-down" fashion. Gestalt perception, if cautiously and carefully combined with structured (techno)logical tools, would permit one to defoliate the often too-many-branches built diagnostic trees, and help physicians to better develop their competency. On the other hand, the practice of evidence-based medicine lies in the integration of individual clinical expertise and judgment with the best available external clinical evidence from systematic research. This article is aimed at providing some general concepts about Gestalt perception, and to discuss some aspects of clinical practice potentially influenced by this approach.

  20. [Clinical judgment is a schema. Conceptual proposals and training perspectives.

    PubMed

    Nagels, Marc

    2017-06-01

    Clinical judgment is a critical concept for the development of nursing and nursing education. Its theoretical origins are multiple and its definition is not yet consensus. The analysis of the scientific and professional literature shows heterogeneous and dispersed points of views, notably on the role of intuition, on its cognitive and metacognitive dimensions, and on its proximity to other concepts. Between professional stakes and epistemological constructions, clinical judgment is still an emerging concept.To overcome the obstacle and contribute to the theoretical effort, we will argue that clinical judgment must be analyzed as a schema. It presents all the characteristics : diagnosis and information necessary for reasoning, rational decision-making process, metacognitive control and evaluation of decision-making. Perspectives then open to better understand the nursing activity.In conclusion, recommendations for developing clinical judgment in training will be presented.

  1. Impact of computer-based treatment planning software on clinical judgment of dental students for planning prosthodontic rehabilitation

    PubMed Central

    Deshpande, Saee; Chahande, Jayashree

    2014-01-01

    Purpose Successful prosthodontic rehabilitation involves making many interrelated clinical decisions which have an impact on each other. Self-directed computer-based training has been shown to be a very useful tool to develop synthetic and analytical problem-solving skills among students. Thus, a computer-based case study and treatment planning (CSTP) software program was developed which would allow students to work through the process of comprehensive, multidisciplinary treatment planning for patients in a structured and logical manner. The present study was aimed at assessing the effect of this CSTP software on the clinical judgment of dental students while planning prosthodontic rehabilitation and to assess the students’ perceptions about using the program for its intended use. Methods A CSTP software program was developed and validated. The impact of this program on the clinical decision making skills of dental graduates was evaluated by real life patient encounters, using a modified and validated mini-CEX. Students’ perceptions about the program were obtained by a pre-validated feedback questionnaire. Results The faculty assessment scores of clinical judgment improved significantly after the use of this program. The majority of students felt it was an informative, useful, and innovative way of learning and they strongly felt that they had learnt the logical progression of planning, the insight into decision making, and the need for flexibility in treatment planning after using this program. Conclusion CSTP software was well received by the students. There was significant improvement in students’ clinical judgment after using this program. It should thus be envisaged fundamentally as an adjunct to conventional teaching techniques to improve students’ decision making skills and confidence. PMID:25170288

  2. Gaming as an Educational Strategy to Enhance Clinical Judgment and Knowledge Retention

    ERIC Educational Resources Information Center

    Lane, Jodie

    2011-01-01

    Classroom lecture methods in nursing education are falling short of providing long-term retention of knowledge and do not enhance problem solving skills or clinical judgment at the bedside. This problem impacts the health care recipients because applied knowledge and an enhanced skill set can provide nurses with confident clinical judgment to…

  3. [Structural elements of critical thinking of nurses in emergency care].

    PubMed

    Crossetti, Maria da Graça Oliveira; Bittencourt, Greicy Kelly Gouveia Dias; Lima, Ana Amélia Antunes; de Góes, Marta Georgina Oliveira; Saurin, Gislaine

    2014-09-01

    The objective of this study was to analyze the structural elements of critical thinking (CT) of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

  4. On assessing the quality of physicians' clinical judgment: the search for outcome variables.

    PubMed

    Wainer, Howard; Mee, Janet

    2004-12-01

    A primary question that must be resolved in the development of tasks to assess the quality of physicians' clinical judgment is, "What is the outcome variable?" One natural choice would seem to be the correctness of the clinical decision. In this article, we use data on the diagnosis of urinary tract infections among young girls to illustrate why, in many clinical situations, this is not a useful variable. We propose instead a judgment weighted by the relative costs of an error. This variable has the disadvantage of requiring expert judgment for scoring, but the advantage of measuring the construct of interest.

  5. [Development and practice evaluation of blood acid-base imbalance analysis software].

    PubMed

    Chen, Bo; Huang, Haiying; Zhou, Qiang; Peng, Shan; Jia, Hongyu; Ji, Tianxing

    2014-11-01

    To develop a blood gas, acid-base imbalance analysis computer software to diagnose systematically, rapidly, accurately and automatically determine acid-base imbalance type, and evaluate the clinical application. Using VBA programming language, a computer aided diagnostic software for the judgment of acid-base balance was developed. The clinical data of 220 patients admitted to the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. The arterial blood gas [pH value, HCO(3)(-), arterial partial pressure of carbon dioxide (PaCO₂)] and electrolytes included data (Na⁺ and Cl⁻) were collected. Data were entered into the software for acid-base imbalances judgment. At the same time the data generation was calculated manually by H-H compensation formula for determining the type of acid-base imbalance. The consistency of judgment results from software and manual calculation was evaluated, and the judgment time of two methods was compared. The clinical diagnosis of the types of acid-base imbalance for the 220 patients: 65 cases were normal, 90 cases with simple type, mixed type in 41 cases, and triplex type in 24 cases. The accuracy of the judgment results of the normal and triplex types from computer software compared with which were calculated manually was 100%, the accuracy of the simple type judgment was 98.9% and 78.0% for the mixed type, and the total accuracy was 95.5%. The Kappa value of judgment result from software and manual judgment was 0.935, P=0.000. It was demonstrated that the consistency was very good. The time for software to determine acid-base imbalances was significantly shorter than the manual judgment (seconds:18.14 ± 3.80 vs. 43.79 ± 23.86, t=7.466, P=0.000), so the method of software was much faster than the manual method. Software judgment can replace manual judgment with the characteristics of rapid, accurate and convenient, can improve work efficiency and quality of clinical doctors and has great clinical application promotion value.

  6. Clinical judgments about endotracheal suctioning: what cues do expert pediatric critical care nurses consider?

    PubMed

    Thomas, Margot; Fothergill-Bourbonnais, Frances

    2005-12-01

    Making accurate and timely judgments based on multiple ways of knowing is an essential skill in critical care nursing practice. Studies have proposed that positive patient outcomes are linked to expert judgments in a variety of critical care situations; however, little is known about clinical judgments related to specific critical care nursing interventions. This article presents a qualitative nursing research study which examined the cues that expert pediatric critical care nurses used in making clinical judgments about suctioning intubated and ventilated, critically ill children. The participants' words and actions attest that the 'sensing' and 'thinking' of the process of cue use, are interwoven with, and integral to, the 'doing,' which is the process of skilled performance.

  7. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  8. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  9. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  10. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  11. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  12. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  13. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  14. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  15. 14 CFR 67.113 - General medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  16. 14 CFR 67.313 - General medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  17. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  18. 14 CFR 67.213 - General medical condition.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...

  19. Clinical nursing informatics. Developing tools for knowledge workers.

    PubMed

    Ozbolt, J G; Graves, J R

    1993-06-01

    Current research in clinical nursing informatics is proceeding along three important dimensions: (1) identifying and defining nursing's language and structuring its data; (2) understanding clinical judgment and how computer-based systems can facilitate and not replace it; and (3) discovering how well-designed systems can transform nursing practice. A number of efforts are underway to find and use language that accurately represents nursing and that can be incorporated into computer-based information systems. These efforts add to understanding nursing problems, interventions, and outcomes, and provide the elements for databases from which nursing's costs and effectiveness can be studied. Research on clinical judgment focuses on how nurses (perhaps with different levels of expertise) assess patient needs, set goals, and plan and deliver care, as well as how computer-based systems can be developed to aid these cognitive processes. Finally, investigators are studying not only how computers can help nurses with the mechanics and logistics of processing information but also and more importantly how access to informatics tools changes nursing care.

  20. Application of a Judgment Model toward Measurement of Clinical Judgment in Senior Nursing Students

    ERIC Educational Resources Information Center

    Pongmarutai, Tiwaporn

    2010-01-01

    Clinical judgment, defined as "the application of the nurse's knowledge and experience in making decisions about client care" (The National Council of State Boards of Nursing, 2005, p. 2), has been recognized as a vital and essential skill for healthcare providers when caring for clients. Undisputedly, nurses represent the largest…

  1. Nurses' Judgment as They Care for Persons Who Exhibit Impaired Judgment: A Phenomenonological Study.

    ERIC Educational Resources Information Center

    Doona, Mary Ellen

    1995-01-01

    A study looked at the process by which psychiatric nurses (n=6) make judgments as they care for people with impaired judgment. Results revealed an overarching theme--judgment as personal responsibility--and four major themes: closeness to clinical data, critical reflection, respect for one's knowledge and ignorance, and the existential nature of…

  2. Impact of high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students.

    PubMed

    Fawaz, Mirna A; Hamdan-Mansour, Ayman M

    2016-11-01

    High-fidelity simulation (HFS) offers a strategy to facilitate cognitive, affective, and psychomotor outcomes and motivate the new generation of students. The purpose of this study was to examine the impact of using high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students. A post-test, quasi-experimental design was used. Two private universities in Lebanon were targeted to implement the intervention. A convenience sample of 56 nursing students from two private universities in Lebanon were recruited. Data were collected using the Lasater Clinical Judgment Rubric and the Motivated Strategies for Learning questionnaires. Nursing students exhibited significant improvement in clinical judgment and motivation due to exposure to HFS. There was a significant difference post HFS between the intervention group and the control group in clinical judgment intervention (t=5.23, p<0.001) and motivation for academic achievement (t=-6.71, p<0.001). The intervention group had a higher mean score of clinical judgment (29.5, SD=5.4) than the control group (22.1, SD=5.7) and, similarly, students had higher mean scores of motivation (198.6, SD=10.5) in the intervention group than in the control group (161.6, SD=20). The analysis related to differences between the intervention and control groups in motivation and clinical judgment; controlling for previous experience in health care services, the analysis showed no significant difference (Wilk's lambda =0.77, F=1.09, p=0.374). There is a need for nursing educators to implement HFS in nursing curricula, where its integration can bridge the gap between theoretical knowledge and nursing practice and enhance critical thinking and motivation among nursing students. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Assessing risk of reoffending in adolescents who have committed a sexual offense: the accuracy of clinical judgments after completion of risk assessment instruments.

    PubMed

    Elkovitch, Natasha; Viljoen, Jodi L; Scalora, Mario J; Ullman, Daniel

    2008-01-01

    As courts often rely on clinicians when differentiating between sexually abusive youth at a low versus high risk of reoffense, understanding factors that contribute to accuracy in assessment of risk is imperative. The present study built on existing research by examining (1) the accuracy of clinical judgments of risk made after completing risk assessment instruments, (2) whether instrument-informed clinical judgments made with a high degree of confidence are associated with greater accuracy, and (3) the risk assessment instruments and subscales most predictive of clinical judgments. Raters assessed each youth's (n = 166) risk of reoffending after completing the SAVRY and J-SOAP-II. Raters were not able to predict detected cases of either sexual recidivism or nonsexual violent recidivism above chance, and a high degree of rater confidence was not associated with higher levels of accuracy. Total scores on the J-SOAP-II were predictive of instrument-informed clinical judgments of sexual risk, and total scores on the SAVRY of nonsexual risk.

  4. Can Student Nurse Critical Thinking Be Predicted from Perceptions of Structural Empowerment within the Undergraduate, Pre-Licensure Learning Environment?

    ERIC Educational Resources Information Center

    Caswell-Moore, Shelley P.

    2013-01-01

    The purpose of this study was to test a model using Rosabeth Kanter's theory (1977; 1993) of structural empowerment to determine if this model can predict student nurses' level of critical thinking. Major goals of nursing education are to cultivate graduates who can think critically with a keen sense of clinical judgment, and who can perform…

  5. The tacit dimension of clinical judgment.

    PubMed Central

    Goldman, G. M.

    1990-01-01

    Two distinct views of the nature of clinical judgment are identified and contrasted. The dominant view that clinical judgment is a fully explicit process is compared to the relatively neglected view that tacit knowledge plays a substantial role in the clinician's mental operations. The tacit dimension of medical thinking is explored at length. The discussion suggests severe limits when applying decision analysis, expert systems, and computer-aided cost-benefit review to medicine. The goals and practices of postgraduate medical education are also examined from this perspective, as are various other implications for the clinician. The paper concludes that it is valuable to explore the nature of medical thinking in order to improve clinical practice and education. Such explorations should, however, take cognizance of the often overlooked tacit dimension of clinical judgment. Possible constraints on the medical applicability of both formal expert systems and heavily didactic instructional programs are considered. PMID:2356625

  6. Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels.

    PubMed

    Formby, Craig; Payne, JoAnne; Yang, Xin; Wu, Delphanie; Parton, Jason M

    2017-02-01

    This study was undertaken with the purpose of streamlining clinical measures of loudness growth to facilitate and enhance prescriptive fitting of nonlinear hearing aids. Repeated measures of loudness at 500 and 3,000 Hz were obtained bilaterally at monthly intervals over a 6-month period from three groups of young adult listeners. All volunteers had normal audiometric hearing sensitivity and middle ear function, and all denied problems related to sound tolerance. Group 1 performed judgments of soft and loud, but OK for presentation of ascending sound levels. We defined these judgments operationally as absolute judgments of loudness. Group 2 initially performed loudness judgments across a continuum of seven loudness categories ranging from judgments of very soft to uncomfortably loud for presentation of ascending sound levels per the Contour Test of Loudness; we defined these judgments as relative judgments of loudness. In the same session, they then performed the absolute judgments for soft and loud, but OK sound levels. Group 3 performed the same set of loudness judgments as did group 2, but the task order was reversed such that they performed the absolute judgments initially within each test session followed by the relative judgments. The key findings from this study were as follows: (1) Within group, the absolute and relative tasks yielded clinically similar judgments for soft and for loud, but OK sound levels. These judgments were largely independent of task order, ear, frequency, or trial order within a given session. (2) Loudness judgments increased, on average, by ∼3 dB between the first and last test session, which is consistent with the commonly reported acclimatization effect reported for incremental changes in loudness discomfort levels as a consequence of chronic bilateral hearing aid use. (3) Measured and predicted comfortable judgments of loudness were in good agreement for the individual listener and for groups of listeners. These comfortable judgments bisect the measured levels judged for soft and for loud, but OK sounds. (4) Loudness judgments within the same loudness category varied across listeners within group by as much as 50 to 60 dB. Such large variation in judgments of loudness is problematic, especially because hearing-impaired listeners are known to exhibit similarly large ranges of intersubject response variation and, yet, poplar prescriptive fitting strategies continue to use average rather than individual loudness data to fit nonlinear hearing aids. The primary conclusions drawn from these findings are that reliable absolute judgments of soft and loud, but OK are clinically practical and economical to measure and, from these judgments, good estimates of comfortable loudness can also be predicted for individuals or for groups of listeners. Such loudness data, as measured as described in this report, offer promise for streamlining and enhancing prescriptive fitting of nonlinear hearing aids to target gain settings for soft (audible), comfortable , and loud, but OK (tolerable) sound inputs for the individual listener.

  7. Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels

    PubMed Central

    Formby, Craig; Payne, JoAnne; Yang, Xin; Wu, Delphanie; Parton, Jason M.

    2017-01-01

    This study was undertaken with the purpose of streamlining clinical measures of loudness growth to facilitate and enhance prescriptive fitting of nonlinear hearing aids. Repeated measures of loudness at 500 and 3,000 Hz were obtained bilaterally at monthly intervals over a 6-month period from three groups of young adult listeners. All volunteers had normal audiometric hearing sensitivity and middle ear function, and all denied problems related to sound tolerance. Group 1 performed judgments of soft and loud, but OK for presentation of ascending sound levels. We defined these judgments operationally as absolute judgments of loudness. Group 2 initially performed loudness judgments across a continuum of seven loudness categories ranging from judgments of very soft to uncomfortably loud for presentation of ascending sound levels per the Contour Test of Loudness; we defined these judgments as relative judgments of loudness. In the same session, they then performed the absolute judgments for soft and loud, but OK sound levels. Group 3 performed the same set of loudness judgments as did group 2, but the task order was reversed such that they performed the absolute judgments initially within each test session followed by the relative judgments. The key findings from this study were as follows: (1) Within group, the absolute and relative tasks yielded clinically similar judgments for soft and for loud, but OK sound levels. These judgments were largely independent of task order, ear, frequency, or trial order within a given session. (2) Loudness judgments increased, on average, by ∼3 dB between the first and last test session, which is consistent with the commonly reported acclimatization effect reported for incremental changes in loudness discomfort levels as a consequence of chronic bilateral hearing aid use. (3) Measured and predicted comfortable judgments of loudness were in good agreement for the individual listener and for groups of listeners. These comfortable judgments bisect the measured levels judged for soft and for loud, but OK sounds. (4) Loudness judgments within the same loudness category varied across listeners within group by as much as 50 to 60 dB. Such large variation in judgments of loudness is problematic, especially because hearing-impaired listeners are known to exhibit similarly large ranges of intersubject response variation and, yet, poplar prescriptive fitting strategies continue to use average rather than individual loudness data to fit nonlinear hearing aids. The primary conclusions drawn from these findings are that reliable absolute judgments of soft and loud, but OK are clinically practical and economical to measure and, from these judgments, good estimates of comfortable loudness can also be predicted for individuals or for groups of listeners. Such loudness data, as measured as described in this report, offer promise for streamlining and enhancing prescriptive fitting of nonlinear hearing aids to target gain settings for soft (audible), comfortable, and loud, but OK (tolerable) sound inputs for the individual listener. PMID:28286363

  8. Physiotherapy Student Clinical Examinations: The Influence of Subjective Judgments on Observational Assessment.

    ERIC Educational Resources Information Center

    Alexander, Helen A.

    1996-01-01

    A study investigated the role of subjective assessment in the evaluation of physiotherapy students in clinical programs. Clinical teachers, visiting lecturers, and students recorded perceptions of daily events and interactions in journals. Analysis suggests that assessors make subjective judgments about students that influence grades, and…

  9. The standard of care: a case report and ethical analysis.

    PubMed

    La Puma, J; Schiedermayer, D L; Toulmin, S; Miles, S H; McAtee, J A

    1988-01-01

    Physicians increasingly allow their perceived legal responsibilities to displace their clinical judgment. Misunderstandings that surround the term "standard of care" have encouraged fears of liability and have led to the practice of defensive medicine. Physicians may consider the standard of care to be a technical or legal obligation, but an optimal standard would be one based on detailed knowledge of a patient's medical history and personal condition. It would include the physician's clinical judgment, which integrates specific technical and legal information with clinical experience in caring for patients. Occasionally, such judgment may conflict with the rulings of a court, which considers technical and legal information without the benefit of clinical judgment. Physicians must be prepared to be advocates for their patients, especially when legal proceedings are flawed or injurious. Systematic processes of examination and analysis, such as those used by ethics consultants, can help resolve questions about the standard of care.

  10. Learning to think like a nurse: stories from new nurse graduates.

    PubMed

    Etheridge, Sharon A

    2007-01-01

    One aim of nursing education is to help students learn to be beginning practitioners, which includes making clinical judgments that ensure patient safety. Clinical judgments often determine how quickly nurses detect a life-threatening complication, how soon patients leave the hospital, or how quickly patients learn to take care of themselves. However, current research shows that new graduates do not perform well when making clinical judgments, despite having graduated from accredited schools of nursing and passing the NCLEX examination. This descriptive, qualitative study examined the perceptions of recent nursing graduates about learning to make clinical judgments. Graduates with baccalaureate degrees in nursing were interviewed three times in 9 months to determine their perceptions of how they learned to think like nurses. The results of this study should be useful in identifying strategies to help new graduates make the transition from students to registered nurses.

  11. Development of a simulation evaluation tool for assessing nursing students' clinical judgment in caring for children with dehydration.

    PubMed

    Kim, Shin-Jeong; Kim, Sunghee; Kang, Kyung-Ah; Oh, Jina; Lee, Myung-Nam

    2016-02-01

    The lack of reliable and valid tools to evaluate learning outcomes during simulations has limited the adoption and progress of simulation-based nursing education. This study had two aims: (a) to develop a simulation evaluation tool (SET(c-dehydration)) to assess students' clinical judgment in caring for children with dehydration based on the Lasater Clinical Judgment Rubric (LCJR) and (b) to examine its reliability and validity. Undergraduate nursing students from two nursing schools in South Korea participated in this study from March 3 through June 10, 2014. The SET(c-dehydration) was developed, and 120 nursing students' clinical judgment was evaluated. Descriptive statistics, Cronbach's alpha, Cohen's kappa coefficient, and confirmatory factor analysis (CFA) were used to analyze the data. A 41-item version of the SET(c-dehydration) with three subscales was developed. Cohen's kappa (measuring inter-observer reliability) of the sessions ranged from .73 to .95, and Cronbach's alpha was .87. The mean total rating of the SET(c-dehydration) by the instructors was 1.92 (±.25), and the mean scores for the four LCJR dimensions of clinical judgment were as follows: noticing (1.74±.27), interpreting (1.85±.43), responding (2.17±.32), and reflecting (1.79±.35). CFA, which was performed to test construct validity, showed that the four dimensions of the SET(c-dehydration) was an appropriate framework. The SET(c-dehydration) provides a means to evaluate clinical judgment in simulation education. Its reliability and validity should be examined further. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Cognitive models of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.

    PubMed

    Earnst, K S; Marson, D C; Harrell, L E

    2000-08-01

    To investigate measures of patient cognitive abilities as predictors of physician judgments of medical treatment consent capacity (competency) in patients with Alzheimer's disease (AD). Predictor models of legal standards (LS) and personal competency judgments were developed for each study physician using independent neuropsychological test measures and logistic regression analyses. A university medical center. Five physicians with experience assessing the competency of AD patients were recruited to make competency judgments of videotaped vignettes from 10 older controls and 21 patients with AD (10 with mild and 11 with moderate dementia). The 31 patient and control videotapes of performance on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI) were rated by the five physicians. The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Each study physician viewed each vignette videotape individually, made judgments of competent or incompetent under each of the LS, and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis and neuropsychological test performance. Stepwise logistic regression was conducted to identify cognitive predictors of each physician's LS and personal competency judgments for Vignette A using the full sample (n = 31). Classification logistic regression analysis was used to determine how well these cognitive predictor models classified each physician's competency judgments for Vignette A. These classification models were then cross-validated using physician's Vignette B judgments. Cognitive predictor models for Vignette A competency judgments differed across individual physicians, and were related to difficulty of LS and to incompetency outcome rates across LS for AD patients. Measures of semantic knowledge and receptive language predicted judgments under less difficult LS of evidencing a treatment choice (LS1) and making the reasonable treatment choice (LS2). Measures of semantic knowledge, short-term verbal recall, and simple reasoning ability predicted judgments under more difficult and clinically relevant LS of appreciating consequences of a treatment choice (LS3), providing rational reasons for a treatment choice (LS4), and understanding the treatment situation and choices (LSS). Cognitive models for physicians' personal competency judgments were virtually identical to their respective models for LS5 judgments. For AD patients, shortterm memory predictors were associated with high incompetency outcome rates (over 70%), a simple reasoning measure was associated with moderately high incompetency outcome rates (60-70%), and a semantic knowledge measure was associated with lower incompetency outcome rates (30-60%). Overall, single predictor models were relatively robust, correctly classifying an average of 83% of physician judgments for Vignette A and 80% of judgments for Vignette B. Multiple cognitive functions predicted physicians' LS and personal competency judgments. Declines in semantic knowledge, short-term verbal recall, and simple reasoning ability predicted physicians' judgments on the three most difficult and clinically most relevant LS (LS3-LS5), as well as their personal competency judgments. Our findings suggest that clinical assessment of competency should include evaluation of semantic knowledge, verbal recall, and simple reasoning abilities.

  13. Effects of LifeSkills Training on Medical Students' Performance in Dealing with Complex Clinical Cases

    ERIC Educational Resources Information Center

    Campo, Ana E.; Williams, Virginia; Williams, Redford B.; Segundo, Marisol A.; Lydston, David; Weiss, Stephen M.'

    2008-01-01

    Objective: Sound clinical judgment is the cornerstone of medical practice and begins early during medical education. The authors consider the effect of personality characteristics (hostility, anger, cynicism) on clinical judgment and whether a brief intervention can affect this process. Methods: Two sophomore medical classes (experimental,…

  14. The Relationship of Critical-Thinking Skills and the Clinical-Judgment Skills of Baccalaureate Nursing Students.

    ERIC Educational Resources Information Center

    Bowles, Kathleen

    2000-01-01

    Nursing graduates (n=65) completed a critical thinking instrument and clinical decision-making scale. The critical thinking subscales of inference and inductive reasoning were positively correlated to clinical judgment. A significant relationship was found between critical thinking score and grade point average in nursing. (SK)

  15. The Practicum Script Concordance Test: An Online Continuing Professional Development Format to Foster Reflection on Clinical Practice

    ERIC Educational Resources Information Center

    Hornos, Eduardo H.; Pleguezuelos, Eduardo M.; Brailovsky, Carlos A.; Harillo, Leandro D.; Dory, Valerie; Charlin, Bernard

    2013-01-01

    Introduction: Judgment in the face of uncertainty is an important dimension of expertise and clinical competence. However, it is challenging to conceive continuing professional development (CPD) initiatives aimed at helping physicians enhance their clinical judgment skills in ill-defined situations. We present an online script concordance-based…

  16. A crisis in critical thinking.

    PubMed

    del Bueno, Dorothy

    2005-01-01

    Aggregate results for competency assessment of new registered nurses using the Performance Based Development System indicate that most new graduates do not meet expectations for entry-level clinical judgment ability.This article discusses implications for nursing education and offers recommendations for developing clinical judgment in nursing students.

  17. Medicine and the call for a moral epistemology, part II: constructing a synthesis of values.

    PubMed

    Tauber, Alfred I

    2008-01-01

    The demands and needs of an individual patient require diverse value judgments to interpret and apply clinical data. Indeed, objective assessment takes on particular meaning in the context of the social and existential status of the patient, and thereby a complex calculus of values determines therapeutic goals. I have previously formulated how this moral thread of care becomes woven into the epistemological project as a "moral epistemology." Having argued its ethical justification elsewhere, I offer another perspective here: clinical choices employ diverse values directed at an array of goals, some of which are derived from a universal clinical science and others from the particular physiological, psychological, and social needs of the patient. Integrating these diverse elements that determine clinical care requires a complex synthesis of facts and judgments from several domains. This constructivist process relies on clinical facts, as well as on personal judgments and subjective assessments in an ongoing negotiation between patient and doctor. A philosophy of medicine must account for the conceptual basis of this process by identifying and addressing the judgments that govern the complex synthesis of these various elements.

  18. Is Grammar Spared in Autism Spectrum Disorder? Data from Judgments of Verb Argument Structure Overgeneralization Errors

    ERIC Educational Resources Information Center

    Ambridge, Ben; Bannard, Colin; Jackson, Georgina H.

    2015-01-01

    Children with Autism Spectrum Disorder (ASD) aged 11-13 (N = 16) and an IQ-matched typically developing (TD) group aged 7-12 (N = 16) completed a graded grammaticality judgment task, as well as a standardized test of cognitive function. In a departure from previous studies, the judgment task involved verb argument structure overgeneralization…

  19. The Reliability and Predictive Validity of the Stalking Risk Profile.

    PubMed

    McEwan, Troy E; Shea, Daniel E; Daffern, Michael; MacKenzie, Rachel D; Ogloff, James R P; Mullen, Paul E

    2018-03-01

    This study assessed the reliability and validity of the Stalking Risk Profile (SRP), a structured measure for assessing stalking risks. The SRP was administered at the point of assessment or retrospectively from file review for 241 adult stalkers (91% male) referred to a community-based forensic mental health service. Interrater reliability was high for stalker type, and moderate-to-substantial for risk judgments and domain scores. Evidence for predictive validity and discrimination between stalking recidivists and nonrecidivists for risk judgments depended on follow-up duration. Discrimination was moderate (area under the curve = 0.66-0.68) and positive and negative predictive values good over the full follow-up period ( Mdn = 170.43 weeks). At 6 months, discrimination was better than chance only for judgments related to stalking of new victims (area under the curve = 0.75); however, high-risk stalkers still reoffended against their original victim(s) 2 to 4 times as often as low-risk stalkers. Implications for the clinical utility and refinement of the SRP are discussed.

  20. Modelling category goodness judgments in children with residual sound errors.

    PubMed

    Dugan, Sarah Hamilton; Silbert, Noah; McAllister, Tara; Preston, Jonathan L; Sotto, Carolyn; Boyce, Suzanne E

    2018-05-24

    This study investigates category goodness judgments of /r/ in adults and children with and without residual speech errors (RSEs) using natural speech stimuli. Thirty adults, 38 children with RSE (ages 7-16) and 35 age-matched typically developing (TD) children provided category goodness judgments on whole words, recorded from 27 child speakers, with /r/ in various phonetic environments. The salient acoustic property of /r/ - the lowered third formant (F3) - was normalized in two ways. A logistic mixed-effect model quantified the relationships between listeners' responses and the third formant frequency, vowel context and clinical group status. Goodness judgments from the adult group showed a statistically significant interaction with the F3 parameter when compared to both child groups (p < 0.001) using both normalization methods. The RSE group did not differ significantly from the TD group in judgments of /r/. All listeners were significantly more likely to judge /r/ as correct in a front-vowel context. Our results suggest that normalized /r/ F3 is a statistically significant predictor of category goodness judgments for both adults and children, but children do not appear to make adult-like judgments. Category goodness judgments do not have a clear relationship with /r/ production abilities in children with RSE. These findings may have implications for clinical activities that include category goodness judgments in natural speech, especially for recorded productions.

  1. Learning to think like a nurse: the development of clinical judgment in nursing students.

    PubMed

    Ashley, Jane; Stamp, Kelly

    2014-09-01

    The purpose of this project was to examine the clinical judgment and reasoning skills of nursing students in high-fidelity simulation. Two levels of students (N = 104), novices and those who are slightly more advanced, participated in individual videotaped simulations. Afterward, interviews were conducted to explore what the student was thinking and feeling during simulation. Five themes emerged from the interviews: thinking like a nurse, assessment, looking for answers, communication, and magical or reflective thinking. There was a clear distinction in the reasoning skills of the novice students compared with students with more clinical experience. Tanner's model of clinical judgment in nursing is used to understand the findings of the study. Copyright 2014, SLACK Incorporated.

  2. Advances in the assessment and prediction of interpersonal violence.

    PubMed

    Mills, Jeremy F

    2005-02-01

    This article underscores the weakness of clinical judgment as a mechanism for prediction with examples from other areas in the psychological literature. Clinical judgment has as its Achilles'heel the reliance on a person to incorporate multiple pieces of information while overcoming human judgment errors--a feat insurmountable thus far. The actuarial approach to risk assessment has overcome many of the weaknesses of clinical judgment and has been shown to be a much superior method. Nonetheless, the static/historical nature of the risk factors associated with most actuarial approaches is limiting. Advances in risk prediction will be found in part in the development of dynamic actuarial instruments that will measure both static/historical and changeable risk factors. The dynamic risk factors can be reevaluated on an ongoing basis, and it is proposed that the level of change in dynamic factors necessary to represent a significant change in overall risk will be an interactive function with static risk factors.

  3. Proportionate Responses to Life Events Influence Clinicians’ Judgments Of Psychological Abnormality

    PubMed Central

    Kim, Nancy S.; Paulus, Daniel J.; Gonzalez, Jeffrey S.; Khalife, Danielle

    2012-01-01

    Psychological abnormality is a fundamental concept in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000) and in all clinical evaluations. How do practicing clinical psychologists use the context of life events to judge the abnormality of a person’s current behaviors? The appropriate role of life-event context in assessment has long been the subject of intense debate and scrutiny among clinical theorists, yet relatively little is known about clinicians’ own judgments in practice. We propose a proportionate-response hypothesis, such that judgments of abnormality are influenced by whether the behaviors are a disproportionate response to past events, rendering them difficult to understand or explain. We presented licensed, practicing clinical psychologists (N=77) with vignettes describing hypothetical people’s behaviors (disordered, mildly distressed, or unaffected) that had been preceded by either traumatic or mildly distressing events. Experts’ judgments of abnormality were strongly and systematically influenced by the degree of mismatch between the past event and current behaviors in strength and valence, such that the greater the mismatch, the more abnormal the person seemed. A separate, additional group of clinical psychologists (N=20) further confirmed that the greater the degree of mismatch, the greater the perceived difficulty in understanding the patient. These findings held true across clinicians of different theoretical orientations and in disorders for which these patterns of judgments ran contrary to formal recommendations in the DSM-IV-TR (APA, 2000). The rationality of these effects and implications for clinical decision science are discussed. PMID:22142425

  4. The influence of causal connections between symptoms on the diagnosis of mental disorders: evidence from online and offline measures.

    PubMed

    Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio; González-Martín, Estrella

    2014-09-01

    An experiment conducted with students and experienced clinicians demonstrated very fast and online causal reasoning in the diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. The experiment also demonstrated that clinicians' causal reasoning is triggered by information that is directly related to the causal structure that explains the symptoms, such as their temporal sequence. The use of causal theories was measured through explicit, verbal diagnostic judgments and through the online registration of participants' reading times of clinical reports. To detect both online and offline causal reasoning, the consistency of clinical reports was manipulated. This manipulation was made by varying the temporal order in which different symptoms developed in hypothetical clients, and by providing explicit information about causal connections between symptoms. The temporal order of symptoms affected the clinicians' but not the students' reading times. However, offline diagnostic judgments in both groups were influenced by the consistency manipulation. Overall, our results suggest that clinicians engage in fast and online causal reasoning processes when dealing with diagnostic information concerning mental disorders, and that both clinicians and students engage in causal reasoning in diagnostic judgment tasks. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  5. Integration of Intention and Outcome for Moral Judgment in Frontotemporal Dementia: Brain Structural Signatures.

    PubMed

    Baez, Sandra; Kanske, Philipp; Matallana, Diana; Montañes, Patricia; Reyes, Pablo; Slachevsky, Andrea; Matus, Cristian; Vigliecca, Nora Silvana; Torralva, Teresa; Manes, Facundo; Ibanez, Agustin

    2016-01-01

    Moral judgment has been proposed to rely on a distributed brain network. This function is impaired in behavioral variant frontotemporal dementia (bvFTD), a condition involving damage to some regions of this network. However, no studies have investigated moral judgment in bvFTD via structural neuroimaging. We compared the performance of 21 bvFTD patients and 19 controls on a moral judgment task involving scenarios that discriminate between the contributions of intentions and outcomes. Voxel-based morphometry was used to assess (a) the atrophy pattern in bvFTD patients, (b) associations between gray matter (GM) volume and moral judgments, and (c) structural differences between bvFTD subgroups (patients with relatively preserved moral judgment and patients with severer moral judgment impairments). Patients judged attempted harm as more permissible and accidental harm as less permissible than controls. The groups' performance on accidental harm was associated with GM volume in the precuneus. In controls, it was al- so associated with the ventromedial prefrontal cortex (VMPFC). Also, both groups' performance on attempted harm was associated with GM volume in the temporoparietal junction. Patients exhibiting worse performance displayed smaller GM volumes in the precuneus and temporal pole. Results suggest that moral judgment abnormalities in bvFTD are associated with impaired integration of intentions and outcomes, which depends on an extended brain network. In bvFTD, moral judgment seems to critically depend on areas beyond the VMPFC. © 2016 S. Karger AG, Basel.

  6. Clinical judgment research on economic topics: Role of congruence of tasks in clinical practice.

    PubMed

    Huttin, Christine C

    2017-01-01

    This paper discusses what can ensure the performance of judgment studies with an information design that integrates economics of medical systems, in the context of digitalization of healthcare. It is part of a series of 5 methodological papers on statistical procedures and problems to implement judgment research designs and decision models, especially to address cost of care, and ways to measure conversation on cost of care between physicians and patients, with unstructured data such as economic narratives to complement billing and financial information (e.g. cost cognitive cues in conjoint or reversed conjoint designs). The paper discusses how congruence of tasks can increase the reliability of data. It uses some results of two Meta reviews of judgment studies in different fields of applications: psychology, business, medical sciences and education. It compares tests for congruence in judgment studies and efficiency tests in econometric studies.

  7. The Role of Extended Time on the SAT[R] for Students with Learning Disabilities and/or Attention-Deficit/Hyperactivity Disorder

    ERIC Educational Resources Information Center

    Lindstrom, Jennifer Hartwig; Gregg, Noel

    2007-01-01

    Accommodation policymaking and practice should be guided by empirical research and informed clinical judgment. Findings from our study can provide information to test users about the validity of inferences that can be made from scores obtained from accommodated test administrations for students with disabilities. The factor structure of the newly…

  8. Complementarity of Clinician Judgment and Evidence Based Models in Medical Decision Making: Antecedents, Prospects, and Challenges

    PubMed Central

    Asante Antwi, Henry

    2016-01-01

    Early accounts of the development of modern medicine suggest that the clinical skills, scientific competence, and doctors' judgment were the main impetus for treatment decision, diagnosis, prognosis, therapy assessment, and medical progress. Yet, clinician judgment has its own critics and is sometimes harshly described as notoriously fallacious and an irrational and unfathomable black box with little transparency. With the rise of contemporary medical research, the reputation of clinician judgment has undergone significant reformation in the last century as its fallacious aspects are increasingly emphasized relative to the evidence based options. Within the last decade, however, medical forecasting literature has seen tremendous change and new understanding is emerging on best ways of sharing medical information to complement the evidence based medicine practices. This review revisits and highlights the core debate on clinical judgments and its interrelations with evidence based medicine. It outlines the key empirical results of clinician judgments relative to evidence based models and identifies its key strengths and prospects, the key limitations and conditions for the effective use of clinician judgment, and the extent to which it can be optimized and professionalized for medical use. PMID:27642588

  9. Suicide in Children Younger than Age Fourteen: Clinical Judgment and Assessment Issues.

    ERIC Educational Resources Information Center

    Wise, Amy J.; Spengler, Paul M.

    1997-01-01

    Discusses the importance of accurate information about childhood suicide to prevent clinical judgment errors. Describes available methods for evaluating suicide risk in children. Looks at myths and misconceptions surrounding childhood suicide; risk factors, such as family dysfunction and distress; and evaluation techniques, such as interviews and…

  10. Simulation and the Development of Clinical Judgment: A Quantitative Study

    ERIC Educational Resources Information Center

    Holland, Susan

    2015-01-01

    The purpose of this quantitative pretest posttest quasi-experimental research study was to explore the effect of the NESD on clinical judgment in associate degree nursing students and compare the differences between groups when the Nursing Education Simulation Design (NESD) guided simulation in order to identify educational strategies promoting…

  11. Consistency of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.

    PubMed

    Marson, D C; Earnst, K S; Jamil, F; Bartolucci, A; Harrell, L E

    2000-08-01

    To investigate the consistency of physician judgments of treatment consent capacity (competency) for patients with Alzheimer's disease (AD) when specific legal standards (LS) for competency are used, and to identify the LS most clinically relevant to experienced physicians. Control and AD patient participants were videotaped being administered a measure of capacity to consent to medical treatment. Study physicians viewed videotapes of these assessments individually and made competency judgments for each participant under different LS followed by their own personal judgment of competency. A university medical center. Participants were 10 older controls and 21 patients with AD (10 with mild and 11 with moderate AD). Five physicians with experience assessing the competency of AD patients were recruited from the geriatric psychiatry, geriatric medicine, and neurology services of a university medical center. The 31 participants were videotaped performing on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI). The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Vignette A and B assessments were videotaped separately for each participant (total videotapes for sample = 62). Each study physician viewed each videotaped vignette individually, made judgments under each of the LS (competent or incompetent), and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis. Within participant group, consistency of physician judgments was evaluated across LS and personal judgments using percentage agreement and kappa. Agreement between personal and LS judgments for the AD group was evaluated for each physician using logistic regression. As expected, physicians as a group generally demonstrated very high percentage agreement in their LS and personal competency judgments for the control group. For the AD group, mean percentage judgment agreement among physicians ranged from a high of 84% (LS1) (evidencing a treatment choice) to a low of 67% (LS3) (appreciating consequences of treatment choice). Mean percentage agreement for personal competency judgments was 76%. For the AD sample, kappa analyses for physicians as a group demonstrated significant agreement not attributable to chance for LS5 (understanding treatment situation/choices) (k = 0.57, P = .001), LS4 (providing rational reasons for treatment choice) (k = 0.39, P = .04), and also for personal judgments (k = 0.48, P = .009). Analysis of LS judgment agreement within physician indicated that physicians applied the LS as discrete standards. Within-physician and for the AD sample, personal competency judgments were associated significantly with judgments on LS5 (P = .001), LS4 (P = .004), and LS3 (P < .04). Experienced physicians demonstrated significant agreement assessing competency in AD patients when judgments were based upon specific legal standards. Personal competency judgments of physicians showed a substantially higher level of agreement than found in a previous study, where specific LS were not used. These results suggest that consistency of physician competency judgments can be enhanced if they are guided by knowledge of specific LS. Physicians' personal competency judgments were most closely associated with comprehension and reasoning LS, the most conservative and clinically appropriate standards for deciding competency.

  12. Key factors in children's competence to consent to clinical research.

    PubMed

    Hein, Irma M; Troost, Pieter W; Lindeboom, Robert; Benninga, Marc A; Zwaan, C Michel; van Goudoever, Johannes B; Lindauer, Ramón J L

    2015-10-24

    Although law is established on a strong presumption that persons younger than a certain age are not competent to consent, statutory age limits for asking children's consent to clinical research differ widely internationally. From a clinical perspective, competence is assumed to involve many factors including the developmental stage, the influence of parents and peers, and life experience. We examined potential determining factors for children's competence to consent to clinical research and to what extent they explain the variation in competence judgments. From January 1, 2012 through January 1, 2014, pediatric patients aged 6 to 18 years, eligible for clinical research studies were enrolled prospectively at various in- and outpatient pediatric departments. Children's competence to consent was assessed by MacArthur Competence Assessment Tool for Clinical Research. Potential determining child variables included age, gender, intelligence, disease experience, ethnicity and socio-economic status (SES). We used logistic regression analysis and change in explained variance in competence judgments to quantify the contribution of a child variable to the total explained variance. Contextual factors included risk and complexity of the decision to participate, parental competence judgment and the child's or parents decision to participate. Out of 209 eligible patients, 161 were included (mean age, 10.6 years, 47.2 % male). Age, SES, intelligence, ethnicity, complexity, parental competence judgment and trial participation were univariately associated with competence (P < 0.05). Total explained variance in competence judgments was 71.5 %. Only age and intelligence significantly and independently explained the variance in competence judgments, explaining 56.6 % and 12.7 % of the total variance respectively. SES, male gender, disease experience and ethnicity each explained less than 1 % of the variance in competence judgments. Contextual factors together explained an extra 2.8 % (P > 0.05). Age is the factor that explaines most of to the variance in children's competence to consent, followed by intelligence. Experience with disease did not affect competence in this study, nor did other variables. Development and use of a standardized instrument for assessing children's competence to consent in drug trials: Are legally established age limits valid?, NTR3918.

  13. Beyond "utilitarianism": maximizing the clinical impact of moral judgment research.

    PubMed

    Rosas, Alejandro; Koenigs, Michael

    2014-01-01

    The use of hypothetical moral dilemmas--which pit utilitarian considerations of welfare maximization against emotionally aversive "personal" harms--has become a widespread approach for studying the neuropsychological correlates of moral judgment in healthy subjects, as well as in clinical populations with social, cognitive, and affective deficits. In this article, we propose that a refinement of the standard stimulus set could provide an opportunity to more precisely identify the psychological factors underlying performance on this task, and thereby enhance the utility of this paradigm for clinical research. To test this proposal, we performed a re-analysis of previously published moral judgment data from two clinical populations: neurological patients with prefrontal brain damage and psychopathic criminals. The results provide intriguing preliminary support for further development of this assessment paradigm.

  14. Can physician examiners overcome their first impression when examinee performance changes?

    PubMed

    Wood, Timothy J; Pugh, Debra; Touchie, Claire; Chan, James; Humphrey-Murto, Susan

    2018-03-20

    There is an increasing focus on factors that influence the variability of rater-based judgments. First impressions are one such factor. First impressions are judgments about people that are made quickly and are based on little information. Under some circumstances, these judgments can be predictive of subsequent decisions. A concern for both examinees and test administrators is whether the relationship remains stable when the performance of the examinee changes. That is, once a first impression is formed, to what degree will an examiner be willing to modify it? The purpose of this study is to determine the degree that first impressions influence final ratings when the performance of examinees changes within the context of an objective structured clinical examination (OSCE). Physician examiners (n = 29) viewed seven videos of examinees (i.e., actors) performing a physical exam on a single OSCE station. They rated the examinees' clinical abilities on a six-point global rating scale after 60 s (first impression or FIGR). They then observed the examinee for the remainder of the station and provided a final global rating (GRS). For three of the videos, the examinees' performance remained consistent throughout the videos. For two videos, examinee performance changed from initially strong to weak and for two videos, performance changed from initially weak to strong. The mean FIGR rating for the Consistent condition (M = 4.80) and the Strong to Weak condition (M = 4.87) were higher compared to their respective GRS ratings (M = 3.93, M = 2.73) with a greater decline for the Strong to Weak condition. The mean FIGR rating for the Weak to Strong condition was lower (3.60) than the corresponding mean GRS (4.81). This pattern of findings suggests that raters were willing to change their judgments based on examinee performance. Future work should explore the impact of making a first impression judgment explicit versus implicit and the role of context on the relationship between a first impression and a subsequent judgment.

  15. Effects of Age Expectations on Oncology Social Workers' Clinical Judgment

    ERIC Educational Resources Information Center

    Conlon, Annemarie; Choi, Namkee G.

    2014-01-01

    Objective: This study examined the influence of oncology social workers' expectations regarding aging (ERA) and ERA with cancer (ERAC) on their clinical judgment. Methods: Oncology social workers (N = 322) were randomly assigned to one of four vignettes describing a patient with lung cancer. The vignettes were identical except for the patent's age…

  16. Psychodiagnostic and Psychotherapeutic Judgments: Expectation-Based Biases in Covariation Assessment.

    ERIC Educational Resources Information Center

    Alloy, Lauren B.

    This paper considers three clinical judgment biases in clinical inference: (1) illusory correlation bias, the report by clinicians of a correlation between psychodiagnostic test signs and patient's symptoms which are not correlated or are correlated to a smaller degree than that reported; (2) labeling bias, the tendency of exposure to diagnositc…

  17. Comparison of Alvarado score evaluation and clinical judgment in acute appendicitis.

    PubMed

    Abou Merhi, Bassem; Khalil, Mahmoud; Daoud, Nabil

    2014-01-01

    Acute appendicitis is the most common surgical emergency in children, but its diagnosis is sometimes difficult. The aim of this study is to evaluate retrospectively the Alvarado score in relation to the surgical management based on clinical judgment. Medical files of 232 children who underwent appendectomy at Makassed General Hospital from January 1997 till December 2006 were reviewed. Demographic characteristics, symptoms and signs, laboratory results and imaging findings for all children were recorded. The positive predictive value of our clinical judgment was 86.4% and the negative appendectomy rate was 13.6% based on the pathology results. The reliability of Alvarado score in our population found a PPV of 80.7% and a negative appendectomy rate of 11.3%. A multivariate analysis revealed that anorexia, neutrophils left shift and rebound tenderness are significantly correlated with a correct diagnosis of appendicitis (p = 0.012, 0.023 and 0.046 respectively). Although, Alvarado score provides measurably useful diagnostic information in evaluating children with suspected appendicitis, we found that good clinical judgment remain the main stay of correct diagnosis of appendicitis.

  18. Comparison of Alvarado Score Evaluation and Clinical Judgment in Acute Appendicitis

    PubMed Central

    Merhi, Bassem Abou; Khalil, Mahmoud; Daoud, Nabil

    2014-01-01

    ABSTRACT Background: Acute appendicitis is the most common surgical emergency in children, but its diagnosis is sometimes difficult. The aim: of this study is to evaluate retrospectively the Alvarado score in relation to the surgical management based on clinical judgment. Methods: Medical files of 232 children who underwent appendectomy at Makassed General Hospital from January 1997 till December 2006 were reviewed. Demographic characteristics, symptoms and signs, laboratory results and imaging findings for all children were recorded. Results: The positive predictive value of our clinical judgment was 86.4% and the negative appendectomy rate was 13.6% based on the pathology results. The reliability of Alvarado score in our population found a PPV of 80.7% and a negative appendectomy rate of 11.3%. A multivariate analysis revealed that anorexia, neutrophils left shift and rebound tenderness are significantly correlated with a correct diagnosis of appendicitis (p = 0.012, 0.023 and 0.046 respectively). Conclusion: Although, Alvarado score provides measurably useful diagnostic information in evaluating children with suspected appendicitis, we found that good clinical judgment remain the main stay of correct diagnosis of appendicitis. PMID:24783903

  19. Clinical Intuition in Family Medicine: More Than First Impressions

    PubMed Central

    Woolley, Amanda; Kostopoulou, Olga

    2013-01-01

    PURPOSE The clinical literature advises physicians not to trust their intuition. Studies of clinical intuition, however, equate it to early impressions, the first thing that comes to the physician’s mind. This study aimed to investigate the validity of this perspective by examining real cases of intuition in family medicine. METHODS Eighteen family physicians were interviewed about patient cases in which they believed that they had experienced an intuition. Cases were included if (1) participants were unaware of the basis of their judgment, or (2) participants talked about the basis of their judgment but believed that it was irrational or unsubstantiated. During the interview, case descriptions were systematically probed following the Critical Decision Method. Transcripts were coded for judgments, informational cues, expectancies, goals, and actions and were reordered into chronological accounts of the decision process. The 2 authors independently categorized cases into 3 emerging decision process types. RESULTS Participants reported 31 cases, 24 of which met inclusion criteria. Three types of decision process emerged: gut feelings, recognitions, and insights (κ = 0.78). In all cases, participants thought that their intuitive judgment was in conflict with a more rational explanation or what other colleagues would do. CONCLUSIONS Automatic, nonanalytical processes in clinical judgment extend beyond first impressions. Rather than admonishing clinicians not to trust their intuition, it should be acknowledged that little is currently known about the different types of intuitive processes and what determines their success or failure. Research on the conditions for accurate clinical intuitions is needed. PMID:23319507

  20. Clinical intuition in family medicine: more than first impressions.

    PubMed

    Woolley, Amanda; Kostopoulou, Olga

    2013-01-01

    The clinical literature advises physicians not to trust their intuition. Studies of clinical intuition, however, equate it to early impressions, the first thing that comes to the physician's mind. This study aimed to investigate the validity of this perspective by examining real cases of intuition in family medicine. Eighteen family physicians were interviewed about patient cases in which they believed that they had experienced an intuition. Cases were included if (1) participants were unaware of the basis of their judgment, or (2) participants talked about the basis of their judgment but believed that it was irrational or unsubstantiated. During the interview, case descriptions were systematically probed following the Critical Decision Method. Transcripts were coded for judgments, informational cues, expectancies, goals, and actions and were reordered into chronological accounts of the decision process. The 2 authors independently categorized cases into 3 emerging decision process types. Participants reported 31 cases, 24 of which met inclusion criteria. Three types of decision process emerged: gut feelings, recognitions, and insights (κ = 0.78). In all cases, participants thought that their intuitive judgment was in conflict with a more rational explanation or what other colleagues would do. Automatic, nonanalytical processes in clinical judgment extend beyond first impressions. Rather than admonishing clinicians not to trust their intuition, it should be acknowledged that little is currently known about the different types of intuitive processes and what determines their success or failure. Research on the conditions for accurate clinical intuitions is needed.

  1. Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment

    PubMed Central

    Benjamin, Daniel K.; Stoll, Barbara J.; Gantz, Marie G.; Walsh, Michele C.; Sanchez, Pablo J.; Das, Abhik; Shankaran, Seetha; Higgins, Rosemary D.; Auten, Kathy J.; Miller, Nancy A.; Walsh, Thomas J.; Laptook, Abbot R.; Carlo, Waldemar A.; Kennedy, Kathleen A.; Finer, Neil N.; Duara, Shahnaz; Schibler, Kurt; Chapman, Rachel L.; Van Meurs, Krisa P.; Frantz, Ivan D.; Phelps, Dale L.; Poindexter, Brenda B.; Bell, Edward F.; O’Shea, T. Michael; Watterberg, Kristi L.; Goldberg, Ronald N.

    2011-01-01

    OBJECTIVE Invasive candidiasis is a leading cause of infection-related morbidity and mortality in extremely low-birth-weight (<1000 g) infants. We quantify risk factors predicting infection in high-risk premature infants and compare clinical judgment with a prediction model of invasive candidiasis. METHODS The study involved a prospective observational cohort of infants <1000 g birth weight at 19 centers of the NICHD Neonatal Research Network. At each sepsis evaluation, clinical information was recorded, cultures obtained, and clinicians prospectively recorded their estimate of the probability of invasive candidiasis. Two models were generated with invasive candidiasis as their outcome: 1) potentially modifiable risk factors and 2) a clinical model at time of blood culture to predict candidiasis. RESULTS Invasive candidiasis occurred in 137/1515 (9.0%) infants and was documented by positive culture from ≥ 1 of these sources: blood (n=96), cerebrospinal fluid (n=9), urine obtained by catheterization (n=52), or other sterile body fluid (n=10). Mortality was not different from infants who had positive blood culture compared to those with isolated positive urine culture. Incidence varied from 2–28% at the 13 centers enrolling ≥ 50 infants. Potentially modifiable risk factors (model 1) included central catheter, broad-spectrum antibiotics (e.g., third-generation cephalosporins), intravenous lipid emulsion, endotracheal tube, and antenatal antibiotics. The clinical prediction model (model 2) had an area under the receiver operating characteristic curve of 0.79, and was superior to clinician judgment (0.70) in predicting subsequent invasive candidiasis. Performance of clinical judgment did not vary significantly with level of training. CONCLUSION Prior antibiotics, presence of a central catheter, endotracheal tube, and center were strongly associated with invasive candidiasis. Modeling was more accurate in predicting invasive candidiasis than clinical judgment. PMID:20876174

  2. Challenges of assessing critical thinking and clinical judgment in nurse practitioner students.

    PubMed

    Gorton, Karen L; Hayes, Janice

    2014-03-01

    The purpose of this study was to determine whether there was a relationship between critical thinking skills and clinical judgment in nurse practitioner students. The study used a convenience, nonprobability sampling technique, engaging participants from across the United States. Correlational analysis demonstrated no statistically significant relationship between critical thinking skills and examination-style questions, critical thinking skills and scores on the evaluation and reevaluation of consequences subscale of the Clinical Decision Making in Nursing Scale, and critical thinking skills and the preceptor evaluation tool. The study found no statistically significant relationships between critical thinking skills and clinical judgment. Educators and practitioners could consider further research in these areas to gain insight into how critical thinking is and could be measured, to gain insight into the clinical decision making skills of nurse practitioner students, and to gain insight into the development and measurement of critical thinking skills in advanced practice educational programs. Copyright 2014, SLACK Incorporated.

  3. The ABC of moral development: an attachment approach to moral judgment

    PubMed Central

    Govrin, Aner

    2014-01-01

    As with other cognitive faculties, the etiology of moral judgment and its connection to early development is complex. Because research is limited, the causative and contributory factors to the development of moral judgment in preverbal infants are unclear. However, evidence is emerging from studies within both infant research and moral psychology that may contribute to our understanding of the early development of moral judgments. Though its finding are preliminary, this proposed paradigm synthesizes these findings to generate an overarching, model of the process that appears to contribute to the development of moral judgment in the first year of life. I will propose that through early interactions with the caregiver, the child acquires an internal representation of a system of rules that determine how right/wrong judgments are to be construed, used, and understood. By breaking moral situations down into their defining features, the attachment model of moral judgment outlines a framework for a universal moral faculty based on a universal, innate, deep structure that appears uniformly in the structure of almost all moral judgments regardless of their content. The implications of the model for our understanding of innateness, universal morality, and the representations of moral situations are discussed. PMID:24478739

  4. Individual and Joint Expert Judgments as Reference Standards in Artifact Detection

    PubMed Central

    Verduijn, Marion; Peek, Niels; de Keizer, Nicolette F.; van Lieshout, Erik-Jan; de Pont, Anne-Cornelie J.M.; Schultz, Marcus J.; de Jonge, Evert; de Mol, Bas A.J.M.

    2008-01-01

    Objective To investigate the agreement among clinical experts in their judgments of monitoring data with respect to artifacts, and to examine the effect of reference standards that consist of individual and joint expert judgments on the performance of artifact filters. Design Individual judgments of four physicians, a majority vote judgment, and a consensus judgment were obtained for 30 time series of three monitoring variables: mean arterial blood pressure (ABPm), central venous pressure (CVP), and heart rate (HR). The individual and joint judgments were used to tune three existing automated filtering methods and to evaluate the performance of the resulting filters. Measurements The interrater agreement was calculated in terms of positive specific agreement (PSA). The performance of the artifact filters was quantified in terms of sensitivity and positive predictive value (PPV). Results PSA values between 0.33 and 0.85 were observed among clinical experts in their selection of artifacts, with relatively high values for CVP data. Artifact filters developed using judgments of individual experts were found to moderately generalize to new time series and other experts; sensitivity values ranged from 0.40 to 0.60 for ABPm and HR filters (PPV: 0.57–0.84), and from 0.63 to 0.80 for CVP filters (PPV: 0.71–0.86). A higher performance value for the filters was found for the three variable types when joint judgments were used for tuning the filtering methods. Conclusion Given the disagreement among experts in their individual judgment of monitoring data with respect to artifacts, the use of joint reference standards obtained from multiple experts is recommended for development of automatic artifact filters. PMID:18096912

  5. The Effect of Learning Styles, Critical Thinking Disposition, and Critical Thinking on Clinical Judgment in Senior Baccalaureate Nursing Students during Human Patient Simulation

    ERIC Educational Resources Information Center

    McCormick, Kiyan

    2014-01-01

    Simulated learning experiences using high-fidelity human patient simulators (HPS) are increasingly being integrated into baccalaureate nursing programs. Thus, the purpose of this study was to examine relationships among learning style, critical thinking disposition, critical thinking, and clinical judgment during high-fidelity human patient…

  6. Effects of Client Bisexuality on Clinical Judgment: When Is Bias Most Likely to Occur?

    ERIC Educational Resources Information Center

    Mohr, Jonathan J.; Weiner, Jennifer L.; Chopp, Regina M.; Wong, Stephanie J.

    2009-01-01

    In this study, the authors investigated whether psychotherapist bias related to client bisexuality is most likely to occur with respect to judgments about stereotype-relevant clinical issues. Participants were 108 psychotherapists who read a fictitious intake report about a male client who was portrayed as heterosexual, gay, or bisexual. Client…

  7. Time Keeps on Ticking: The Experience of Clinical Judgment

    ERIC Educational Resources Information Center

    Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.

    2009-01-01

    The reactions by Ridley and Shaw-Ridley (EJ832451) and Lichtenberg (EJ832452) to the authors' meta-analysis on the effects of experience on judgment accuracy add positively to what is hoped will become an ever more focused discourse on this most basic question: How can mental health clinical decision making be improved? In this rejoinder, the…

  8. The logic of syntactic priming and acceptability judgments.

    PubMed

    Gaston, Phoebe; Huang, Nick; Phillips, Colin

    2017-01-01

    A critical flaw in Branigan & Pickering's (B&P's) advocacy of structural priming is the absence of a theory of priming. This undermines their claims about the value of priming as a methodology. In contrast, acceptability judgments enable clearer inferences about structure. It is important to engage thoroughly with the logic behind different structural diagnostics.

  9. Implementing psychophysiology in clinical assessments of adolescent social anxiety: use of rater judgments based on graphical representations of psychophysiology.

    PubMed

    De Los Reyes, Andres; Augenstein, Tara M; Aldao, Amelia; Thomas, Sarah A; Daruwala, Samantha; Kline, Kathryn; Regan, Timothy

    2015-01-01

    Social stressor tasks induce adolescents' social distress as indexed by low-cost psychophysiological methods. Unknown is how to incorporate these methods within clinical assessments. Having assessors judge graphical depictions of psychophysiological data may facilitate detections of data patterns that may be difficult to identify using judgments about numerical depictions of psychophysiological data. Specifically, the Chernoff Face method involves graphically representing data using features on the human face (eyes, nose, mouth, and face shape). This method capitalizes on humans' abilities to discern subtle variations in facial features. Using adolescent heart rate norms and Chernoff Faces, we illustrated a method for implementing psychophysiology within clinical assessments of adolescent social anxiety. Twenty-two clinic-referred adolescents completed a social anxiety self-report and provided psychophysiological data using wireless heart rate monitors during a social stressor task. We graphically represented participants' psychophysiological data and normative adolescent heart rates. For each participant, two undergraduate coders made comparative judgments between the dimensions (eyes, nose, mouth, and face shape) of two Chernoff Faces. One Chernoff Face represented a participant's heart rate within a context (baseline, speech preparation, or speech-giving). The second Chernoff Face represented normative heart rate data matched to the participant's age. Using Chernoff Faces, coders reliably and accurately identified contextual variation in participants' heart rate responses to social stress. Further, adolescents' self-reported social anxiety symptoms predicted Chernoff Face judgments, and judgments could be differentiated by social stress context. Our findings have important implications for implementing psychophysiology within clinical assessments of adolescent social anxiety.

  10. Assessment of the Impact of Integrated Simulation on Critical Thinking and Clinical Judgment in Nursing Instruction

    ERIC Educational Resources Information Center

    Meyer, Rita Allen

    2012-01-01

    The purpose of this study was to explore the effects of using simulation and didactic instruction on critical thinking and clinical judgment with student nurses enrolled in a fall semester medical-surgical class. Specifically, it was of interest to compare the performance of these fall semester nursing students with the performance of nursing…

  11. The Clinical Assessment in the Legal Field: An Empirical Study of Bias and Limitations in Forensic Expertise

    PubMed Central

    Iudici, Antonio; Salvini, Alessandro; Faccio, Elena; Castelnuovo, Gianluca

    2015-01-01

    According to the literature, psychological assessment in forensic contexts is one of the most controversial application areas for clinical psychology. This paper presents a review of systematic judgment errors in the forensic field. Forty-six psychological reports written by psychologists, court consultants, have been analyzed with content analysis to identify typical judgment errors related to the following areas: (a) distortions in the attribution of causality, (b) inferential errors, and (c) epistemological inconsistencies. Results indicated that systematic errors of judgment, usually referred also as “the man in the street,” are widely present in the forensic evaluations of specialist consultants. Clinical and practical implications are taken into account. This article could lead to significant benefits for clinical psychologists who want to deal with this sensitive issue and are interested in improving the quality of their contribution to the justice system. PMID:26648892

  12. Instructional Storytelling: Application of the Clinical Judgment Model in Nursing.

    PubMed

    Timbrell, Jessica

    2017-05-01

    Little is known about the teaching and learning implications of instructional storytelling (IST) in nursing education or its potential connection to nursing theory. The literature establishes storytelling as a powerful teaching-learning method in the educational, business, humanities, and health sectors, but little exploration exists that is specific to nursing. An example of a story demonstrating application of the domains of Tanner's clinical judgment model links storytelling with learning outcomes appropriate for the novice nursing student. Application of Tanner's clinical judgment model offers consistency of learning experience while preserving the creativity inherent in IST. Further research into student learning outcomes achievement using IST is warranted as a step toward establishing best practices with IST in nursing education. [J Nurs Educ. 2017;56(5):305-308.]. Copyright 2017, SLACK Incorporated.

  13. Reflections on Self-Reflection: Contemplating Flawed Self-Judgments in the Clinic, Classroom, and Office Cubicle.

    PubMed

    Dunning, David; Heath, Chip; Suls, Jerry M

    2018-03-01

    We reflect back on our 2004 monograph reviewing the implications of faulty self-judgment for health, education, and the workplace. The review proved popular, no doubt because the importance of accurate self-assessment is best reflected in just how broad the literature is that touches on this topic. We discuss opportunities and challenges to be found in the future study of self-judgment accuracy and error, and suggest that designing interventions aimed at improving self-judgments may prove to be a worthwhile but complex and nuanced task.

  14. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY 2016 OUTPATIENT GLUCOSE MONITORING CONSENSUS STATEMENT.

    PubMed

    Bailey, Timothy S; Grunberger, George; Bode, Bruce W; Handelsman, Yehuda; Hirsch, Irl B; Jovanovič, Lois; Roberts, Victor Lawrence; Rodbard, David; Tamborlane, William V; Walsh, John

    2016-02-01

    This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

  15. Leadership Styles and Moral Judgment Competence of Community College Personnel

    ERIC Educational Resources Information Center

    McFadden, Cheryl; Miller, Brian; Sypawka, William; Clay, Maria; Hoover-Plonk, Shelly

    2013-01-01

    This study investigated the convergence of leadership styles and moral judgment competence of community college personnel participating in a leadership institute using the Leadership Orientation Instrument (Bolman & Deal, 1984) and the Moral Judgment Test (Lind, 1978). Results indicated that the human resource and structural frames were the…

  16. Clinimetrics: the science of clinical measurements.

    PubMed

    Fava, G A; Tomba, E; Sonino, N

    2012-01-01

    'Clinimetrics' is the term introduced by Alvan R. Feinstein in the early 1980s to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs and other clinical phenomena. Clinimetrics has a set of rules that govern the structure of indexes, the choice of component variables, the evaluation of consistency, validity and responsiveness. This review illustrates how clinimetrics may help expanding the narrow range of information that is currently used in clinical science. It will focus on characteristics and types of clinimetric indexes and their current use. The clinimetric perspective provides an intellectual home for clinical judgment, whose implementation is likely to improve outcomes both in clinical research and practice. © 2011 Blackwell Publishing Ltd.

  17. Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism

    PubMed Central

    Torralva, Teresa; Rattazzi, Alexia; Marenco, Victoria; Roca, María; Manes, Facundo

    2013-01-01

    Faced with a moral dilemma, conflict arises between a cognitive controlled response aimed at maximizing welfare, i.e. the utilitarian judgment, and an emotional aversion to harm, i.e. the deontological judgment. In the present study, we investigated moral judgment in adult individuals with high functioning autism/Asperger syndrome (HFA/AS), a clinical population characterized by impairments in prosocial emotions and social cognition. In Experiment 1, we compared the response patterns of HFA/AS participants and neurotypical controls to moral dilemmas with low and high emotional saliency. We found that HFA/AS participants more frequently delivered the utilitarian judgment. Their perception of appropriateness of moral transgression was similar to that of controls, but HFA/AS participants reported decreased levels of emotional reaction to the dilemma. In Experiment 2, we explored the way in which demographic, clinical and social cognition variables including emotional and cognitive aspects of empathy and theory of mind influenced moral judgment. We found that utilitarian HFA/AS participants showed a decreased ability to infer other people’s thoughts and to understand their intentions, as measured both by performance on neuropsychological tests and through dispositional measures. We conclude that greater prevalence of utilitarianism in HFA/AS is associated with difficulties in specific aspects of social cognition. PMID:22689217

  18. Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism.

    PubMed

    Gleichgerrcht, Ezequiel; Torralva, Teresa; Rattazzi, Alexia; Marenco, Victoria; Roca, María; Manes, Facundo

    2013-10-01

    Faced with a moral dilemma, conflict arises between a cognitive controlled response aimed at maximizing welfare, i.e. the utilitarian judgment, and an emotional aversion to harm, i.e. the deontological judgment. In the present study, we investigated moral judgment in adult individuals with high functioning autism/Asperger syndrome (HFA/AS), a clinical population characterized by impairments in prosocial emotions and social cognition. In Experiment 1, we compared the response patterns of HFA/AS participants and neurotypical controls to moral dilemmas with low and high emotional saliency. We found that HFA/AS participants more frequently delivered the utilitarian judgment. Their perception of appropriateness of moral transgression was similar to that of controls, but HFA/AS participants reported decreased levels of emotional reaction to the dilemma. In Experiment 2, we explored the way in which demographic, clinical and social cognition variables including emotional and cognitive aspects of empathy and theory of mind influenced moral judgment. We found that utilitarian HFA/AS participants showed a decreased ability to infer other people's thoughts and to understand their intentions, as measured both by performance on neuropsychological tests and through dispositional measures. We conclude that greater prevalence of utilitarianism in HFA/AS is associated with difficulties in specific aspects of social cognition.

  19. Laterality judgments in people with low back pain--A cross-sectional observational and test-retest reliability study.

    PubMed

    Linder, Martin; Michaelson, Peter; Röijezon, Ulrik

    2016-02-01

    Disruption of cortical representation, or body schema, has been indicated as a factor in the persistence and recurrence of low back pain (LBP). This has been observed through impaired laterality judgment ability and it has been suggested that this ability is affected in a spatial rather than anatomical manner. We compared laterality judgment performance of foot and trunk movements between people with LBP with or without leg pain and healthy controls, and investigated associations between test performance and pain. We also assessed the test-retest reliability of the Recognise Online™ software when used in a clinical and a home setting. Cross-sectional observational and test-retest study. Thirty individuals with LBP and 30 healthy controls performed judgment tests of foot and trunk laterality once supervised in a clinic and twice at home. No statistically significant group differences were found. LBP intensity was negatively related to trunk laterality accuracy (p = 0.019). Intraclass correlation values ranged from 0.51 to 0.91. Reaction time improved significantly between test occasions while accuracy did not. Laterality judgments were not impaired in subjects with LBP compared to controls. Further research may clarify the relationship between pain mechanisms in LBP and laterality judgment ability. Reliability values were mostly acceptable, with wide and low confidence intervals, suggesting test-retest reliability for Recognise Online™ could be questioned in this trial. A significant learning effect was observed which should be considered in clinical and research application of the test. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. A Quantitative Methodology to Examine the Development of Moral Judgment

    ERIC Educational Resources Information Center

    Buchanan, James P.; Thompson, Spencer K.

    1973-01-01

    Unlike Piaget's clinical procedure, the experiment's methodology allowed substantiation of the ability of children to simultaneously weigh damage and intent information when making a moral judgment. Other advantages of this quantitative methodology are also presented. (Authors)

  1. Pillars of judgment: how memory abilities affect performance in rule-based and exemplar-based judgments.

    PubMed

    Hoffmann, Janina A; von Helversen, Bettina; Rieskamp, Jörg

    2014-12-01

    Making accurate judgments is an essential skill in everyday life. Although how different memory abilities relate to categorization and judgment processes has been hotly debated, the question is far from resolved. We contribute to the solution by investigating how individual differences in memory abilities affect judgment performance in 2 tasks that induced rule-based or exemplar-based judgment strategies. In a study with 279 participants, we investigated how working memory and episodic memory affect judgment accuracy and strategy use. As predicted, participants switched strategies between tasks. Furthermore, structural equation modeling showed that the ability to solve rule-based tasks was predicted by working memory, whereas episodic memory predicted judgment accuracy in the exemplar-based task. Last, the probability of choosing an exemplar-based strategy was related to better episodic memory, but strategy selection was unrelated to working memory capacity. In sum, our results suggest that different memory abilities are essential for successfully adopting different judgment strategies. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  2. Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice.

    PubMed

    Elzakkers, Isis F F M; Danner, Unna N; Grisso, Thomas; Hoek, Hans W; van Elburg, Annemarie A

    Informed consent requires adequate mental capacity to consent to treatment. Mental capacity (MC) to consent to treatment refers to the ability to make medical decisions. MC is assessed in a general psychiatric interview, but this clinical assessment is known to overestimate mental capacity in patients and the inter rater reliability is low. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) has emerged as the gold standard to assess mental capacity to consent to treatment. The MacCAT-T is a semi-structured interview designed to aid clinicians in this assessment and has shown good inter rater reliability in patients with schizophrenia and other mental disorders, but has hardly been studied in patients with anorexia nervosa. Patients with anorexia nervosa (AN) regularly avoid treatment, even when severely ill and discussion includes assessing MC to consent to treatment. The aim of this study is to compare clinical judgment and the MacCAT-T in evaluating MC in patients with AN which in turn may influence use of the MacCAT-T in daily practice. In a sample of 70 consecutively referred severely ill patients with AN with a mean BMI of 15.5 kg/m 2 and a mean duration of illness of 8.6 years, clinical assessment of MC by experienced psychiatrists and the outcome of the MacCAT-T interview were compared. Agreement (κ-value) was calculated. Agreement between clinical assessment and outcome of the MacCAT-T was questionable (κ 0.23). Unlike in other psychiatric populations, clinicians judged a high proportion of patients with AN as having diminished MC. The MacCAT-T can be useful in assessing MC in AN when used in addition to clinical judgment to aid clinicians in complex cases. Why clinicians judge a relatively high proportion of patients with AN as having diminished MC, in contrast to lower proportions in other psychiatric disorders, is an area in need of further research. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Clinical peer mentoring: partnering BSN seniors and sophomores on a dedicated education unit.

    PubMed

    Harmer, Bonnie McKay; Huffman, Jaime; Johnson, Barbara

    2011-01-01

    The authors describe a clinical peer mentoring (CPM) program that partnered 16 pairs of senior (mentors) and sophomore (novices) BSN students to provide patient care on a dedicated education unit at a VA Medical Center. Situated learning theory and Tanner's Clinical Judgment Model provided frameworks for CPM implementation. Survey findings suggested novices and mentors perceived improvements in self-confidence, prioritization, time management, clinical judgment, and evidence-based practice use. Many mentors spontaneously expressed an interest in becoming a preceptor or nurse educator. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

  4. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM--2015 EXECUTIVE SUMMARY.

    PubMed

    Garber, Alan J; Abrahamson, Martin Julian; Barzilay, Joshua I; Blonde, Lawrence; Bloomgarden, Zachary T; Bush, Michael A; Dagogo-Jack, Samuel; Davidson, Michael B; Einhorn, Daniel; Garber, Jeffrey R; Garvey, W Timothy; Grunberger, George; Handelsman, Yehuda; Hirsch, Irl B; Jellinger, Paul S; McGill, Janet B; Mechanick, Jeffrey I; Rosenblit, Paul David; Umpierrez, Guillermo E

    2015-12-01

    This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

  5. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON TESTING FOR AUTONOMIC AND SOMATIC NERVE DYSFUNCTION.

    PubMed

    Vinik, Aaron I; Camacho, Pauline M; Davidson, Jaime A; Handelsman, Yehuda; Lando, Howard M; Leddy, Anne L; Reddy, Sethu K; Cook, Richard; Spallone, Vicenza; Tesfaye, Solomon; Ziegler, Dan

    2017-12-01

    This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

  6. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THE ASSOCIATION OF TESTOSTERONE AND CARDIOVASCULAR RISK.

    PubMed

    Goodman, Neil; Guay, Andre; Dandona, Paresh; Dhindsa, Sandeep; Faiman, Charles; Cunningham, Glenn R

    2015-09-01

    This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

  7. The Script Concordance Test: a new tool assessing clinical judgement in neurology.

    PubMed

    Lubarsky, Stuart; Chalk, Colin; Kazitani, Driss; Gagnon, Robert; Charlin, Bernard

    2009-05-01

    Clinical judgment, the ability to make appropriate decisions in uncertain situations, is central to neurological practice, but objective measures of clinical judgment in neurology trainees are lacking. The Script Concordance Test (SCT), based on script theory from cognitive psychology, uses authentic clinical scenarios to compare a trainee's judgment skills with those of experts. The SCT has been validated in several medical disciplines, but has not been investigated in neurology. We developed an Internet-based neurology SCT (NSCT) comprising 24 clinical scenarios with three to four questions each. The scenarios were designed to reflect the uncertainty of real-life clinical encounters in adult neurology. The questions explored aspects of the scenario in which several responses might be acceptable; trainees were asked to judge which response they considered to be best. Forty-one PGY1-PGY5 neurology residents and eight medical students from three North American neurology programs (McGill, Calgary, and Mayo Clinic) completed the NSCT. The responses of trainees to each question were compared with the aggregate responses of an expert panel of 16 attending neurologists. The NSCT demonstrated good reliability (Cronbach alpha = 0.79). Neurology residents scored higher than medical students and lower than attending neurologists, supporting the test's construct validity. Furthermore, NSCT scores discriminated between senior (PGY3-5) and junior residents (PGY1-2). Our NSCT is a practical and reliable instrument, and our findings support its construct validity for assessing judgment in neurology trainees. The NSCT has potentially widespread applications as an evaluation tool, both in neurology training and for licensing examinations.

  8. Is It Safe? Reliability and Validity of Structured versus Unstructured Child Safety Judgments

    ERIC Educational Resources Information Center

    Bartelink, Cora; de Kwaadsteniet, Leontien; ten Berge, Ingrid J.; Witteman, Cilia L. M.

    2017-01-01

    Background: The LIRIK, an instrument for the assessment of child safety and risk, is designed to improve assessments by guiding professionals through a structured evaluation of relevant signs, risk factors, and protective factors. Objective: We aimed to assess the interrater agreement and the predictive validity of professionals' judgments made…

  9. The speed of metacognition: taking time to get to know one's structural knowledge.

    PubMed

    Mealor, Andy D; Dienes, Zoltan

    2013-03-01

    The time course of different metacognitive experiences of knowledge was investigated using artificial grammar learning. Experiment 1 revealed that when participants are aware of the basis of their judgments (conscious structural knowledge) decisions are made most rapidly, followed by decisions made with conscious judgment but without conscious knowledge of underlying structure (unconscious structural knowledge), and guess responses (unconscious judgment knowledge) were made most slowly, even when controlling for differences in confidence and accuracy. In experiment 2, short response deadlines decreased the accuracy of unconscious but not conscious structural knowledge. Conversely, the deadline decreased the proportion of conscious structural knowledge in favour of guessing. Unconscious structural knowledge can be applied rapidly but becomes more reliable with additional metacognitive processing time whereas conscious structural knowledge is an all-or-nothing response that cannot always be applied rapidly. These dissociations corroborate quite separate theories of recognition (dual-process) and metacognition (higher order thought and cross-order integration). Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Damage to the ventromedial prefrontal cortex is associated with impairments in both spontaneous and deliberative moral judgments

    PubMed Central

    Cameron, C. Daryl; Reber, Justin; Spring, Victoria L.; Tranel, Daniel

    2018-01-01

    Implicit moral evaluations—spontaneous, unintentional judgments about the moral status of actions or persons—are thought to play a pivotal role in moral experience, suggesting a need for research to model these moral evaluations in clinical populations. Prior research reveals that the ventromedial prefrontal cortex (vmPFC) is a critical area underpinning affect and morality, and patients with vmPFC lesions show abnormalities in moral judgment and moral behavior. We use indirect measurement and multinomial modeling to understand differences in implicit moral evaluations among patients with vmPFC lesions. Our model quantifies multiple processes of moral judgment: implicit moral evaluations in response to distracting moral transgressions (Unintentional Judgment), accurate moral judgments about target actions (Intentional Judgment), and a directional tendency to judge actions as morally wrong (Response Bias). Compared to individuals with non-vmPFC brain damage and neurologically healthy comparisons, patients with vmPFC lesions showed a dual deficit in processes of moral judgment. First, patients with vmPFC lesions showed reduced Unintentional Judgment about moral transgressions, but not about non-moral negative affective distracters. Second, patients with vmPFC lesions showed reduced Intentional Judgment about target actions. These findings highlight the utility of a formal modeling approach in moral psychology, revealing a dual deficit in multiple component processes of moral judgment among patients with vmPFC lesions. PMID:29382558

  11. Damage to the ventromedial prefrontal cortex is associated with impairments in both spontaneous and deliberative moral judgments.

    PubMed

    Cameron, C Daryl; Reber, Justin; Spring, Victoria L; Tranel, Daniel

    2018-03-01

    Implicit moral evaluations-spontaneous, unintentional judgments about the moral status of actions or persons-are thought to play a pivotal role in moral experience, suggesting a need for research to model these moral evaluations in clinical populations. Prior research reveals that the ventromedial prefrontal cortex (vmPFC) is a critical area underpinning affect and morality, and patients with vmPFC lesions show abnormalities in moral judgment and moral behavior. We use indirect measurement and multinomial modeling to understand differences in implicit moral evaluations among patients with vmPFC lesions. Our model quantifies multiple processes of moral judgment: implicit moral evaluations in response to distracting moral transgressions (Unintentional Judgment), accurate moral judgments about target actions (Intentional Judgment), and a directional tendency to judge actions as morally wrong (Response Bias). Compared to individuals with non-vmPFC brain damage and neurologically healthy comparisons, patients with vmPFC lesions showed a dual deficit in processes of moral judgment. First, patients with vmPFC lesions showed reduced Unintentional Judgment about moral transgressions, but not about non-moral negative affective distracters. Second, patients with vmPFC lesions showed reduced Intentional Judgment about target actions. These findings highlight the utility of a formal modeling approach in moral psychology, revealing a dual deficit in multiple component processes of moral judgment among patients with vmPFC lesions. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Gifted Education Quarterly, 1998.

    ERIC Educational Resources Information Center

    Fisher, Maurice, Ed.

    1998-01-01

    These four issues of "Gifted Education Quarterly" include the following articles: (1) "Using Test Results To Support Clinical Judgment" (Linda Kreger Silverman), which discusses some of the difficulties in obtaining accurate indications of a child's level of giftedness and the importance of using professional judgment in…

  13. Clinical versus actuarial judgment.

    PubMed

    Dawes, R M; Faust, D; Meehl, P E

    1989-03-31

    Professionals are frequently consulted to diagnose and predict human behavior; optimal treatment and planning often hinge on the consultant's judgmental accuracy. The consultant may rely on one of two contrasting approaches to decision-making--the clinical and actuarial methods. Research comparing these two approaches shows the actuarial method to be superior. Factors underlying the greater accuracy of actuarial methods, sources of resistance to the scientific findings, and the benefits of increased reliance on actuarial approaches are discussed.

  14. Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

    PubMed Central

    Brehaut, Jamie C; Poses, Roy; Shojania, Kaveh G; Lott, Alison; Man-Son-Hing, Malcolm; Bassin, Elise; Grimshaw, Jeremy

    2007-01-01

    Background There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1) prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2) initiation of anticoagulation for patients with atrial fibrillation (AF), where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin. Methods For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2) to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes) for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be able to identify which variables have the greatest effect on physician judgments, and whether judgments are affected by inappropriate cues or incorrect weighting of appropriate cues. We will send antibiotics surveys to family physicians (300 per survey), and warfarin surveys to both family physicians and internal medicine specialists (300 per group per survey), for a total of 1,800 physicians. Each Type 1 survey will be two to four pages in length and take about fifteen minutes to complete, while each Type 2 survey will be eight to ten pages in length and take about thirty minutes to complete. Discussion This work will provide insight into the extent to which clinicians' judgments about the likelihood of important treatment outcomes explain inappropriate treatment decisions. This work will also provide information necessary for the development of an individualized feedback tool designed to improve treatment decisions. The techniques developed here have the potential to be applicable to a wide range of clinical areas where inappropriate utilization stems from biased judgments. PMID:17555586

  15. How Does Sequence Structure Affect the Judgment of Time? Exploring a Weighted Sum of Segments Model

    ERIC Educational Resources Information Center

    Matthews, William J.

    2013-01-01

    This paper examines the judgment of segmented temporal intervals, using short tone sequences as a convenient test case. In four experiments, we investigate how the relative lengths, arrangement, and pitches of the tones in a sequence affect judgments of sequence duration, and ask whether the data can be described by a simple weighted sum of…

  16. Evidence-based medicine, clinical practice guidelines, and common sense in the management of osteoporosis.

    PubMed

    Lewiecki, E Michael; Binkley, Neil

    2009-01-01

    To evaluate the benefits and limitations of randomized controlled trials (RCTs), clinical practice guidelines (CPGs), and clinical judgment in the management of osteoporosis. A review was conducted of the English-language literature on the origins and applications of RCTs, CPGs, evidence-based medicine, and clinical judgment in the management of osteoporosis. Evidence-based medicine is use of the currently available best evidence in making clinical decisions for individual patients. CPGs are recommendations for making clinical decisions based on research evidence, sometimes with consideration of expert opinion, health care policy, and costs of care. The highest levels of medical evidence are usually thought to be RCTs and meta-analyses of high-quality RCTs. Although it is desirable and appropriate for clinicians to consider research evidence from RCTs and recommendations presented in CPGs in making clinical decisions, other factors-such as patient preference, comorbidities, affordability, and availability of care-are important for the actual implementation of evidence-based medicine. Decisions about who to treat, which drug to use, how best to monitor, and how long to treat require clinical skills in addition to knowledge of medical research. The necessity of integrating common sense and clinical judgment is highlighted by the fact that many patients treated for osteoporosis in clinical practice would not qualify for participation in the pivotal clinical trials that demonstrated efficacy and safety of the drugs used to treat them.

  17. Accuracy of clinicians and models for estimating the probability that a pulmonary nodule is malignant.

    PubMed

    Balekian, Alex A; Silvestri, Gerard A; Simkovich, Suzanne M; Mestaz, Peter J; Sanders, Gillian D; Daniel, Jamie; Porcel, Jackie; Gould, Michael K

    2013-12-01

    Management of pulmonary nodules depends critically on the probability of malignancy. Models to estimate probability have been developed and validated, but most clinicians rely on judgment. The aim of this study was to compare the accuracy of clinical judgment with that of two prediction models. Physician participants reviewed up to five clinical vignettes, selected at random from a larger pool of 35 vignettes, all based on actual patients with lung nodules of known final diagnosis. Vignettes included clinical information and a representative slice from computed tomography. Clinicians estimated the probability of malignancy for each vignette. To examine agreement with models, we calculated intraclass correlation coefficients (ICC) and kappa statistics. To examine accuracy, we compared areas under the receiver operator characteristic curve (AUC). Thirty-six participants completed 179 vignettes, 47% of which described patients with malignant nodules. Agreement between participants and models was fair for the Mayo Clinic model (ICC, 0.37; 95% confidence interval [CI], 0.23-0.50) and moderate for the Veterans Affairs model (ICC, 0.46; 95% CI, 0.34-0.57). There was no difference in accuracy between participants (AUC, 0.70; 95% CI, 0.62-0.77) and the Mayo Clinic model (AUC, 0.71; 95% CI, 0.62-0.80; P = 0.90) or the Veterans Affairs model (AUC, 0.72; 95% CI, 0.64-0.80; P = 0.54). In this vignette-based study, clinical judgment and models appeared to have similar accuracy for lung nodule characterization, but agreement between judgment and the models was modest, suggesting that qualitative and quantitative approaches may provide complementary information.

  18. Pressure ulcer risk assessment and prevention: what difference does a risk scale make? A comparison between Norway and Ireland.

    PubMed

    Johansen, E; Moore, Z; van Etten, M; Strapp, H

    2014-07-01

    To explore similarities and differences in nurses' views on risk assessment practices and preventive care activities in a context where patients' risk of developing pressure ulcers is assessed using clinical judgment (Norway) and a context where patients' risk of developing pressure ulcers is assessed using a formal structured risk assessment combined with clinical judgement (Ireland). A descriptive, qualitative design was employed across two different care settings with a total of 14 health care workers, nine from Norway and five from Ireland. Regardless of whether risk assessment was undertaken using clinical judgment or formal structured risk assessment, identified risk factors, at risk patients and appropriate preventive initiatives discussed by participant were similar across care settings. Furthermore, risk assessment did not necessarily result in the planning and implementation of appropriate pressure ulcer prevention initiatives. Thus, in this instance, use of a formal risk assessment tool does not seem to make any difference to the planning, initiation and evaluation of pressure ulcer prevention strategies. Regardless of the method of risk assessment, patients at risk of developing pressure ulcers are detected, suggesting that the practice of risk assessment should be re-evaluated. Moreover, appropriate preventive interventions were described. However, the missing link between risk assessment and documented care planning is of concern and barriers to appropriate pressure ulcer documentation should be explored further. This work is partly funded by a research grant from the Norwegian Nurses Organisation (NNO) (Norsk Sykepleierforbund NSF) in 2012. The authors have no conflict of interest to declare.

  19. Reach and speed of judgment propagation in the laboratory.

    PubMed

    Moussaïd, Mehdi; Herzog, Stefan M; Kämmer, Juliane E; Hertwig, Ralph

    2017-04-18

    In recent years, a large body of research has demonstrated that judgments and behaviors can propagate from person to person. Phenomena as diverse as political mobilization, health practices, altruism, and emotional states exhibit similar dynamics of social contagion. The precise mechanisms of judgment propagation are not well understood, however, because it is difficult to control for confounding factors such as homophily or dynamic network structures. We introduce an experimental design that renders possible the stringent study of judgment propagation. In this design, experimental chains of individuals can revise their initial judgment in a visual perception task after observing a predecessor's judgment. The positioning of a very good performer at the top of a chain created a performance gap, which triggered waves of judgment propagation down the chain. We evaluated the dynamics of judgment propagation experimentally. Despite strong social influence within pairs of individuals, the reach of judgment propagation across a chain rarely exceeded a social distance of three to four degrees of separation. Furthermore, computer simulations showed that the speed of judgment propagation decayed exponentially with the social distance from the source. We show that information distortion and the overweighting of other people's errors are two individual-level mechanisms hindering judgment propagation at the scale of the chain. Our results contribute to the understanding of social-contagion processes, and our experimental method offers numerous new opportunities to study judgment propagation in the laboratory.

  20. Reach and speed of judgment propagation in the laboratory

    PubMed Central

    Herzog, Stefan M.; Kämmer, Juliane E.; Hertwig, Ralph

    2017-01-01

    In recent years, a large body of research has demonstrated that judgments and behaviors can propagate from person to person. Phenomena as diverse as political mobilization, health practices, altruism, and emotional states exhibit similar dynamics of social contagion. The precise mechanisms of judgment propagation are not well understood, however, because it is difficult to control for confounding factors such as homophily or dynamic network structures. We introduce an experimental design that renders possible the stringent study of judgment propagation. In this design, experimental chains of individuals can revise their initial judgment in a visual perception task after observing a predecessor’s judgment. The positioning of a very good performer at the top of a chain created a performance gap, which triggered waves of judgment propagation down the chain. We evaluated the dynamics of judgment propagation experimentally. Despite strong social influence within pairs of individuals, the reach of judgment propagation across a chain rarely exceeded a social distance of three to four degrees of separation. Furthermore, computer simulations showed that the speed of judgment propagation decayed exponentially with the social distance from the source. We show that information distortion and the overweighting of other people’s errors are two individual-level mechanisms hindering judgment propagation at the scale of the chain. Our results contribute to the understanding of social-contagion processes, and our experimental method offers numerous new opportunities to study judgment propagation in the laboratory. PMID:28373540

  1. 'Utilitarian' judgments in sacrificial moral dilemmas do not reflect impartial concern for the greater good.

    PubMed

    Kahane, Guy; Everett, Jim A C; Earp, Brian D; Farias, Miguel; Savulescu, Julian

    2015-01-01

    A growing body of research has focused on so-called 'utilitarian' judgments in moral dilemmas in which participants have to choose whether to sacrifice one person in order to save the lives of a greater number. However, the relation between such 'utilitarian' judgments and genuine utilitarian impartial concern for the greater good remains unclear. Across four studies, we investigated the relationship between 'utilitarian' judgment in such sacrificial dilemmas and a range of traits, attitudes, judgments and behaviors that either reflect or reject an impartial concern for the greater good of all. In Study 1, we found that rates of 'utilitarian' judgment were associated with a broadly immoral outlook concerning clear ethical transgressions in a business context, as well as with sub-clinical psychopathy. In Study 2, we found that 'utilitarian' judgment was associated with greater endorsement of rational egoism, less donation of money to a charity, and less identification with the whole of humanity, a core feature of classical utilitarianism. In Studies 3 and 4, we found no association between 'utilitarian' judgments in sacrificial dilemmas and characteristic utilitarian judgments relating to assistance to distant people in need, self-sacrifice and impartiality, even when the utilitarian justification for these judgments was made explicit and unequivocal. This lack of association remained even when we controlled for the antisocial element in 'utilitarian' judgment. Taken together, these results suggest that there is very little relation between sacrificial judgments in the hypothetical dilemmas that dominate current research, and a genuine utilitarian approach to ethics. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  2. ‘Utilitarian’ judgments in sacrificial moral dilemmas do not reflect impartial concern for the greater good

    PubMed Central

    Kahane, Guy; Everett, Jim A.C.; Earp, Brian D.; Farias, Miguel; Savulescu, Julian

    2015-01-01

    A growing body of research has focused on so-called ‘utilitarian’ judgments in moral dilemmas in which participants have to choose whether to sacrifice one person in order to save the lives of a greater number. However, the relation between such ‘utilitarian’ judgments and genuine utilitarian impartial concern for the greater good remains unclear. Across four studies, we investigated the relationship between ‘utilitarian’ judgment in such sacrificial dilemmas and a range of traits, attitudes, judgments and behaviors that either reflect or reject an impartial concern for the greater good of all. In Study 1, we found that rates of ‘utilitarian’ judgment were associated with a broadly immoral outlook concerning clear ethical transgressions in a business context, as well as with sub-clinical psychopathy. In Study 2, we found that ‘utilitarian’ judgment was associated with greater endorsement of rational egoism, less donation of money to a charity, and less identification with the whole of humanity, a core feature of classical utilitarianism. In Studies 3 and 4, we found no association between ‘utilitarian’ judgments in sacrificial dilemmas and characteristic utilitarian judgments relating to assistance to distant people in need, self-sacrifice and impartiality, even when the utilitarian justification for these judgments was made explicit and unequivocal. This lack of association remained even when we controlled for the antisocial element in ‘utilitarian’ judgment. Taken together, these results suggest that there is very little relation between sacrificial judgments in the hypothetical dilemmas that dominate current research, and a genuine utilitarian approach to ethics. PMID:25460392

  3. Soldier Decision-Making for Allocation of Intelligence, Surveillance, and Reconnaissance Assets

    DTIC Science & Technology

    2014-06-01

    Judgments; also called Algoritmic or Statistical Judgements Computer Science , Psychology, and Statistics Actuarial or algorithmic...Jan. 2011. [17] R. M. Dawes, D. Faust, and P. E. Meehl, “Clinical versus Actuarial Judgment,” Science , vol. 243, no. 4899, pp. 1668–1674, 1989. [18...School of Computer Science

  4. Clinimetrics and clinical psychometrics: macro- and micro-analysis.

    PubMed

    Tomba, Elena; Bech, Per

    2012-01-01

    Clinimetrics was introduced three decades ago to specify the domain of clinical markers in clinical medicine (indexes or rating scales). In this perspective, clinical validity is the platform for selecting the various indexes or rating scales (macro-analysis). Psychometric validation of these indexes or rating scales is the measuring aspect (micro-analysis). Clinical judgment analysis by experienced psychiatrists is included in the macro-analysis and the item response theory models are especially preferred in the micro-analysis when using the total score as a sufficient statistic. Clinical assessment tools covering severity of illness scales, prognostic measures, issues of co-morbidity, longitudinal assessments, recovery, stressors, lifestyle, psychological well-being, and illness behavior have been identified. The constructive dialogue in clinimetrics between clinical judgment and psychometric validation procedures is outlined for generating developments of clinical practice in psychiatry. Copyright © 2012 S. Karger AG, Basel.

  5. Mistakes and missed opportunities regarding cosmetic surgery and conscientious objection.

    PubMed

    Saad, Toni C

    2017-04-24

    In her paper 'Cosmetic surgery and conscientious objection', Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because (1) it overlooks an important distinction regarding autonomy's meaning and place in clinical practice, and (2) it makes obsolete the important concepts of expert clinical judgment and beneficence. Finally, we discuss two ideas which emerge from consideration of cosmetic surgery in relation to conscientious objection. These are the possible analogy between clinical judgment and conscientious objection, and the possible role the goals of medicine can play in defining the scope of conscientious objection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. Instruction in information structuring improves Bayesian judgment in intelligence analysts.

    PubMed

    Mandel, David R

    2015-01-01

    An experiment was conducted to test the effectiveness of brief instruction in information structuring (i.e., representing and integrating information) for improving the coherence of probability judgments and binary choices among intelligence analysts. Forty-three analysts were presented with comparable sets of Bayesian judgment problems before and immediately after instruction. After instruction, analysts' probability judgments were more coherent (i.e., more additive and compliant with Bayes theorem). Instruction also improved the coherence of binary choices regarding category membership: after instruction, subjects were more likely to invariably choose the category to which they assigned the higher probability of a target's membership. The research provides a rare example of evidence-based validation of effectiveness in instruction to improve the statistical assessment skills of intelligence analysts. Such instruction could also be used to improve the assessment quality of other types of experts who are required to integrate statistical information or make probabilistic assessments.

  7. Exploring children's face-space: a multidimensional scaling analysis of the mental representation of facial identity.

    PubMed

    Nishimura, Mayu; Maurer, Daphne; Gao, Xiaoqing

    2009-07-01

    We explored differences in the mental representation of facial identity between 8-year-olds and adults. The 8-year-olds and adults made similarity judgments of a homogeneous set of faces (individual hair cues removed) using an "odd-man-out" paradigm. Multidimensional scaling (MDS) analyses were performed to represent perceived similarity of faces in a multidimensional space. Five dimensions accounted optimally for the judgments of both children and adults, with similar local clustering of faces. However, the fit of the MDS solutions was better for adults, in part because children's responses were more variable. More children relied predominantly on a single dimension, namely eye color, whereas adults appeared to use multiple dimensions for each judgment. The pattern of findings suggests that children's mental representation of faces has a structure similar to that of adults but that children's judgments are influenced less consistently by that overall structure.

  8. Clinical Ethics Consultants are not “Ethics” Experts—But They do Have Expertise 1

    PubMed Central

    Rasmussen, Lisa M.

    2016-01-01

    The attempt to critique the profession of clinical ethics consultation by establishing the impossibility of ethics expertise has been a red herring. Decisions made in clinical ethics cases are almost never based purely on moral judgments. Instead, they are all-things-considered judgments that involve determining how to balance other values as well. A standard of justified decision-making in this context would enable us to identify experts who could achieve these standards more often than others, and thus provide a basis for expertise in clinical ethics consultation. This expertise relies in part on what Richard Zaner calls the “expert knowledge of ethical phenomena” (1988, 8). PMID:27302970

  9. Visual discrimination of local surface structure: slant, tilt, and curvedness.

    PubMed

    Norman, J Farley; Todd, James T; Norman, Hideko F; Clayton, Anna Marie; McBride, T Ryan

    2006-03-01

    In four experiments, observers were required to discriminate interval or ordinal differences in slant, tilt, or curvedness between designated probe points on randomly shaped curved surfaces defined by shading, texture, and binocular disparity. The results reveal that discrimination thresholds for judgments of slant or tilt typically range between 4 degrees and 10 degrees; that judgments of one component are unaffected by simultaneous variations in the other; and that the individual thresholds for either the slant or tilt components of orientation are approximately equal to those obtained for judgments of the total orientation difference between two probed regions. Performance was much worse, however, for judgments of curvedness, and these judgments were significantly impaired when there were simultaneous variations in the shape index parameter of curvature.

  10. Medical Judgments Across the Range of Reported Pain Severity: Clinician and Lay Perspectives.

    PubMed

    Tait, Raymond C; Chibnall, John T; House, Kylie; Biehl, Joann

    2016-07-01

    While increasing evidence suggests that observers discount high-severity chronic pain, factors that occasion such discounting are poorly understood, particularly regarding health provider vs lay perspectives. This study examined the effects of supporting medical evidence and comorbid psychological distress (pain behavior) on medical student and lay clinical judgments of increasingly severe patient pain reports. In a 2 × 2 × 2 × (7) mixed between- and within-subject design, participants (medical students vs lay) made clinical judgments after reading vignettes describing a hypothetical patient that varied in levels of medical evidence and pain behavior (low vs high) and pain severity (4/10-10/10). Fourth-year medical students (N = 115) and lay persons in the community (N = 300) participated in this research. While both medical student and lay judgments plateaued at high levels of pain severity, judgments regarding cause (medical vs psychological), treatment (opioid prescription), and disability showed growing divergence as levels of reported pain severity increased. Divergence relative to medical and psychological causes of pain was found irrespective of the level of supporting medical evidence; divergence relative to opioid treatment and support for a disability claim was found when supporting medical evidence was low. The results indicate differing expectations of chronic pain treatment for health care providers relative to the lay public that could impact clinical care, especially at high pain severity levels, where lay expectations diverge significantly from those of health professionals. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Functional assessment of the elderly. A comparison of standard instruments with clinical judgment.

    PubMed

    Pinholt, E M; Kroenke, K; Hanley, J F; Kussman, M J; Twyman, P L; Carpenter, J L

    1987-03-01

    Using specific instruments and scales to measure mental status, nutritional state, visual acuity, gait, and activities of daily living, we studied 79 medical inpatients aged 70 years or older. We then interviewed the patients' primary physicians and nurses and asked them to rate their patients. The prevalence of functional impairment was high: 25 (32%) of the 79 patients were mentally impaired, 31 (39%) were malnourished, 18 (23%) were visually impaired, 31 (39%) had impaired gait, and 23 (29%) had problems with continence. Although clinicians recognized severe impairments, the sensitivity of their clinical judgment was poor in detecting moderate impairment in four categories: mental status sensitivity was 28% (5/18); nutrition, 54% (14/26); vision, 27% (4/15); and continence, 42% (5/12). With clinical judgment alone, physicians and nurses correctly identify severe impairment, but the more prevalent moderate impairments in mental status, nutrition, vision, and continence are poorly recognized. Comprehensive functional assessment instruments can detect these moderate impairments, which may be remediable through early intervention.

  12. Thinking about thinking: implications for patient safety.

    PubMed

    Montgomery, Kathryn

    2009-01-01

    Clinical medicine, a learned, rational, science-using practice, is labelled a science even though physicians have the good sense not to practise it that way. Rather than thinking like scientists - or how we think scientists think - physicians are engaged in analogical, interpretive reasoning that resembles Aristotle's phronesis, or practical reasoning, more closely than episteme, or scientific reasoning. In medicine, phronesis is clinical judgment; and while it depends on both a fund of information and extensive experience, somehow it is not quite teachable. This practical, clinical rationality relies on case narrative for teaching and learning about illness and disease, for recording and communicating about patient care and, inevitably, for thinking about and remembering the details, as well as the overarching rules of practice. At the same time, "anecdotal" remains the most pejorative word in medicine, and the tension between the justifiable caution this disdain expresses and the pervasive narrative structure of medical knowledge is characteristic of clinical knowing generally: a tug-of-war between apparent irreconcilables that can be settled only by an appeal to the circumstances of the clinical situation. Practical rationality in the clinical encounter is characterized by a productive circulation between the particular details of the patient's presentation and general information about disease stored as a taxonomy of cases. Evidence-based medicine can improve this negotiation between general knowledge and the patient's particulars, but it cannot replace it. In a scientific era, clinical judgment remains the quintessential intellectual strength of the clinician. Why, then, do we not teach the epistemology of medicine? Understanding the mis-description of physicians' thinking - and the accompanying claim that medicine is, in itself, a science - could mitigate the misplaced perfectionism that makes mistakes in medicine personal and unthinkable.

  13. In person versus Computer Screening for Intimate Partner Violence Among Pregnant Patients

    PubMed Central

    Dado, Diane; Schussler, Sara; Hawker, Lynn; Holland, Cynthia L.; Burke, Jessica G.; Cluss, Patricia A.

    2012-01-01

    Objective To compare in person versus computerized screening for intimate partner violence (IPV) in a hospital-based prenatal clinic and explore women’s assessment of the screening methods. Methods We compared patient IPV disclosures on a computerized questionnaire to audio-taped first obstetric visits with an obstetric care provider and performed semi-structured interviews with patient participants who reported experiencing IPV. Results Two-hundred and fifty patient participants and 52 provider participants were in the study. Ninety-one (36%) patients disclosed IPV either via computer or in person. Of those who disclosed IPV, 60 (66%) disclosed via both methods, but 31 (34%) disclosed IPV via only one of the two methods. Twenty-three women returned for interviews. They recommended using both types together. While computerized screening was felt to be non-judgmental and more anonymous, in person screening allowed for tailored questioning and more emotional connection with the provider. Conclusion Computerized screening allowed disclosure without fear of immediate judgment. In person screening allows more flexibility in wording of questions regarding IPV and opportunity for interpersonal rapport. Practice Implications Both computerized or self-completed screening and in person screening is recommended. Providers should address IPV using non-judgmental, descriptive language, include assessments for psychological IPV, and repeat screening in person, even if no patient disclosure occurs via computer. PMID:22770815

  14. In person versus computer screening for intimate partner violence among pregnant patients.

    PubMed

    Chang, Judy C; Dado, Diane; Schussler, Sara; Hawker, Lynn; Holland, Cynthia L; Burke, Jessica G; Cluss, Patricia A

    2012-09-01

    To compare in person versus computerized screening for intimate partner violence (IPV) in a hospital-based prenatal clinic and explore women's assessment of the screening methods. We compared patient IPV disclosures on a computerized questionnaire to audio-taped first obstetric visits with an obstetric care provider and performed semi-structured interviews with patient participants who reported experiencing IPV. Two-hundred and fifty patient participants and 52 provider participants were in the study. Ninety-one (36%) patients disclosed IPV either via computer or in person. Of those who disclosed IPV, 60 (66%) disclosed via both methods, but 31 (34%) disclosed IPV via only one of the two methods. Twenty-three women returned for interviews. They recommended using both types together. While computerized screening was felt to be non-judgmental and more anonymous, in person screening allowed for tailored questioning and more emotional connection with the provider. Computerized screening allowed disclosure without fear of immediate judgment. In person screening allows more flexibility in wording of questions regarding IPV and opportunity for interpersonal rapport. Both computerized or self-completed screening and in person screening is recommended. Providers should address IPV using non-judgmental, descriptive language, include assessments for psychological IPV, and repeat screening in person, even if no patient disclosure occurs via computer. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care.

    PubMed

    Sinn, Chi-Ling Joanna; Jones, Aaron; McMullan, Janet Legge; Ackerman, Nancy; Curtin-Telegdi, Nancy; Eckel, Leslie; Hirdes, John P

    2017-11-25

    Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

  16. A conceptual model for generating and validating in-session clinical judgments

    PubMed Central

    Jacinto, Sofia B.; Lewis, Cara C.; Braga, João N.; Scott, Kelli

    2016-01-01

    Objective Little attention has been paid to the nuanced and complex decisions made in the clinical session context and how these decisions influence therapy effectiveness. Despite decades of research on the dual-processing systems, it remains unclear when and how intuitive and analytical reasoning influence the direction of the clinical session. Method This paper puts forth a testable conceptual model, guided by an interdisciplinary integration of the literature, that posits that the clinical session context moderates the use of intuitive versus analytical reasoning. Results A synthesis of studies examining professional best practices in clinical decision-making, empirical evidence from clinical judgment research, and the application of decision science theories indicate that intuitive and analytical reasoning may have profoundly different impacts on clinical practice and outcomes. Conclusions The proposed model is discussed with respect to its implications for clinical practice and future research. PMID:27088962

  17. Restoring and Managing Gulf of Mexico Fisheries: A Path Toward Creative Decision-Making

    EPA Science Inventory

    This chapter introduces decision analysis concepts with examples for managing fisheries. Decision analytic methods provide useful tools for structuring environmental management problems and separating technical judgments from preference judgments to better weigh the prospects fro...

  18. Using Dynamic Risk and Protective Factors to Predict Inpatient Aggression: Reliability and Validity of START Assessments

    PubMed Central

    Desmarais, Sarah L.; Nicholls, Tonia L.; Wilson, Catherine M.; Brink, Johann

    2012-01-01

    The Short-Term Assessment of Risk and Treatability (START) is a relatively new structured professional judgment guide for the assessment and management of short-term risks associated with mental, substance use, and personality disorders. The scheme may be distinguished from other violence risk instruments because of its inclusion of 20 dynamic factors that are rated in terms of both vulnerability and strength. This study examined the reliability and validity of START assessments in predicting inpatient aggression. Research assistants completed START assessments for 120 male forensic psychiatric patients through review of hospital files. They additionally completed Historical-Clinical-Risk Management – 20 (HCR-20) and the Hare Psychopathy Checklist: Screening Version (PCL:SV) assessments. Outcome data was coded from hospital files for a 12-month follow-up period using the Overt Aggression Scale (OAS). START assessments evidenced excellent interrater reliability and demonstrated both predictive and incremental validity over the HCR-20 Historical subscale scores and PCL:SV total scores. Overall, results support the reliability and validity of START assessments, and use of the structured professional judgment approach more broadly, as well as the value of using dynamic risk and protective factors to assess violence risk. PMID:22250595

  19. Provider judgments of patients in pain: seeking symptom certainty.

    PubMed

    Tait, Raymond C; Chibnall, John T; Kalauokalani, Donna

    2009-01-01

    Uncertainty often surrounds judgments of pain, especially when pain is chronic. In order to simplify their decisions, providers adduce information from a variety of sources. Unfortunately, an extensive literature suggests that the information that is brought to bear actually can bias pain judgments, resulting in judgments that consistently differ from patient reports, with a potential negative impact on treatment. This review examines the pain assessment literature from a social cognition perspective that emphasizes interpersonal and situational factors that can influence judgments. Consistent with that model, it organizes research findings into three broad domains that have been shown to systematically influence assessments of pain, involving patient, provider, and situational factors. A causal model for pain judgment is proposed, and its implications for clinical research and practice are explored. In order to minimize the uncertainty that can characterize symptoms such as chronic pain, practitioners bring information to bear on pain assessment that can lead to misjudgments. While intuitively appealing, much of the information that is considered often has little association with pain severity and/or adjustment. A more rational decision-making process can reduce the judgment errors common to pain assessment and treatment.

  20. Aspiration in children and adolescents with neurogenic dysphagia: comparison of clinical judgment and fiberoptic endoscopic evaluation of swallowing.

    PubMed

    Beer, Sabrina; Hartlieb, Till; Müller, Arnd; Granel, Michael; Staudt, Martin

    2014-12-01

    A total of 30 children and adolescents with dysphagia due to various chronic neurological disorders were assessed for their risk of aspiration. This assessment was performed clinically by experienced speech and swallowing therapists, and verified thereafter by fiberoptic endoscopy. We found the clinical judgment to be correct in only 70% (for aspiration of saliva), 55% (of puree), and 67% (of thin liquids). We conclude that, because of this unacceptably high error rate of clinical assessment, a fiberoptic evaluation of swallowing is a necessary diagnostic step both for the planning of therapy and for the development of feeding strategies in children and adolescents with neurogenic dysphagia. Georg Thieme Verlag KG Stuttgart · New York.

  1. Effect of Explicit Evaluation on Neural Connectivity Related to Listening to Unfamiliar Music

    PubMed Central

    Liu, Chao; Brattico, Elvira; Abu-jamous, Basel; Pereira, Carlos S.; Jacobsen, Thomas; Nandi, Asoke K.

    2017-01-01

    People can experience different emotions when listening to music. A growing number of studies have investigated the brain structures and neural connectivities associated with perceived emotions. However, very little is known about the effect of an explicit act of judgment on the neural processing of emotionally-valenced music. In this study, we adopted the novel consensus clustering paradigm, called binarisation of consensus partition matrices (Bi-CoPaM), to study whether and how the conscious aesthetic evaluation of the music would modulate brain connectivity networks related to emotion and reward processing. Participants listened to music under three conditions – one involving a non-evaluative judgment, one involving an explicit evaluative aesthetic judgment, and one involving no judgment at all (passive listening only). During non-evaluative attentive listening we obtained auditory-limbic connectivity whereas when participants were asked to decide explicitly whether they liked or disliked the music excerpt, only two clusters of intercommunicating brain regions were found: one including areas related to auditory processing and action observation, and the other comprising higher-order structures involved with visual processing. Results indicate that explicit evaluative judgment has an impact on the neural auditory-limbic connectivity during affective processing of music. PMID:29311874

  2. The Delphi Method: An Approach for Facilitating Evidence Based Practice in Athletic Training

    ERIC Educational Resources Information Center

    Sandrey, Michelle A.; Bulger, Sean M.

    2008-01-01

    Objective: The growing importance of evidence based practice in athletic training is necessitating academics and clinicians to be able to make judgments about the quality or lack of the body of research evidence and peer-reviewed standards pertaining to clinical questions. To assist in the judgment process, consensus methods, namely brainstorming,…

  3. Changes in Emotional-Social Intelligence, Caring, Leadership and Moral Judgment during Health Science Education Programs

    ERIC Educational Resources Information Center

    Larin, Helene; Benson, Gerry; Wessel, Jean; Martin, Lynn; Ploeg, Jenny

    2014-01-01

    In addition to having academic knowledge and clinical skills, health professionals need to be caring, ethical practitioners able to understand the emotional concerns of their patients and to effect change. The purpose of this study was to determine whether emotional-social intelligence, caring, leadership and moral judgment of health science…

  4. Adolescent Judgments and Reasoning about the Failure to Include Peers with Social Disabilities

    ERIC Educational Resources Information Center

    Bottema-Beutel, Kristen; Li, Zhushan

    2015-01-01

    Adolescents with autism spectrum disorder often do not have access to crucial peer social activities. This study examines how typically developing adolescents evaluate decisions not to include a peer based on disability status, and the justifications they apply to these decisions. A clinical interview methodology was used to elicit judgments and…

  5. [GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines.

    PubMed

    Morgano, Gian Paolo; Parmelli, Elena; Amato, Laura; Iannone, Primiano; Marchetti, Marco; Moja, Lorenzo; Davoli, Marina; Schünemann, Holger

    2018-05-01

    In the first article in this series we described the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision (EtD) frameworks and their rationale for different types of decisions. In this second article, we describe the use of EtD frameworks for clinical recommendations and how it can help clinicians and patients who use those recommendations. EtD frameworks for clinical practice recommendations provide a structured and transparent approach for guideline panels. The framework helps ensure consideration of key criteria that determine whether an intervention should be recommended and that judgments are informed by the best available evidence. Frameworks are also a way for panels to make guideline users aware of the rationale (justification) for their recommendations.

  6. Estimating structural collapse fragility of generic building typologies using expert judgment

    USGS Publications Warehouse

    Jaiswal, Kishor; Wald, David J.; Perkins, David M.; Aspinall, Willy P.; Kiremidjian, Anne S.

    2014-01-01

    The structured expert elicitation process proposed by Cooke (1991), hereafter referred to as Cooke's approach, is applied for the first time in the realm of structural collapse-fragility assessment for selected generic construction types. Cooke's approach works on the principle of objective calibration scoring of judgments couple with hypothesis testing used in classical statistics. The performance-based scoring system reflects the combined measure of an expert's informativeness about variables in the problem are under consideration, and their ability to enumerate, in a statistically accurate way through expressing their true beliefs, the quantitative uncertainties associated with their assessments. We summarize the findings of an expert elicitation workshop in which a dozen earthquake-engineering professionals from around the world were engaged to estimate seismic collapse fragility for generic construction types. Development of seismic collapse fragility-functions was accomplished by combining their judgments using weights derived from Cooke's method. Although substantial effort was needed to elicit the inputs of these experts successfully, we anticipate that the elicitation strategy described here will gain momentum in a wide variety of earthquake seismology and engineering hazard and risk analyses where physical model and data limitations are inherent and objective professional judgment can fill gaps.

  7. Estimating structural collapse fragility of generic building typologies using expert judgment

    USGS Publications Warehouse

    Jaiswal, Kishor S.; Wald, D.J.; Perkins, D.; Aspinall, W.P.; Kiremidjian, Anne S.; Deodatis, George; Ellingwood, Bruce R.; Frangopol, Dan M.

    2014-01-01

    The structured expert elicitation process proposed by Cooke (1991), hereafter referred to as Cooke’s approach, is applied for the first time in the realm of structural collapse-fragility assessment for selected generic construction types. Cooke’s approach works on the principle of objective calibration scoring of judgments coupled with hypothesis testing used in classical statistics. The performance-based scoring system reflects the combined measure of an expert’s informativeness about variables in the problem area under consideration, and their ability to enumerate, in a statistically accurate way through expressing their true beliefs, the quantitative uncertainties associated with their assessments. We summarize the findings of an expert elicitation workshop in which a dozen earthquake-engineering professionals from around the world were engaged to estimate seismic collapse fragility for generic construction types. Development of seismic collapse fragility functions was accomplished by combining their judgments using weights derived from Cooke’s method. Although substantial effort was needed to elicit the inputs of these experts successfully, we anticipate that the elicitation strategy described here will gain momentum in a wide variety of earthquake seismology and engineering hazard and risk analyses where physical model and data limitations are inherent and objective professional judgment can fill gaps.

  8. The perceived effectiveness of persuasive messages: questions of structure, referent, and bias.

    PubMed

    Dillard, James Price; Ye, Sun

    2008-03-01

    To gain a sense of the persuasive efficacy of a message prior to implementation of a campaign, researchers often gather judgments of perceived effectiveness (PE). At present, they do so without much knowledge of the conceptual meaning or empirical properties of PE. In the spirit of construct explication, we report a study intended to address a series of questions about PE. Using student (N = 155) and community samples (N = 100), we found the following: (a) PE is a two-dimensional judgment involving global evaluations of message impact and specific judgments of message attributes, but it may be reducible to a single second-order factor, (b) most individuals reported using more than one referent (i.e., person or group) when making PE judgments, but the choice of referents varies by message and judge, and (c) judgments of PE are biased upward as a function of the number of referents chosen. Suggestions are offered for enhancing the validity of PE judgments in formative campaign research.

  9. Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies.

    PubMed

    Djulbegovic, Benjamin; Hozo, Iztok; Dale, William

    2018-02-27

    Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision-making. A typical approach to improve practitioners' decision-making is to develop evidence-based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a "black-box" operation-a process with defined inputs and outputs but without sufficient knowledge of its internal workings. Increased explicitness and transparency in the process can be achieved by implementing CPG as clinical pathways (CPs) (also known as clinical algorithms or flow-charts). However, clinical recommendations thus derived are typically ad hoc and developed by experts in a theory-free environment. As any recommendation can be right (true positive or negative), or wrong (false positive or negative), the lack of theoretical structure precludes the quantitative assessment of the management strategies recommended by CPGs/CPs. To realize the full potential of CPGs/CPs, they need to be placed on more solid theoretical grounds. We believe this potential can be best realized by converting CPGs/CPs within the heuristic theory of decision-making, often implemented as fast-and-frugal (FFT) decision trees. This is possible because FFT heuristic strategy of decision-making can be linked to signal detection theory, evidence accumulation theory, and a threshold model of decision-making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies. Fast-and-frugal provides a simple and transparent, yet solid and robust, methodological framework connecting decision science to clinical care, a sorely needed missing link between CPGs/CPs and patient outcomes. We therefore advocate that all guidelines panels express their recommendations as CPs, which in turn should be converted into FFTs to guide clinical care. © 2018 John Wiley & Sons, Ltd.

  10. Throwing the baby out with the bath water: is it time for clinical judgment to supplement actuarial risk assessment?

    PubMed

    Abbott, Brian R

    2011-01-01

    The assessment of the potential for sexual violence is one of three prongs that must be met to satisfy the requirements for civil confinement of dangerous sex offenders in the 21 U.S. jurisdictions that have these laws. In a recent issue of The Journal, Sreenivasan et al. argued that, because of a host of methodological problems, actuarial risk assessment methods in general and the Static-99 and its progeny in particular are insufficient for accurate assessment of risk for dangerous sex offenders. They propose using a combination of clinical judgment with actuarial science as a solution. This analysis and review of Sreenivasan et al. reveals and corrects flaws in the arguments they employed to support their position and shows how the combination of actuarial science with clinical judgment is more error prone than the actuarial approach only, and cannot be forensically defended in court. Recommendations on reporting Static-99R data in expert testimony are provided, taking into account the limitations of the instrument.

  11. Race, Color-Blind Racial Attitudes, and Judgments About Mental Health: A Shifting Standards Perspective

    ERIC Educational Resources Information Center

    Gushue, George V.

    2004-01-01

    A fictitious counseling center intake report was given to a sample of 158 White graduate students in counseling and clinical psychology to examine the impact of reported client race (Black or White) on perceptions of clients' symptom severity. As predicted by the shifting standards model of social judgment (M. Biernat, M. Manis, & T. E. Nelson,…

  12. [Role of the orbitofrontal cortex in moral judgment].

    PubMed

    Mimura, Masaru

    2010-11-01

    The neural substrates of moral judgments have recently been advocated to consist of widely distributed brain networks including the orbitofrontal cortex (OFC), anterior temporal lobe and superior temporal gyrus. Moral judgments could be regarded as a conflict between the top-down rational/logical processes and the bottom-up irrational/emotional processes. Individuals with OFC damage are usually difficult to inhibit emotionally-driven outrages, thereby demonstrating severe impairment of moral judgments despite their well-preserved moral knowledge. Individuals with OFC damage frequently present with anti-social less moral behaviors. However, clinical observation indicates that some OFC patients may show "hypermoral" tendency in the sense that they are too strict to overlook other person's offense. Two representative cases with OFC damage were reported, both presented with extreme rage against others' offensive behaviors. To further elucidate the "hypermorality" of OFC patients, an experiment was performed in which patients with OFC damage and healthy control participants were asked to determine punishments for other's fictitious crimes that varied in perpetrator responsibility and crime severity. Individuals with OFC damage punished more strictly than healthy controls those persons for mitigating circumstances. The results are consistent with clinical observation of OFC patients' highly rigid and inflexible behaviors against third person's offense.

  13. Does skull shape mediate the relationship between objective features and subjective impressions about the face?

    PubMed

    Marečková, Klára; Chakravarty, M Mallar; Huang, Mei; Lawrence, Claire; Leonard, Gabriel; Perron, Michel; Pike, Bruce G; Richer, Louis; Veillette, Suzanne; Pausova, Zdenka; Paus, Tomáš

    2013-10-01

    In our previous work, we described facial features associated with a successful recognition of the sex of the face (Marečková et al., 2011). These features were based on landmarks placed on the surface of faces reconstructed from magnetic resonance (MR) images; their position was therefore influenced by both soft tissue (fat and muscle) and bone structure of the skull. Here, we ask whether bone structure has dissociable influences on observers' identification of the sex of the face. To answer this question, we used a novel method of studying skull morphology using MR images and explored the relationship between skull features, facial features, and sex recognition in a large sample of adolescents (n=876; including 475 adolescents from our original report). To determine whether skull features mediate the relationship between facial features and identification accuracy, we performed mediation analysis using bootstrapping. In males, skull features mediated fully the relationship between facial features and sex judgments. In females, the skull mediated this relationship only after adjusting facial features for the amount of body fat (estimated with bioimpedance). While body fat had a very slight positive influence on correct sex judgments about male faces, there was a robust negative influence of body fat on the correct sex judgments about female faces. Overall, these results suggest that craniofacial bone structure is essential for correct sex judgments about a male face. In females, body fat influences negatively the accuracy of sex judgments, and craniofacial bone structure alone cannot explain the relationship between facial features and identification of a face as female. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Medical Students' Development of Ethical Judgment - Exploring the Learners' Perspectives using a mixed methods approach.

    PubMed

    Langer, Thorsten; Jazmati, Danny; Jung, Ole; Schulz, Christian; Schnell, Martin W

    2016-01-01

    Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students' perspectives on their development in ethical judgment has received less attention. Better insights in the learners' experiences can help to improve educational interventions in medical ethics. Methods: A vignette featuring a challenging case with opposing views between a patient's parents and a physician followed by a questionnaire was presented to a cohort of medical students at a German medical school at three points in time during their medical training (Year 1, 2 and 5). The questionnaire included closed and open-ended questions addressing the participant's preferred, hypothetical actions, their reasoning as well as the resources informing their reasoning. Content analysis was used for qualitative data; frequencies and percentages were used to describe quantitative findings. Results: The response rate remained stable (28%) over the study period. Participants' responses changed overtime. Accepting parents' autonomy in the decision-making process was the majority standpoint of students in year 1 and 2 and became less often cited in year 5 (Year 1/2/5: 68/67/48%). On the contrary, not readily following the parents' decision for medical reasons was a minority standpoint in year 1 and became more prevalent over time (year 1/2/5: 12/17/42%). Judgments were only partly based on ethics training. Instead, participants drew on experiences from their clinical clerkships and their personal lives. Throughout the study, participants did not feel well-prepared to make a judgment in the case (Average 2.7 on a Likert-Scale; 1=very well prepared, 4=very poor). Conclusions: Over the course of their medical training, the participants seemed to increasingly frame the presented vignette as a medical problem. To optimize the development of ethical judgment teaching of ethics should be more integrated in clinical teaching. In addition to the analysis of rare and extreme cases, teaching ethics should also expand on challenges students and junior doctors commonly encounter themselves to promote ethical sensitivity and confidence in students.

  15. Medical Students’ Development of Ethical Judgment – Exploring the Learners’ Perspectives using a mixed methods approach

    PubMed Central

    Langer, Thorsten; Jazmati, Danny; Jung, Ole; Schulz, Christian; Schnell, Martin W.

    2016-01-01

    Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students’ perspectives on their development in ethical judgment has received less attention. Better insights in the learners’ experiences can help to improve educational interventions in medical ethics. Methods: A vignette featuring a challenging case with opposing views between a patient’s parents and a physician followed by a questionnaire was presented to a cohort of medical students at a German medical school at three points in time during their medical training (Year 1, 2 and 5). The questionnaire included closed and open-ended questions addressing the participant’s preferred, hypothetical actions, their reasoning as well as the resources informing their reasoning. Content analysis was used for qualitative data; frequencies and percentages were used to describe quantitative findings. Results: The response rate remained stable (28%) over the study period. Participants’ responses changed overtime. Accepting parents’ autonomy in the decision-making process was the majority standpoint of students in year 1 and 2 and became less often cited in year 5 (Year 1/2/5: 68/67/48%). On the contrary, not readily following the parents’ decision for medical reasons was a minority standpoint in year 1 and became more prevalent over time (year 1/2/5: 12/17/42%). Judgments were only partly based on ethics training. Instead, participants drew on experiences from their clinical clerkships and their personal lives. Throughout the study, participants did not feel well-prepared to make a judgment in the case (Average 2.7 on a Likert-Scale; 1=very well prepared, 4=very poor). Conclusions: Over the course of their medical training, the participants seemed to increasingly frame the presented vignette as a medical problem. To optimize the development of ethical judgment teaching of ethics should be more integrated in clinical teaching. In addition to the analysis of rare and extreme cases, teaching ethics should also expand on challenges students and junior doctors commonly encounter themselves to promote ethical sensitivity and confidence in students. PMID:27990470

  16. On Designing Construct Driven Situational Judgment Tests: Some Preliminary Recommendations

    ERIC Educational Resources Information Center

    Guenole, Nigel; Chernyshenko, Oleksandr S.; Weekly, Jeff

    2017-01-01

    Situational judgment tests (SJTs) are widely agreed to be a measurement technique. It is also widely agreed that SJTs are a questionable methodological choice for measurement of psychological constructs, such as behavioral competencies, due to a lack of evidence supporting appropriate factor structures and high internal consistencies.…

  17. The Effects of Unstructured Group Discussion on Ethical Judgment

    ERIC Educational Resources Information Center

    Richards, Clinton H.; Alder, G. Stoney

    2014-01-01

    The authors examine the effects of shared information and group discussion on ethical judgment when no structure is imposed on the discussion to encourage ethical considerations. Discussants were asked to identify arguments for and against a variety of business behaviors with ethical implications. A group moderator solicited and recorded arguments…

  18. Critical Aesthetic Realism

    ERIC Educational Resources Information Center

    McMahon, Jennifer A.

    2011-01-01

    A clear-cut concept of the aesthetic is elusive. Kant's "Critique of Judgment" presents one of the more comprehensive aesthetic theories from which one can extract a set of features, some of which pertain to aesthetic experience and others to the logical structure of aesthetic judgment. When considered together, however, these features present a…

  19. Factors Influencing Mini-CEX Rater Judgments and Their Practical Implications: A Systematic Literature Review.

    PubMed

    Lee, Victor; Brain, Keira; Martin, Jenepher

    2017-06-01

    At present, little is known about how mini-clinical evaluation exercise (mini-CEX) raters translate their observations into judgments and ratings. The authors of this systematic literature review aim both to identify the factors influencing mini-CEX rater judgments in the medical education setting and to translate these findings into practical implications for clinician assessors. The authors searched for internal and external factors influencing mini-CEX rater judgments in the medical education setting from 1980 to 2015 using the Ovid MEDLINE, PsycINFO, ERIC, PubMed, and Scopus databases. They extracted the following information from each study: country of origin, educational level, study design and setting, type of observation, occurrence of rater training, provision of feedback to the trainee, research question, and identified factors influencing rater judgments. The authors also conducted a quality assessment for each study. Seventeen articles met the inclusion criteria. The authors identified both internal and external factors that influence mini-CEX rater judgments. They subcategorized the internal factors into intrinsic rater factors, judgment-making factors (conceptualization, interpretation, attention, and impressions), and scoring factors (scoring integration and domain differentiation). The current theories of rater-based judgment have not helped clinicians resolve the issues of rater idiosyncrasy, bias, gestalt, and conflicting contextual factors; therefore, the authors believe the most important solution is to increase the justification of rater judgments through the use of specific narrative and contextual comments, which are more informative for trainees. Finally, more real-world research is required to bridge the gap between the theory and practice of rater cognition.

  20. Clinical judgement and the medical profession

    PubMed Central

    Kienle, Gunver S; Kiene, Helmut

    2011-01-01

    Objectives Clinical judgment is a central element of the medical profession, essential for the performance of the doctor, and potentially generating information also for other clinicians and for scientists and health care managers. The recently renewed interest in clinical judgement is primarily engaged with its role in communication, diagnosis and decision making. Beyond this issue, the present article highlights the interrelations between clinical judgement, therapy assessment and medical professionalism. Methods Literature review and theory development. Results The article presents different methodological approaches to causality assessment in clinical studies and in clinical judgement, and offers criteria for clinical single case causality. The article outlines models of medical professionalism such as technical rationality and practice epistemology, and characterizes features of professional expertise such as tacit knowledge, reflection in action, and gestalt cognition. Conclusions Consequences of a methodological and logistical advancement of clinical judgment are discussed, both in regard to medical progress and to the renewel of the cognitive basis of the medical profession. PMID:20973873

  1. Subjective experience of coercion in psychiatric care: a study comparing the attitudes of patients and healthy volunteers towards coercive methods and their justification.

    PubMed

    Mielau, J; Altunbay, J; Gallinat, J; Heinz, A; Bermpohl, F; Lehmann, A; Montag, C

    2016-06-01

    Under certain conditions, coercive interventions in psychotic patients can help to regain insight and alleviate symptoms, but can also traumatize subjects. This study explored attitudes towards psychiatric coercive interventions in healthy individuals and persons suffering from schizophrenia, schizoaffective or bipolar disorder. The impact of personal history of coercive treatment on preferences concerning clinical management of patients unable to consent was investigated. Six case vignettes depicting scenarios of ethical dilemmas and demanding decisions in favour of or against coercive interventions were presented to 60 healthy volunteers and 90 patients. Structured interviews focusing on experienced coercion were performed in conjunction with the Coercion Experience Scale and the Admission Experience Survey. Symptom severity, psychosocial functioning and insight into illness were assessed as influencing variables. Student's t tests compared patients' and controls' judgments, followed by regression analyses to define the predictive value of symptoms and measures of coercion on judgments regarding the total patient sample and patients with experience of fixation. Patients and non-psychiatric controls showed no significant difference in their attitudes towards involuntary admission and forced medication. Conversely, patients more than controls significantly disapproved of mechanical restraint. Subjective experience of coercive interventions played an important role for the justification of treatment against an individual's "natural will". Factors influencing judgments on coercion were overall functioning and personal experience of treatment effectiveness and fairness. Qualitative and quantitative aspects of perceived coercion, in addition to insight into illness, predicted judgments of previously fixated patients. Results underline the importance of the quality of practical implementation and care, if coercive interventions cannot be avoided.

  2. Clinical extracts of biomedical literature for patient-centered problem solving.

    PubMed Central

    Florance, V

    1996-01-01

    This paper reports on a four-part qualitative research project aimed at designing an online document surrogate tailored to the needs of physicians seeking biomedical literature for use in clinical problem solving. The clinical extract, designed in collaboration with three practicing physicians, combines traditional elements of the MEDLINE record (e.g., title, author, source, abstract) with new elements (e.g., table captions, text headings, case profiles) suggested by the physicians. Specifications for the prototype clinical extract were developed through a series of relevance-scoring exercises and semi-structured interviews. For six clinical questions, three physicians assessed the applicability of selected articles and their document surrogates, articulating relevance criteria and reasons for their judgments. A prototype clinical extract based on their suggestions was developed, tested, evaluated, and revised. The final version includes content and format aids to make the extract easy to use. The goals, methods, and outcomes of the research study are summarized, and a template of the final design is provided. PMID:8883986

  3. Cognitive Engineering of Advanced Information Technology for Air Force Systems Design and Deployment: Prototype for Air Defense Intelligence and Operations

    DTIC Science & Technology

    1989-10-01

    train members of the eventual decision-making group to have different strategies, called " policies ," for making inferences and/or decisions. For example...group task, the task side of the lens model is structured so that each person must modify his judgment policy by learning from the other person in order...judgment policy ; that is, they would receive in both pictorial and textual form a description of how each person combines information to make a judgment

  4. Adolescent civic and political engagement: associations between domain-specific judgments and behavior.

    PubMed

    Metzger, Aaron; Smetana, Judith G

    2009-01-01

    Judgments and justifications for different forms of civic involvement and their associations with organized and civic behavior were examined in 312 middle-class primarily White adolescents (M = 17.01 years). Adolescents applied moral, conventional, and personal criteria to distinguish involvement in community service, standard political, social movement, and social gathering activities. Males judged standard political involvement to be more obligatory and important than did females, who judged community service to be more obligatory and important than did males. For each form of civic involvement, greater involvement was associated with more positive judgments and fewer personal justifications. Structural equation modeling indicated that adolescents' judgments about specific types of civic involvement were associated with similar forms of civic behaviors.

  5. An empirical test of competing theories of hazard-related trust: the case of GM food.

    PubMed

    Allum, Nick

    2007-08-01

    Few scholars doubt the importance of trust in explaining variation in public perception of technological risk. Relatively little, however, is known about the particular types of judgments that people use in granting or withholding trust. This article presents findings from an empirical study that explores several dimensions of trust relevant for citizens' judgments of scientists involved in the development of GM food. The relationship between particular dimensions of trust and perceptions of GM food risk is also explored, using structural equation modeling. Results suggest that trust judgments based on the perception of shared values are most important in relation to GM food risk, but that judgments about scientists' technical competence are also important.

  6. Usefulness of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) in differentiating congestive heart failure from noncardiac cause of acute dyspnea in elderly patients with a normal left ventricular ejection fraction and permanent, nonvalvular atrial fibrillation: insights from a prospective, monocenter study.

    PubMed

    Arques, Stephane; Roux, Emmanuel; Sbragia, Pascal; Pieri, Bertrand; Gelisse, Richard; Luccioni, Roger; Ambrosi, Pierre

    2007-05-01

    The incremental role of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) over the clinical judgment has been recently reported in the emergency diagnosis of congestive heart failure with a normal left ventricular ejection fraction (HFNEF). However, how well does this diagnostic strategy be applicable in the setting of atrial fibrillation is unknown. To investigate the usefulness of bedside tissue Doppler echocardiography and BNP in the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation. Forty-one consecutive elderly patients with an ejection fraction > or =50% (mean age 84 years; 22 with HFNEF and 19 with noncardiac cause), hospitalized for acute dyspnea at rest, were prospectively enrolled; bedside septal E/Ea and BNP were obtained at admission. By multivariable logistic regression analysis including the clinical judgment of heart failure, E/Ea and BNP, E/Ea (P = 0.014) and BNP (P = 0.018) provided independent diagnostic information. Optimal cutoffs were 13 for E/Ea (area under the ROC curve of 0.846, P < 0.0001; sensitivity 81.8%, specificity 89.5%) and 253 pg/ml for BNP (area under the ROC curve of 0.928, P < 0.0001; sensitivity 86.4%, specificity 89.5%). The concordance between the clinical judgment and BNP concentration at the cutoff of 253 pg/ml correctly classified 24 of 25 patients; E/Ea at the cutoff of 13 correctly classified 14 of the 16 patients with discrepancy. Bedside tissue Doppler echocardiography and BNP provide useful additional diagnostic information over the clinical judgment for the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation.

  7. Event-related repetitive TMS reveals distinct, critical roles for right OFA and bilateral posterior STS in judging the sex and trustworthiness of faces.

    PubMed

    Dzhelyova, Milena P; Ellison, Amanda; Atkinson, Anthony P

    2011-10-01

    Judging the sex of faces relies on cues related to facial morphology and spatial relations between features, whereas judging the trustworthiness of faces relies on both structural and expressive cues that signal affective valence. The right occipital face area (OFA) processes structural cues and has been associated with sex judgments, whereas the posterior STS processes changeable facial cues related to muscle movements and is activated when observers judge trustworthiness. It is commonly supposed that the STS receives inputs from the OFA, yet it is unknown whether these regions have functionally dissociable, critical roles in sex and trustworthiness judgments. We addressed this issue using event-related, fMRI-guided repetitive transcranial magnetic stimulation (rTMS). Twelve healthy volunteers judged the sex of individually presented faces and, in a separate session, whether those same faces were trustworthy or not. Relative to sham stimulation, RTs were significantly longer for sex judgments when rTMS was delivered over the right OFA but not the right or left STS, and for trustworthiness judgments on male but not female faces when rTMS was delivered over the right STS or left STS but not the right OFA. Nonetheless, an analysis of the RT distributions revealed a possible critical role also for the right OFA in trustworthiness judgments, limited to faces with longer RTs, perhaps reflecting the later, ancillary use of structural cues related to the sex of the face. On the whole, our findings provide evidence that evaluations of the trustworthiness and sex of faces rely on functionally dissociable cortical regions.

  8. Prefrontal Cortex Contributions to Controlled Memory Judgment: fMRI Evidence from Adolescents and Young Adults

    ERIC Educational Resources Information Center

    Jaeger, Antonio; Selmeczy, Diana; O'Connor, Akira R.; Diaz, Michael; Dobbins, Ian G.

    2012-01-01

    Cortical regions supporting cognitive control and memory judgment are structurally immature in adolescents. Here we studied adolescents (13-15 y.o.) and young adults (20-22 y.o.) using a recognition memory paradigm that modulates cognitive control demands through cues that probabilistically forecast memory probe status. Behaviorally, adolescence…

  9. Education in Values and Moral Education in Vocational Colleges

    ERIC Educational Resources Information Center

    Ludecke-Plumer, Sigrid

    2007-01-01

    On the assumption that education in values and moral education are necessary, moral competence (to make judgments) and the structure and development of the faculty of moral judgment should not be disregarded, even in the vocational education system. The main features of Lawrence Kohlberg's theory of moral development are described as a basis for…

  10. Discrimination of tonal and atonal music in congenital amusia: The advantage of implicit tasks.

    PubMed

    Tillmann, Barbara; Lalitte, Philippe; Albouy, Philippe; Caclin, Anne; Bigand, Emmanuel

    2016-05-01

    Congenital amusia is a neurodevelopmental disorder of music perception and production, which has been attributed to a major deficit in pitch processing. While most studies and diagnosis tests have used explicit investigation methods, recent studies using implicit investigation approaches have revealed some unimpaired pitch structure processing in congenital amusia. The present study investigated amusic individuals' processing of tonal structures (e.g., musical structures respecting the Western tonal system) via three different questions. Amusic participants and their matched controls judged tonal versions (original musical excerpts) and atonal versions (with manipulated pitch content to remove tonal structures) of 12 musical pieces. For each piece, participants answered three questions that required judgments from different perspectives: an explicit structural one, a personal, emotional one and a more social one (judging the perception of others). Results revealed that amusic individuals' judgments differed between tonal and atonal versions. However, the question type influenced the extent of the revealed structure processing: while amusic individuals were impaired for the question requiring explicit structural judgments, they performed as well as their matched controls for the two other questions. Together with other recent studies, these findings suggest that congenital amusia might be related to a disorder of the conscious access to music processing rather than music processing per se. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Moral development in context: Associations of neighborhood and maternal discipline with preschoolers' moral judgments.

    PubMed

    Ball, Courtney L; Smetana, Judith G; Sturge-Apple, Melissa L; Suor, Jennifer H; Skibo, Michael A

    2017-10-01

    Associations among moral judgments, neighborhood risk, and maternal discipline were examined in 118 socioeconomically diverse preschoolers (Mage = 41.84 months, SD = 1.42). Children rated the severity and punishment deserved for 6 prototypical moral transgressions entailing physical and psychological harm and unfairness. They also evaluated 3 criteria for assessing maturity in moral judgments: whether acts were considered wrong regardless of rules and wrong independent of authority, as well as whether moral rules were considered unacceptable to alter (collectively called criterion judgments). Mothers reported on their socioeconomic status, neighborhood characteristics and risk, and consistency of discipline; harsh maternal discipline was observed during a mother-child clean-up task. Structural equation modeling indicated that greater neighborhood risk was associated with less mature criterion judgments and ratings that transgressions were less serious and less deserving of punishment, particularly for children who were disciplined less harshly. Although harsh maternal discipline was associated with children's ratings of moral transgressions as more serious and deserving of punishment, this effect for severity judgments was more pronounced when mothers were inconsistent versus consistent in applying harsh discipline. Preschoolers who received consistent harsh discipline had less sophisticated moral criterion judgments than their less consistently or harshly disciplined peers. Results demonstrate the importance of social contexts in preschoolers' developing moral judgments. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. Deciphering the use and predictive value of "emergency medical services provider judgment" in out-of-hospital trauma triage: a multisite, mixed methods assessment.

    PubMed

    Newgard, Craig D; Kampp, Michael; Nelson, Maria; Holmes, James F; Zive, Dana; Rea, Thomas; Bulger, Eileen M; Liao, Michael; Sherck, John; Hsia, Renee Y; Wang, N Ewen; Fleischman, Ross J; Barton, Erik D; Daya, Mohamud; Heineman, John; Kuppermann, Nathan

    2012-05-01

    "Emergency medical services (EMS) provider judgment" was recently added as a field triage criterion to the national guidelines, yet its predictive value and real world application remain unclear. We examine the use and independent predictive value of EMS provider judgment in identifying seriously injured persons. We analyzed a population-based retrospective cohort, supplemented by qualitative analysis, of injured children and adults evaluated and transported by 47 EMS agencies to 94 hospitals in five regions across the Western United States from 2006 to 2008. We used logistic regression models to evaluate the independent predictive value of EMS provider judgment for Injury Severity Score ≥ 16. EMS narratives were analyzed using qualitative methods to assess and compare common themes for each step in the triage algorithm, plus EMS provider judgment. 213,869 injured patients were evaluated and transported by EMS over the 3-year period, of whom 41,191 (19.3%) met at least one of the field triage criteria. EMS provider judgment was the most commonly used triage criterion (40.0% of all triage-positive patients; sole criterion in 21.4%). After accounting for other triage criteria and confounders, the adjusted odds ratio of Injury Severity Score ≥ 16 for EMS provider judgment was 1.23 (95% confidence interval, 1.03-1.47), although there was variability in predictive value across sites. Patients meeting EMS provider judgment had concerning clinical presentations qualitatively similar to those meeting mechanistic and other special considerations criteria. Among this multisite cohort of trauma patients, EMS provider judgment was the most commonly used field trauma triage criterion, independently associated with serious injury, and useful in identifying high-risk patients missed by other criteria. However, there was variability in predictive value between sites.

  13. Automatic prediction of facial trait judgments: appearance vs. structural models.

    PubMed

    Rojas, Mario; Masip, David; Todorov, Alexander; Vitria, Jordi

    2011-01-01

    Evaluating other individuals with respect to personality characteristics plays a crucial role in human relations and it is the focus of attention for research in diverse fields such as psychology and interactive computer systems. In psychology, face perception has been recognized as a key component of this evaluation system. Multiple studies suggest that observers use face information to infer personality characteristics. Interactive computer systems are trying to take advantage of these findings and apply them to increase the natural aspect of interaction and to improve the performance of interactive computer systems. Here, we experimentally test whether the automatic prediction of facial trait judgments (e.g. dominance) can be made by using the full appearance information of the face and whether a reduced representation of its structure is sufficient. We evaluate two separate approaches: a holistic representation model using the facial appearance information and a structural model constructed from the relations among facial salient points. State of the art machine learning methods are applied to a) derive a facial trait judgment model from training data and b) predict a facial trait value for any face. Furthermore, we address the issue of whether there are specific structural relations among facial points that predict perception of facial traits. Experimental results over a set of labeled data (9 different trait evaluations) and classification rules (4 rules) suggest that a) prediction of perception of facial traits is learnable by both holistic and structural approaches; b) the most reliable prediction of facial trait judgments is obtained by certain type of holistic descriptions of the face appearance; and c) for some traits such as attractiveness and extroversion, there are relationships between specific structural features and social perceptions.

  14. FRAMING EFFECTS ON PHYSICIANS' JUDGMENT AND DECISION MAKING.

    PubMed

    Bui, Thanh C; Krieger, Heather A; Blumenthal-Barby, Jennifer S

    2015-10-01

    This study aimed to assess physicians' susceptibility to framing effects in clinical judgment and decision making. A survey was administered online to 159 general internists in the United States. Participants were randomized into two groups, in which clinical scenarios varied in their framings: frequency vs percentage, with cost information vs without, female patient vs male patient, and mortality vs survival. Results showed that physicians' recommendations for patients in hypothetical scenarios were significantly different when the predicted probability of the outcomes was presented in frequency versus percentage form and when it was presented in mortality rate vs survival rate of the same magnitude. Physicians' recommendations were not different for other framing effects.

  15. Enhancing Critical Thinking Via a Clinical Scholar Approach.

    PubMed

    Simpson, Vicki; McComb, Sara A; Kirkpatrick, Jane M

    2017-11-01

    Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice. A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills. Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement. Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.]. Copyright 2017, SLACK Incorporated.

  16. When fast logic meets slow belief: Evidence for a parallel-processing model of belief bias.

    PubMed

    Trippas, Dries; Thompson, Valerie A; Handley, Simon J

    2017-05-01

    Two experiments pitted the default-interventionist account of belief bias against a parallel-processing model. According to the former, belief bias occurs because a fast, belief-based evaluation of the conclusion pre-empts a working-memory demanding logical analysis. In contrast, according to the latter both belief-based and logic-based responding occur in parallel. Participants were given deductive reasoning problems of variable complexity and instructed to decide whether the conclusion was valid on half the trials or to decide whether the conclusion was believable on the other half. When belief and logic conflict, the default-interventionist view predicts that it should take less time to respond on the basis of belief than logic, and that the believability of a conclusion should interfere with judgments of validity, but not the reverse. The parallel-processing view predicts that beliefs should interfere with logic judgments only if the processing required to evaluate the logical structure exceeds that required to evaluate the knowledge necessary to make a belief-based judgment, and vice versa otherwise. Consistent with this latter view, for the simplest reasoning problems (modus ponens), judgments of belief resulted in lower accuracy than judgments of validity, and believability interfered more with judgments of validity than the converse. For problems of moderate complexity (modus tollens and single-model syllogisms), the interference was symmetrical, in that validity interfered with belief judgments to the same degree that believability interfered with validity judgments. For the most complex (three-term multiple-model syllogisms), conclusion believability interfered more with judgments of validity than vice versa, in spite of the significant interference from conclusion validity on judgments of belief.

  17. Variation in the oxytocin receptor gene (OXTR) is associated with differences in moral judgment

    PubMed Central

    Chaponis, Jonathan; Siburian, Richie; Gallagher, Patience; Ransohoff, Katherine; Wikler, Daniel; Perlis, Roy H.; Greene, Joshua D.

    2016-01-01

    Moral judgments are produced through the coordinated interaction of multiple neural systems, each of which relies on a characteristic set of neurotransmitters. Genes that produce or regulate these neurotransmitters may have distinctive influences on moral judgment. Two studies examined potential genetic influences on moral judgment using dilemmas that reliably elicit competing automatic and controlled responses, generated by dissociable neural systems. Study 1 (N = 228) examined 49 common variants (SNPs) within 10 candidate genes and identified a nominal association between a polymorphism (rs237889) of the oxytocin receptor gene (OXTR) and variation in deontological vs utilitarian moral judgment (that is, judgments favoring individual rights vs the greater good). An association was likewise observed for rs1042615 of the arginine vasopressin receptor gene (AVPR1A). Study 2 (N = 322) aimed to replicate these findings using the aforementioned dilemmas as well as a new set of structurally similar medical dilemmas. Study 2 failed to replicate the association with AVPR1A, but replicated the OXTR finding using both the original and new dilemmas. Together, these findings suggest that moral judgment is influenced by variation in the oxytocin receptor gene and, more generally, that single genetic polymorphisms can have a detectable effect on complex decision processes. PMID:27497314

  18. Variation in the oxytocin receptor gene (OXTR) is associated with differences in moral judgment.

    PubMed

    Bernhard, Regan M; Chaponis, Jonathan; Siburian, Richie; Gallagher, Patience; Ransohoff, Katherine; Wikler, Daniel; Perlis, Roy H; Greene, Joshua D

    2016-12-01

    Moral judgments are produced through the coordinated interaction of multiple neural systems, each of which relies on a characteristic set of neurotransmitters. Genes that produce or regulate these neurotransmitters may have distinctive influences on moral judgment. Two studies examined potential genetic influences on moral judgment using dilemmas that reliably elicit competing automatic and controlled responses, generated by dissociable neural systems. Study 1 (N = 228) examined 49 common variants (SNPs) within 10 candidate genes and identified a nominal association between a polymorphism (rs237889) of the oxytocin receptor gene (OXTR) and variation in deontological vs utilitarian moral judgment (that is, judgments favoring individual rights vs the greater good). An association was likewise observed for rs1042615 of the arginine vasopressin receptor gene (AVPR1A). Study 2 (N = 322) aimed to replicate these findings using the aforementioned dilemmas as well as a new set of structurally similar medical dilemmas. Study 2 failed to replicate the association with AVPR1A, but replicated the OXTR finding using both the original and new dilemmas. Together, these findings suggest that moral judgment is influenced by variation in the oxytocin receptor gene and, more generally, that single genetic polymorphisms can have a detectable effect on complex decision processes. © The Author (2016). Published by Oxford University Press.

  19. Identification and Recall of Structurally Important Units in Prose by Mentally Retarded Learners.

    ERIC Educational Resources Information Center

    Luftig, Richard L.; Johnson, Ronald E.

    The study investigated the ability of 80 mildly mentally retarded students (19 to 17 years old) to make accurate judgments of textual idea importance and to differentially and spontaneously remember important rather than unimportant ideas. Ss were assigned to one of six conditions which differed as a function of whether importance judgments were…

  20. Judgments of Successful Inclusion by Education Service Personnel

    ERIC Educational Resources Information Center

    Frederickson, Norah; Osborne, Lisa A.; Reed, Phil

    2004-01-01

    Three different methods were used to investigate the basis of judgments about the success of inclusion made by key staff in an education service in the UK. First, a structured questionnaire was used by staff to rate the pupil social and learning skills needed for success in mainstream classes. Second, an open-ended elicitation technique was used…

  1. A novel magnetic resonance imaging segmentation technique for determining diffuse intrinsic pontine glioma tumor volume.

    PubMed

    Singh, Ranjodh; Zhou, Zhiping; Tisnado, Jamie; Haque, Sofia; Peck, Kyung K; Young, Robert J; Tsiouris, Apostolos John; Thakur, Sunitha B; Souweidane, Mark M

    2016-11-01

    OBJECTIVE Accurately determining diffuse intrinsic pontine glioma (DIPG) tumor volume is clinically important. The aims of the current study were to 1) measure DIPG volumes using methods that require different degrees of subjective judgment; and 2) evaluate interobserver agreement of measurements made using these methods. METHODS Eight patients from a Phase I clinical trial testing convection-enhanced delivery (CED) of a therapeutic antibody were included in the study. Pre-CED, post-radiation therapy axial T2-weighted images were analyzed using 2 methods requiring high degrees of subjective judgment (picture archiving and communication system [PACS] polygon and Volume Viewer auto-contour methods) and 1 method requiring a low degree of subjective judgment (k-means clustering segmentation) to determine tumor volumes. Lin's concordance correlation coefficients (CCCs) were calculated to assess interobserver agreement. RESULTS The CCCs of measurements made by 2 observers with the PACS polygon and the Volume Viewer auto-contour methods were 0.9465 (lower 1-sided 95% confidence limit 0.8472) and 0.7514 (lower 1-sided 95% confidence limit 0.3143), respectively. Both were considered poor agreement. The CCC of measurements made using k-means clustering segmentation was 0.9938 (lower 1-sided 95% confidence limit 0.9772), which was considered substantial strength of agreement. CONCLUSIONS The poor interobserver agreement of PACS polygon and Volume Viewer auto-contour methods highlighted the difficulty in consistently measuring DIPG tumor volumes using methods requiring high degrees of subjective judgment. k-means clustering segmentation, which requires a low degree of subjective judgment, showed better interobserver agreement and produced tumor volumes with delineated borders.

  2. Clinical errors and therapist discomfort with client disclosure of troublesome pornography use: Implications for clinical practice and error reduction.

    PubMed

    Walters, Nathan T; Spengler, Paul M

    2016-09-01

    Mental health professionals are increasingly aware of the need for competence in the treatment of clients with pornography-related concerns. However, while researchers have recently sought to explore efficacious treatments for pornography-related concerns, few explorations of potential clinical judgment issues have occurred. Due to the sensitive, and at times uncomfortable, nature of client disclosures of sexual concerns within therapy, therapists are required to manage their own discomfort while retaining fidelity to treatment. The present paper explores clinician examples of judgment errors that may result from feelings of discomfort, and specifically from client use of pornography. Issues of potential bias, bias management techniques, and therapeutic implications are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  3. Concept-Based Learning in Clinical Experiences: Bringing Theory to Clinical Education for Deep Learning.

    PubMed

    Nielsen, Ann

    2016-07-01

    Concept-based learning is used increasingly in nursing education to support the organization, transfer, and retention of knowledge. Concept-based learning activities (CBLAs) have been used in clinical education to explore key aspects of the patient situation and principles of nursing care, without responsibility for total patient care. The nature of best practices in teaching and the resultant learning are not well understood. The purpose of this multiple-case study research was to explore and describe concept-based learning in the context of clinical education in inpatient settings. Four clinical groups (each a case) were observed while they used CBLAs in the clinical setting. Major findings include that concept-based learning fosters deep learning, connection of theory with practice, and clinical judgment. Strategies used to support learning, major teaching-learning foci, and preconditions for concept-based teaching and learning will be described. Concept-based learning is promising to support integration of theory with practice and clinical judgment through application experiences with patients. [J Nurs Educ. 2016;55(7):365-371.]. Copyright 2016, SLACK Incorporated.

  4. Biomarkers and surrogate endpoints in glaucoma clinical trials

    PubMed Central

    Medeiros, Felipe A

    2015-01-01

    Surrogate endpoints are often used as replacements for true clinically relevant endpoints in several areas of medicine, as they enable faster and less expensive clinical trials. However, without proper validation, the use of surrogates may lead to incorrect conclusions about the efficacy and safety of treatments. This article reviews the general requirements for validating surrogate endpoints and provides a critical assessment of the use of intraocular pressure (IOP), visual fields, and structural measurements of the optic nerve as surrogate endpoints in glaucoma clinical trials. A valid surrogate endpoint must be able to predict the clinically relevant endpoint and fully capture the effect of an intervention on that endpoint. Despite its widespread use in clinical trials, no proper validation of IOP as a surrogate endpoint has ever been conducted for any class of IOP-lowering treatments. Evidence has accumulated with regard to the role of imaging measurements of optic nerve damage as surrogate endpoints in glaucoma. These measurements are predictive of functional losses in the disease and may explain, at least in part, treatment effects on clinically relevant endpoints. The use of composite endpoints in glaucoma trials may overcome weaknesses of the use of structural or functional endpoints in isolation. Unless research is dedicated to fully develop and validate suitable endpoints that can be used in glaucoma clinical trials, we run the risk of inappropriate judgments about the value of new therapies. PMID:25034049

  5. The ADA's practice parameters.

    PubMed

    Ellek, Donalda M

    2005-01-01

    The ADA parameters of care have served the needs of practicing dentists for fifteen years. Their purpose is to describe a range of treatment options that dentists will want to consider, in combination with particular clinical conditions and patient preferences. These options have been developed based on available evidence and a consensus of professional judgment. The ADA has exercised concern that parameters not be used, out of the context of individual professional judgment, for policy purposes.

  6. COMFORT scale: a reliable and valid method to measure the amount of stress of ventilated preterm infants.

    PubMed

    Wielenga, J M; De Vos, R; de Leeuw, R; De Haan, R J

    2004-01-01

    Assessment of clinimetric properties and diagnostic quality of a stress measurement scale (COMFORT scale). Sample of an open population. Neonatology department (Neonatal Intensive Care Unit), Academic Medical Centre/Emma Children's Hospital, Amsterdam, The Netherlands. One clinical expert and 9 observers observed ventilated premature born babies simultaneously. Criterion validity was assessed by correlating the COMFORT scale with the clinical judgment regarding the amount of stress. Interobserver reliability was assessed on the clinical judgment as well as on the COMFORT scale. Diagnostic qualities were evaluated with a ROC curve. On 19 ventilated prematurely born babies (mean gestational age 30 weeks, mean birth weight 1385 gm), one clinical expert and 9 observers made 30 paired observations. The criterion validity of the COMFORT scale was good (Pearson's r of 0.84). The interobserver reliability of the clinical judgment was very good (weighted Kappa 0.84). The interobserver reliability of each item varied from good to almost perfect (weighted Kappa of 0.64 for muscle tone to 1.00 on heart rate). The reliability of the total COMFORT scale score was satisfying (intra-class correlation coefficient of 0.94). The diagnostic quality of the COMFORT scale was excellent, at a cut-off point of 20 the sensitivity was 100 percent, the specificity was 77 percent, and the area under the curve (AUC) of 0.95. In this first evaluation, the COMFORT scale appears to be a valid and reliable measurement tool to assess the stress of ventilated prematurely born babies.

  7. Neuropsychological Correlates of Capacity Determinations in Alzheimer’s Disease: Implications for Assessment

    PubMed Central

    Palmer, Barton W.; Ryan, Kerry A.; Kim, H. Myra; Karlawish, Jason H.; Appelbaum, Paul S.; Kim, Scott Y. H.

    2011-01-01

    Objectives To explore the neuropsychological correlates of the capacity to consent to research and to appoint a research proxy among persons with Alzheimer’s disease. Design, Setting, and Participants Interview study of 77 persons with Alzheimer’s disease recruited through an Alzheimer’s disease research center and a memory disorder clinic. Measurements The capacity to consent to two research scenarios (a drug randomized clinical trial and a neurosurgical clinical trial) and the capacity to appoint a research proxy were determined by five experienced consultation psychiatrists who rendered categorical judgments based on videotaped interviews of the MacArthur Competence Assessment Tool-Clinical Research (MacCAT-CR) and the Capacity to Appoint a Proxy Assessment (CAPA). Mattis Dementia Rating Scale-2 (DRS-2) was used to assess neuropsychological functioning. Results The capacity to appoint a proxy and to consent to the drug randomized clinical trial, as determined by a majority or greater opinion of the 5-psychiatrist panel, were predicted by Conceptualization and Initiation/Perseveration subscales whereas the capacity to consent to a neurosurgical randomized clinical trial was predicted by the Memory subscale. Furthermore, the more lenient individual psychiatrists’ judgments were predicted by the Conceptualization subscale whereas the stricter psychiatrists’ judgments were predicted by the Memory subscale. Conclusions How experienced psychiatrists view Alzheimer’s patients’ capacity for consenting to research and for appointing a proxy may be related to the patients’ conceptualization and memory functioning. More explicit and standardized guidance on the role of short term memory in capacity determinations may be useful. PMID:23498384

  8. The Development of Adaptive Decision Making: Recognition-Based Inference in Children and Adolescents

    ERIC Educational Resources Information Center

    Horn, Sebastian S.; Ruggeri, Azzurra; Pachur, Thorsten

    2016-01-01

    Judgments about objects in the world are often based on probabilistic information (or cues). A frugal judgment strategy that utilizes memory (i.e., the ability to discriminate between known and unknown objects) as a cue for inference is the recognition heuristic (RH). The usefulness of the RH depends on the structure of the environment,…

  9. Neural correlates of the self-concept in adolescence-A focus on the significance of friends.

    PubMed

    Romund, Lydia; Golde, Sabrina; Lorenz, Robert C; Raufelder, Diana; Pelz, Patricia; Gleich, Tobias; Heinz, Andreas; Beck, Anne

    2017-02-01

    The formation of a coherent and unified self-concept represents a key developmental stage during adolescence. Imaging studies on self-referential processing in adolescents are rare, and it is not clear whether neural structures involved in self-reflection are also involved in reflections of familiar others. In the current study, 41 adolescents were asked to make judgments about trait adjectives during functional magnetic resonance imaging (fMRI): they had to indicate whether the word describes themselves, their friends, their teachers or politicians. Findings indicate a greater overlap in neural networks for responses to self- and friend-related judgments compared to teachers and politicians. In particular, classic self-reference structures such as the ventromedial prefrontal cortex and medial posterior parietal cortex also exhibited higher activation to judgments about friends. In contrast, brain responses towards judgments of teachers (familiar others) compared to politicians (unfamiliar others) did not significantly differ. Results support behavioral findings of a greater relevance of friends for the development of a self-concept during adolescence and indicate underlying functional brain processes. Hum Brain Mapp 38:987-996, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  10. The role of the human pulvinar in visual attention and action: evidence from temporal-order judgment, saccade decision, and antisaccade tasks.

    PubMed

    Arend, Isabel; Machado, Liana; Ward, Robert; McGrath, Michelle; Ro, Tony; Rafal, Robert D

    2008-01-01

    The pulvinar nucleus of the thalamus has been considered as a key structure for visual attention functions (Grieve, K.L. et al. (2000). Trends Neurosci., 23: 35-39; Shipp, S. (2003). Philos. Trans. R. Soc. Lond. B Biol. Sci., 358(1438): 1605-1624). During the past several years, we have studied the role of the human pulvinar in visual attention and oculomotor behaviour by testing a small group of patients with unilateral pulvinar lesions. Here we summarize some of these findings, and present new evidence for the role of this structure in both eye movements and visual attention through two versions of a temporal-order judgment task and an antisaccade task. Pulvinar damage induces an ipsilesional bias in perceptual temporal-order judgments and in saccadic decision, and also increases the latency of antisaccades away from contralesional targets. The demonstration that pulvinar damage affects both attention and oculomotor behaviour highlights the role of this structure in the integration of visual and oculomotor signals and, more generally, its role in flexibly linking visual stimuli with context-specific motor responses.

  11. Futility and the varieties of medical judgment.

    PubMed

    Sulmasy, D P

    1997-01-01

    Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory of futility according to Pellegrino would deny that latter but would permit some cases of the former. I call this the "circumspect" view. I show that Pellegrino would adopt the circumspect view because he would see the medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is challenged by those who would deny that one can distinguish objective from subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine-an examination of varieties of medical judgment. I then offer some practical applications of this theory in clinical practice.

  12. Comparison of Trained Clinician Ratings with Expert Ratings of Aspiration on Videofluoroscopic Images from a Randomized Clinical Trial

    PubMed Central

    Hind, Jacqueline A.; Gensler, Gary; Brandt, Diane K.; Miller Gardner, Patricia J.; Blumenthal, Loreen; Gramigna, Gary D.; Kosek, Steven; Lundy, Donna; McGarvey-Toler, Susan; Rockafellow, Susan; Sullivan, Paula A.; Villa, Marybell; Gill, Gary D.; Lindblad, Anne S.; Logemann, Jeri A.; Robbins, JoAnne

    2009-01-01

    Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation, the most commonly utilized instrumental method for dysphagia diagnosis and treatment. Currently published literature indicates that inter-judge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians. The majority of extant studies compared judgments among clinicians. No studies included judgments made during the use of a postural compensatory strategy. The purpose of this study was to examine the accuracy of judgments made by speech-language pathologists (SLPs) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale. Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale. Videofluoroscopic data were collected from 669 patients as part of a large, randomized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states. Judgments were made on swallows during use of dysphagia compensatory strategies: chin down posture with thin-liquids and thickened liquids (nectar-thick and honey-thick consistencies) in a head neutral posture. The subject population included patients with Parkinson’s disease and/or dementia. Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration (all К > .86) and variable accuracy (range 69%–76%) using the Penetration/Aspiration Scale when compared to expert judges. It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent, more extensive training and/or image enhancement is recommended for precise use of the Penetration/Aspiration Scale. PMID:18953607

  13. A novel magnetic resonance imaging segmentation technique for determining diffuse intrinsic pontine glioma tumor volume

    PubMed Central

    Singh, Ranjodh; Zhou, Zhiping; Tisnado, Jamie; Haque, Sofia; Peck, Kyung K.; Young, Robert J.; Tsiouris, Apostolos John; Thakur, Sunitha B.; Souweidane, Mark M.

    2017-01-01

    OBJECTIVE Accurately determining diffuse intrinsic pontine glioma (DIPG) tumor volume is clinically important. The aims of the current study were to 1) measure DIPG volumes using methods that require different degrees of subjective judgment; and 2) evaluate interobserver agreement of measurements made using these methods. METHODS Eight patients from a Phase I clinical trial testing convection-enhanced delivery (CED) of a therapeutic antibody were included in the study. Pre-CED, post–radiation therapy axial T2-weighted images were analyzed using 2 methods requiring high degrees of subjective judgment (picture archiving and communication system [PACS] polygon and Volume Viewer auto-contour methods) and 1 method requiring a low degree of subjective judgment (k-means clustering segmentation) to determine tumor volumes. Lin’s concordance correlation coefficients (CCCs) were calculated to assess interobserver agreement. RESULTS The CCCs of measurements made by 2 observers with the PACS polygon and the Volume Viewer auto-contour methods were 0.9465 (lower 1-sided 95% confidence limit 0.8472) and 0.7514 (lower 1-sided 95% confidence limit 0.3143), respectively. Both were considered poor agreement. The CCC of measurements made using k-means clustering segmentation was 0.9938 (lower 1-sided 95% confidence limit 0.9772), which was considered substantial strength of agreement. CONCLUSIONS The poor interobserver agreement of PACS polygon and Volume Viewer auto-contour methods high-lighted the difficulty in consistently measuring DIPG tumor volumes using methods requiring high degrees of subjective judgment. k-means clustering segmentation, which requires a low degree of subjective judgment, showed better interob-server agreement and produced tumor volumes with delineated borders. PMID:27391980

  14. Pressure ulcer prevalence and prevention practices: a cross-sectional comparative survey in Norway and Ireland.

    PubMed

    Moore, Z; Johansen, E; Etten, M van; Strapp, H; Solbakken, T; Smith, B Eskerud; Faulstich, J

    2015-08-01

    This study explored whether the risk assessment method, structured versus clinical judgment, influences pressure ulcer (PU) prevalence or prevention strategies. A cross section survey design was employed with use of a pre-designed data collection instrument. Following ethical approval and consent, data was gathered from two acute care settings, one in Norway (clinical judgment) and one in Ireland (structured risk assessment using the Maelor Score). Data were obtained from 180 patients, 59 in Norway and 121 in Ireland. Of the patients 48% were male and 49% were female, gender was not recorded for 3%. The most common age bracket was 70-99 years of age, 46% of the study population. PU prevalence was 54% in the Norwegian site with the majority of PUs (69%) being category 1, and 12% in the Irish site with the majority (50%) being category 2. Only 8% of patients in the Norwegian site were risk assessed on admission compared with 85% in the Irish site. No dynamic mattresses and four pressure redistribution cushions were in use in the Norwegian site, whereas, in the Irish site, 27 dynamic mattresses and 11 pressure redistribution cushions were used, the majority (44%) for high-risk individuals. Of those at risk of PU development, 15% in the Norwegian site and 56% in the Irish site had a documented repositioning care plan when in bed, and 0% in the Norwegian site and 13% in the Irish site for when seated on a chair. There were inconsistencies in approach to PU risk assessment and prevention across the two clinical settings. However, prevalence rates differed, mainly relating to category 1 PU damage. Even though formal risk assessment is well established in the Irish site, this is not necessarily followed up with appropriated PU prevention. Thus, the method of risk assessment does not seem to influence subsequent care planning, questioning the role of formal risk assessment; however, despite this, risk assessment does put a focus on an important clinical problem. In the Norwegian site, a lack of risk assessment and appropriate equipment may be a confounding factor worthy of further exploration.

  15. Caregivers' concerns about judgment and safety of patients with brain injury: a preliminary investigation.

    PubMed

    Kreutzer, Jeffrey S; Livingston, Lee A; Everley, Rachel S; Gary, Kelli W; Arango-Lasprilla, Juan Carlos; Powell, Victoria D; Marwitz, Jennifer H

    2009-08-01

    To identify caregivers' most common concerns about the judgment and safety of patients with brain injury in home and community environments. To quantify caregivers' stress levels and their level of comfort leaving patients at home unsupervised and examine the interrelationships between caregivers' safety and judgment ratings, stress levels, and levels of comfort leaving patients unattended. Retrospective, cross-sectional design. Outpatient brain injury neuropsychology clinic at a university medical center. A convenience sample of 121 caregivers of traumatic brain injury survivors at least 1 month postinjury and 18 years of age or older. Scores in 9 domains from the Judgment and Safety Screening Inventory; ratings of stress levels and levels of comfort leaving patients at home unattended derived from the General Health and History Questionnaire. Caregivers' most common judgment and safety-related concerns were in the Travel and Financial domains, with many reflecting patients' memory deficits. Heightened caregiver stress levels were prevalent. Higher levels of concern about judgment and safety were associated with higher stress levels and concerns about leaving patients unattended. Consistent with research on patients with other types of neurological disorders, concerns about driving and financial management among caregivers are prevalent. Additional research is needed to identify the most cost-effective methods of evaluating patients and enabling them to function at their highest level in the community.

  16. Fear of knowledge: Clinical hypotheses in diagnostic and prognostic reasoning.

    PubMed

    Chiffi, Daniele; Zanotti, Renzo

    2017-10-01

    Patients are interested in receiving accurate diagnostic and prognostic information. Models and reasoning about diagnoses have been extensively investigated from a foundational perspective; however, for all its importance, prognosis has yet to receive a comparable degree of philosophical and methodological attention, and this may be due to the difficulties inherent in accurate prognostics. In the light of these considerations, we discuss a considerable body of critical thinking on the topic of prognostication and its strict relations with diagnostic reasoning, pointing out the distinction between nosographic and pathophysiological types of diagnosis and prognosis, underlying the importance of the explication and explanation processes. We then distinguish between various forms of hypothetical reasoning applied to reach diagnostic and prognostic judgments, comparing them with specific forms of abductive reasoning. The main thesis is that creative abduction regarding clinical hypotheses in diagnostic process is very unlikely to occur, whereas this seems to be often the case for prognostic judgments. The reasons behind this distinction are due to the different types of uncertainty involved in diagnostic and prognostic judgments. © 2016 John Wiley & Sons, Ltd.

  17. Aspirin in Older Adults: Need for Wider Utilization in Secondary Prevention and Individual Clinical Judgments in Primary Prevention.

    PubMed

    Sehgal, Mandi; Wood, Sarah K; Ouslander, Joseph G; Hennekens, Charles H

    2017-11-01

    In the treatment or secondary prevention of cardiovascular disease (CVD), there is general consensus that the absolute benefits of aspirin far outweigh the absolute risks. Despite evidence from randomized trials and their meta-analyses, older adults, defined as aged 65 years or older, are less likely to be prescribed aspirin than their middle-aged counterparts. In primary prevention, the optimal utilization of aspirin is widely debated. There is insufficient randomized evidence among apparently healthy participants at moderate to high risk of a first CVD event, so general guidelines seem premature. Among older adults, randomized data are even more sparse but trials are ongoing. Further, older adults commonly take multiple medications due to comorbidities, which may increase deleterious interactions and side effects. Older adults have higher risks of occlusive events as well as bleeding. All these considerations support the need for individual clinical judgments in prescribing aspirin in the context of therapeutic lifestyle changes and other adjunctive drug therapies. These include statins for lipids and usually multiple drugs to achieve control of high blood pressure. As regards aspirin, the clinician should weigh the absolute benefit on occlusion against the absolute risk of bleeding. These issues should be considered with each patient to facilitate an informed and person-centered individual clinical judgment. The use of aspirin in primary prevention is particularly attractive because the drug is generally over the counter and, for developing countries where CVD is becoming the leading cause of death, is extremely inexpensive. The more widespread use of aspirin in older adults with prior CVD will confer net benefits to risks and even larger net benefits to costs in the United States as well as other developed and developing countries. In primary prevention among older adults, individual clinical judgments should be made by the health-care professional and each of his or her patients.

  18. Conflict between object structural and functional affordances in peripersonal space.

    PubMed

    Kalénine, Solène; Wamain, Yannick; Decroix, Jérémy; Coello, Yann

    2016-10-01

    Recent studies indicate that competition between conflicting action representations slows down planning of object-directed actions. The present study aims to assess whether similar conflict effects exist during manipulable object perception. Twenty-six young adults performed reach-to-grasp and semantic judgements on conflictual objects (with competing structural and functional gestures) and non-conflictual objects (with similar structural and functional gestures) presented at difference distances in a 3D virtual environment. Results highlight a space-dependent conflict between structural and functional affordances. Perceptual judgments on conflictual objects were slower that perceptual judgments on non-conflictual objects, but only when objects were presented within reach. Findings demonstrate that competition between structural and functional affordances during object perception induces a processing cost, and further show that object position in space can bias affordance competition. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Comparison of Cramer classification between Toxtree, the OECD QSAR Toolbox and expert judgment.

    PubMed

    Bhatia, Sneha; Schultz, Terry; Roberts, David; Shen, Jie; Kromidas, Lambros; Marie Api, Anne

    2015-02-01

    The Threshold of Toxicological Concern (TTC) is a pragmatic approach in risk assessment. In the absence of data, it sets up levels of human exposure that are considered to have no appreciable risk to human health. The Cramer decision tree is used extensively to determine these exposure thresholds by categorizing non-carcinogenic chemicals into three different structural classes. Therefore, assigning an accurate Cramer class to a material is a crucial step to preserve the integrity of the risk assessment. In this study the Cramer class of over 1000 fragrance materials across diverse chemical classes were determined by using Toxtree (TT), the OECD QSAR Toolbox (TB), and expert judgment. Disconcordance was observed between TT and the TB. A total of 165 materials (16%) showed different results from the two programs. The overall concordance for Cramer classification between TT and expert judgment is 83%, while the concordance between the TB and expert judgment is 77%. Amines, lactones and heterocycles have the lowest percent agreement with expert judgment for TT and the TB. For amines, the expert judgment agreement is 45% for TT and 55% for the TB. For heterocycles, the expert judgment agreement is 55% for TT and the TB. For lactones, the expert judgment agreement is 56% for TT and 50% for the TB. Additional analyses were conducted to determine the concordance within various chemical classes. Critical checkpoints in the decision tree are identified. Strategies and guidance on determining the Cramer class for various chemical classes are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Integrative moral judgment: dissociating the roles of the amygdala and ventromedial prefrontal cortex.

    PubMed

    Shenhav, Amitai; Greene, Joshua D

    2014-03-26

    A decade's research highlights a critical dissociation between automatic and controlled influences on moral judgment, which is subserved by distinct neural structures. Specifically, negative automatic emotional responses to prototypically harmful actions (e.g., pushing someone off of a footbridge) compete with controlled responses favoring the best consequences (e.g., saving five lives instead of one). It is unknown how such competitions are resolved to yield "all things considered" judgments. Here, we examine such integrative moral judgments. Drawing on insights from research on self-interested, value-based decision-making in humans and animals, we test a theory concerning the respective contributions of the amygdala and ventromedial prefrontal cortex (vmPFC) to moral judgment. Participants undergoing fMRI responded to moral dilemmas, separately evaluating options for their utility (Which does the most good?), emotional aversiveness (Which feels worse?), and overall moral acceptability. Behavioral data indicate that emotional aversiveness and utility jointly predict "all things considered" integrative judgments. Amygdala response tracks the emotional aversiveness of harmful utilitarian actions and overall disapproval of such actions. During such integrative moral judgments, the vmPFC is preferentially engaged relative to utilitarian and emotional assessments. Amygdala-vmPFC connectivity varies with the role played by emotional input in the task, being the lowest for pure utilitarian assessments and the highest for pure emotional assessments. These findings, which parallel those of research on self-interested economic decision-making, support the hypothesis that the amygdala provides an affective assessment of the action in question, whereas the vmPFC integrates that signal with a utilitarian assessment of expected outcomes to yield "all things considered" moral judgments.

  1. Implementing the dynamic appraisal of situational aggression in mental health units.

    PubMed

    Lantta, Tella; Daffern, Michael; Kontio, Raija; Välimäki, Maritta

    2015-01-01

    The aims of this study are to explain the intervention of implementing a structured violence risk assessment procedure in mental health inpatient units using the Ottawa Model of Research Use (OMRU) as a guiding framework and to consider nurses' perspectives of its clinical utility and implementation process. Patient aggression toward staff is a global concern in mental health units. The limited extant literature exploring the use of structured violence risk assessments in mental health units, although small and inconsistent, reveals some positive impacts on the incidence of aggression and staff's use of restrictive interventions. Although numerous violence risk assessment instruments have been developed and tested, their systematic implementation and use are still limited. A project titled "Safer Working Management" (111298) was conducted in a Finnish hospital district, across 3 mental health units. The 6 steps of OMRU were followed during implementation of the Dynamic Appraisal of Situational Aggression (DASA). Nurses' views toward structured violence risk assessment procedures varied. Although implementation of the DASA was seen as a useful method to increase discussions with patients and nursing staff, some staff preferred their own clinical judgment for assessment of violence risk. It is possible to use a specific model to promote the implementation of risk assessment instruments in mental health units. However, the complex mental health inpatient environment and the difficulties in understanding and managing aggressive patients present challenges for the implementation of structured violence risk assessment methods. The OMRU provides a tool for clinical nurse specialists to guide implementation process in mental health units. Clinical nurse specialists must promote training for staff regarding use of new innovations, such as the DASA. Implementation processes should be reviewed so that clinical nurse specialists can lead and support mental health staff to properly use structured violence risk assessment measures.

  2. Rendering clinical psychology an evidence-based scientific discipline: a case study.

    PubMed

    St Stoyanov, Drozdstoj; Machamer, Peter K; Schaffner, Kenneth F

    2012-02-01

    Both modern neuroscience and clinical psychology taken as separate fields have failed to reveal the explanatory mechanisms underlying mental disorders. The evidence acquired inside the mono-disciplinary matrices of neurobiology, clinical psychology and psychopathology are deeply insufficient in terms of their validity, reliability and utility. Further, no effective trans-disciplinary connections have been developed between them. In this context, our case study aims at illustrating some specific facets of clinical psychology as a crucial discipline for explaining and understanding mental disorder. The methods employed in clinical psychology are scrutinized using the exemplar case of the Minnesota Multiphasic Personality Inventory (MMPI). We demonstrate that a clinical interview and a clinical psychological rating scale consist of the same kind of cognitive content. The provisional difference can be described in terms of its having two comparable complementary cognitive structures. The test is composed of self-evaluation reports (items) formulated as questions or statements. The psychopathological structured interview is formulated in terms of subjective experience indicated as symptoms (these are self-reports recorded by the physician), complemented with the so-called 'signs' or the presumably 'objective' observations of the overt behaviours of the patient. However, the cognitive content of clinical judgment is beyond any doubt as subjective as the narrative of the patient. None of the components of the structured psychopathological interview is independent of the inter-subjective system created in the situation of clinical assessment. Therefore, the protocols from various clinicians that serve to sustain the reliability claim of the 'scientific' Diagnostic Statistical Manual of Mental Disorders cannot be regarded as independent measurements of the cognitive content and value of the psychological rating scales or vice versa. © 2011 Blackwell Publishing Ltd.

  3. Audiovisual Simultaneity Judgment and Rapid Recalibration throughout the Lifespan.

    PubMed

    Noel, Jean-Paul; De Niear, Matthew; Van der Burg, Erik; Wallace, Mark T

    2016-01-01

    Multisensory interactions are well established to convey an array of perceptual and behavioral benefits. One of the key features of multisensory interactions is the temporal structure of the stimuli combined. In an effort to better characterize how temporal factors influence multisensory interactions across the lifespan, we examined audiovisual simultaneity judgment and the degree of rapid recalibration to paired audiovisual stimuli (Flash-Beep and Speech) in a sample of 220 participants ranging from 7 to 86 years of age. Results demonstrate a surprisingly protracted developmental time-course for both audiovisual simultaneity judgment and rapid recalibration, with neither reaching maturity until well into adolescence. Interestingly, correlational analyses revealed that audiovisual simultaneity judgments (i.e., the size of the audiovisual temporal window of simultaneity) and rapid recalibration significantly co-varied as a function of age. Together, our results represent the most complete description of age-related changes in audiovisual simultaneity judgments to date, as well as being the first to describe changes in the degree of rapid recalibration as a function of age. We propose that the developmental time-course of rapid recalibration scaffolds the maturation of more durable audiovisual temporal representations.

  4. Subjective measures of unconscious knowledge.

    PubMed

    Dienes, Zoltán

    2008-01-01

    The chapter gives an overview of the use of subjective measures of unconscious knowledge. Unconscious knowledge is knowledge we have, and could very well be using, but we are not aware of. Hence appropriate methods for indicating unconscious knowledge must show that the person (a) has knowledge but (b) does not know that she has it. One way of determining awareness of knowing is by taking confidence ratings after making judgments. If the judgments are above baseline but the person believes they are guessing (guessing criterion) or confidence does not relate to accuracy (zero-correlation criterion) there is evidence of unconscious knowledge. The way these methods can deal with the problem of bias is discussed, as is the use of different types of confidence scales. The guessing and zero-correlation criteria show whether or not the person is aware of knowing the content of the judgment, but not whether the person is aware of what any knowledge was that enabled the judgment. Thus, a distinction is made between judgment and structural knowledge, and it is shown how the conscious status of the latter can also be assessed. Finally, the use of control over the use of knowledge as a subjective measure of judgment knowledge is illustrated. Experiments using artificial grammar learning and a serial reaction time task explore these issues.

  5. Heuristic reasoning and cognitive biases: Are they hindrances to judgments and decision making in orthodontics?

    PubMed

    Hicks, E Preston; Kluemper, G Thomas

    2011-03-01

    Studies show that our brains use 2 modes of reasoning: heuristic (intuitive, automatic, implicit processing) and analytic (deliberate, rule-based, explicit processing). The use of intuition often dominates problem solving when innovative, creative thinking is required. Under conditions of uncertainty, we default to an even greater reliance on the heuristic processing. In health care settings and other such environments of increased importance, this mode becomes problematic. Since choice heuristics are quickly constructed from fragments of memory, they are often biased by prior evaluations of and preferences for the alternatives being considered. Therefore, a rigorous and systematic decision process notwithstanding, clinical judgments under uncertainty are often flawed by a number of unwitting biases. Clinical orthodontics is as vulnerable to this fundamental failing in the decision-making process as any other health care discipline. Several of the more common cognitive biases relevant to clinical orthodontics are discussed in this article. By raising awareness of these sources of cognitive errors in our clinical decision making, our intent was to equip the clinician to take corrective action to avoid them. Our secondary goal was to expose this important area of empirical research and encourage those with expertise in the cognitive sciences to explore, through further research, the possible relevance and impact of cognitive heuristics and biases on the accuracy of orthodontic judgments and decision making. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  6. A model to systematically employ professional judgment in the Bayesian Decision Analysis for a semiconductor industry exposure assessment.

    PubMed

    Torres, Craig; Jones, Rachael; Boelter, Fred; Poole, James; Dell, Linda; Harper, Paul

    2014-01-01

    Bayesian Decision Analysis (BDA) uses Bayesian statistics to integrate multiple types of exposure information and classify exposures within the exposure rating categorization scheme promoted in American Industrial Hygiene Association (AIHA) publications. Prior distributions for BDA may be developed from existing monitoring data, mathematical models, or professional judgment. Professional judgments may misclassify exposures. We suggest that a structured qualitative risk assessment (QLRA) method can provide consistency and transparency in professional judgments. In this analysis, we use a structured QLRA method to define prior distributions (priors) for BDA. We applied this approach at three semiconductor facilities in South Korea, and present an evaluation of the performance of structured QLRA for determination of priors, and an evaluation of occupational exposures using BDA. Specifically, the structured QLRA was applied to chemical agents in similar exposure groups to identify provisional risk ratings. Standard priors were developed for each risk rating before review of historical monitoring data. Newly collected monitoring data were used to update priors informed by QLRA or historical monitoring data, and determine the posterior distribution. Exposure ratings were defined by the rating category with the highest probability--i.e., the most likely. We found the most likely exposure rating in the QLRA-informed priors to be consistent with historical and newly collected monitoring data, and the posterior exposure ratings developed with QLRA-informed priors to be equal to or greater than those developed with data-informed priors in 94% of comparisons. Overall, exposures at these facilities are consistent with well-controlled work environments. That is, the 95th percentile of exposure distributions are ≤50% of the occupational exposure limit (OEL) for all chemical-SEG combinations evaluated; and are ≤10% of the limit for 94% of chemical-SEG combinations evaluated.

  7. Clinical judgment to estimate pretest probability in the diagnosis of Cushing's syndrome under a Bayesian perspective.

    PubMed

    Cipoli, Daniel E; Martinez, Edson Z; Castro, Margaret de; Moreira, Ayrton C

    2012-12-01

    To estimate the pretest probability of Cushing's syndrome (CS) diagnosis by a Bayesian approach using intuitive clinical judgment. Physicians were requested, in seven endocrinology meetings, to answer three questions: "Based on your personal expertise, after obtaining clinical history and physical examination, without using laboratorial tests, what is your probability of diagnosing Cushing's Syndrome?"; "For how long have you been practicing Endocrinology?"; and "Where do you work?". A Bayesian beta regression, using the WinBugs software was employed. We obtained 294 questionnaires. The mean pretest probability of CS diagnosis was 51.6% (95%CI: 48.7-54.3). The probability was directly related to experience in endocrinology, but not with the place of work. Pretest probability of CS diagnosis was estimated using a Bayesian methodology. Although pretest likelihood can be context-dependent, experience based on years of practice may help the practitioner to diagnosis CS.

  8. Investigating the cognitive structure of stereotypes: Generic beliefs about groups predict social judgments better than statistical beliefs.

    PubMed

    Hammond, Matthew D; Cimpian, Andrei

    2017-05-01

    Stereotypes are typically defined as beliefs about groups, but this definition is underspecified. Beliefs about groups can be generic or statistical. Generic beliefs attribute features to entire groups (e.g., men are strong), whereas statistical beliefs encode the perceived prevalence of features (e.g., how common it is for men to be strong). In the present research, we sought to determine which beliefs-generic or statistical-are more central to the cognitive structure of stereotypes. Specifically, we tested whether generic or statistical beliefs are more influential in people's social judgments, on the assumption that greater functional importance indicates greater centrality in stereotype structure. Relative to statistical beliefs, generic beliefs about social groups were significantly stronger predictors of expectations (Studies 1-3) and explanations (Study 4) for unfamiliar individuals' traits. In addition, consistent with prior evidence that generic beliefs are cognitively simpler than statistical beliefs, generic beliefs were particularly predictive of social judgments for participants with more intuitive (vs. analytic) cognitive styles and for participants higher (vs. lower) in authoritarianism, who tend to view outgroups in simplistic, all-or-none terms. The present studies suggest that generic beliefs about groups are more central than statistical beliefs to the cognitive structure of stereotypes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. Moral motivation based on multiple developmental structures: an exploration of cognitive and emotional dynamics.

    PubMed

    Kaplan, Ulas; Tivnan, Terrence

    2014-01-01

    Intrapersonal variability and multiplicity in the complexity of moral motivation were examined from Dynamic Systems and Self-Determination Theory perspectives. L. Kohlberg's (1969) stages of moral development are reconceptualized as soft-assembled and dynamically transformable process structures of motivation that may operate simultaneously within person in different degrees. Moral motivation is conceptualized as the real-time process of self-organization of cognitive and emotional dynamics out of which moral judgment and action emerge. A detailed inquiry into intrapersonal variation in moral motivation is carried out based on the differential operation of multiple motivational structures. A total of 74 high school students and 97 college students participated in the study by completing a new questionnaire, involving 3 different hypothetical moral judgments. As hypothesized, findings revealed significant multiplicity in the within-person operation of developmental stage structures, and intrapersonal variability in the degrees to which stages were used. Developmental patterns were found in terms of different distributions of multiple stages between high school and college samples, as well as the association between age and overall motivation scores. Differential relations of specific emotions to moral motivation revealed and confirmed the value of differentiating multiple emotions. Implications of the present theoretical perspective and the findings for understanding the complexity of moral judgment and motivation are discussed.

  10. Human judgment vs. quantitative models for the management of ecological resources.

    PubMed

    Holden, Matthew H; Ellner, Stephen P

    2016-07-01

    Despite major advances in quantitative approaches to natural resource management, there has been resistance to using these tools in the actual practice of managing ecological populations. Given a managed system and a set of assumptions, translated into a model, optimization methods can be used to solve for the most cost-effective management actions. However, when the underlying assumptions are not met, such methods can potentially lead to decisions that harm the environment and economy. Managers who develop decisions based on past experience and judgment, without the aid of mathematical models, can potentially learn about the system and develop flexible management strategies. However, these strategies are often based on subjective criteria and equally invalid and often unstated assumptions. Given the drawbacks of both methods, it is unclear whether simple quantitative models improve environmental decision making over expert opinion. In this study, we explore how well students, using their experience and judgment, manage simulated fishery populations in an online computer game and compare their management outcomes to the performance of model-based decisions. We consider harvest decisions generated using four different quantitative models: (1) the model used to produce the simulated population dynamics observed in the game, with the values of all parameters known (as a control), (2) the same model, but with unknown parameter values that must be estimated during the game from observed data, (3) models that are structurally different from those used to simulate the population dynamics, and (4) a model that ignores age structure. Humans on average performed much worse than the models in cases 1-3, but in a small minority of scenarios, models produced worse outcomes than those resulting from students making decisions based on experience and judgment. When the models ignored age structure, they generated poorly performing management decisions, but still outperformed students using experience and judgment 66% of the time. © 2016 by the Ecological Society of America.

  11. Age-related changes to spectral voice characteristics affect judgments of prosodic, segmental, and talker attributes for child and adult speech.

    PubMed

    Dilley, Laura C; Wieland, Elizabeth A; Gamache, Jessica L; McAuley, J Devin; Redford, Melissa A

    2013-02-01

    As children mature, changes in voice spectral characteristics co-vary with changes in speech, language, and behavior. In this study, spectral characteristics were manipulated to alter the perceived ages of talkers' voices while leaving critical acoustic-prosodic correlates intact, to determine whether perceived age differences were associated with differences in judgments of prosodic, segmental, and talker attributes. Speech was modified by lowering formants and fundamental frequency, for 5-year-old children's utterances, or raising them, for adult caregivers' utterances. Next, participants differing in awareness of the manipulation (Experiment 1A) or amount of speech-language training (Experiment 1B) made judgments of prosodic, segmental, and talker attributes. Experiment 2 investigated the effects of spectral modification on intelligibility. Finally, in Experiment 3, trained analysts used formal prosody coding to assess prosodic characteristics of spectrally modified and unmodified speech. Differences in perceived age were associated with differences in ratings of speech rate, fluency, intelligibility, likeability, anxiety, cognitive impairment, and speech-language disorder/delay; effects of training and awareness of the manipulation on ratings were limited. There were no significant effects of the manipulation on intelligibility or formally coded prosody judgments. Age-related voice characteristics can greatly affect judgments of speech and talker characteristics, raising cautionary notes for developmental research and clinical work.

  12. General practitioners' judgment of their elderly patients' cognitive status.

    PubMed

    Pentzek, Michael; Fuchs, Angela; Wiese, Birgitt; Cvetanovska-Pllashniku, Gabriela; Haller, Franziska; Maier, Wolfgang; Riedel-Heller, Steffi G; Angermeyer, Matthias C; Bickel, Horst; Mösch, Edelgard; Weyerer, Siegfried; Werle, Jochen; van den Bussche, Hendrik; Eisele, Marion; Kaduszkiewicz, Hanna

    2009-12-01

    General practitioners (GP) play an important role in detecting cognitive impairment among their patients. To explore factors associated with GPs' judgment of their elderly patients' cognitive status. Cross-sectional data from an observational cohort study (AgeCoDe study); General practice surgeries in six German metropolitan study centers; home visits by interviewers. 138 GPs, 3,181 patients (80.13 +/- 3.61 years, 65.23% female). General practitioner questionnaire for each patient: familiarity with the patient, patient morbidity, judgment of cognitive status. Home visits by trained interviewers: sociodemographic and clinical data, psychometric test performance. Multivariate regression analysis was used to identify independent associations with the GPs' judgment of "cognitively impaired" vs. "cognitively unimpaired." Less familiar patients (adjusted odds ratio [aOR] 2.42, 95% CI 1.35-4.32, for poor vs. very high familiarity), less mobile patients (aOR 1.29, 95% CI 1.13-1.46), patients with impaired hearing (aOR 5.46, 95% CI 2.35-12.67 for serious vs. no problems), and patients with greater comorbidity (aOR 1.15, 95% CI 1.08-1.22) were more likely to be rated as "cognitively impaired" by their GPs. The associations between GPs' assessments of cognitive impairment and their familiarity with their patients and patients' mobility, hearing, and morbidity provide important insights into how GPs make their judgments.

  13. Altered Neural Correlate of the Self-Agency Experience in First-Episode Schizophrenia-Spectrum Patients: An fMRI Study

    PubMed Central

    Spaniel, Filip; Tintera, Jaroslav; Rydlo, Jan; Ibrahim, Ibrahim; Kasparek, Tomas; Horacek, Jiri; Zaytseva, Yuliya; Matejka, Martin; Fialova, Marketa; Slovakova, Andrea; Mikolas, Pavol; Melicher, Tomas; Görnerova, Natalie; Höschl, Cyril; Hajek, Tomas

    2016-01-01

    Background: The phenomenology of the clinical symptoms indicates that disturbance of the sense of self be a core marker of schizophrenia. Aims: To compare neural activity related to the self/other-agency judgment in patients with first-episode schizophrenia-spectrum disorders (FES, n = 35) and healthy controls (HC, n = 35). Method: A functional magnetic resonance imaging (fMRI) using motor task with temporal distortion of the visual feedback was employed. A task-related functional connectivity was analyzed with the use of independent component analysis (ICA). Results: (1) During self-agency experience, FES showed a deficit in cortical activation in medial frontal gyrus (BA 10) and posterior cingulate gyrus, (BA 31; P < .05, Family-Wise Error [FWE] corrected). (2) Pooled-sample task-related ICA revealed that the self/other-agency judgment was dependent upon anti-correlated default mode and central-executive networks (DMN/CEN) dynamic switching. This antagonistic mechanism was substantially impaired in FES during the task. Discussion: During self-agency experience, FES demonstrate deficit in engagement of cortical midline structures along with substantial attenuation of anti-correlated DMN/CEN activity underlying normal self/other-agency discriminative processes. PMID:26685867

  14. Problematizing the concept of the "borderline" group in performance assessments.

    PubMed

    Homer, Matt; Pell, Godfrey; Fuller, Richard

    2017-05-01

    Many standard setting procedures focus on the performance of the "borderline" group, defined through expert judgments by assessors. In performance assessments such as Objective Structured Clinical Examinations (OSCEs), these judgments usually apply at the station level. Using largely descriptive approaches, we analyze the assessment profile of OSCE candidates at the end of a five year undergraduate medical degree program to investigate the consistency of the borderline group across stations. We look specifically at those candidates who are borderline in individual stations, and in the overall assessment. While the borderline group can be clearly defined at the individual station level, our key finding is that the membership of this group varies considerably across stations. These findings pose challenges for some standard setting methods, particularly the borderline group and objective borderline methods. They also suggest that institutions should ensure appropriate conjunctive rules to limit compensation in performance between stations to maximize "diagnostic accuracy". In addition, this work highlights a key benefit of sequential testing formats in OSCEs. In comparison with a traditional, single-test format, sequential models allow assessment of "borderline" candidates across a wider range of content areas with concomitant improvements in pass/fail decision-making.

  15. Attitudes of pediatric intensive care unit physicians towards the use of cognitive aids: a qualitative study.

    PubMed

    Weiss, Matthew J; Kramer, Chelsea; Tremblay, Sébastien; Côté, Luc

    2016-05-21

    Cognitive aids are increasingly recommended in clinical practice, yet little is known about the attitudes of physicians towards these tools. We employed a qualitative, descriptive design to explore physician attitudes towards cognitive aids in pediatric intensive care units (PICUs). Semi-structured interviews elicited the opinions of a convenience sample of practicing PICU physicians towards the use of cognitive aids. We analyzed interview data for thematic content to examine the three factors of intention to use cognitive aids as defined by the Theory of Planned Behavior (TPB), attitudes, social norms, and perceived control. Analysis of 14 interviews suggested that in the PICU setting, cognitive aids are widely used. Discovered themes related to their use touched on all three TPB factors of intention and included: aids are perceived to improve team communication; aids may improve patient safety; aids may hinder clinician judgment; physicians may resist implementation if it occurs prior to demonstration of benefit; effective adoption requires cognitive aids to be integrated into local workplace culture; and implementation should take physician concerns into account. Our sample of PICU physicians were open to cognitive aids in their practice, as long as such aids preserve the primacy of clinical judgment, focus on team communication, demonstrate effectiveness through preliminary testing, and are designed and implemented with the local culture and work environment in mind. Future knowledge translation efforts to implement cognitive aids would benefit from consideration of these issues.

  16. Integrating some mind and brain views of transference: the phenomena.

    PubMed

    Levin, F M

    1997-01-01

    Because understanding the underpinnings of transferential learning allows the analyst to more effectively exploit transference in the clinical situation, as well as to advance psychoanalytic theory, the functions and mechanisms of transference phenomena in learning are subjected to an interdisciplinary analysis. Through transference the brain creates hierarchical databases that make emotional sense of the world, especially the world of human relationships. Transference plays a role in defense and resistance clinically; less explored but equally important is the adaptive potential of transference and its effect on an individual's readiness for structural change through the activation of working memory. Most investigators within psychoanalysis have not considered the importance of similarity judgments and memory priming, especially as these help to explain why transference and its proper handling are effective in treatment. Yet there are complex relationships among transference, similarity judgment, and memory priming that tie together psychoanalysis, cognitive psychology, and neurophysiology. Evidence increasingly suggests a relationship between transference and the transfer of knowledge between various content domains (databases) of mind and brain, which is essential to cognitive and emotional learning. There are indications as well that transference decisively facilitates learning readiness ("windows") in general by means of two of its components: free association and spontaneous (self-initiated) activity. The important question of which mind/brain mechanisms motivate transference is not yet understood comprehensively. However, Vygotsky's work on the zone of proximal development (ZPD), M.Stern's teleonomic theory, schema theory, and neural network theory offer further insights into what motivates transference.

  17. The role of social comparison in social judgments of dental appearance: An experimental study.

    PubMed

    Al-Kharboush, Ghada H; Asimakopoulou, Koula; AlJabaa, AlJazi H; Newton, J Tim

    2017-06-01

    The objective of this study was to examine the influence of social comparison on social judgments of dental malalignment in a sample of females. In a Repeated measures design, N=218 female participants of which N=128 were orthodontic patients (mean age 31.4) and N=90 controls (mean age 26.1) rated their satisfaction with their facial appearance after viewing stereotypically beautiful images of faces (experimental condition) or houses (neutral condition). After 4-6 weeks participants returned to view an image of a female with severe crowding and were asked to make judgments of social competence (SC), intellectual ability (IA), psychological adjustment (PA) and attractiveness (A). The comparison of social judgments between high comparers (High SocComp) and low comparers (Low SocComp) was not statistically significant; (SC (t (204)=0.30, p=0.76), IA (t (204)=0.14, p=0.89) PA (t (204)=0.004, p=0.996), A (t(204)=1.26, (p=0.209). However, dentally induced social judgments (DISJ) was statistically significant in the clinical sample than the non-clinical sample SC (t (204)=0.784, p=0.434), IA (t (204)=0.2.15, p=0.033) PA (t (204)=-0.003, p=0.997) A (t (204)=1.58, p=0.116). Social comparison has little impact on DISJ. However, there are differences in DISJs between individuals who seek treatment for their malocclusion versus the nonclinical population; the reason for this is unclear but does not appear to be the result of adoption of societal standards of beauty and instead suggests individual ranking of important 'beauty areas' may play a role. This paper uses social comparison theory to investigate the basis of judgments in regards to dental appearance. The findings of this research may help to identify individuals who are more susceptible to societal pressures towards non-ideal dentitions. This will help clinicians become more aware of the patient's comparison orientation, which seems to have an impact on satisfaction with treatment outcomes. This study may form the foundation for future behaviour studies seeking to alleviate the negative effects of social comparison. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Judgments of Omitted BE and DO in Questions as Extended Finiteness Clinical Markers of SLI to Fifteen Years: A Study of Growth and Asymptote

    PubMed Central

    Rice, Mabel L; Hoffman, Lesa; Wexler, Ken

    2009-01-01

    Purpose Clinical grammar markers are needed for children with SLI older than 8 years. This study followed children studied earlier on sentences with omitted finiteness to determine if affected children continue to perform at low levels and to examine possible predictors of low performance. This is the first longitudinal report of grammaticality judgments of questions. Method Three groups of children participated: 20 SLI, 20 age controls and 18 language-matched controls, followed from ages 6–15 years. An experimental grammaticality judgment task was administered with BE copula/auxiliary and DO auxiliary in Wh- and Yes/No questions for 9 times of measurement. Predictors were indices of vocabulary, nonverbal intelligence, and maternal education. Results Growth curve analyses show that the affected group performed below the younger controls at each time of measurement, for each variable. Growth analyses show linear and quadratic effects for both groups across variables, with the exception of BE acquisition which was flat for both groups. The control children reached ceiling levels; the affected children reached a lower asymptote. Conclusions The results suggest an on-going maturational lag in finiteness marking for affected children with promise as a clinical marker for language impairment in school-aged and adolescent children and probably adults as well. PMID:19786705

  19. Prognostic value of resident clinical performance ratings.

    PubMed

    Williams, Reed G; Dunnington, Gary L

    2004-10-01

    This study investigated the concurrent and predictive validity of end-of-rotation (EOR) clinical performance ratings. Surgeon EOR ratings of residents were collected and compared with end-of-year (EOY) progress decisions and to EOR and EOY confidential judgments of resident ability to provide patient care without direct supervision. Eighty percent to 85% of EOR ratings were Excellent or Very Good. Five percent or fewer were Fair or Poor. Almost all residents receiving Excellent or Very Good EOR ratings also received positive EOR judgments about ability to provide patient care without direct supervision. Residents rated Fair or Poor received negative EOR judgments about ability to provide patient care without direct supervision. As the cumulative percent of Good, Fair, and Poor EOR ratings increased, the number of residents promoted without stipulations at the end of the year decreased and the percentage of faculty members who judged the residents capable of providing effective patient care without direct supervision at the end of the year declined. All residents receiving 40% or more EOR ratings below Very Good had stipulations associated with their promotion. Despite use of descriptive anchors on the scale, clinical performance ratings have no direct meaning. Their meaning needs to be established in the same manner as is done in setting normal values for diagnostic tests, ie, by establishing the relationship between EOR ratings and practice outcomes.

  20. 20 CFR 656.5 - Schedule A.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... Professional nursing generally includes making clinical judgments involving the observation, care and counsel... ability in the sciences or arts including college and university teachers of exceptional ability who have...

  1. 20 CFR 656.5 - Schedule A.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    .... Professional nursing generally includes making clinical judgments involving the observation, care and counsel... ability in the sciences or arts including college and university teachers of exceptional ability who have...

  2. 20 CFR 656.5 - Schedule A.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... Professional nursing generally includes making clinical judgments involving the observation, care and counsel... ability in the sciences or arts including college and university teachers of exceptional ability who have...

  3. 20 CFR 656.5 - Schedule A.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... Professional nursing generally includes making clinical judgments involving the observation, care and counsel... ability in the sciences or arts including college and university teachers of exceptional ability who have...

  4. Comparing moral judgments of patients with frontotemporal dementia and frontal stroke.

    PubMed

    Baez, Sandra; Couto, Blas; Torralva, Teresa; Sposato, Luciano A; Huepe, David; Montañes, Patricia; Reyes, Pablo; Matallana, Diana; Vigliecca, Nora S; Slachevsky, Andrea; Manes, Facundo; Ibanez, Agustin

    2014-09-01

    Several clinical reports have stated that patients with prefrontal lesions or patients with the behavioral variant of frontotemporal dementia share social cognition impairments. Moral reasoning is impaired in both conditions but there have been few investigations that directly compare this domain in the 2 groups. This work compared the moral judgments of these patient groups using a task designed to disentangle the contributions of intentions and outcomes in moral judgment. For both disorders, patients judged scenarios where the protagonists believed that they would cause harm but did not as being more permissible than the control group. Moreover, patients with frontotemporal dementia judged harmful outcomes in the absence of harmful intentions as less permissible than the control participants. There were no differences between the 2 conditions. Both disorders involved impairments in integrating intention and outcome information for moral judgment. This study was the first, to our knowledge, to directly compare a social cognition domain in 2 frontal pathologies with different etiology. Our results highlighted the importance of comparing patients with vascular lesions and patients with neurodegenerative diseases.

  5. COMPREHENSIVE EVALUATIVE TECHNIQUES FOR THE CHILD WITH A CLEFT PALATE.

    ERIC Educational Resources Information Center

    BENSEN, JACK F.; WHITE, FRAZER D.

    A MULTIDISCIPLINARY APPROACH TO CHILDREN WITH CLEFT PALATES IS DESCRIBED. THE SOUTH FLORIDA CLEFT PALATE CLINIC, REPRESENTING NINE PROFESSIONAL SPECIALTIES, MEETS WEEKLY TO SEE SIX OR SEVEN CASES. SPEECH PERFORMANCE IS RECORDED ON SIX DIAGNOSTIC, DATA COLLECTING FORMS WHICH PROVIDE A BASIS FOR RECORDING CLINICAL JUDGMENTS. PROGNOSIS AND…

  6. Cultural adaptation and validation of the Lasater Clinical Judgment Rubric in nursing students in Spain.

    PubMed

    Román-Cereto, Montserrat; García-Mayor, Silvia; Kaknani-Uttumchandani, Shakira; García-Gámez, Marina; León-Campos, Alvaro; Fernández-Ordóñez, Eloisa; Ruiz-García, Maria Luisa; Martí-García, C; López-Leiva, Inmaculada; Lasater, Kathie; Morales-Asencio, José Miguel

    2018-05-01

    The clinical judgment and decision-making abilities of nurses can influence many health outcomes, hence the importance of addressing these qualities in university studies. In this respect, clinical simulation is a commonly employed teaching method. The evaluation of simulation activities requires standardised instruments, such as the Lasater Clinical Judgment Rubric, which is widely used for this purpose, although a culturally adapted and validated version in Spain is not available. To obtain a Spanish culturally adapted and validated version of the rubric for undergraduate students of nursing. Cultural adaptation and psychometric validation study carried out with undergraduate nursing students in the simulation laboratories at the University of Málaga (Spain). A process of translation/back-translation and cultural adaptation was carried out in accordance with international standards. The rubric was empirically evaluated in standardised scenarios with high and medium-fidelity simulators. Each student took part in two different simulation sessions, led by two instructors. In each simulation, the data were collected by two independent observers. 152 observations were obtained from 76 students. The interobserver reliability was high, with an intraclass correlation coefficient of 0.93 (95% CI 0.92-0.95) (p = 0.0001) and Cronbach's alpha of 0.93. According to the confirmatory factor analysis, the fit of the model was satisfactory in all indices, with a χ 2 /df value of 1.08, GFI 0.96, TLI 0.99, NFI 0.97 and RMSEA 0.24 (90% CI 0.000-0.066). The rubric obtained is culturally adapted to the Spanish educational context, and is valid and reliable for nursing students. Further prospective studies should be undertaken to evaluate the responsiveness, potential for transfer to clinical practice and cost-benefit ratios of different simulation designs. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department

    PubMed Central

    Balamuth, Fran; Alpern, Elizabeth R.; Grundmeier, Robert W.; Chilutti, Marianne; Weiss, Scott L.; Fitzgerald, Julie C.; Hayes, Katie; Bilker, Warren; Lautenbach, Ebbing

    2015-01-01

    Objectives To compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED). Methods This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared. Results Of 19,524 eligible patient visits, 88 patients developed consensus-confirmed severe sepsis or septic shock. Physician judgment identified 159, and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% CI = 72.1% to 73.4%) and specificity 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity 92.1% (95% CI = 91.7% to 92.4%), and specificity 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment vs. algorithmic alert were 40.3% vs. 2.5% and 99.88 % vs. 99.96%, respectively. Conclusions The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities. PMID:26474032

  8. Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department.

    PubMed

    Balamuth, Fran; Alpern, Elizabeth R; Grundmeier, Robert W; Chilutti, Marianne; Weiss, Scott L; Fitzgerald, Julie C; Hayes, Katie; Bilker, Warren; Lautenbach, Ebbing

    2015-11-01

    The objective was to compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED). This was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared. Of 19,524 eligible patient visits, 88 patients developed consensus-confirmed severe sepsis or septic shock. Physician judgment identified 159 and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% confidence interval [CI] = 72.1% to 73.4%) and specificity of 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity of 92.1% (95% CI = 91.7% to 92.4%) and specificity of 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment versus algorithmic alert were 40.3% versus 2.5% and 99.88% versus 99.96%, respectively. The electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities. © 2015 by the Society for Academic Emergency Medicine.

  9. Neural correlates of context-independent and context-dependent self-knowledge.

    PubMed

    Martial, Charlotte; Stawarczyk, David; D'Argembeau, Arnaud

    2018-05-25

    The self-concept consists of both a general (context-independent) self-representation and a set of context-dependent selves that represent personal attributes in particular contexts (e.g., as a student, as a daughter). To date, however, neuroimaging studies have focused on general self-representations, such that little is known about the neural correlates of context-dependent self-knowledge. The present study aimed at investigating this issue by examining the neural correlates of both kinds of self-knowledge. Participants judged the extent to which trait adjectives described their own personality or the personality of a close friend, either in a specific context (i.e., as a student) or in general. We found that both kinds of self-judgments were associated with common activation in the medial prefrontal cortex (MPFC), as compared to judgments about others. Interestingly, however, there were also notable differences between self-judgments, with context-independent judgments being associated with higher activity in the MPFC, whereas context-dependent judgments were associated with greater activation in posterior brain regions (i.e., the posterior cingulate/retrosplenial cortex). These findings show that context-independent and context-dependent self-referential judgments recruit both common and distinct brain regions, thereby supporting the view that the self-concept is a multi-dimensional knowledge structure that includes a general self-representation and a set of context-specific selves. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. The closed-mindedness that wasn't: need for structure and expectancy-inconsistent information.

    PubMed

    Kemmelmeier, Markus

    2015-01-01

    Social-cognitive researchers have typically assumed that individuals high in need for structure or need for closure tend to be closed-minded: they are motivated to resist or ignore information that is inconsistent with existing beliefs but instead they rely on category-based expectancies. The present paper argues that this conclusion is not necessarily warranted because previous studies did not allow individual differences in categorical processing to emerge and did not consider different distributions of category-relevant information. Using a person memory paradigm, Experiments 1 and 2 shows that, when categorical processing is optional, high need-for-structure individuals are especially likely to use this type processing to reduce uncertainty, which results in superior recall for expectancy-inconsistent information. Experiment 2 demonstrates that such information is also more likely to be used in judgment making, leading to judgmental moderation among high need-for-structure individuals. Experiments 3 and 4 used a person memory paradigm which requires categorical processing regardless of levels of need for structure. Experiments 3 and 4 demonstrate that, whether expectancy-consistent or -inconsistent information is recalled better is a function of whether the majority of available information is compatible or incompatible with an initial category-based expectancy. Experiment 4 confirmed that the extent to which high need-for-structure individuals attend to different types of information varies with their distribution. The discussion highlights that task affordances have a critical influence on the consequences of categorical processing for memory and social judgment. Thus, high need for structure does not necessarily equate closed-mindedness.

  11. The closed-mindedness that wasn’t: need for structure and expectancy-inconsistent information

    PubMed Central

    Kemmelmeier, Markus

    2015-01-01

    Social-cognitive researchers have typically assumed that individuals high in need for structure or need for closure tend to be closed-minded: they are motivated to resist or ignore information that is inconsistent with existing beliefs but instead they rely on category-based expectancies. The present paper argues that this conclusion is not necessarily warranted because previous studies did not allow individual differences in categorical processing to emerge and did not consider different distributions of category-relevant information. Using a person memory paradigm, Experiments 1 and 2 shows that, when categorical processing is optional, high need-for-structure individuals are especially likely to use this type processing to reduce uncertainty, which results in superior recall for expectancy-inconsistent information. Experiment 2 demonstrates that such information is also more likely to be used in judgment making, leading to judgmental moderation among high need-for-structure individuals. Experiments 3 and 4 used a person memory paradigm which requires categorical processing regardless of levels of need for structure. Experiments 3 and 4 demonstrate that, whether expectancy-consistent or -inconsistent information is recalled better is a function of whether the majority of available information is compatible or incompatible with an initial category-based expectancy. Experiment 4 confirmed that the extent to which high need-for-structure individuals attend to different types of information varies with their distribution. The discussion highlights that task affordances have a critical influence on the consequences of categorical processing for memory and social judgment. Thus, high need for structure does not necessarily equate closed-mindedness. PMID:26191017

  12. [Study on Information Extraction of Clinic Expert Information from Hospital Portals].

    PubMed

    Zhang, Yuanpeng; Dong, Jiancheng; Qian, Danmin; Geng, Xingyun; Wu, Huiqun; Wang, Li

    2015-12-01

    Clinic expert information provides important references for residents in need of hospital care. Usually, such information is hidden in the deep web and cannot be directly indexed by search engines. To extract clinic expert information from the deep web, the first challenge is to make a judgment on forms. This paper proposes a novel method based on a domain model, which is a tree structure constructed by the attributes of search interfaces. With this model, search interfaces can be classified to a domain and filled in with domain keywords. Another challenge is to extract information from the returned web pages indexed by search interfaces. To filter the noise information on a web page, a block importance model is proposed. The experiment results indicated that the domain model yielded a precision 10.83% higher than that of the rule-based method, whereas the block importance model yielded an F₁ measure 10.5% higher than that of the XPath method.

  13. Professional identity as a resource for talk: exploring the mentor-student relationship.

    PubMed

    Shakespeare, Pam; Webb, Christine

    2008-12-01

    This paper discusses a study examining how mentors in nurse education make professional judgments about the clinical competence of their pre-registration nursing students. Interviews were undertaken with nine UK students and 15 mentors, using critical incidents in practice settings as a focus. The study was undertaken for the English National Practice-Based Professional Learning Centre for Excellence in Teaching and Learning. This paper reports on the conversation analytic thread of the work. The mentor role with pre-registration nursing students is not only supportive but involves formal assessment. Central to the relationship is communication. In professional education, communication is seen as a skill to be applied and assessed in practice settings but is also the medium mentors and mentees use to talk about the relationship. Analysis of excerpts of conversation in the interviews shows that episodes of communication are used as topics of conversation to establish professional identity. It also reveals that judgments about the extent of professional capacity of both students and mentors are grounded in everyday behaviours (for example, enthusiasm, indifference and confidence) as well as professional competence. In addition to focusing on clinical issues, mentors can and do use mundane communication as a resource for judgments about competence.

  14. Accuracy in inference of nursing diagnoses in heart failure patients.

    PubMed

    Pereira, Juliana de Melo Vellozo; Cavalcanti, Ana Carla Dantas; Lopes, Marcos Venícios de Oliveira; da Silva, Valéria Gonçalves; de Souza, Rosana Oliveira; Gonçalves, Ludmila Cuzatis

    2015-01-01

    Heart failure (HF) is a common cause of hospitalization and requires accuracy in clinical judgment and appropriate nursing diagnoses. to determine the accuracy of nursing diagnoses of fatigue, intolerance to activity and decreased cardiac output in hospitalized HF patients. descriptive study applied to nurses with experience in NANDA-I and/or HF nursing diagnoses. Evaluation and accuracy were determined by calculating efficacy (E), false negative (FN), false positive (FP) and trend (T) measures. Nurses who showed acceptable inspection for two diagnoses were selected. the nursing diagnosis of fatigue was the most commonly mistaken diagnosis identified by the nursing evaluators. the search for improving diagnostic accuracy reaffirms the need for continuous and specific training to improve the diagnosis capability of nurses. the training allowed the exercise of clinical judgment and better accuracy of nurses.

  15. Influence of Learning Style and Learning Flexibility on Clinical Judgment of Prelicensure Nursing Students within a Human Patient Computer Simulation Environment

    ERIC Educational Resources Information Center

    Robison, Elizabeth Sharon

    2012-01-01

    Nursing education is experiencing a transition in how students are exposed to clinical situations. Technology, specifically human patient computer simulation, is replacing human exposure in clinical education (Nehring, 2010b). Kaakinen and Arwood (2009) discuss the need to apply learning theories to instructional designs involving simulation for…

  16. Clinical Significance of Human Herpesvirus 6 Positivity on the FilmArray Meningitis/Encephalitis Multiplex PCR Panel.

    PubMed

    Green, Daniel A; Pereira, Marcus; Miko, Benjamin; Radmard, Sara; Whittier, Susan; Thakur, Kiran

    2018-04-09

    A review of 15 patients who tested positive for HHV-6 on the FilmArray Meningitis/Encephalitis (M/E) panel revealed that the majority were unlikely to have HHV-6 encephalitis. Interpreting HHV-6 positive results on the M/E panel requires careful clinical judgment, as this finding may be clinically insignificant for many patients.

  17. Development of a Self-Management Theory-Guided Discharge Intervention for Parents of Hospitalized Children.

    PubMed

    Sawin, Kathleen J; Weiss, Marianne E; Johnson, Norah; Gralton, Karen; Malin, Shelly; Klingbeil, Carol; Lerret, Stacee M; Thompson, Jamie J; Zimmanck, Kim; Kaul, Molly; Schiffman, Rachel F

    2017-03-01

    Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self-management of their child's care at home after discharge. No theory-based discharge intervention exists to guide pediatric nurses' preparation of parents for discharge. To develop a theory-based conversation guide to optimize nurses' preparation of parents for discharge and self-management of their child at home following hospitalization. Two frameworks and one method influenced the development of the intervention: the Individual and Family Self-Management Theory, Tanner's Model of Clinical Judgment, and the Teach-Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine-domain conversation guide for use in acute care pediatric hospitals. The theory-based intervention operationalized self-management concepts, added components of nursing clinical judgment, and integrated the Teach-Back method. Development of a theory-based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention. © 2017 Sigma Theta Tau International.

  18. Clinic expert information extraction based on domain model and block importance model.

    PubMed

    Zhang, Yuanpeng; Wang, Li; Qian, Danmin; Geng, Xingyun; Yao, Dengfu; Dong, Jiancheng

    2015-11-01

    To extract expert clinic information from the Deep Web, there are two challenges to face. The first one is to make a judgment on forms. A novel method based on a domain model, which is a tree structure constructed by the attributes of query interfaces is proposed. With this model, query interfaces can be classified to a domain and filled in with domain keywords. Another challenge is to extract information from response Web pages indexed by query interfaces. To filter the noisy information on a Web page, a block importance model is proposed, both content and spatial features are taken into account in this model. The experimental results indicate that the domain model yields a precision 4.89% higher than that of the rule-based method, whereas the block importance model yields an F1 measure 10.5% higher than that of the XPath method. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Cognitive error as the most frequent contributory factor in cases of medical injury: a study on verdict's judgment among closed claims in Japan.

    PubMed

    Tokuda, Yasuharu; Kishida, Naoki; Konishi, Ryota; Koizumi, Shunzo

    2011-03-01

    Cognitive errors in the course of clinical decision-making are prevalent in many cases of medical injury. We used information on verdict's judgment from closed claims files to determine the important cognitive factors associated with cases of medical injury. Data were collected from claims closed between 2001 to 2005 at district courts in Tokyo and Osaka, Japan. In each case, we recorded all the contributory cognitive, systemic, and patient-related factors judged in the verdicts to be causally related to the medical injury. We also analyzed the association between cognitive factors and cases involving paid compensation using a multivariable logistic regression model. Among 274 cases (mean age 49 years old; 45% women), there were 122 (45%) deaths and 67 (24%) major injuries (incomplete recovery within a year). In 103 cases (38%), the verdicts ordered hospitals to pay compensation (median; 8,000,000 Japanese Yen). An error in judgment (199/274, 73%) and failure of vigilance (177/274, 65%) were the most prevalent causative cognitive factors, and error in judgment was also significantly associated with paid compensation (odds ratio, 1.9; 95% confidence interval [CI], 1.0-3.4). Systemic causative factors including poor teamwork (11/274, 4%) and technology failure (5/274, 2%) were less common. The closed claims analysis based on verdict's judgment showed that cognitive errors were common in cases of medical injury, with an error in judgment being most prevalent and closely associated with compensation payment. Reduction of this type of error is required to produce safer healthcare. 2010 Society of Hospital Medicine.

  20. Is being mindful associated with reduced risk for internally-motivated drinking and alcohol use among undergraduates?

    PubMed

    Reynolds, Ashley; Keough, Matthew T; O'Connor, Roisin M

    2015-03-01

    Mindfulness encompasses four core skills: observing, describing, acting with awareness, and accepting without judgment; which aim to increase one's awareness, tolerance, and acceptance of internal experiences (Baer et al., 2004). Despite promising clinical results that mindfulness reduces alcohol craving and relapse, complementary etiological research is underdeveloped. Theory suggests that those who are motivated to drink to change internal states (reduce negative/increase positive affect) are at risk for elevated alcohol use. The ability to accept one's affective state should preclude internally-motivated drinking, and thus, elevated alcohol use. The purpose of this study was to parse out which mindfulness skills are central to alcohol use. We hypothesized that accepting without judgment would be a unique negative predictor of internally-motivated drinking (drinking for coping and enhancement motives) and alcohol use. Students (N=76) completed self-report measures of past month alcohol use and four motives for drinking: to cope, for enhancement, to conform, and for social reasons. Partially supporting our hypotheses, accepting without judgment was negatively associated with drinking for coping motives, but was unassociated with drinking for enhancement motives. Interestingly, acceptance without judgment was negatively associated with drinking for conformity motives (to reduce social rejection). Unexpectedly, acting with awareness, but not accepting without judgment, was a negative predictor of alcohol use. Our findings suggest that interventions aimed at reducing coping- and conformity-motivated drinking and alcohol use by young adults may benefit from incorporating mindfulness skills training (i.e., accepting without judgment; acting with awareness). Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Biomarkers and surrogate endpoints in glaucoma clinical trials.

    PubMed

    Medeiros, Felipe A

    2015-05-01

    Surrogate endpoints are often used as replacements for true clinically relevant endpoints in several areas of medicine, as they enable faster and less expensive clinical trials. However, without proper validation, the use of surrogates may lead to incorrect conclusions about the efficacy and safety of treatments. This article reviews the general requirements for validating surrogate endpoints and provides a critical assessment of the use of intraocular pressure (IOP), visual fields, and structural measurements of the optic nerve as surrogate endpoints in glaucoma clinical trials. A valid surrogate endpoint must be able to predict the clinically relevant endpoint and fully capture the effect of an intervention on that endpoint. Despite its widespread use in clinical trials, no proper validation of IOP as a surrogate endpoint has ever been conducted for any class of IOP-lowering treatments. Evidence has accumulated with regard to the role of imaging measurements of optic nerve damage as surrogate endpoints in glaucoma. These measurements are predictive of functional losses in the disease and may explain, at least in part, treatment effects on clinically relevant endpoints. The use of composite endpoints in glaucoma trials may overcome weaknesses of the use of structural or functional endpoints in isolation. Unless research is dedicated to fully develop and validate suitable endpoints that can be used in glaucoma clinical trials, we run the risk of inappropriate judgments about the value of new therapies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. The Psychometric Properties of the Kentucky Inventory of Mindfulness Skills in Clinical Populations

    ERIC Educational Resources Information Center

    Baum, Corinna; Kuyken, Willem; Bohus, Martin; Heidenreich, Thomas; Michalak, Johannes; Steil, Regina

    2010-01-01

    The Kentucky Inventory of Mindfulness Skills (KIMS) is a well-validated multidimensional questionnaire measuring dimensions of mindfulness on four scales: Observing, Describing, Act With Awareness, and Accept Without Judgment. Even though the KIMS has been used in several clinical studies no information is available about the psychometric…

  3. Should I Pack My Umbrella? Clinical versus Statistical Prediction of Mental Health Decisions

    ERIC Educational Resources Information Center

    Aegisdottir, Stefania; Spengler, Paul M.; White, Michael J.

    2006-01-01

    In this rejoinder, the authors respond to the insightful commentary of Strohmer and Arm, Chwalisz, and Hilton, Harris, and Rice about the meta-analysis on statistical versus clinical prediction techniques for mental health judgments. The authors address issues including the availability of statistical prediction techniques for real-life psychology…

  4. Identification of Clinical Markers of Specific Language Impairment in Adults

    ERIC Educational Resources Information Center

    Poll, Gerard H.; Betz, Stacy K.; Miller, Carol A.

    2010-01-01

    Purpose: To investigate the usefulness of 3 tasks known to be effective diagnostic clinical markers of specific language impairment (SLI) in children: (a) nonword repetition, (b) sentence repetition, and (c) grammaticality judgments of finiteness marking. Method: Two groups of young adults, 13 with SLI and 18 with typical language, completed 3…

  5. Proportionate Responses to Life Events Influence Clinicians' Judgments of Psychological Abnormality

    ERIC Educational Resources Information Center

    Kim, Nancy S.; Paulus, Daniel J.; Gonzalez, Jeffrey S.; Khalife, Danielle

    2012-01-01

    Psychological abnormality is a fundamental concept in the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM-IV-TR"; American Psychiatric Association, 2000) and in all clinical evaluations. How do practicing clinical psychologists use the context of life events to judge the abnormality of a person's current behaviors? The appropriate…

  6. Unraveling the Contributions of the Diencephalon to Recognition Memory: A Review

    ERIC Educational Resources Information Center

    Aggleton, John P.; Dumont, Julie R.; Warburton, Elizabeth Clea

    2011-01-01

    Both clinical investigations and studies with animals reveal nuclei within the diencephalon that are vital for recognition memory (the judgment of prior occurrence). This review seeks to identify these nuclei and to consider why they might be important for recognition memory. Despite the lack of clinical cases with circumscribed pathology within…

  7. Understanding the Cranial Nerves: Evaluation of a Self-Paced Online Module in Optometric Education

    ERIC Educational Resources Information Center

    Taylor, Daniel Arnett

    2016-01-01

    Among the faculty of Southern College of Optometry in Memphis, Tennessee, it is perceived that optometry students often enter their clinical assignments with poor clinical judgment. To address this, "Understanding the Cranial Nerves"--an online-self paced instructional intervention of approximately two hours' duration--was developed. In…

  8. The Development of the Simulation Thinking Rubric

    ERIC Educational Resources Information Center

    Doolen, Jessica

    2012-01-01

    High fidelity simulation has become a widespread and costly learning strategy in nursing education because it can fill the gap left by a shortage of clinical sites. In addition, high fidelity simulation is an active learning strategy that is thought to increase higher order thinking such as clinical reasoning and judgment skills in nursing…

  9. Age-related changes to spectral voice characteristics affect judgments of prosodic, segmental, and talker attributes for child and adult speech

    PubMed Central

    Dilley, Laura C.; Wieland, Elizabeth A.; Gamache, Jessica L.; McAuley, J. Devin; Redford, Melissa A.

    2013-01-01

    Purpose As children mature, changes in voice spectral characteristics covary with changes in speech, language, and behavior. Spectral characteristics were manipulated to alter the perceived ages of talkers’ voices while leaving critical acoustic-prosodic correlates intact, to determine whether perceived age differences were associated with differences in judgments of prosodic, segmental, and talker attributes. Method Speech was modified by lowering formants and fundamental frequency, for 5-year-old children’s utterances, or raising them, for adult caregivers’ utterances. Next, participants differing in awareness of the manipulation (Exp. 1a) or amount of speech-language training (Exp. 1b) made judgments of prosodic, segmental, and talker attributes. Exp. 2 investigated the effects of spectral modification on intelligibility. Finally, in Exp. 3 trained analysts used formal prosody coding to assess prosodic characteristics of spectrally-modified and unmodified speech. Results Differences in perceived age were associated with differences in ratings of speech rate, fluency, intelligibility, likeability, anxiety, cognitive impairment, and speech-language disorder/delay; effects of training and awareness of the manipulation on ratings were limited. There were no significant effects of the manipulation on intelligibility or formally coded prosody judgments. Conclusions Age-related voice characteristics can greatly affect judgments of speech and talker characteristics, raising cautionary notes for developmental research and clinical work. PMID:23275414

  10. Clinicians’ Personal Theories of Developmental Disorders Explain Their Judgments of Effectiveness of Interventions

    PubMed Central

    de Kwaadsteniet, Leontien; Hagmayer, York

    2017-01-01

    Evidence-based psychotherapy requires clinicians to consider theories of psychopathology and evidence about effectiveness, and their experience when choosing interventions. Research on clinical decision making indicates that clinicians’ theories of disorders might be personal and inform judgments and choices beyond current scientific theory and evidence. We asked 20 child therapists to draw models of how they believed that biological, psychological, environmental, and behavioral factors interact to cause and maintain four common developmental disorders. They were also asked to judge the effectiveness of interventions recommended in the literature. Therapists showed only fair agreement about the factors and a slight to fair agreement about the causal relations between these, and just fair agreement about interventions’ effectiveness. Despite these disagreements, we could predict effectiveness judgments from therapists’ personal theories, which indicates that clinicians use personal theories in decision making. We discuss the implications of these findings for evidence-based practice. PMID:29527408

  11. Cognitive Constraints and Island Effects

    PubMed Central

    Hofmeister, Philip; Sag, Ivan A.

    2012-01-01

    Competence-based theories of island effects play a central role in generative grammar, yet the graded nature of many syntactic islands has never been properly accounted for. Categorical syntactic accounts of island effects have persisted in spite of a wealth of data suggesting that island effects are not categorical in nature and that non-structural manipulations that leave island structures intact can radically alter judgments of island violations. We argue here, building on work by Deane, Kluender, and others, that processing factors have the potential to account for this otherwise unexplained variation in acceptability judgments. We report the results of self-paced reading experiments and controlled acceptability studies which explore the relationship between processing costs and judgments of acceptability. In each of the three self-paced reading studies, the data indicate that the processing cost of different types of island violations can be significantly reduced to a degree comparable to that of non-island filler-gap constructions by manipulating a single non-structural factor. Moreover, this reduction in processing cost is accompanied by significant improvements in acceptability. This evidence favors the hypothesis that island-violating constructions involve numerous processing pressures that aggregate to drive processing difficulty above a threshold so that a perception of unacceptability ensues. We examine the implications of these findings for the grammar of filler-gap dependencies.* PMID:22661792

  12. 40 CFR 86.1305-2010 - Introduction; structure of subpart.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 19 2010-07-01 2010-07-01 false Introduction; structure of subpart. 86... Exhaust Test Procedures § 86.1305-2010 Introduction; structure of subpart. (a) This subpart specifies the... use good engineering judgment when testing under this paragraph (h), and must comply with the...

  13. Genetics Home Reference: GRN-related frontotemporal dementia

    MedlinePlus

    ... temporal lobes . The frontal lobes are involved in reasoning, planning, judgment, and problem-solving, while the temporal ... MND. Phenotype variability in progranulin mutation carriers: a clinical, neuropsychological, imaging and genetic study. Brain. 2008 Mar; ...

  14. Memory Loss: When to Seek Help

    MedlinePlus

    ... a set of symptoms, including impairment in memory, reasoning, judgment, language and other thinking skills. Dementia usually ... et al. Mild cognitive impairment: Epidemiology, pathology and clinical assessment. http://www.uptodate.com/home. Accessed March ...

  15. The doctor as businessman: the changing politics of a cultural icon.

    PubMed

    Stone, D A

    1997-04-01

    From just after the Civil War, when medicine began to professionalize, until the late 1970s, doctors and policy makers believed that clinical judgment should not be influenced by the financial interests of doctors. Physicians were highly entrepreneurial, and organized medicine fought to preserve their entrepreneurial interests, but the moral norm that justified their autonomy from state regulation was a strict separation of clinical judgment and pecuniary interests. Under managed care, the old norm is reversed. A good doctor takes financial considerations into account in making clinical decisions. Theoretically, doctors should consider measures of cost to society, but in practice, the payment systems of managed care plans induce doctors to consider the impact of each clinical decision on their own income. Because doctors share the risks of insuring patients with managed care plans, they have the same incentives as insurers to avoid patients who are expensively sick. The new cultural image of doctors as entrepreneurs masks their considerable loss of clinical autonomy under managed care. It also serves to persuade doctors to accept managed care arrangements and to persuade insurance consumers and patients to accept reduced benefits from employers and the government.

  16. Cultural differences in moral judgment and behavior, across and within societies.

    PubMed

    Graham, Jesse; Meindl, Peter; Beall, Erica; Johnson, Kate M; Zhang, Li

    2016-04-01

    We review contemporary work on cultural factors affecting moral judgments and values, and those affecting moral behaviors. In both cases, we highlight examples of within-societal cultural differences in morality, to show that these can be as substantial and important as cross-societal differences. Whether between or within nations and societies, cultures vary substantially in their promotion and transmission of a multitude of moral judgments and behaviors. Cultural factors contributing to this variation include religion, social ecology (weather, crop conditions, population density, pathogen prevalence, residential mobility), and regulatory social institutions such as kinship structures and economic markets. This variability raises questions for normative theories of morality, but also holds promise for future descriptive work on moral thought and behavior. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Kant, cognitive psychotherapy, and the hardening of the categories.

    PubMed

    Nevid, Jeffrey S

    2007-12-01

    Contemporary models of psychotherapy owe a considerable intellectual debt to philosophy, even though the contributions of philosophers to contemporary practice in the field often go unrecognized. A case in point is Kant's epistemology, which is foundational to cognitive approaches to psychotherapy. Here, it is argued that the rigid use of certain judgments represented in Kant's conceptual scheme underlies patterns of distorted or dysfunctional thinking associated with emotional disorders. Kantian judgments of necessity, disjunction, particularity and universality have counterpoints in contemporary conceptions of cognitive distortions. Moreover, Kantian epistemology has important therapeutic implications with respect to helping people with emotional disorders recognize and challenge rigidly held judgments or categories of understanding. The Kantian perspective also leads us to consider the cognitive frameworks or thought structures that underlie dysfunctional thinking patterns.

  18. Happiness as a belief system: individual differences and priming in emotion judgments.

    PubMed

    Robinson, Michael D; Kirkeby, Ben S

    2005-08-01

    Three studies involving 104 undergraduates sought to examine how an individual's level of life satisfaction organizes their knowledge concerning the self's emotions. Participants judged the self's positive and negative emotions within a computerized task. Key results sought to determine whether judging two positive emotions in a consecutive sequence speeds the second judgment--a pattern of priming that would suggest a tighter, more interconnected structure in semantic memory related to one's positive emotions. As expected, individual differences in life satisfaction predicted the magnitude of this priming effect (Studies 1 & 2), which appeared to be unique to judgments of the self's emotions (Study 3). The results indicate that happy, relative to less happy, individuals organize information concerning their positive emotions in a qualitatively different and tighter semantic manner.

  19. An audit about clinical governance skills in Italian medical managers.

    PubMed

    Tafuri, S; Martinelli, D; Vece, M M; Prato, R; Germinario, C

    2013-01-01

    The objective of this study is to describe the knowledge and skills of managers working in health organizations in the Region of Puglia (South of Italy) on the principles and tools of clinical governance. A KAP (Knowledge, Attitudes and Practice) survey was conducted using a questionnaire. The target population of the survey was represented by Hospital Directors and Managers of local health care structures (Primary Care Districts, Public Health Departments, and Mental Health Departments). 92 managers participated at the study (response rate was 90.2%). 98.9% of respondents reported being aware of the concept of clinical governance and believe that clinical governance is an appropriate strategy for the continuous improvement in quality of services. 96.7% of respondents had heard of Evidence Based Practice and 80.6% reported using the method of EBP in nursing practice. The availability of guidelines for consultation was reported by 54.9% of respondents. Of those interviewed, 79.8% knew about Health Technology Assessment. 95.5% reported they have heard of clinical audit and 98.9% knowing the concept of risk management. In our survey, an high value judgment about clinical governance was reported by medical managers. The lower attitudes towards the use of the tools of clinical governance highlights an important discrepancy with respect to knowledge and opinions, which becomes more evident in community care structures. Above and beyond training managers, it is also necessary to change training methods used on all health personnel, which should be oriented towards EBM in order to build an adaptable organizational climate.

  20. Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism.

    PubMed

    Patil, Indrajeet; Melsbach, Jens; Hennig-Fast, Kristina; Silani, Giorgia

    2016-03-29

    This study investigated hypothetical moral choices in adults with high-functioning autism and the role of empathy and alexithymia in such choices. We used a highly emotionally salient moral dilemma task to investigate autistics' hypothetical moral evaluations about personally carrying out harmful utilitarian behaviours aimed at maximizing welfare. Results showed that they exhibited a normal pattern of moral judgments despite the deficits in social cognition and emotional processing. Further analyses revealed that this was due to mutually conflicting biases associated with autistic and alexithymic traits after accounting for shared variance: (a) autistic traits were associated with reduced utilitarian bias due to elevated personal distress of demanding social situations, while (b) alexithymic traits were associated with increased utilitarian bias on account of reduced empathic concern for the victim. Additionally, autistics relied on their non-verbal reasoning skills to rigidly abide by harm-norms. Thus, utilitarian moral judgments in autism were spared due to opposite influences of autistic and alexithymic traits and compensatory intellectual strategies. These findings demonstrate the importance of empathy and alexithymia in autistic moral cognition and have methodological implications for studying moral judgments in several other clinical populations.

  1. Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism

    PubMed Central

    Patil, Indrajeet; Melsbach, Jens; Hennig-Fast, Kristina; Silani, Giorgia

    2016-01-01

    This study investigated hypothetical moral choices in adults with high-functioning autism and the role of empathy and alexithymia in such choices. We used a highly emotionally salient moral dilemma task to investigate autistics’ hypothetical moral evaluations about personally carrying out harmful utilitarian behaviours aimed at maximizing welfare. Results showed that they exhibited a normal pattern of moral judgments despite the deficits in social cognition and emotional processing. Further analyses revealed that this was due to mutually conflicting biases associated with autistic and alexithymic traits after accounting for shared variance: (a) autistic traits were associated with reduced utilitarian bias due to elevated personal distress of demanding social situations, while (b) alexithymic traits were associated with increased utilitarian bias on account of reduced empathic concern for the victim. Additionally, autistics relied on their non-verbal reasoning skills to rigidly abide by harm-norms. Thus, utilitarian moral judgments in autism were spared due to opposite influences of autistic and alexithymic traits and compensatory intellectual strategies. These findings demonstrate the importance of empathy and alexithymia in autistic moral cognition and have methodological implications for studying moral judgments in several other clinical populations. PMID:27020307

  2. Validating the proposed diagnostic and statistical manual of mental disorders, 5th edition, severity indicator for personality disorder.

    PubMed

    Morey, Leslie C; Bender, Donna S; Skodol, Andrew E

    2013-09-01

    The authors sought to determine whether a 5-point global rating of personality dysfunction on the Level of Personality Functioning Scale proposed as a severity index for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), would be related to DSM-IV personality disorder diagnosis as well as to other key clinical judgments. Data were collected from a national sample of 337 mental health clinicians who provided complete diagnostic information relevant to DSM-IV and proposed DSM-5 personality disorder diagnoses, as well as demographic information and other clinical judgments, on one of their patients. Of the 337 patients described, 248 met criteria for 1 of the 10 specific DSM-IV personality disorders. A "moderate" or greater rating of impairment in personality functioning on the Level Scale demonstrated 84.6% sensitivity and 72.7% specificity for identifying patients meeting criteria for a specific DSM-IV personality disorder. The Level of Personality Functioning Scale had significant and substantial validity correlations with other measures of personality pathology and with clinical judgments regarding functioning, risk, prognosis, and optimal treatment intensity. Furthermore, the single-item Level of Personality Functioning rating was viewed as being as clinically useful as the 10 DSM-IV categories for treatment planning and patient description and was a better predictor of clinician ratings of broad psychosocial functioning than were the 10 DSM-IV categories combined. These results confirm hypotheses that the single-item Level of Personality Functioning Scale rating provides an indication of severity of personality pathology that predicts both assignment of personality disorder diagnosis and clinician appraisals of functioning, risk, prognosis, and needed treatment intensity.

  3. Genetics Home Reference: autosomal dominant nocturnal frontal lobe epilepsy

    MedlinePlus

    ... brain are involved in many critical functions, including reasoning, planning, judgment, and problem-solving. It is unclear ... E, Montagna P. Nocturnal frontal lobe epilepsy. A clinical and polygraphic overview of 100 consecutive cases. Brain. ...

  4. The Influence of Context on Residents' Evaluations: Effects of Priming on Clinical Judgment and Affect

    ERIC Educational Resources Information Center

    Teunissen, P. W.; Stapel, D. A.; Scheele, F.; Scherpbier, A. J. J. A.; Boor, K.; van Diemen-Steenvoorde, J. A. A. M.; van der Vleuten, C. P. M.

    2009-01-01

    Different lines of research have suggested that context is important in acting and learning in the clinical workplace. It is not clear how contextual information influences residents' constructions of the situations in which they participate. The category accessibility paradigm from social psychology appears to offer an interesting perspective for…

  5. Clinical Judgment in Science: Reply

    ERIC Educational Resources Information Center

    Westen, Drew; Weinberger, Joel

    2005-01-01

    This paper presents replies to comments published by M. S. Schulz and R. J. Waldinger, J. M. Wood and M. T. Nezworski, and H. N. Garb and W. M. Grove on the original article by D. Westen and J. Weinberger. Schulz and Waldinger (2005) make the important point that just as researchers can capitalize on the knowledge of experienced clinical observers…

  6. Grammar Clinical Marker Yields Substantial Heritability for Language Impairments in 16-Year-Old Twins

    ERIC Educational Resources Information Center

    Dale, Philip S.; Rice, Mabel L.; Rimfeld, Kaili; Hayiou-Thomas, Marianna E.

    2018-01-01

    Purpose: There is a need for well-defined language phenotypes suitable for adolescents in twin studies and other large-scale research projects. Rice, Hoffman, and Wexler (2009) have developed a grammatical judgment measure as a clinical marker of language impairment, which has an extended developmental range to adolescence. Method: We conducted…

  7. Abdominal shotgun trauma: A case report

    PubMed Central

    Toutouzas, Konstantinos G; Larentzakis, Andreas; Drimousis, Panagiotis; Riga, Maria; Theodorou, Dimitrios; Katsaragakis, Stylianos

    2008-01-01

    Introduction One of the most lethal mechanisms of injury is shotgun wound and particularly the abdominal one. Case presentation We report a case of a 45 years old male suffering abdominal shotgun trauma, who survived his injuries. Conclusion The management of the abdominal shotgun wounds is mainly dependent on clinical examination and clinical judgment, while requires advanced surgical skills. PMID:18625076

  8. Los Angeles Free Clinic [and]"Adolescent Health Care Programs That Work."

    ERIC Educational Resources Information Center

    Rainwater, Mary; De Caprio, Chris

    The first paper describes The Los Angeles Free Clinic and its services, which are specifically designed to respond to the needs of low-income and homeless youth within the community. The paper describes a free-of-charge, free-of-judgment comprehensive response system that exists because of collaboration with other health facilities such as…

  9. Observing functional actions affects semantic processing of tools: evidence of a motor-to-semantic priming.

    PubMed

    De Bellis, Francesco; Ferrara, Antonia; Errico, Domenico; Panico, Francesco; Sagliano, Laura; Conson, Massimiliano; Trojano, Luigi

    2016-01-01

    Recent evidence shows that activation of motor information can favor identification of related tools, thus suggesting a strict link between motor and conceptual knowledge in cognitive representation of tools. However, the involvement of motor information in further semantic processing has not been elucidated. In three experiments, we aimed to ascertain whether motor information provided by observation of actions could affect processing of conceptual knowledge about tools. In Experiment 1, healthy participants judged whether pairs of tools evoking different functional handgrips had the same function. In Experiment 2 participants judged whether tools were paired with appropriate recipients. Finally, in Experiment 3 we again required functional judgments as in Experiment 1, but also included in the set of stimuli pairs of objects having different function and similar functional handgrips. In all experiments, pictures displaying either functional grasping (aimed to use tools) or structural grasping (just aimed to move tools independently from their use) were presented before each stimulus pair. The results demonstrated that, in comparison with structural grasping, observing functional grasping facilitates judgments about tools' function when objects did not imply the same functional manipulation (Experiment 1), whereas worsened such judgments when objects shared functional grasp (Experiment 3). Instead, action observation did not affect judgments concerning tool-recipient associations (Experiment 2). Our findings support a task-dependent influence of motor information on high-order conceptual tasks and provide further insights into how motor and conceptual processing about tools can interact.

  10. Altered Neural Correlate of the Self-Agency Experience in First-Episode Schizophrenia-Spectrum Patients: An fMRI Study.

    PubMed

    Spaniel, Filip; Tintera, Jaroslav; Rydlo, Jan; Ibrahim, Ibrahim; Kasparek, Tomas; Horacek, Jiri; Zaytseva, Yuliya; Matejka, Martin; Fialova, Marketa; Slovakova, Andrea; Mikolas, Pavol; Melicher, Tomas; Görnerova, Natalie; Höschl, Cyril; Hajek, Tomas

    2016-07-01

    The phenomenology of the clinical symptoms indicates that disturbance of the sense of self be a core marker of schizophrenia. To compare neural activity related to the self/other-agency judgment in patients with first-episode schizophrenia-spectrum disorders (FES, n = 35) and healthy controls (HC, n = 35). A functional magnetic resonance imaging (fMRI) using motor task with temporal distortion of the visual feedback was employed. A task-related functional connectivity was analyzed with the use of independent component analysis (ICA). (1) During self-agency experience, FES showed a deficit in cortical activation in medial frontal gyrus (BA 10) and posterior cingulate gyrus, (BA 31; P < .05, Family-Wise Error [FWE] corrected). (2) Pooled-sample task-related ICA revealed that the self/other-agency judgment was dependent upon anti-correlated default mode and central-executive networks (DMN/CEN) dynamic switching. This antagonistic mechanism was substantially impaired in FES during the task. During self-agency experience, FES demonstrate deficit in engagement of cortical midline structures along with substantial attenuation of anti-correlated DMN/CEN activity underlying normal self/other-agency discriminative processes. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  11. Phonological Similarity in American Sign Language.

    ERIC Educational Resources Information Center

    Hildebrandt, Ursula; Corina, David

    2002-01-01

    Investigates deaf and hearing subjects' ratings of American Sign Language (ASL) signs to assess whether linguistic experience shapes judgments of sign similarity. Findings are consistent with linguistic theories that posit movement and location as core structural elements of syllable structure in ASL. (Author/VWL)

  12. Uncertainty of Comparative Judgments and Multidimensional Structure

    ERIC Educational Resources Information Center

    Sjoberg, Lennart

    1975-01-01

    An analysis of preferences with respect to silhouette drawings of nude females is presented. Systematic intransitivities were discovered. The dispersions of differences (comparatal dispersons) were shown to reflect the multidimensional structure of the stimuli, a finding expected on the basis of prior work. (Author)

  13. The conscious, the unconscious, and familiarity.

    PubMed

    Scott, Ryan B; Dienes, Zoltán

    2008-09-01

    This article examines the role of subjective familiarity in the implicit and explicit learning of artificial grammars. Experiment 1 found that objective measures of similarity (including fragment frequency and repetition structure) predicted ratings of familiarity, that familiarity ratings predicted grammaticality judgments, and that the extremity of familiarity ratings predicted confidence. Familiarity was further shown to predict judgments in the absence of confidence, hence contributing to above-chance guessing. Experiment 2 found that confidence developed as participants refined their knowledge of the distribution of familiarity and that differences in familiarity could be exploited prior to confidence developing. Experiment 3 found that familiarity was consciously exploited to make grammaticality judgments including those made without confidence and that familiarity could in some instances influence participants' grammaticality judgments apparently without their awareness. All 3 experiments found that knowledge distinct from familiarity was derived only under deliberate learning conditions. The results provide decisive evidence that familiarity is the essential source of knowledge in artificial grammar learning while also supporting a dual-process model of implicit and explicit learning. (c) 2008 APA, all rights reserved.

  14. Clinical reasoning: concept analysis.

    PubMed

    Simmons, Barbara

    2010-05-01

    This paper is a report of a concept analysis of clinical reasoning in nursing. Clinical reasoning is an ambiguous term that is often used synonymously with decision-making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources. Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision-making. Our concept analysis defines one of these terms, 'clinical reasoning,' as a complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. This concept analysis provides a middle-range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations.

  15. Social trait judgment and affect recognition from static faces and video vignettes in schizophrenia

    PubMed Central

    McIntosh, Lindsey G.; Park, Sohee

    2014-01-01

    Social impairment is a core feature of schizophrenia, present from the pre-morbid stage and predictive of outcome, but the etiology of this deficit remains poorly understood. Successful and adaptive social interactions depend on one’s ability to make rapid and accurate judgments about others in real time. Our surprising ability to form accurate first impressions from brief exposures, known as “thin slices” of behavior has been studied very extensively in healthy participants. We sought to examine affect and social trait judgment from thin slices of static or video stimuli in order to investigate the ability of schizophrenic individuals to form reliable social impressions of others. 21 individuals with schizophrenia (SZ) and 20 matched healthy participants (HC) were asked to identify emotions and social traits for actors in standardized face stimuli as well as brief video clips. Sound was removed from videos to remove all verbal cues. Clinical symptoms in SZ and delusional ideation in both groups were measured. Results showed a general impairment in affect recognition for both types of stimuli in SZ. However, the two groups did not differ in the judgments of trustworthiness, approachability, attractiveness, and intelligence. Interestingly, in SZ, the severity of positive symptoms was correlated with higher ratings of attractiveness, trustworthiness, and approachability. Finally, increased delusional ideation in SZ was associated with a tendency to rate others as more trustworthy, while the opposite was true for HC. These findings suggest that complex social judgments in SZ are affected by symptomatology. PMID:25037526

  16. Review of the refeeding syndrome.

    PubMed

    Kraft, Michael D; Btaiche, Imad F; Sacks, Gordon S

    2005-12-01

    Refeeding syndrome describes a constellation of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. We reviewed literature on refeeding syndrome and the associated electrolyte abnormalities, fluid disturbances, and associated complications. In addition to assessing scientific literature, we also considered clinical experience and judgment in developing recommendations for prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk for developing refeeding syndrome, institute nutrition support cautiously, and correct and supplement electrolyte and vitamin deficiencies to avoid refeeding syndrome. We provide suggestions for the prevention of refeeding syndrome and suggestions for treatment of electrolyte disturbances and complications in patients who develop refeeding syndrome, according to evidence in the literature, the pathophysiology of refeeding syndrome, and clinical experience and judgment.

  17. Integrating nursing diagnostic concepts into the medical entities dictionary using the ISO Reference Terminology Model for Nursing Diagnosis.

    PubMed

    Hwang, Jee-In; Cimino, James J; Bakken, Suzanne

    2003-01-01

    The purposes of the study were (1) to evaluate the usefulness of the International Standards Organization (ISO) Reference Terminology Model for Nursing Diagnoses as a terminology model for defining nursing diagnostic concepts in the Medical Entities Dictionary (MED) and (2) to create the additional hierarchical structures required for integration of nursing diagnostic concepts into the MED. The authors dissected nursing diagnostic terms from two source terminologies (Home Health Care Classification and the Omaha System) into the semantic categories of the ISO model. Consistent with the ISO model, they selected Focus and Judgment as required semantic categories for creating intensional definitions of nursing diagnostic concepts in the MED. Because the MED does not include Focus and Judgment hierarchies, the authors developed them to define the nursing diagnostic concepts. The ISO model was sufficient for dissecting the source terminologies into atomic terms. The authors identified 162 unique focus concepts from the 266 nursing diagnosis terms for inclusion in the Focus hierarchy. For the Judgment hierarchy, the authors precoordinated Judgment and Potentiality instead of using Potentiality as a qualifier of Judgment as in the ISO model. Impairment and Alteration were the most frequently occurring judgments. Nursing care represents a large proportion of health care activities; thus, it is vital that terms used by nurses are integrated into concept-oriented terminologies that provide broad coverage for the domain of health care. This study supports the utility of the ISO Reference Terminology Model for Nursing Diagnoses as a facilitator for the integration process.

  18. Integrating Nursing Diagnostic Concepts into the Medical Entities Dictionary Using the ISO Reference Terminology Model for Nursing Diagnosis

    PubMed Central

    Hwang, Jee-In; Cimino, James J.; Bakken, Suzanne

    2003-01-01

    Objective: The purposes of the study were (1) to evaluate the usefulness of the International Standards Organization (ISO) Reference Terminology Model for Nursing Diagnoses as a terminology model for defining nursing diagnostic concepts in the Medical Entities Dictionary (MED) and (2) to create the additional hierarchical structures required for integration of nursing diagnostic concepts into the MED. Design and Measurements: The authors dissected nursing diagnostic terms from two source terminologies (Home Health Care Classification and the Omaha System) into the semantic categories of the ISO model. Consistent with the ISO model, they selected Focus and Judgment as required semantic categories for creating intensional definitions of nursing diagnostic concepts in the MED. Because the MED does not include Focus and Judgment hierarchies, the authors developed them to define the nursing diagnostic concepts. Results: The ISO model was sufficient for dissecting the source terminologies into atomic terms. The authors identified 162 unique focus concepts from the 266 nursing diagnosis terms for inclusion in the Focus hierarchy. For the Judgment hierarchy, the authors precoordinated Judgment and Potentiality instead of using Potentiality as a qualifier of Judgment as in the ISO model. Impairment and Alteration were the most frequently occurring judgments. Conclusions: Nursing care represents a large proportion of health care activities; thus, it is vital that terms used by nurses are integrated into concept-oriented terminologies that provide broad coverage for the domain of health care. This study supports the utility of the ISO Reference Terminology Model for Nursing Diagnoses as a facilitator for the integration process. PMID:12668692

  19. What Medical Oncologist Residents Think about the Italian Speciality Schools: A Survey of the Italian Association of Medical Oncology (AIOM) on Educational, Clinical and Research Activities

    PubMed Central

    Moretti, Anna; De Angelis, Carmine; Lambertini, Matteo; Cremolini, Chiara; Imbimbo, Martina; Berardi, Rossana; Di Maio, Massimo; Cascinu, Stefano; La Verde, Nicla

    2016-01-01

    Background and objectives Relevant heterogeneity exists among Postgraduate Schools in Medical Oncology, also within the same country. In order to provide a comprehensive overview of the landscape of Italian Postgraduate Schools in Medical Oncology, the Italian Association of Medical Oncology (AIOM) undertook an online survey, inviting all the residents to describe their daily activities and to express their overall satisfaction about their programs. Methods A team composed of five residents and three consultants in medical oncology prepared a 38 items questionnaire that was published online in a reserved section, accessible through a link sent by e-mail. Residents were invited to anonymously fill in the questionnaire that included the following sub-sections: quality of teaching, clinical and research activity, overall satisfaction. Results Three-hundred and eleven (57%) out of 547 invited residents filled in the questionnaire. Two-hundred and twenty-three (72%) participants declared that attending lessons was frequently difficult and 153 (49%) declared they did not gain substantial improvement in their knowledge from them. Fifty-five percent stated that they did not receive lessons on palliative care. Their overall judgment about didactic activity was low in 63% of the interviewed. The satisfaction for clinical activity was in 86% of cases good: 84% recognized that, during the training period, they acquired a progressive independence on patients' management. About research activity, the majority (79%) of participants in the survey was actively engaged in managing patients included in clinical trials but the satisfaction level for the involvement in research activities was quite low (54%). Overall, 246 residents (79%) gave a positive global judgment of their Medical Oncology Schools. Conclusions The landscape of Italian Postgraduate Schools in Medical Oncology is quite heterogeneous across the country. Some improvements in the organization of teaching and in the access to research opportunity are needed; the perception about clinical activity and the overall judgment of the programs are quite satisfactory. PMID:27403529

  20. What Medical Oncologist Residents Think about the Italian Speciality Schools: A Survey of the Italian Association of Medical Oncology (AIOM) on Educational, Clinical and Research Activities.

    PubMed

    Moretti, Anna; Ghidini, Michele; De Angelis, Carmine; Lambertini, Matteo; Cremolini, Chiara; Imbimbo, Martina; Berardi, Rossana; Di Maio, Massimo; Cascinu, Stefano; La Verde, Nicla

    2016-01-01

    Relevant heterogeneity exists among Postgraduate Schools in Medical Oncology, also within the same country. In order to provide a comprehensive overview of the landscape of Italian Postgraduate Schools in Medical Oncology, the Italian Association of Medical Oncology (AIOM) undertook an online survey, inviting all the residents to describe their daily activities and to express their overall satisfaction about their programs. A team composed of five residents and three consultants in medical oncology prepared a 38 items questionnaire that was published online in a reserved section, accessible through a link sent by e-mail. Residents were invited to anonymously fill in the questionnaire that included the following sub-sections: quality of teaching, clinical and research activity, overall satisfaction. Three-hundred and eleven (57%) out of 547 invited residents filled in the questionnaire. Two-hundred and twenty-three (72%) participants declared that attending lessons was frequently difficult and 153 (49%) declared they did not gain substantial improvement in their knowledge from them. Fifty-five percent stated that they did not receive lessons on palliative care. Their overall judgment about didactic activity was low in 63% of the interviewed. The satisfaction for clinical activity was in 86% of cases good: 84% recognized that, during the training period, they acquired a progressive independence on patients' management. About research activity, the majority (79%) of participants in the survey was actively engaged in managing patients included in clinical trials but the satisfaction level for the involvement in research activities was quite low (54%). Overall, 246 residents (79%) gave a positive global judgment of their Medical Oncology Schools. The landscape of Italian Postgraduate Schools in Medical Oncology is quite heterogeneous across the country. Some improvements in the organization of teaching and in the access to research opportunity are needed; the perception about clinical activity and the overall judgment of the programs are quite satisfactory.

  1. Reasoning about Causal Relationships: Inferences on Causal Networks

    PubMed Central

    Rottman, Benjamin Margolin; Hastie, Reid

    2013-01-01

    Over the last decade, a normative framework for making causal inferences, Bayesian Probabilistic Causal Networks, has come to dominate psychological studies of inference based on causal relationships. The following causal networks—[X→Y→Z, X←Y→Z, X→Y←Z]—supply answers for questions like, “Suppose both X and Y occur, what is the probability Z occurs?” or “Suppose you intervene and make Y occur, what is the probability Z occurs?” In this review, we provide a tutorial for how normatively to calculate these inferences. Then, we systematically detail the results of behavioral studies comparing human qualitative and quantitative judgments to the normative calculations for many network structures and for several types of inferences on those networks. Overall, when the normative calculations imply that an inference should increase, judgments usually go up; when calculations imply a decrease, judgments usually go down. However, two systematic deviations appear. First, people’s inferences violate the Markov assumption. For example, when inferring Z from the structure X→Y→Z, people think that X is relevant even when Y completely mediates the relationship between X and Z. Second, even when people’s inferences are directionally consistent with the normative calculations, they are often not as sensitive to the parameters and the structure of the network as they should be. We conclude with a discussion of productive directions for future research. PMID:23544658

  2. "A Very Steep Climb": Therapists' Perspectives on Barriers to Disclosure of Child Sexual Abuse Experiences for Men.

    PubMed

    Gruenfeld, Elizabeth; Willis, Danny G; Easton, Scott D

    2017-01-01

    Recent studies indicate that men experience unique barriers to disclosure of child sexual abuse. Blind spots held by mental health providers and social service agencies may inadvertently help produce and sustain these barriers. However, therapists who specialize in treating this population may also hold important insights into the barriers clients face. Because delayed and nondisclosure of child sexual abuse have been associated with negative mental health outcomes for adult survivors, understanding these barriers is critical to improve clinical practice and facilitate help-seeking. Using conventional content analysis, this study examined the perceptions of nine therapists who specialize in the treatment of men who were sexually abused in childhood, many of whom are considered pioneers in the field. Analyses identified nine types of barriers, which were organized into three categories: intrapersonal experience (difficult feelings, lack of language, and self-engagement), social milieu (internalized social stigma, negative responses, social loss or judgment, and masculine identity dissonance), and health care environment (structural barriers, relational challenges with therapists, and unhelpful therapeutic strategies). Implications for future research, clinical training, and clinical practice are discussed.

  3. Atherectomy for calcified coronary lesions: When and how?

    PubMed

    Karatasakis, Aris; Brilakis, Emmanouil S

    2016-03-01

    Percutaneous coronary intervention of heavily calcified lesions can be challenging. Although the ROTAXUS trial did not demonstrate long-term clinical benefit with routine rotational atherectomy, atherectomy remains an indispensable tool to achieve acute procedural success. Until new data becomes available determining when and how to optimally use coronary atherectomy depends heavily on personal experience and clinical judgment. © 2016 Wiley Periodicals, Inc.

  4. Assessing severity of patients with community-acquired pneumonia.

    PubMed

    Pereira, Jose Manuel; Paiva, Jose Artur; Rello, Jordi

    2012-06-01

    Despite all advances in its management, community-acquired pneumonia (CAP) is still an important cause of morbidity and mortality requiring a great consumption of health, social, and economic resources. An early and adequate severity assessment is of paramount importance to provide optimized care to these patients. In the last 2 decades, this issue has been the subject of extensive research. Based on 30 day mortality, several prediction rules have been proposed to aid clinicians in deciding on the appropriate site of care. In spite of being well validated, their sensitivity and specificity vary, which limits their widespread use. The utility of biomarkers to overcome this problem has been investigated. At this moment, their full clinical value remains undetermined, and no single biomarker is consistently ideal for assessing CAP severity. Biomarkers should be seen as a complement rather than superseding clinical judgment or validated clinical scores. The search for a gold standard is not over, and new tools, like bacterial DNA load, are in the pipeline. Until then, CAP severity assessment should be based in three key points: a pneumonia-specific score, biomarkers, and clinical judgment. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. A sampling model of social judgment.

    PubMed

    Galesic, Mirta; Olsson, Henrik; Rieskamp, Jörg

    2018-04-01

    Studies of social judgments have demonstrated a number of diverse phenomena that were so far difficult to explain within a single theoretical framework. Prominent examples are false consensus and false uniqueness, as well as self-enhancement and self-depreciation. Here we show that these seemingly complex phenomena can be a product of an interplay between basic cognitive processes and the structure of social and task environments. We propose and test a new process model of social judgment, the social sampling model (SSM), which provides a parsimonious quantitative account of different types of social judgments. In the SSM, judgments about characteristics of broader social environments are based on sampling of social instances from memory, where instances receive activation if they belong to a target reference class and have a particular characteristic. These sampling processes interact with the properties of social and task environments, including homophily, shapes of frequency distributions, and question formats. For example, in line with the model's predictions we found that whether false consensus or false uniqueness will occur depends on the level of homophily in people's social circles and on the way questions are asked. The model also explains some previously unaccounted-for patterns of self-enhancement and self-depreciation. People seem to be well informed about many characteristics of their immediate social circles, which in turn influence how they evaluate broader social environments and their position within them. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  6. Using a fuzzy comprehensive evaluation method to determine product usability: A proposed theoretical framework.

    PubMed

    Zhou, Ronggang; Chan, Alan H S

    2017-01-01

    In order to compare existing usability data to ideal goals or to that for other products, usability practitioners have tried to develop a framework for deriving an integrated metric. However, most current usability methods with this aim rely heavily on human judgment about the various attributes of a product, but often fail to take into account of the inherent uncertainties in these judgments in the evaluation process. This paper presents a universal method of usability evaluation by combining the analytic hierarchical process (AHP) and the fuzzy evaluation method. By integrating multiple sources of uncertain information during product usability evaluation, the method proposed here aims to derive an index that is structured hierarchically in terms of the three usability components of effectiveness, efficiency, and user satisfaction of a product. With consideration of the theoretical basis of fuzzy evaluation, a two-layer comprehensive evaluation index was first constructed. After the membership functions were determined by an expert panel, the evaluation appraisals were computed by using the fuzzy comprehensive evaluation technique model to characterize fuzzy human judgments. Then with the use of AHP, the weights of usability components were elicited from these experts. Compared to traditional usability evaluation methods, the major strength of the fuzzy method is that it captures the fuzziness and uncertainties in human judgments and provides an integrated framework that combines the vague judgments from multiple stages of a product evaluation process.

  7. School Perceptions of Children Raised by Grandparents

    ERIC Educational Resources Information Center

    Edwards, Oliver W.

    2018-01-01

    Increasing numbers of children raised by grandparents are students in schools. Their substitute family structure and precursors to the emergence of this family structure have implications for the children's school performance. Research suggests teachers view these children as at risk for difficult school functioning. The aforementioned judgment is…

  8. Detecting fast, online reasoning processes in clinical decision making.

    PubMed

    Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio

    2014-06-01

    In an experiment that used the inconsistency paradigm, experienced clinical psychologists and psychology students performed a reading task using clinical reports and a diagnostic judgment task. The clinical reports provided information about the symptoms of hypothetical clients who had been previously diagnosed with a specific mental disorder. Reading times of inconsistent target sentences were slower than those of control sentences, demonstrating an inconsistency effect. The results also showed that experienced clinicians gave different weights to different symptoms according to their relevance when fluently reading the clinical reports provided, despite the fact that all the symptoms were of equal diagnostic value according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The diagnostic judgment task yielded a similar pattern of results. In contrast to previous findings, the results of the reading task may be taken as direct evidence of the intervention of reasoning processes that occur very early, rapidly, and online. We suggest that these processes are based on the representation of mental disorders and that these representations are particularly suited to fast retrieval from memory and to making inferences. They may also be related to the clinicians' causal reasoning. The implications of these results for clinician training are also discussed.

  9. Determining dangerousness in sexually violent predator evaluations: cognitive-experiential self-theory and juror judgments of expert testimony.

    PubMed

    Lieberman, Joel D; Krauss, Daniel A; Kyger, Mariel; Lehoux, Maribeth

    2007-01-01

    Past research examining the effects of expert testimony on the future dangerousness of a defendant in death penalty sentencing found that jurors are more influenced by less scientific clinical expert testimony and tend to devalue scientific actuarial testimony. This study was designed to determine whether these findings extend to civil commitment trials for sexual offenders and to test a theoretical rationale for this effect. In addition, we investigated the influence of a recently developed innovation in risk assessment procedures, Guided Professional Judgment (GPJ) instruments. Consistent with a cognitive-experiential self-theory based explanation, mock jurors motivated to process information in an experiential condition were more influenced by clinical testimony, while mock jurors in a rational mode were more influenced by actuarial testimony. Participants responded to clinical and GPJ testimony in a similar manner. However, participants' gender exerted important interactive effects on dangerousness decisions, with male jurors showing the predicted effect while females did not. The policy implications of these findings are discussed. 2007 John Wiley & Sons, Ltd

  10. The role of sexual abuse on functional neuroimaging markers associated with major depressive disorder.

    PubMed

    Skokauskas, Norbert; Carballedo, Angela; Fagan, Andrew; Frodl, Thomas

    2015-10-01

    Victims of child sexual abuse can develop depression and other mental health conditions that follow them well into adulthood. This study aimed to clarify the role of sexual abuse (SA) on functional imaging markers associated with MDD. Thirty-seven patients with MDD only; and 13 patients with both MDD and SA and 43 healthy controls performed emotional attention shifting tasks during fMRI session. Clinical diagnoses were made by consultant psychiatrists based on the DSM-IV-TR criteria and diagnoses were confirmed using SCID-I. Magnetic resonance images were obtained with a Philips Achieva 3 Tesla MRI scanner. Short form childhood trauma questionnaire, Hamilton Rating Scale for Depression and Beck's Depression Inventory were also employed. Data were analysed with Statistical Parametric Mapping 8 (SPM8). Using the contrast judgment of emotion minus judgment of geometry following emotional neutral stimuli, patients with MDD showed significantly reduced activation in comparison to healthy controls in the area of the right fusiform gyrus. With the contrast judgment of emotion minus judgment of geometry following emotional negative stimuli, participants with MDD and SA showed significantly higher activation in the area of the left inferior parietal lobe in comparison to participants with MDD without SA. The history of sexual abuse affects functional neuroimaging markers associated with major depressive disorder.

  11. From aggregation to interpretation: how assessors judge complex data in a competency-based portfolio.

    PubMed

    Oudkerk Pool, Andrea; Govaerts, Marjan J B; Jaarsma, Debbie A D C; Driessen, Erik W

    2018-05-01

    While portfolios are increasingly used to assess competence, the validity of such portfolio-based assessments has hitherto remained unconfirmed. The purpose of the present research is therefore to further our understanding of how assessors form judgments when interpreting the complex data included in a competency-based portfolio. Eighteen assessors appraised one of three competency-based mock portfolios while thinking aloud, before taking part in semi-structured interviews. A thematic analysis of the think-aloud protocols and interviews revealed that assessors reached judgments through a 3-phase cyclical cognitive process of acquiring, organizing, and integrating evidence. Upon conclusion of the first cycle, assessors reviewed the remaining portfolio evidence to look for confirming or disconfirming evidence. Assessors were inclined to stick to their initial judgments even when confronted with seemingly disconfirming evidence. Although assessors reached similar final (pass-fail) judgments of students' professional competence, they differed in their information-processing approaches and the reasoning behind their judgments. Differences sprung from assessors' divergent assessment beliefs, performance theories, and inferences about the student. Assessment beliefs refer to assessors' opinions about what kind of evidence gives the most valuable and trustworthy information about the student's competence, whereas assessors' performance theories concern their conceptualizations of what constitutes professional competence and competent performance. Even when using the same pieces of information, assessors furthermore differed with respect to inferences about the student as a person as well as a (future) professional. Our findings support the notion that assessors' reasoning in judgment and decision-making varies and is guided by their mental models of performance assessment, potentially impacting feedback and the credibility of decisions. Our findings also lend further credence to the assertion that portfolios should be judged by multiple assessors who should, moreover, thoroughly substantiate their judgments. Finally, it is suggested that portfolios be designed in such a way that they facilitate the selection of and navigation through the portfolio evidence.

  12. Examination of clinical and cognitive insight in acute schizophrenia patients.

    PubMed

    Greenberger, Cheryl; Serper, Mark R

    2010-07-01

    Lack of insight or awareness of illness is a hallmark feature of schizophrenic illness and has become an increasingly important area of investigation. Although clinical insight focuses on awareness of illness factors, the concept of cognitive insight focuses on the cognitive processes involved in correcting erroneous judgments and certainty about mistaken judgments. The present study was aimed at further investigating the clinical utility and the statistical coherence of the Beck Cognitive Insight Scale (BCIS) (Beck et al., 2004) in acute schizoaffective and schizophrenia (SZ) patients. The present study examined the internal consistency of the scale, as well as its discriminative and predictive validity relative to a well-established traditional measure of clinical insight in a sample of 50 DSM-IV diagnosed SZ patients, presenting for acute inpatient treatment. The BCIS was found to be an internally consistent and a coherent measure of cognitive insight. The BCIS was unassociated with clinical insight, indicating the 2 constructs share little empirical overlap. Cognitive insight was found to be inversely associated with patients' severity of autistic preoccupation symptoms such that those individuals with more cognitive insight, exhibited fewer autistic/cognitive symptoms. Patients' clinical insight, however, was found to be inversely associated specifically with patients' severity of depression. Additionally, clinical insight was also found to be more impaired in patients residing in nursing home environments relative to their counterparts living in less restrictive settings when outside the hospital. Results are discussed in terms of the relationship between clinical and cognitive insight constructs to SZ symptom domains.

  13. Non-Bayesian Inference: Causal Structure Trumps Correlation

    ERIC Educational Resources Information Center

    Bes, Benedicte; Sloman, Steven; Lucas, Christopher G.; Raufaste, Eric

    2012-01-01

    The study tests the hypothesis that conditional probability judgments can be influenced by causal links between the target event and the evidence even when the statistical relations among variables are held constant. Three experiments varied the causal structure relating three variables and found that (a) the target event was perceived as more…

  14. Developmental frontal lobe imaging in moral judgment: Arthur Benton's enduring influence 60 years later.

    PubMed

    Eslinger, Paul J; Robinson-Long, Melissa; Realmuto, Jennifer; Moll, Jorge; deOliveira-Souza, Ricardo; Tovar-Moll, Fernanda; Wang, Jianli; Yang, Qing X

    2009-02-01

    Early prefrontal cortex damage has been associated with developmental deficits in social adaptation, moral behavior, and empathy that alter the maturation of social cognition and social emotions. The seminal case of Ackerly and Benton (1948) continues to provide the most striking clinical example of prefrontal-related neurodevelopmental impairments, with more recent case reports confirming and elaborating these influential observations. This study investigated the prefrontal hypothesis of moral decision making in healthy, typically developing children and adolescents (10-17 years of age) using functional magnetic resonance imaging (fMRI). Participants judged the actions in age-appropriate moral vignettes as right or wrong, and results were contrasted to a nonsocial/nonmoral baseline condition requiring similar right versus wrong judgments. Results confirmed a predominant cluster of activity in the most rostral-medial (frontal polar) prefrontal region across moral judgment conditions, along with left lateroposterior orbitofrontal/ventrolateral prefrontal, left temporoparietal junction, midline thalamus and globus pallidus, and bilateral inferior occipital clusters. Trials entailing ambiguous moral situations activated considerably more prefrontal and parietal regions than did routine moral situations, suggesting the need for more neurocognitive resources. While age regression analysis identified a few regions of greater or lesser activity with age, the frontal polar activations did not change with age. Findings confirm a significant role for anterior-medial prefrontal cortex in the typical development and maturation of moral decision making, consistent with clinical lesion case descriptions.

  15. Duration, distance, and speed judgments of two moving objects by 4- to 11-year olds.

    PubMed

    Matsuda, F

    1996-11-01

    Four- to 11-year-old children (N = 133) made duration, distance, and speed judgments on a Piagetian task where two cars ran on two parallel tracks. Special effort was made to make duration judgment tasks and distance judgment tasks comparable. Among younger children, difficulties of duration judgments and distance judgments were approximately the same. Additionally, temporal attributes had nearly the same effects on duration judgments as spatial attributes had on distance judgments, and spatial attributes had nearly the same effects on duration judgments as temporal attributes had on distance judgments. Among older children, distance judgments were easier than duration judgments, and the above-mentioned symmetry in effects of temporal and spatial attributes decreased somewhat. Temporal and spatial attributes affected speed judgments equally, across age groups.

  16. Task-dependency and structure-dependency in number interference effects in sentence comprehension

    PubMed Central

    Franck, Julie; Colonna, Saveria; Rizzi, Luigi

    2015-01-01

    We report three experiments on French that explore number mismatch effects in intervention configurations in the comprehension of object A’-dependencies, relative clauses and questions. The study capitalizes on the finding of object attraction in sentence production, in which speakers sometimes erroneously produce a verb that agrees in number with a plural object in object relative clauses. Evidence points to the role of three critical constructs from formal syntax: intervention, intermediate traces and c-command (Franck et al., 2010). Experiment 1, using a self-paced reading procedure on these grammatical structures with an agreement error on the verb, shows an enhancing effect of number mismatch in intervention configurations, with faster reading times with plural (mismatching) objects. Experiment 2, using an on-line grammaticality judgment task on the ungrammatical versions of these structures, shows an interference effect in the form of attraction, with slower response times with plural objects. Experiment 3 with a similar grammaticality judgment task shows stronger attraction from c-commanding than from preceding interveners. Overall, the data suggest that syntactic computations in performance refer to the same syntactic representations in production and comprehension, but that different tasks tap into different processes involved in parsing: whereas performance in self-paced reading reflects the intervention of the subject in the process of building an object A’-dependency, performance in grammaticality judgment reflects intervention of the object on the computation of the subject-verb agreement dependency. The latter shows the hallmarks of structure-dependent attraction effects in sentence production, in particular, a sensitivity to specific characteristics of hierarchical representations. PMID:25914652

  17. Professionalism and clinical autonomy in the practice of medicine.

    PubMed

    Morreim, E Haavi

    2002-11-01

    Professionalism in medicine requires a reasonable measure of freedom for physicians to determine patients needs based on their own judgment. However, because virtually every medical decision is also a spending decision, third-party payers concerned about rising health care costs have introduced cost-containment tactics that significantly limit physicians accustomed autonomy. In response, groups of physicians have filed class-action lawsuits against managed care plans, alleging causes of action such as fraud, breach of contract, extortion, and violations of federal RICO (Racketeer-Influenced and Corrupt Organizations) law. Such litigation may have merits, but it also faces significant obstacles, in part because the contracts involved may not actually have promised the broad measure of clinical autonomy that the physicians allege was promised, then denied. As physicians seek to restore and retain their professional autonomy, it will be important for them to be increasingly proactive in structuring or modifying the contracts under whose terms they practice as some physicians have successfully done.

  18. Regression equations for calculation of z scores for echocardiographic measurements of left heart structures in healthy Han Chinese children.

    PubMed

    Wang, Shan-Shan; Hong, Wen-Jing; Zhang, Yu-Qi; Chen, Shu-Bao; Huang, Guo-Ying; Zhang, Hong-Yan; Chen, Li-Jun; Wu, Lan-Ping; Shen, Rong; Liu, Yi-Qing; Zhu, Jun-Xue

    2018-06-01

    Clinical decision making in children with heart disease relies on detailed measurements of cardiac structures using two-dimensional and M-mode echocardiography. However, no echocardiographic reference values are available for the Chinese children. We aimed to establish z-score regression equations for left heart structures in a population-based cohort of healthy Chinese Han children. Echocardiography was performed in 545 children with a normal heart. The dimensions of the aortic valve annulus (AVA), aortic sinuses of Valsalva (ASV), sinotubular junction (STJ), ascending aorta (AAO), left atrium (LA), mitral valve annulus (MVA), interventricular septal end-diastolic thickness (IVSd), interventricular septal end-systolic thickness (IVSs), left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular posterior wall end-diastolic thickness (LVPWd), left ventricular posterior wall end-systolic thickness (LVPWs) were measured. Regression analyses were conducted to relate the measurements of left heart structures to body surface area (BSA). Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were calculated. Several models were used, and the adjusted R2 values were compared for each model. AVA, ASV, STJ, AAO, LA, MVA, IVSd, IVSs, LVIDd, LVIDs, LVPWd, and LVPWs had a cubic relationship with BSA. LVEF and LVFS fell within a narrow range. Our results provide reference values for z scores and regression equations for left heart structures in Han Chinese children. These data may help make a quick and accurate judgment of the routine clinical measurement of left heart structures in children with heart disease. © 2018 Wiley Periodicals, Inc.

  19. Neural Substrates for Judgment of Self-Agency in Ambiguous Situations

    PubMed Central

    Fukushima, Hirokata; Goto, Yurie; Maeda, Takaki; Kato, Motoichiro; Umeda, Satoshi

    2013-01-01

    The sense of agency is the attribution of oneself as the cause of one’s own actions and their effects. Accurate agency judgments are essential for adaptive behaviors in dynamic environments, especially in conditions of uncertainty. However, it is unclear how agency judgments are made in ambiguous situations where self-agency and non-self-agency are both possible. Agency attribution is thus thought to require higher-order neurocognitive processes that integrate several possibilities. Furthermore, neural activity specific to self-attribution, as compared with non-self-attribution, may reflect higher-order critical operations that contribute to constructions of self-consciousness. Based on these assumptions, the present study focused on agency judgments under ambiguous conditions and examined the neural correlates of this operation with functional magnetic resonance imaging. Participants performed a simple but demanding agency-judgment task, which required them to report on whether they attributed their own action as the cause of a visual stimulus change. The temporal discrepancy between the participant’s action and the visual events was adaptively set to be maximally ambiguous for each individual on a trial-by-trial basis. Comparison with results for a control condition revealed that the judgment of agency was associated with activity in lateral temporo-parietal areas, medial frontal areas, the dorsolateral prefrontal area, and frontal operculum/insula regions. However, most of these areas did not differentiate between self- and non-self-attribution. Instead, self-attribution was associated with activity in posterior midline areas, including the precuneus and posterior cingulate cortex. These results suggest that deliberate self-attribution of an external event is principally associated with activity in posterior midline structures, which is imperative for self-consciousness. PMID:23977268

  20. What's fair is fair--or is it? Value differences underlying public views about social justice.

    PubMed

    Rasinski, K A

    1987-07-01

    Individual differences in judgments of the fairness of various sociopolitical phenomena were examined in three surveys. Scales measuring two value dimensions thought to underlie the meaning of fairness were constructed, and survey respondents endorsing these different values were compared on their evaluation of the procedural and distributive fairness of political objects. Those endorsing the value of proportionality, hypothesized by equity theorists to underlie fairness judgments, judged equity-based public policies to be fairer than equality-based policies and judged that Ronald Reagan would be a fairer president than Walter Mondale. These people also emphasized the procedural aspects of government when judging government fairness. Respondents endorsing the value of egalitarianism, hypothesized by developmental theorists and some political philosophers to underlie fairness judgments, judged equality-based public policies to be fairer than equity-based policies and judged that Mondale would be a fairer president than Reagan. These people emphasized the distributive aspects of government when judging government fairness. Results support the naive moral philosopher image of the individual as judge of political objects (Tyler, 1984a). Political fairness judgments are ideological responses and are subject to the influence of the value structure of the judge (Tetlock, 1986).

  1. Emerging Technologies for Environmental Remediation: Integrating Data and Judgment.

    PubMed

    Bates, Matthew E; Grieger, Khara D; Trump, Benjamin D; Keisler, Jeffrey M; Plourde, Kenton J; Linkov, Igor

    2016-01-05

    Emerging technologies present significant challenges to researchers, decision-makers, industry professionals, and other stakeholder groups due to the lack of quantitative risk, benefit, and cost data associated with their use. Multi-criteria decision analysis (MCDA) can support early decisions for emerging technologies when data is too sparse or uncertain for traditional risk assessment. It does this by integrating expert judgment with available quantitative and qualitative inputs across multiple criteria to provide relative technology scores. Here, an MCDA framework provides preliminary insights on the suitability of emerging technologies for environmental remediation by comparing nanotechnology and synthetic biology to conventional remediation methods. Subject matter experts provided judgments regarding the importance of criteria used in the evaluations and scored the technologies with respect to those criteria. The results indicate that synthetic biology may be preferred over nanotechnology and conventional methods for high expected benefits and low deployment costs but that conventional technology may be preferred over emerging technologies for reduced risks and development costs. In the absence of field data regarding the risks, benefits, and costs of emerging technologies, structuring evidence-based expert judgment through a weighted hierarchy of topical questions may be helpful to inform preliminary risk governance and guide emerging technology development and policy.

  2. Number and density discrimination rely on a common metric: Similar psychophysical effects of size, contrast, and divided attention.

    PubMed

    Tibber, Marc S; Greenwood, John A; Dakin, Steven C

    2012-06-04

    While observers are adept at judging the density of elements (e.g., in a random-dot image), it has recently been proposed that they also have an independent visual sense of number. To test the independence of number and density discrimination, we examined the effects of manipulating stimulus structure (patch size, element size, contrast, and contrast-polarity) and available attentional resources on both judgments. Five observers made a series of two-alternative, forced-choice discriminations based on the relative numerosity/density of two simultaneously presented patches containing 16-1,024 Gaussian blobs. Mismatches of patch size and element size (across reference and test) led to bias and reduced sensitivity in both tasks, whereas manipulations of contrast and contrast-polarity had varied effects on observers, implying differing strategies. Nonetheless, the effects reported were consistent across density and number judgments, the only exception being when luminance cues were made available. Finally, density and number judgment were similarly impaired by attentional load in a dual-task experiment. These results are consistent with a common underlying metric to density and number judgments, with the caveat that additional cues may be exploited when they are available.

  3. SCIENTIFIC AND SOCIAL VALUE JUDGMENTS FOR ORPHAN DRUGS IN HEALTH TECHNOLOGY ASSESSMENT.

    PubMed

    Nicod, Elena; Kanavos, Panos

    2016-01-01

    We explore how broader aspects of a treatment's value and the impact of the condition on patients not captured by routine health technology assessment (HTA) methods using clinical and economic evidence, defined as "other considerations," may influence HTA processes in different settings. Countries included were England, Scotland, Sweden, and France. Data sources were the publicly available reports on HTA recommendations. Ten drugs with European Medicines Agency orphan designation and appraised in England were selected. Qualitative thematic analysis was used to systematically identify and code all "other considerations" based on a previously developed methodological framework, which also coded whether it was provided by stakeholders, and how it influenced the decision. A classification framework of scientific and social value judgments was developed and used throughout the study. A total of 125 "other considerations" were identified and grouped into ten subcategories based on the information provided. Eighteen to 100 percent of these, depending on the agency, were put forward as one of the main reasons for the final decision potentially contributing to accepting a higher incremental cost-effectiveness ratio or uncertain evidence. Some of these were nonquantified or nonelicited and pertained to the assessor's judgment. A taxonomy of these value judgments was created to be used in future cases. Results also contributed to better defining the determinants of social value and improving accountability for reasonableness. The systematic identification of the scientific and social value judgments enables to better understanding the dimensions of value, which can be used to improve their transparency and consistent use across decisions and settings.

  4. Social trait judgment and affect recognition from static faces and video vignettes in schizophrenia.

    PubMed

    McIntosh, Lindsey G; Park, Sohee

    2014-09-01

    Social impairment is a core feature of schizophrenia, present from the pre-morbid stage and predictive of outcome, but the etiology of this deficit remains poorly understood. Successful and adaptive social interactions depend on one's ability to make rapid and accurate judgments about others in real time. Our surprising ability to form accurate first impressions from brief exposures, known as "thin slices" of behavior has been studied very extensively in healthy participants. We sought to examine affect and social trait judgment from thin slices of static or video stimuli in order to investigate the ability of schizophrenic individuals to form reliable social impressions of others. 21 individuals with schizophrenia (SZ) and 20 matched healthy participants (HC) were asked to identify emotions and social traits for actors in standardized face stimuli as well as brief video clips. Sound was removed from videos to remove all verbal cues. Clinical symptoms in SZ and delusional ideation in both groups were measured. Results showed a general impairment in affect recognition for both types of stimuli in SZ. However, the two groups did not differ in the judgments of trustworthiness, approachability, attractiveness, and intelligence. Interestingly, in SZ, the severity of positive symptoms was correlated with higher ratings of attractiveness, trustworthiness, and approachability. Finally, increased delusional ideation in SZ was associated with a tendency to rate others as more trustworthy, while the opposite was true for HC. These findings suggest that complex social judgments in SZ are affected by symptomatology. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Using the Dreyfus Model of Skill Acquisition to Describe and Interpret Skill Acquisition and Clinical Judgment in Nursing Practice and Education

    ERIC Educational Resources Information Center

    Benner, Patricia

    2004-01-01

    Three studies using the Dreyfus model of skill acquisition were conducted over a period of 21 years. Nurses with a range of experience and reported skillfulness were interviewed. Each study used nurses' narrative accounts of actual clinical situations. A subsample of participants were observed and interviewed at work. These studies extend the…

  6. Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover.

    PubMed

    Pickering, Brian W; Hurley, Killian; Marsh, Brian

    2009-11-01

    To use a handover assessment tool for identifying patient information corruption and objectively evaluating interventions designed to reduce handover errors and improve medical decision making. The continuous monitoring, intervention, and evaluation of the patient in modern intensive care unit practice generates large quantities of information, the platform on which medical decisions are made. Information corruption, defined as errors of distortion/omission compared with the medical record, may result in medical judgment errors. Identifying these errors may lead to quality improvements in intensive care unit care delivery and safety. Handover assessment instrument development study divided into two phases by the introduction of a handover intervention. Closed, 17-bed, university-affiliated mixed surgical/medical intensive care unit. Senior and junior medical members of the intensive care unit team. Electronic handover page. Study subjects were asked to recall clinical information commonly discussed at handover on individual patients. The handover score measured the percentage of information correctly retained for each individual doctor-patient interaction. The clinical intention score, a subjective measure of medical judgment, was graded (1-5) by three blinded intensive care unit experts. A total of 137 interactions were scored. Median (interquartile range) handover scores for phases 1 and 2 were 79.07% (67.44-84.50) and 83.72% (76.16-88.37), respectively. Score variance was reduced by the handover intervention (p < .05). Increasing median handover scores, 68.60 to 83.72, were associated with increases in clinical intention scores from 1 to 5 (chi-square = 23.59, df = 4, p < .0001). When asked to recall clinical information discussed at handover, medical members of the intensive care unit team provide data that are significantly corrupted compared with the medical record. Low subjective clinical judgment scores are significant associated with low handover scores. The handover/clinical intention scores may, therefore, be useful screening tools for intensive care unit system vulnerability to medical error. Additionally, handover instruments can identify interventions that reduce system vulnerability to error and may be used to guide quality improvements in handover practice.

  7. Discordance of physician clinical judgment vs. pneumonia severity index (PSI) score to admit patients with low risk community-acquired pneumonia: a prospective multicenter study.

    PubMed

    Marcos, Pedro J; Restrepo, Marcos I; González-Barcala, Francisco J; Soni, Nilam J; Vidal, Iria; Sanjuàn, Pilar; Llinares, Diego; Ferreira-Gonzalez, Lucía; Rábade, Carlos; Otero-González, Isabel; Marcos, Pedro; Verea-Hernando, Héctor

    2017-06-01

    The relationship between clinical judgment and the pneumonia severity index (PSI) score in deciding the site of care for patients with community-acquired pneumonia (CAP) has not been well investigated. The objective of the study was to determine the clinical factors that influence decision-making to hospitalize low-risk patients (PSI ≤2) with CAP. An observational, prospective, multicenter study of consecutive CAP patients was performed at five hospitals in Spain. Patients admitted with CAP and a PSI ≤2 were identified. Admitting physicians completed a patient-specific survey to identify the clinical factors influencing the decision to admit a patient. The reason for admission was categorized into 1 of 6 categories. We also assessed whether the reason for admission was associated with poorer clinical outcomes [intensive care unit (ICU) admission, 30-day mortality or readmission]. One hundred and fifty-five hospitalized patients were enrolled. Two or more reasons for admission were seen in 94 patients (60.6%), including abnormal clinical test results (60%), signs of clinical deterioration (43.2%), comorbid conditions (28.4%), psychosocial factors (28.4%), suspected H1N1 pneumonia (20.6%), and recent visit to the emergency department (ED) in the past 2 weeks (7.7%). Signs of clinical deterioration and abnormal clinical test results were associated with poorer clinical outcomes (P<0.005). Low-risk patients with CAP and a PSI ≤2 are admitted to the hospital for multiple reasons. Abnormal clinical test results and signs of clinical deterioration are two specific reasons for admission that are associated with poorer clinical outcomes in low risk CAP patients.

  8. Diagnosing Flu

    MedlinePlus

    ... your symptoms and their clinical judgment. Will my health care provider test me for flu if I have flu-like ... with flu symptoms are not tested because the test results usually do not change how you are treated. Your health care provider may diagnose you with flu based on ...

  9. Using a fuzzy comprehensive evaluation method to determine product usability: A proposed theoretical framework

    PubMed Central

    Zhou, Ronggang; Chan, Alan H. S.

    2016-01-01

    BACKGROUND: In order to compare existing usability data to ideal goals or to that for other products, usability practitioners have tried to develop a framework for deriving an integrated metric. However, most current usability methods with this aim rely heavily on human judgment about the various attributes of a product, but often fail to take into account of the inherent uncertainties in these judgments in the evaluation process. OBJECTIVE: This paper presents a universal method of usability evaluation by combining the analytic hierarchical process (AHP) and the fuzzy evaluation method. By integrating multiple sources of uncertain information during product usability evaluation, the method proposed here aims to derive an index that is structured hierarchically in terms of the three usability components of effectiveness, efficiency, and user satisfaction of a product. METHODS: With consideration of the theoretical basis of fuzzy evaluation, a two-layer comprehensive evaluation index was first constructed. After the membership functions were determined by an expert panel, the evaluation appraisals were computed by using the fuzzy comprehensive evaluation technique model to characterize fuzzy human judgments. Then with the use of AHP, the weights of usability components were elicited from these experts. RESULTS AND CONCLUSIONS: Compared to traditional usability evaluation methods, the major strength of the fuzzy method is that it captures the fuzziness and uncertainties in human judgments and provides an integrated framework that combines the vague judgments from multiple stages of a product evaluation process. PMID:28035943

  10. Comparison of ethical judgments exhibited by clients and ethics consultants in Japan.

    PubMed

    Nagao, Noriko; Kadooka, Yasuhiro; Asai, Atsushi

    2014-03-04

    Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and CEC consultants. The CEC request and response documents of all 60 cases reviewed across Japan between October 2006 and the end of October 2011 were classified in terms of the presence of decisional capacity in the patient. We conducted a qualitative content analysis of the differences in reasoning between client and CEC consultants. Reasoned judgments were verified in individual cases to classify the similarities or differences of opinion between CEC clients and teams. As the result of classification of the decisional capacity and the difference of opinion regarding medical care, the most frequent category was 25 cases (41.7%) of "uncertain decisional capacity," and 23 cases (38.3%) of "withholding of decision-making." A chi-square analysis was performed on presence of decisional capacity and agreement in decision-making, yielding a statistically significant difference (p < 0.05). The CEC consultants' reasoning was based on "patient's preference was ambiguous," "validity of family as a surrogate," "estimation of patient preference," and "patient's best interest," whereas the CEC client's reasoning was based on "consistent family preference was shown/not shown" and "appropriate therapeutic methods to manage patient safety." Differences in opinions were found in cases classified according to decisional capacity. Furthermore, the reasoning behind judgments differed between CEC clients and CEC consultants. The reasoning of CEC consultants was critical and reflective, while for clients it was situational and pragmatic.

  11. The Structured Interview & Scoring Tool-Massachusetts Alzheimer's Disease Research Center (SIST-M): development, reliability, and cross-sectional validation of a brief structured clinical dementia rating interview.

    PubMed

    Okereke, Olivia I; Copeland, Maura; Hyman, Bradley T; Wanggaard, Taylor; Albert, Marilyn S; Blacker, Deborah

    2011-03-01

    The Clinical Dementia Rating (CDR) and CDR Sum-of-Boxes can be used to grade mild but clinically important cognitive symptoms of Alzheimer disease. However, sensitive clinical interview formats are lengthy. To develop a brief instrument for obtaining CDR scores and to assess its reliability and cross-sectional validity. Using legacy data from expanded interviews conducted among 347 community-dwelling older adults in a longitudinal study, we identified 60 questions (from a possible 131) about cognitive functioning in daily life using clinical judgment, inter-item correlations, and principal components analysis. Items were selected in 1 cohort (n=147), and a computer algorithm for generating CDR scores was developed in this same cohort and re-run in a replication cohort (n=200) to evaluate how well the 60 items retained information from the original 131 items. Short interviews based on the 60 items were then administered to 50 consecutively recruited older individuals, with no symptoms or mild cognitive symptoms, at an Alzheimer's Disease Research Center. Clinical Dementia Rating scores based on short interviews were compared with those from independent long interviews. In the replication cohort, agreement between short and long CDR interviews ranged from κ=0.65 to 0.79, with κ=0.76 for Memory, κ=0.77 for global CDR, and intraclass correlation coefficient for CDR Sum-of-Boxes=0.89. In the cross-sectional validation, short interview scores were slightly lower than those from long interviews, but good agreement was observed for global CDR and Memory (κ≥0.70) as well as for CDR Sum-of-Boxes (intraclass correlation coefficient=0.73). The Structured Interview & Scoring Tool-Massachusetts Alzheimer's Disease Research Center is a brief, reliable, and sensitive instrument for obtaining CDR scores in persons with symptoms along the spectrum of mild cognitive change.

  12. The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels.

    PubMed

    Neumann, Ignacio; Brignardello-Petersen, Romina; Wiercioch, Wojtek; Carrasco-Labra, Alonso; Cuello, Carlos; Akl, Elie; Mustafa, Reem A; Al-Hazzani, Waleed; Etxeandia-Ikobaltzeta, Itziar; Rojas, Maria Ximena; Falavigna, Maicon; Santesso, Nancy; Brozek, Jan; Iorio, Alfonso; Alonso-Coello, Pablo; Schünemann, Holger J

    2016-07-15

    Judgments underlying guideline recommendations are seldom recorded and presented in a systematic fashion. The GRADE Evidence-to-Decision Framework (EtD) offers a transparent way to record and report guideline developers' judgments. In this paper, we report the experiences with the EtD frameworks in 15 real guideline panels. Following the guideline panel meetings, we asked methodologists participating in the panel to provide feedback regarding the EtD framework. They were instructed to consider their own experience and the feedback collected from the rest of the panel. Two investigators independently summarized the responses and jointly interpreted the data using pre-specified domains as coding system. We asked methodologists to review the results and provide further input to improve the structure of the EtDs iteratively. The EtD framework was well received, and the comments were generally positive. Methodologists felt that in a real guideline panel, the EtD framework helps structuring a complex process through relatively simple steps in an explicit and transparent way. However, some sections (e.g., "values and preferences" and "balance between benefits and harms") required further development and clarification that were considered in the current version of the EtD framework. The use of an EtD framework in guideline development offers a structured and explicit way to record and report the judgments and discussion of guideline panels during the formulation of recommendations. In addition, it facilitates the formulation of recommendations, assessment of their strength, and identifying gaps in research.

  13. Re J (A Minor) (Wardship: Medical Treatment)

    PubMed

    1992-06-10

    The Civil Division of England's Court of Appeal overturned the lower court's order of mechanical ventilation for a profoundly handicapped sixteen-month-old child against the clinical judgment of the child's doctors. Since hitting his head in a fall at age four weeks, J had not mentally developed past that time and he was blind and he suffered from severe cerebral palsy and epilepsy. He required nasogastric tubal feeding and, although he occasionally responded to sound, whether or not he recognized his caregivers was uncertain. His divorced mother and the local authority shared parental authority over J, who resided with foster parents. The consultant pediatrician reported that if J were to suffer a life-threatening event, ordinary resuscitation, antibiotics and physiotherapy would be appropriate, but intervention with intensive measures including mechanical ventilation would be medically inappropriate. Two other specialists agreed with those findings, but another consultant found mechanical ventilation not to be cruel and thought J could be weaned from it if it became so. The mother and local health authority asked the court to require the health authority to continue all treatment, including mechanical ventilation, of J. The Official Solicitor and the health authority opposed such an order. The lower court granted an interim order requiring mechanical ventilation if necessary over the five weeks prior to the main hearing. The appellate court viewed such an order as an abuse of judicial power and held that the physician's duty to the patient is to treat with the necessary consent in accord with the best clinical judgment and that, as long as those with parental authority consent to J's treatment by the health authority, he must be treated in accord with the best clinical judgment of that authority's personnel.

  14. [Problem solving abilities of nursing students: the experience of the bachelor degree course in nursing at the University of Udine].

    PubMed

    Bulfone, Giampiera; Galletti, Caterina; Vellone, Ercole; Zanini, Antonietta; Quattrin, Rosanna

    2008-01-01

    The process nurses adopt to solve the patients' problems is known as "Problem Solving" in the literature. Problem Solving Abilities include Diagnostic Reasoning, Prognostic Judgment and Decision Making. Nursing students apply the Problem Solving to the Nursing Process that is the mental and operative approach that nurses use to plan the nursing care. The purpose of the present study is to examine if there is a positive relationship between the number of Educational Tutorial Strategies (Briefing, Debriefing and Discussion according to the Objective Structured Clinical Examination Methodology) used for nursing students and their learning of Problem Solving Abilities (Diagnostic Reasoning, Prognostic Judgment and Decision Making). The study design was retrospective, descriptive and comparative. The Problem Solving Instrument, specifically developed for this study and proved for its reliability and validity, was used to collect the data from a sample of 106 nursing care plans elaborated by the second-year students of the Bachelor Degree in Nursing of the University of Udine. Nursing care plans were elaborated during three times consecutively, after students had participated in different Educational Tutorial Strategies. Results showed that the more the students took part in a higher number of Educational Tutorial Strategies the more they significantly increased their Problem Solving Abilities. The results demonstrate that it is important to use Educational Tutorial Strategies in the nursing education to teach skills.

  15. Cocited Author Mapping as a Valid Representation of Intellectual Structure.

    ERIC Educational Resources Information Center

    McCain, Katherine W.

    1986-01-01

    To test validity of cocitation studies as representations of intellectual structure, five-six years of aggregate cocitation data for 41 authors in macroeconomics and 49 authors in genetics of fruit flies were compared with independent judgments of interauthor similarity collected from 14 macroeconomists and 15 geneticists via a card-sorting…

  16. Structure induction in diagnostic causal reasoning.

    PubMed

    Meder, Björn; Mayrhofer, Ralf; Waldmann, Michael R

    2014-07-01

    Our research examines the normative and descriptive adequacy of alternative computational models of diagnostic reasoning from single effects to single causes. Many theories of diagnostic reasoning are based on the normative assumption that inferences from an effect to its cause should reflect solely the empirically observed conditional probability of cause given effect. We argue against this assumption, as it neglects alternative causal structures that may have generated the sample data. Our structure induction model of diagnostic reasoning takes into account the uncertainty regarding the underlying causal structure. A key prediction of the model is that diagnostic judgments should not only reflect the empirical probability of cause given effect but should also depend on the reasoner's beliefs about the existence and strength of the link between cause and effect. We confirmed this prediction in 2 studies and showed that our theory better accounts for human judgments than alternative theories of diagnostic reasoning. Overall, our findings support the view that in diagnostic reasoning people go "beyond the information given" and use the available data to make inferences on the (unobserved) causal rather than on the (observed) data level. (c) 2014 APA, all rights reserved.

  17. Whose statistical reasoning is facilitated by a causal structure intervention?

    PubMed

    McNair, Simon; Feeney, Aidan

    2015-02-01

    People often struggle when making Bayesian probabilistic estimates on the basis of competing sources of statistical evidence. Recently, Krynski and Tenenbaum (Journal of Experimental Psychology: General, 136, 430-450, 2007) proposed that a causal Bayesian framework accounts for peoples' errors in Bayesian reasoning and showed that, by clarifying the causal relations among the pieces of evidence, judgments on a classic statistical reasoning problem could be significantly improved. We aimed to understand whose statistical reasoning is facilitated by the causal structure intervention. In Experiment 1, although we observed causal facilitation effects overall, the effect was confined to participants high in numeracy. We did not find an overall facilitation effect in Experiment 2 but did replicate the earlier interaction between numerical ability and the presence or absence of causal content. This effect held when we controlled for general cognitive ability and thinking disposition. Our results suggest that clarifying causal structure facilitates Bayesian judgments, but only for participants with sufficient understanding of basic concepts in probability and statistics.

  18. Original research in pathology: judgment, or evidence-based medicine?

    PubMed

    Crawford, James M

    2007-02-01

    Pathology is both a medical specialty and an investigative scientific discipline, concerned with understanding the essential nature of human disease. Ultimately, pathology is accountable as well, as measured by the accuracy of our diagnoses and the resultant patient care outcomes. As such, we must consider the evidence base underlying our practices. Within the realm of Laboratory Medicine, extensive attention has been given to testing accuracy and precision. Critical examination of the evidence base supporting the clinical use of specific laboratory tests or technologies is a separate endeavor, to which specific attention must be given. In the case of anatomic pathology and more specifically surgical pathology, the expertise required to render a diagnosis is derived foremost from experience, both personal and literature-based. In the first instance, knowledge of the linkage between one's own diagnoses and individual patient outcomes is required, to validate the role of one's own interpretations in the clinical course of patients. Experience comes from seeing this linkage first hand, from which hopefully comes wisdom and, ultimately, good clinical judgment. In the second instance, reading the literature and learning from experts is required. Only a minority of the relevant literature is published in pathology journals to which one may subscribe. A substantial portion of major papers relevant to the practice of anatomic pathology are published in collateral clinical specialty journals devoted to specific disease areas or organs. Active effort is therefore required to seek out the literature beyond the domain of pathology journals. In examining the published literature, the essential question then becomes: Does the practice of anatomic pathology fulfill the tenets of 'evidence-based medicine' (EBM)? If the pinnacle of EBM is 'systematic review of randomized clinical trials, with or without meta-analysis', then anatomic pathology falls far short. Our published literature is largely observational in nature, with reports of case series (with or without statistical analysis) constituting the majority of our 'evidence base'. Moreover, anatomic pathology is subject to 'interobserver variation', and potentially to 'error'. Taken further, individual interpretation of tissue samples is not an objective endeavor, and it is not easy to fulfill the role of a 'gold standard'. Both for rendering of an overall interpretation, and for providing the semi-quantitative and quantitative numerical 'scores' which support evidence-based clinical treatment algorithms, the Pathologist has to exercise a high level of interpretive judgment. Nevertheless, the contribution of anatomic pathology to 'EBM' is remarkably strong. To the extent that our judgmental interpretations become data, our tissue interpretations become the arbiters of patient care management decisions. In a more global sense, we support highly successful cancer screening programs, and play critical roles in the multidisciplinary management of complex patients. The true error is for the clinical practitioners of 'EBM' to forget the contribution to the supporting evidence base of the physicians that are Anatomic Pathologists. Finally, the academic productivity of pathology faculty who operate in the clinical realm must be considered. A survey of six North American academic pathology departments reveals that 26% of all papers published in 2005 came from 'unfunded' clinical faculty. While it is likely that their academic productivity is lower than that of 'funded' research faculty, the contribution of clinical faculty to the knowledge base for the practice of modern medicine, and to the academic reputation of the department, must not be overlooked. The ability of clinical faculty in academic departments of pathology to pursue original scholarship must be supported if our specialty is to retain its preeminence as an investigative scientific discipline in the age of EBM.

  19. Combining bimodal presentation schemes and buzz groups improves clinical reasoning and learning at morning report.

    PubMed

    Balslev, Thomas; Rasmussen, Astrid Bruun; Skajaa, Torjus; Nielsen, Jens Peter; Muijtjens, Arno; De Grave, Willem; Van Merriënboer, Jeroen

    2014-12-11

    Abstract Morning reports offer opportunities for intensive work-based learning. In this controlled study, we measured learning processes and outcomes with the report of paediatric emergency room patients. Twelve specialists and 12 residents were randomised into four groups and discussed the same two paediatric cases. The groups differed in their presentation modality (verbal only vs. verbal + text) and the use of buzz groups (with vs. without). The verbal interactions were analysed for clinical reasoning processes. Perceptions of learning and judgment of learning were reported in a questionnaire. Diagnostic accuracy was assessed by a 20-item multiple-choice test. Combined bimodal presentation and buzz groups increased the odds ratio of clinical reasoning to occur in the discussion of cases by a factor of 1.90 (p = 0.013), indicating superior reasoning for buzz groups working with bimodal materials. For specialists, a positive effect of bimodal presentation was found on perceptions of learning (p < 0.05), and for residents, a positive effect of buzz groups was found on judgment of learning (p < 0.005). A positive effect of bimodal presentation on diagnostic accuracy was noted in the specialists (p < 0.05). Combined bimodal presentation and buzz group discussion of emergency cases improves clinicians' clinical reasoning and learning.

  20. Development of cognitive processing and judgments of knowledge in medical students: Analysis of progress test results.

    PubMed

    Cecilio-Fernandes, Dario; Kerdijk, Wouter; Jaarsma, A D Debbie C; Tio, René A

    2016-11-01

    Beside acquiring knowledge, medical students should also develop the ability to apply and reflect on it, requiring higher-order cognitive processing. Ideally, students should have reached higher-order cognitive processing when they enter the clinical program. Whether this is the case, is unknown. We investigated students' cognitive processing, and awareness of their knowledge during medical school. Data were gathered from 347 first-year preclinical and 196 first-year clinical students concerning the 2008 and 2011 Dutch progress tests. Questions were classified based upon Bloom's taxonomy: "simple questions" requiring lower and "vignette questions" requiring higher-order cognitive processing. Subsequently, we compared students' performance and awareness of their knowledge in 2008 to that in 2011 for each question type. Students' performance on each type of question increased as students progressed. Preclinical and first-year clinical students performed better on simple questions than on vignette questions. Third-year clinical students performed better on vignette questions than on simple questions. The accuracy of students' judgment of knowledge decreased over time. The progress test is a useful tool to assess students' cognitive processing and awareness of their knowledge. At the end of medical school, students achieved higher-order cognitive processing but their awareness of their knowledge had decreased.

  1. Medical Problem-Solving: A Critique of the Literature.

    ERIC Educational Resources Information Center

    McGuire, Christine H.

    1985-01-01

    Prescriptive, decision-analysis of medical problem-solving has been based on decision theory that involves calculation and manipulation of complex probability and utility values to arrive at optimal decisions that will maximize patient benefits. The studies offer a methodology for improving clinical judgment. (Author/MLW)

  2. The Influence of Framing on Clinicians’ Judgments of the Biological Basis of Behaviors

    PubMed Central

    Kim, Nancy S.; Ahn, Woo-kyoung; Johnson, Samuel G. B.; Knobe, Joshua

    2015-01-01

    Practicing clinicians frequently think about behaviors both abstractly (i.e., in terms of symptoms, as in the DSM-5; APA, 2013) and concretely (i.e., in terms of individual clients, as in DSM-5 Clinical Cases; Barnhill, 2013). Does abstract/concrete framing influence clinical judgments about behaviors? Seventy-four practicing mental health clinicians were presented with hallmark symptoms of six disorders framed abstractly versus concretely, and provided ratings of their biological and psychological bases (Experiment 1) and the likely efficacy of medication and psychotherapy in alleviating them (Experiment 2). Clinicians perceived behavioral symptoms in the abstract to be more biologically and less psychologically based than when concretely described, and medication was viewed as more effective for abstractly than concretely described symptoms. These findings suggest one possible basis for miscommunication and misalignment of views between primarily research-oriented and primarily practice-oriented clinicians; furthermore, clinicians may accept new neuroscience research more strongly in the abstract than for individual clients. PMID:26651348

  3. When reality is out of focus: Can people tell whether their beliefs and judgments are correct or wrong?

    PubMed

    Koriat, Asher

    2018-05-01

    Can we tell whether our beliefs and judgments are correct or wrong? Results across many domains indicate that people are skilled at discriminating between correct and wrong answers, endorsing the former with greater confidence than the latter. However, it has not been realized that because of people's adaptation to reality, representative samples of items tend to favor the correct answer, yielding object-level accuracy (OLA) that is considerably better than chance. Across 16 experiments that used 2-alternative forced-choice items from several domains, the confidence/accuracy (C/A) relationship was positive for items with OLA >50%, but consistently negative across items with OLA <50%. A systematic sampling of items that covered the full range of OLA (0-100%) yielded a U-function relating confidence to OLA. The results imply that the positive C/A relationship that has been reported in many studies is an artifact of OLA being better than chance rather than representing a general ability to discriminate between correct and wrong responses. However, the results also support the ecological approach, suggesting that confidence is based on a frugal, "bounded" heuristic that has been specifically tailored to the ecological structure of the natural environment. This heuristic is used despite the fact that for items with OLA <50%, it yields confidence judgments that are counterdiagnostic of accuracy. Our ability to tell between correct and wrong judgments is confined to the probability structure of the world we live in. The results were discussed in terms of the contrast between systematic design and representative design. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  4. Comparative-effectiveness research to aid population decision making by relating clinical outcomes and quality-adjusted life years.

    PubMed

    Campbell, Jonathan D; Zerzan, Judy; Garrison, Louis P; Libby, Anne M

    2013-04-01

    Comparative-effectiveness research (CER) at the population level is missing standardized approaches to quantify and weigh interventions in terms of their clinical risks, benefits, and uncertainty. We proposed an adapted CER framework for population decision making, provided example displays of the outputs, and discussed the implications for population decision makers. Building on decision-analytical modeling but excluding cost, we proposed a 2-step approach to CER that explicitly compared interventions in terms of clinical risks and benefits and linked this evidence to the quality-adjusted life year (QALY). The first step was a traditional intervention-specific evidence synthesis of risks and benefits. The second step was a decision-analytical model to simulate intervention-specific progression of disease over an appropriate time. The output was the ability to compare and quantitatively link clinical outcomes with QALYs. The outputs from these CER models include clinical risks, benefits, and QALYs over flexible and relevant time horizons. This approach yields an explicit, structured, and consistent quantitative framework to weigh all relevant clinical measures. Population decision makers can use this modeling framework and QALYs to aid in their judgment of the individual and collective risks and benefits of the alternatives over time. Future research should study effective communication of these domains for stakeholders. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

  5. Neural bases of motivated reasoning: an FMRI study of emotional constraints on partisan political judgment in the 2004 U.S. Presidential election.

    PubMed

    Westen, Drew; Blagov, Pavel S; Harenski, Keith; Kilts, Clint; Hamann, Stephan

    2006-11-01

    Research on political judgment and decision-making has converged with decades of research in clinical and social psychology suggesting the ubiquity of emotion-biased motivated reasoning. Motivated reasoning is a form of implicit emotion regulation in which the brain converges on judgments that minimize negative and maximize positive affect states associated with threat to or attainment of motives. To what extent motivated reasoning engages neural circuits involved in "cold" reasoning and conscious emotion regulation (e.g., suppression) is, however, unknown. We used functional neuroimaging to study the neural responses of 30 committed partisans during the U.S. Presidential election of 2004. We presented subjects with reasoning tasks involving judgments about information threatening to their own candidate, the opposing candidate, or neutral control targets. Motivated reasoning was associated with activations of the ventromedial prefrontal cortex, anterior cingulate cortex, posterior cingulate cortex, insular cortex, and lateral orbital cortex. As predicted, motivated reasoning was not associated with neural activity in regions previously linked to cold reasoning tasks and conscious (explicit) emotion regulation. The findings provide the first neuroimaging evidence for phenomena variously described as motivated reasoning, implicit emotion regulation, and psychological defense. They suggest that motivated reasoning is qualitatively distinct from reasoning when people do not have a strong emotional stake in the conclusions reached.

  6. The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study

    PubMed Central

    2011-01-01

    Background The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity. Methods All those assessed following screening over a three month period at a busy remand committals prison (n = 246) were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100). Results The 11 item scale had good internal consistency (Cronbach's alpha = 0.95) and inter-rater reliability. The scale score did not correlate with the HCR-20 'historical' score. For the three month sample, the receiver operating characteristic area under the curve (AUC) for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943). For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930); low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949). Item to outcome correlations were significant for all 11 items. Conclusions The DUNDRUM-1 triage security scale and its items performed to criterion levels when tested against the real world outcome. This instrument can be used to ensure consistency in decision making when deciding who to admit to secure forensic hospitals. It can also be used to benchmark admission thresholds between services and jurisdictions. In this study we found some divergence between assessed need and actual placement. This provides fertile ground for future research as well as practical assistance in assessing unmet need, auditing case mix and planning care pathways. PMID:21410967

  7. Medical Decision Making for Patients Without Proxies: The Effect of Personal Experience in the Deliberative Process.

    PubMed

    Robichaud, Allyson L

    2015-01-01

    The number of admissions to hospitals of patients without a proxy decision maker is rising. Very often these patients need fairly immediate medical intervention for which informed consent--or informed refusal--is required. Many have recommended that there be a process in place to make these decisions, and that it include a variety of perspectives. People are particularly wary of relying solely on medical staff to make these decisions. The University Hospitals Case Medical Center recruits community members from its Ethics Committee to serve on a subcommittee, the Patients Without Proxies (PWP) Committee, which works with medical staff during the decision-making process for these patients. Generally, the community members go to the bedside to observe patients. This article looks at how those unused to observing hospitalized patients who are sick and/or dying are affected, comparing them to mock jurors in a research study who are exposed to graphic photographs related to a fabricated crime scene. Judgments made by the mock jurors are affected by viewing such images. The personal experience of witnessing unfamiliar and shocking scenes affects their subsequent judgments. While it may be difficult to tease out whether observing patients causes PWP members to be benefited or harmed, they are affected by what they see. If a variety of perspectives is desirable to reduce possible bias or error, this article argues that at least one community member should refrain from seeing the patient in order to add a different and valuable voice to the decision-making process. Members of the subcommittee base their judgments on the various kinds of information available. Sometimes the things they see, hear, or feel may affect them particularly deeply, and affect their judgments as well. In this article I explore the idea that something like this may be happening in a particular kind of clinical ethics case consultation. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  8. The Scope of Our Affective Influences: When and How Naturally Occurring Positive, Negative, and Neutral Affects Alter Judgment.

    PubMed

    Gasper, Karen; Danube, Cinnamon L

    2016-03-01

    To determine how naturally arising affect alters judgment, we examined whether (a) affective states exert a specific, rather than a general, influence on valenced-specific judgments; (b) neutral affect is associated with increased neutral judgments, independent of positive, negative, and ambivalent affects, and whether neutral judgments are associated with behavioral disengagement; and (c) the informational value of naturally arising states may be difficult to alter via salience and relevance manipulations. The results support several conclusions: (a) Affective states exerted a judgment-specific effect-positive affect was most strongly associated with positive judgments, negative affect with negative judgments, and neutral affect with neutral judgments. (b) Neutral affect influenced judgments, taking into account positive, negative, and ambivalent affects; and neutral judgments predicted behavioral disengagement. (c) With the exception of negative affect, naturally arising affective states typically influenced judgments regardless of their salience and relevance. © 2016 by the Society for Personality and Social Psychology, Inc.

  9. Relating DSM-5 section II and section III personality disorder diagnostic classification systems to treatment planning.

    PubMed

    Morey, Leslie C; Benson, Kathryn T

    2016-07-01

    Beginning with DSM-III, the inclusion of a "personality" axis was designed to encourage awareness of personality disorders and the treatment-related implications of individual differences, but since that time there is little accumulated evidence that the personality disorder categories provide substantial treatment-related guidance. The DSM-5 Personality and Personality Disorders Work Group sought to develop an Alternative Model for personality disorder, and this study examined whether this model is more closely related to clinicians' decision-making processes than the traditional categorical personality disorder diagnoses. A national sample of 337 clinicians provided complete personality disorder diagnostic information and several treatment-related clinical judgments about one of their patients. The dimensional concepts of the DSM-5 Alternative Model for personality disorders demonstrated stronger relationships than categorical DSM-IV/DSM-5 Section II diagnoses to 10 of 11 clinical judgments regarding differential treatment planning, optimal treatment intensity, and long-term prognosis. The constructs of the DSM-5 Alternative Model for personality disorders may provide more clinically useful information for treatment planning than the official categorical personality disorder diagnostic system retained in DSM-5 Section II. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Trust based obligations of the state and physician‐researchers to patient‐subjects

    PubMed Central

    Miller, P B; Weijer, C

    2006-01-01

    When may a physician enroll a patient in clinical research? An adequate answer to this question requires clarification of trust‐based obligations of the state and the physician‐researcher respectively to the patient‐subject. The state relies on the voluntarism of patient‐subjects to advance the public interest in science. Accordingly, it is obligated to protect the agent‐neutral interests of patient‐subjects through promulgating standards that secure these interests. Component analysis is the only comprehensive and systematic specification of regulatory standards for benefit‐harm evaluation by research ethics committees (RECs). Clinical equipoise, a standard in component analysis, ensures the treatment arms of a randomised control trial are consistent with competent medical care. It thus serves to protect agent‐neutral welfare interests of the patient‐subject. But REC review occurs prior to enrolment, highlighting the independent responsibility of the physician‐researcher to protect the agent‐relative welfare interests of the patient‐subject. In a novel interpretation of the duty of care, we argue for a “clinical judgment principle” which requires the physician‐researcher to exercise judgment in the interests of the patient‐subject taking into account evidence on treatments and the patient‐subject‘s circumstances. PMID:16943338

  11. Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force.

    PubMed

    Walton, Marc K; Powers, John H; Hobart, Jeremy; Patrick, Donald; Marquis, Patrick; Vamvakas, Spiros; Isaac, Maria; Molsen, Elizabeth; Cano, Stefan; Burke, Laurie B

    2015-09-01

    An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to describe the treatment's intended benefit as an effect on a clearly identified aspect of how a patient feels or functions. This aspect must have importance to the patient and be part of the patient's typical life. This meaningful health aspect can be measured directly or measured indirectly when it is impractical to evaluate it directly or when it is difficult to measure. For indirect measurement, a concept of interest (COI) can be identified. The COI must be related to how a patient feels or functions. Procedures are then developed to measure the COI. The relationship of these measurements with how a patient feels or functions in the intended setting and manner of use of the COA (the context of use) could then be defined. A COA has identifiable attributes or characteristics that affect the measurement properties of the COA when used in endpoints. One of these features is whether judgment can influence the measurement, and if so, whose judgment. This attribute defines four categories of COAs: patient reported outcomes, clinician reported outcomes, observer reported outcomes, and performance outcomes. A full description as well as explanation of other important COA features is included in this report. The information in this report should aid in the development, refinement, and standardization of COAs, and, ultimately, improve their measurement properties. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Improving bicycle safety: The role of paediatricians and family physicians

    PubMed Central

    LeBlanc, John C; Huybers, Sherry

    2004-01-01

    Cycling is a complex activity requiring motor, sensory and cognitive skills that develop at different rates from childhood to adolescence. While children can successfully ride a two-wheeled bicycle at age five or six, judgment of road hazards are poor at that age and matures slowly until adult-like judgment is reached in early adolescence. Safe cycling depends on the care, skills and judgment of cyclists and motorists; roadway design that promotes safe coexistence of bicycles and motor vehicles; and the use of safety devices, including bicycle helmets, lights and reflective tape. Whereas, research into optimal roadway design and educational programs for drivers to improve road safety has yielded contradictory results, the benefits of bicycle helmet use and programs to enhance their use have been clearly shown. This paper has the following objectives for paediatricians and family physicians: To understand the relationship between bicycle safety and children’s motor and cognitive skills.To understand the effectiveness and limitations of strategies to improve bicycle safety.To describe activities to promote bicycle safety that physicians can undertake in clinical settings and in the community. PMID:19657515

  13. 42 CFR 418.22 - Certification of terminal illness.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... certification of terminal illness for each of the periods listed in § 418.21, even if a single election... certification. Certification will be based on the physician's or medical director's clinical judgment regarding... certification or recertification form, in addition to the physician's signature on the certification or...

  14. Murdering while Asleep: Clinical and Forensic Issues.

    ERIC Educational Resources Information Center

    Gilmore, John Vaughn

    On the basis of the relevant research literature, this article discusses adult sleepwalking disorders, and focuses particularly on the documented cases of violence occurring during sleepwalking. Important diagnostic elements are reviewed, including family history, age of onset, gender, stages of sleep, impairments in memory and judgment, automatic…

  15. 22 CFR 96.38 - Training requirements for social service personnel.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... social services that involve the application of clinical skills and judgment (home studies, child... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Training requirements for social service....38 Training requirements for social service personnel. (a) The agency or person provides newly hired...

  16. 22 CFR 96.38 - Training requirements for social service personnel.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... social services that involve the application of clinical skills and judgment (home studies, child... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Training requirements for social service....38 Training requirements for social service personnel. (a) The agency or person provides newly hired...

  17. 22 CFR 96.38 - Training requirements for social service personnel.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... social services that involve the application of clinical skills and judgment (home studies, child... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Training requirements for social service....38 Training requirements for social service personnel. (a) The agency or person provides newly hired...

  18. 22 CFR 96.38 - Training requirements for social service personnel.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... social services that involve the application of clinical skills and judgment (home studies, child... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Training requirements for social service....38 Training requirements for social service personnel. (a) The agency or person provides newly hired...

  19. 22 CFR 96.38 - Training requirements for social service personnel.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... social services that involve the application of clinical skills and judgment (home studies, child... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Training requirements for social service....38 Training requirements for social service personnel. (a) The agency or person provides newly hired...

  20. A Causal Role for V5/MT Neurons Coding Motion-Disparity Conjunctions in Resolving Perceptual Ambiguity

    PubMed Central

    Krug, Kristine; Cicmil, Nela; Parker, Andrew J.; Cumming, Bruce G.

    2013-01-01

    Summary Judgments about the perceptual appearance of visual objects require the combination of multiple parameters, like location, direction, color, speed, and depth. Our understanding of perceptual judgments has been greatly informed by studies of ambiguous figures, which take on different appearances depending upon the brain state of the observer. Here we probe the neural mechanisms hypothesized as responsible for judging the apparent direction of rotation of ambiguous structure from motion (SFM) stimuli. Resolving the rotation direction of SFM cylinders requires the conjoint decoding of direction of motion and binocular depth signals [1, 2]. Within cortical visual area V5/MT of two macaque monkeys, we applied electrical stimulation at sites with consistent multiunit tuning to combinations of binocular depth and direction of motion, while the monkey made perceptual decisions about the rotation of SFM stimuli. For both ambiguous and unambiguous SFM figures, rotation judgments shifted as if we had added a specific conjunction of disparity and motion signals to the stimulus elements. This is the first causal demonstration that the activity of neurons in V5/MT contributes directly to the perception of SFM stimuli and by implication to decoding the specific conjunction of disparity and motion, the two different visual cues whose combination drives the perceptual judgment. PMID:23871244

  1. The good, the bad, and the timely: how temporal order and moral judgment influence causal selection

    PubMed Central

    Reuter, Kevin; Kirfel, Lara; van Riel, Raphael; Barlassina, Luca

    2014-01-01

    Causal selection is the cognitive process through which one or more elements in a complex causal structure are singled out as actual causes of a certain effect. In this paper, we report on an experiment in which we investigated the role of moral and temporal factors in causal selection. Our results are as follows. First, when presented with a temporal chain in which two human agents perform the same action one after the other, subjects tend to judge the later agent to be the actual cause. Second, the impact of temporal location on causal selection is almost canceled out if the later agent did not violate a norm while the former did. We argue that this is due to the impact that judgments of norm violation have on causal selection—even if the violated norm has nothing to do with the obtaining effect. Third, moral judgments about the effect influence causal selection even in the case in which agents could not have foreseen the effect and did not intend to bring it about. We discuss our findings in connection to recent theories of the role of moral judgment in causal reasoning, on the one hand, and to probabilistic models of temporal location, on the other. PMID:25477851

  2. Olympic Medals as Fruits of Comparison? Assimilation and Contrast in Sequential Performance Judgments

    ERIC Educational Resources Information Center

    Damisch, Lysann; Mussweiler, Thomas; Plessner, Henning

    2006-01-01

    The authors investigated the evaluative consequences of sequential performance judgments. Recent social comparison research has suggested that performance judgments may be influenced by judgments about a preceding performance. Specifically, performance judgments may be assimilated to judgments of the preceding performance if judges focus on…

  3. On the relativity of athletic performance: a comparison perspective on performance judgments in sports.

    PubMed

    Damisch, Lysann; Mussweiler, Thomas

    2009-01-01

    Identifying the best performance at a specific point in time constitutes the central purpose of all competitive sports. In many sports, this decision is based on subjective performance judgments. In the present chapter, we consider how these judgments are formed by emphasizing the relative nature of person judgments and athletic performance judgments in particular. Specifically, we argue that athletic judgments are influenced by comparisons with prior performances thereby leading to similar judgmental consequences as have been observed in other comparison domains (e.g., social comparison). Particularly, we demonstrate that performance judgments are assimilated to judgments of the preceding performance if judges focus on similarities between the two. If judges focus on differences, however, contrast ensues. Strategies for preventing or correcting this judgmental bias are discussed.

  4. Mapping High Dimensional Sparse Customer Requirements into Product Configurations

    NASA Astrophysics Data System (ADS)

    Jiao, Yao; Yang, Yu; Zhang, Hongshan

    2017-10-01

    Mapping customer requirements into product configurations is a crucial step for product design, while, customers express their needs ambiguously and locally due to the lack of domain knowledge. Thus the data mining process of customer requirements might result in fragmental information with high dimensional sparsity, leading the mapping procedure risk uncertainty and complexity. The Expert Judgment is widely applied against that background since there is no formal requirements for systematic or structural data. However, there are concerns on the repeatability and bias for Expert Judgment. In this study, an integrated method by adjusted Local Linear Embedding (LLE) and Naïve Bayes (NB) classifier is proposed to map high dimensional sparse customer requirements to product configurations. The integrated method adjusts classical LLE to preprocess high dimensional sparse dataset to satisfy the prerequisite of NB for classifying different customer requirements to corresponding product configurations. Compared with Expert Judgment, the adjusted LLE with NB performs much better in a real-world Tablet PC design case both in accuracy and robustness.

  5. Interface strategies in monolingual and end-state L2 Spanish grammars are not that different.

    PubMed

    Parafita Couto, María C; Mueller Gathercole, Virginia C; Stadthagen-González, Hans

    2014-01-01

    This study explores syntactic, pragmatic, and lexical influences on adherence to SV and VS orders in native and fluent L2 speakers of Spanish. A judgment task examined 20 native monolingual and 20 longstanding L2 bilingual Spanish speakers' acceptance of SV and VS structures. Seventy-six distinct verbs were tested under a combination of syntactic and pragmatic constraints. Our findings challenge the hypothesis that internal interfaces are acquired more easily than external interfaces (Sorace, 2005, 2011; Sorace and Filiaci, 2006; White, 2006). Additional findings are that (a) bilinguals' judgments are less firm overall than monolinguals' (i.e., monolinguals are more likely to give extreme "yes" or "no" judgments) and (b) individual verbs do not necessarily behave as predicted under standard definitions of unaccusatives and unergatives. Correlations of the patterns found in the data with verb frequencies suggest that usage-based accounts of grammatical knowledge could help provide insight into speakers' knowledge of these constructs.

  6. Cognitive Demands of Lower Paleolithic Toolmaking

    PubMed Central

    Stout, Dietrich; Hecht, Erin; Khreisheh, Nada; Bradley, Bruce; Chaminade, Thierry

    2015-01-01

    Stone tools provide some of the most abundant, continuous, and high resolution evidence of behavioral change over human evolution, but their implications for cognitive evolution have remained unclear. We investigated the neurophysiological demands of stone toolmaking by training modern subjects in known Paleolithic methods (“Oldowan”, “Acheulean”) and collecting structural and functional brain imaging data as they made technical judgments (outcome prediction, strategic appropriateness) about planned actions on partially completed tools. Results show that this task affected neural activity and functional connectivity in dorsal prefrontal cortex, that effect magnitude correlated with the frequency of correct strategic judgments, and that the frequency of correct strategic judgments was predictive of success in Acheulean, but not Oldowan, toolmaking. This corroborates hypothesized cognitive control demands of Acheulean toolmaking, specifically including information monitoring and manipulation functions attributed to the "central executive" of working memory. More broadly, it develops empirical methods for assessing the differential cognitive demands of Paleolithic technologies, and expands the scope of evolutionary hypotheses that can be tested using the available archaeological record. PMID:25875283

  7. Exploring the theoretical pathways through which asthma app features can promote adolescent self-management.

    PubMed

    Carpenter, Delesha M; Geryk, Lorie L; Sage, Adam; Arrindell, Courtney; Sleath, Betsy L

    2016-12-01

    Asthma apps often lack strong theoretical underpinnings. We describe how specific features of asthma apps influenced adolescents' self-observation, self-judgment, and self-reactions, which are key constructs of Self-Regulation Theory (SRT). Adolescents (ages 12-16) with persistent asthma (n = 20) used two asthma self-management apps over a 1-week period. During semi-structured interviews, participants identified their asthma goals and the app features that best promoted self-observation, self-judgment, and fostered positive self-reactions. Interviews were digitally recorded, transcribed verbatim, and analyzed thematically using MAXQDA. Adolescents' goals were to reduce the impact of asthma on their lives. Adolescents reported that self-check quizzes, reminders, and charting features increased their ability to self-observe and self-judge their asthma, which, in turn, helped them feel more confident they could manage their asthma independently and keep their asthma well-controlled. Asthma apps can positively influence adolescents' self-management behaviors via increased self-observation, self-judgment, and increased self-efficacy.

  8. Healthcare provider cultural competency: development and initial validation of a patient report measure.

    PubMed

    Lucas, Todd; Michalopoulou, Georgia; Falzarano, Pamela; Menon, Shanti; Cunningham, Windy

    2008-03-01

    Health researchers have proposed that provider cultural competency may contribute to health disparities. Yet, this belief continues to lack empirical support, and this is due in part to measurement issues that have plagued the cultural competency construct. In the present research, we report on the development of a theoretically grounded, generally applicable, and patient report measure of provider cultural competency. Samples of predominantly African American patients (N=310) were recruited from three urban medical clinics to complete a survey about their relationship with their physician. We examined the factor structure, validity and other psychometric characteristics of a newly proposed patient report measure of provider cultural competency. Psychometric analyses supported a tripartite model of cultural competency that was comprised of patient judgments of their physician's cultural knowledge, awareness, and skill. In addition, this result was replicated across multiple clinical contexts, while also demonstrating convergent and incremental validity when correlated with measures of trust, satisfaction and discrimination. This newly proposed measure addresses prior limitations in cultural competency measurement and may enhance future research by providing a standardized tool for use in multiple clinical and cultural contexts. Copyright (c) 2008 APA, all rights reserved.

  9. A Structured Approach to Teaching Applied Problem Solving through Technology Assessment.

    ERIC Educational Resources Information Center

    Fischbach, Fritz A.; Sell, Nancy J.

    1986-01-01

    Describes an approach to problem solving based on real-world problems. Discusses problem analysis and definitions, preparation of briefing documents, solution finding techniques (brainstorming and synectics), solution evaluation and judgment, and implementation. (JM)

  10. [Self-judgment of personality traits and cognitive dimensions of the self].

    PubMed

    Horiuchi, T

    1996-12-01

    When people make a judgment as to whether a trait describes themselves or not, cognitive structure about the self must play an important role. Cognitive dimensions are a characteristic of such cognitive structure. The present study examined whether a self-referent information processing was mediated by cognitive dimensions of the self. For the purpose, Klein, Loftus, and Burton's task facilitation paradigm (1989) was adapted, which consisted of performing in succession two tasks, initial and target, for each trait adjective used. Experiment 1, which examined the evaluative dimension, showed that an evaluative processing in the target task was facilitated when the initial task was self-referent. Experiment 2, which examined six dimensions, showed that processing of the relevant dimension in the target task was facilitated when the initial task was self-referent. These results suggest that a self-referent information processing is mediated by cognitive dimensions of the self.

  11. Supernatural beliefs, natural kinds, and conceptual structure.

    PubMed

    Walker, S J

    1992-11-01

    This article presents cross-cultural evidence in support of the notion that adults' natural kind concepts are theory based but may be informed by knowledge/belief systems other than the biological. Three groups of subjects from western Nigeria--rural, urban, and elite--participated in the study. Subjects heard stories describing alterations of appearance; that is, one natural kind was made to resemble another in both ritual and nonritual contexts. Subjects then were required to judge the identity of the altered item and to give an explanation for the category judgment. It was predicted that subjects would make more nonpreservation-of-identity category judgments supported by supernatural explanations in the ritual contexts and that subjects' use of supernatural explanations would reflect the extent of their engagement with the supernatural. The first prediction was borne out; the second prediction was only partially supported. Discussion of the results emphasizes the importance of exploring the role of sociocultural factors in conceptual structure.

  12. Brain correlates of aesthetic judgment of beauty.

    PubMed

    Jacobsen, Thomas; Schubotz, Ricarda I; Höfel, Lea; Cramon, D Yves V

    2006-01-01

    Functional MRI was used to investigate the neural correlates of aesthetic judgments of beauty of geometrical shapes. Participants performed evaluative aesthetic judgments (beautiful or not?) and descriptive symmetry judgments (symmetric or not?) on the same stimulus material. Symmetry was employed because aesthetic judgments are known to be often guided by criteria of symmetry. Novel, abstract graphic patterns were presented to minimize influences of attitudes or memory-related processes and to test effects of stimulus symmetry and complexity. Behavioral results confirmed the influence of stimulus symmetry and complexity on aesthetic judgments. Direct contrasts showed specific activations for aesthetic judgments in the frontomedian cortex (BA 9/10), bilateral prefrontal BA 45/47, and posterior cingulate, left temporal pole, and the temporoparietal junction. In contrast, symmetry judgments elicited specific activations in parietal and premotor areas subserving spatial processing. Interestingly, beautiful judgments enhanced BOLD signals not only in the frontomedian cortex, but also in the left intraparietal sulcus of the symmetry network. Moreover, stimulus complexity caused differential effects for each of the two judgment types. Findings indicate aesthetic judgments of beauty to rely on a network partially overlapping with that underlying evaluative judgments on social and moral cues and substantiate the significance of symmetry and complexity for our judgment of beauty.

  13. The Effect of Information Analysis Automation Display Content on Human Judgment Performance in Noisy Environments.

    PubMed

    Bass, Ellen J; Baumgart, Leigh A; Shepley, Kathryn Klein

    2013-03-01

    Displaying both the strategy that information analysis automation employs to makes its judgments and variability in the task environment may improve human judgment performance, especially in cases where this variability impacts the judgment performance of the information analysis automation. This work investigated the contribution of providing either information analysis automation strategy information, task environment information, or both, on human judgment performance in a domain where noisy sensor data are used by both the human and the information analysis automation to make judgments. In a simplified air traffic conflict prediction experiment, 32 participants made probability of horizontal conflict judgments under different display content conditions. After being exposed to the information analysis automation, judgment achievement significantly improved for all participants as compared to judgments without any of the automation's information. Participants provided with additional display content pertaining to cue variability in the task environment had significantly higher aided judgment achievement compared to those provided with only the automation's judgment of a probability of conflict. When designing information analysis automation for environments where the automation's judgment achievement is impacted by noisy environmental data, it may be beneficial to show additional task environment information to the human judge in order to improve judgment performance.

  14. The utility of the Historical Clinical Risk-20 Scale as a predictor of outcomes in decisions to transfer patients from high to lower levels of security--a UK perspective.

    PubMed

    Dolan, Mairead; Blattner, Regine

    2010-09-29

    Structured Professional Judgment (SPJ) approaches to violence risk assessment are increasingly being adopted into clinical practice in international forensic settings. The aim of this study was to examine the predictive validity of the Historical Clinical Risk -20 (HCR-20) violence risk assessment scale for outcome following transfers from high to medium security in a United Kingdom setting. The sample was predominately male and mentally ill and the majority of cases were detained under the criminal section of the Mental Health Act (1986). The HCR-20 was rated based on detailed case file information on 72 cases transferred from high to medium security. Outcomes were examined, independent of risk score, and cases were classed as "success or failure" based on established criteria. The mean length of follow up was 6 years. The total HCR-20 score was a robust predictor of failure at lower levels of security and return to high security. The Clinical and Risk management items contributed most to predictive accuracy. Although the HCR-20 was designed as a violence risk prediction tool our findings suggest it has potential utility in decisions to transfer patients from high to lower levels of security.

  15. Visualizing surgical quality data with treemaps.

    PubMed

    Hugine, Akilah L; Guerlain, Stephanie A; Turrentine, Florence E

    2014-09-01

    Treemaps are space-constrained visualizations for displaying hierarchical data structures using nested rectangles. The visualization allows large amounts of data to be examined in one display. The objective of this research was to examine the effects of using treemap visualizations to help surgeons assess surgical quality data from the American College of Surgeons created the National Surgical Quality Improvement Program database in a quick and timely manner. A controlled human subjects experiment was conducted to assess the ability of individuals to make quick and accurate judgments on surgery data by visualizing a treemap, with data hierarchically displayed by surgeon group, surgeon, and patient. Participants were given 20 task questions to complete involving examining the treemap and comparing surgeons' patients based on outcomes (dead or alive) and length of stay days. The outcomes measured were error (incorrect or correct) and task completion time. 120 participants completed 20 task questions for a total of 2400 responses. The main effects of layout and node size were found to be significant for absolute error, P < 0.0505 and P < 0.0185, respectively. The average judgment time to complete a task was 24 s with an accuracy rate of approximately 68%. This study served as a proof of concept to determine if treemaps could be beneficial in assessing surgical data retrospectively by allowing surgeons and healthcare administrators to make quick visual judgments. The study found that factors about the layout design affect judgment performance. Future research is needed to examine whether implementing the treemap within a dashboard system will improve on judgment accuracy for surgical quality questions. Published by Elsevier Inc.

  16. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America

    PubMed Central

    Pappas, Peter G.; Kauffman, Carol A.; Andes, David R.; Clancy, Cornelius J.; Marr, Kieren A.; Ostrosky-Zeichner, Luis; Reboli, Annette C.; Schuster, Mindy G.; Vazquez, Jose A.; Walsh, Thomas J.; Zaoutis, Theoklis E.; Sobel, Jack D.

    2016-01-01

    It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. PMID:26679628

  17. Judgments of Omitted BE and DO in Questions as Extended Finiteness Clinical Markers of Specific Language Impairment (SLI) to 15 Years: A Study of Growth and Asymptote

    ERIC Educational Resources Information Center

    Rice, Mabel L.; Hoffman, Lesa; Wexler, Ken

    2009-01-01

    Purpose: Clinical grammar markers are needed for children with SLI older than 8 years. This study followed children who were previously studied on sentences with omitted finiteness to determine if affected children continue to perform at low levels and to examine possible predictors of low performance. This is the first longitudinal report of…

  18. Mindfulness in occupational therapy education.

    PubMed

    Gura, Shira Taylor

    2010-07-01

    ABSTRACT The purpose of this paper is to explore the value of mindfulness and its role in occupational therapy education. The plethora of research on mindfulness-based stress reduction programs has shown consistent and positive results to enhance quality of life in clinical and nonclinical populations. Offering students the opportunities to learn and experience mindfulness could lead to enhanced self-awareness and care, focus and empathy, and a decrease of client judgment enhancing the success of clinical interventions.

  19. Adolescent judgments and reasoning about the failure to include peers with social disabilities.

    PubMed

    Bottema-Beutel, Kristen; Li, Zhushan

    2015-06-01

    Adolescents with autism spectrum disorder often do not have access to crucial peer social activities. This study examines how typically developing adolescents evaluate decisions not to include a peer based on disability status, and the justifications they apply to these decisions. A clinical interview methodology was used to elicit judgments and justifications across four contexts. We found adolescents are more likely to judge the failure to include as acceptable in personal as compared to public contexts. Using logistic regression, we found that adolescents are more likely to provide moral justifications as to why failure to include is acceptable in a classroom as compared to home, lab group, and soccer practice contexts. Implications for intervention are also discussed.

  20. Clinical decision making by nurses when faced with third-space fluid shift. How well do they fare?

    PubMed

    Redden, M; Wotton, K

    2001-01-01

    Nurses' use of knowledge, the connection of this knowledge to treatment decisions and information actually used to reach such decisions, delineates nurses' level of expertise. Previous research has shown that nurses in their clinical decision-making use the hypothetico-deductive method and intuitive judgment or pattern recognition. This interpretive study explored experienced critical care nurses' (n = 5) and gastrointestinal surgical nurses' (n = 5) clinical decision-making processes through ascertaining their knowledge and understanding of third-space fluid shift in elderly patients undergoing major gastrointestinal surgery. Both groups of nurses, because of their experience with elderly patients undergoing gastrointestinal surgery, were assumed to be experts. Data collection techniques included semi-structured interviews and the use of think aloud protocol for clinical scenario analysis. The findings demonstrated that the gastrointestinal surgical nurses used the hypothetico-deductive method to recognize critical cues and the existence of a problem but could not name the problem. The critical care nurses, on the other hand, used a combination of the hypothetico-deductive method and pattern recognition as a basis for identification of critical cues. The critical care nurses also possessed in depth knowledge of third-space fluid shift and were able to use pivotal cues to identify the actual phenomenon. Ultimately, it would appear that the structure of critical care nurses' work, their increased educational qualifications and the culture of the critical care unit promote a more proactive approach to reasoning in the physiological domain. The findings have implications for the development of practice guidelines and curriculum development in both tertiary and continuing nurse education.

  1. Comparison of PECARN, CATCH, and CHALICE Rules for Children with Minor Head Injury: A prospective cohort study

    PubMed Central

    Easter, Joshua S.; Bakes, Katherine; Dhaliwal, Jasmeet; Miller, Michael; Caruso, Emily; Haukoos, Jason S.

    2014-01-01

    Objective To evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries (TBIs) in children with minor head injuries presenting to the emergency department (ED). Methods We prospectively enrolled children <18 years of age with minor head injury (Glasgow Coma Scale 13 – 15) presenting within 24 hours of their injuries. We assessed the ability of 3 clinical decision rules (CATCH, CHALICE, PECARN) and 2 measures of physician judgment (estimated of <1% risk of TBI, actual CT ordering practice) to predict clinically important TBI, as defined by death from TBI, need for neurosurgery, intubation >24 hours for TBI, or hospital admission >2 nights for TBI. Results Among the 1,009 children, 21 (2%; 95% CI: 1% to 3%) had clinically important TBIs. Only physician practice and PECARN identified all clinically important TBIs, with ranked sensitivities as follows (95% CI): Physician practice and PECARN each 100% (84% to 100%), physician estimates 95% (76% to 100%), CATCH 91% (70% to 99%), and CHALICE 84% (60% to 97%). Ranked specificities were as follows: CHALICE 85% (82% to 87%), physician estimates 68% (65% to 71%), PECARN 62% (59% to 66%), physician practice 50% (47% to 53%), and CATCH 44% (41% to 47%). Conclusions Of the 5 modalities studied, only physician practice and PECARN identified all clinically important TBIs, with PECARN being slightly more specific. CHALICE was incompletely sensitive but the most specific of all rules. CATCH was incompletely sensitive and had the poorest specificity of all modalities. PMID:24635987

  2. Relationship Between Performance in Medical School and Postgraduate Competence.

    ERIC Educational Resources Information Center

    Gonnella, Joseph S.; Hojat, Mohammadreza

    1983-01-01

    The hypothesis that the relationship between medical school achievement and postgraduate performance would vary by specialty was confirmed in a comparison of grades, standardized medical exams, and ratings in four areas of competence (medical knowledge, data-gathering skills, clinical judgment, and professional attitudes) in internal medicine,…

  3. Patients' Contexts and Their Effects on Clinicians' Impressions of Conduct Disorder Symptoms

    ERIC Educational Resources Information Center

    De Los Reyes, Andres; Marsh, Jessecae K.

    2011-01-01

    The purpose of this study was to examine whether contextual information about patients' clinical presentations affected clinicians' judgments of conduct disorder symptoms. Forty-five clinicians read vignettes describing hypothetical patients who displayed one conduct disorder symptom alongside information about the patients' home, school, and peer…

  4. Duty-to-Warn Guidelines for Mental Health Counselors.

    ERIC Educational Resources Information Center

    Costa, Luann; Altekruse, Michael

    1994-01-01

    Summarizes legal cases in which duty-to-warn was an issue. Suggests that guidelines for counselors are few and lack definition. Offers a model to guide counselors in making clinical judgments in cases and case examples to exemplify possible ethical dilemmas in the practice of counseling. Includes 36 citations. (Author/CRR)

  5. Comparison of Automated Scoring Methods for a Computerized Performance Assessment of Clinical Judgment

    ERIC Educational Resources Information Center

    Harik, Polina; Baldwin, Peter; Clauser, Brian

    2013-01-01

    Growing reliance on complex constructed response items has generated considerable interest in automated scoring solutions. Many of these solutions are described in the literature; however, relatively few studies have been published that "compare" automated scoring strategies. Here, comparisons are made among five strategies for…

  6. Professional responsibility in maternity care: role of medical audit.

    PubMed

    Bhatt, R V

    1989-09-01

    In 1965, Baroda Medical College initiated a process of medical audit of maternal and perinatal deaths occurring at this institution, and consultation in peripheral medical facilities providing antenatal and obstetric care. By 1984 maternal and perinatal mortality had declined and clinical judgment in maternity care had improved.

  7. Disfluency in Spasmodic Dysphonia: A Multivariate Analysis.

    ERIC Educational Resources Information Center

    Cannito, Michael P.; Burch, Annette Renee; Watts, Christopher; Rappold, Patrick W.; Hood, Stephen B.; Sherrard, Kyla

    1997-01-01

    This study examined visual analog scaling judgments of disfluency by normal listeners in response to oral reading by 20 adults with spasmodic dysphonia (SD) and nondysphonic controls. Findings suggest that although dysfluency is not a defining feature of SD, it does contribute significantly to the overall clinical impression of severity of the…

  8. Constructing Clinical Judgments about Preschool Pragmatic Language Skills: An Action Research Study

    ERIC Educational Resources Information Center

    Boje, Noreen Susan

    2009-01-01

    The literature suggests that children who struggle with communication during social interactions, called "pragmatic language" in the field of speech language pathology, have fewer opportunities to engage in social practices that promote learning because of inadequate skills in interacting with others. Children with even subtle difficulties in…

  9. Dentist-Patient Interactions in Treatment Decision-Making: A Qualitative Study.

    ERIC Educational Resources Information Center

    Redford, Maryann; Gift, Helen C.

    1997-01-01

    A University of North Carolina study using focus groups of dentists and patients found dentist-patient interactions play an important role in treatment decision-making, and are predicated on non-clinical factors, including dentists' intuition and judgment and patient impressions of dentists' examination styles, personalities, and interpersonal…

  10. Controlled Trial Using Computerized Feedback to Improve Physicians' Diagnostic Judgments.

    ERIC Educational Resources Information Center

    Poses, Roy M.; And Others

    1992-01-01

    A study involving 14 experienced physicians investigated the effectiveness of a computer program (providing statistical feedback to teach a clinical diagnostic rule that predicts the probability of streptococcal pharyngitis), in conjunction with traditional lecture and periodic disease-prevalence reports. Results suggest the integrated method is a…

  11. Selection Practices of Group Leaders: A National Survey.

    ERIC Educational Resources Information Center

    Riva, Maria T.; Lippert, Laurel; Tackett, M. Jan

    2000-01-01

    Study surveys the selection practices of group leaders. Explores methods of selection, variables used to make selection decisions, and the types of selection errors that leaders have experienced. Results suggest that group leaders use clinical judgment to make selection decisions and endorse using some specific variables in selection. (Contains 22…

  12. The influence of first impressions on subsequent ratings within an OSCE station.

    PubMed

    Wood, Timothy J; Chan, James; Humphrey-Murto, Susan; Pugh, Debra; Touchie, Claire

    2017-10-01

    Competency-based assessment is placing increasing emphasis on the direct observation of learners. For this process to produce valid results, it is important that raters provide quality judgments that are accurate. Unfortunately, the quality of these judgments is variable and the roles of factors that influence the accuracy of those judgments are not clearly understood. One such factor is first impressions: that is, judgments about people we do not know, made quickly and based on very little information. This study explores the influence of first impressions in an OSCE. Specifically, the purpose is to begin to examine the accuracy of a first impression and its influence on subsequent ratings. We created six videotapes of history-taking performance. Each video was scripted from a real performance by six examinee residents within a single OSCE station. Each performance was re-enacted with six different actors playing the role of the examinees and one actor playing the role of the patient and videotaped. A total of 23 raters (i.e., physician examiners) reviewed each video and were asked to make a global judgment of the examinee's clinical abilities after 60 s (First Impression GR) by providing a rating on a six-point global rating scale and then to rate their confidence in the accuracy of that judgment by providing a rating on a five-point rating scale (Confidence GR). After making these ratings, raters then watched the remainder of the examinee's performance and made another global rating of performance (Final GR) before moving on to the next video. First impression ratings of ability varied across examinees and were moderately correlated to expert ratings (r = .59, 95% CI [-.13, .90]). There were significant differences in mean ratings for three examinees. Correlations ranged from .05 to .56 but were only significant for three examinees. Rater confidence in their first impression was not related to the likelihood of a rater changing their rating between the first impression and a subsequent rating. The findings suggest that first impressions could play a role in explaining variability in judgments, but their importance was determined by the videotaped performance of the examinees. More work is needed to clarify conditions that support or discourage the use of first impressions.

  13. Descriptive and evaluative judgment processes: behavioral and electrophysiological indices of processing symmetry and aesthetics.

    PubMed

    Jacobsen, Thomas; Höfel, Lea

    2003-12-01

    Descriptive symmetry and evaluative aesthetic judgment processes were compared using identical stimuli in both judgment tasks. Electrophysiological activity was recorded while participants judged novel formal graphic patterns in a trial-by-trial cuing setting using binary responses (symmetric, not symmetric; beautiful, not beautiful). Judgment analyses of a Phase 1 test and main experiment performance resulted in individual models, as well as group models, of the participants' judgment systems. Symmetry showed a strong positive correlation with beautiful judgments and was the most important cue. Descriptive judgments were performed faster than evaluative judgments. The ERPs revealed a phasic, early frontal negativity for the not-beautiful judgments. A sustained posterior negativity was observed in the symmetric condition. All conditions showed late positive potentials (LPPs). Evaluative judgment LPPs revealed a more pronounced right lateralization. It is argued that the present aesthetic judgments engage a two-stage process consisting of early, anterior frontomedian impression formation after 300 msec and right-hemisphere evaluative categorization around 600 msec after onset of the graphic patterns.

  14. Unpacking the neural associations of emotion and judgment in emotion-congruent judgment

    PubMed Central

    Beer, Jennifer S.

    2012-01-01

    The current study takes a new approach to understand the neural systems that support emotion-congruent judgment. The bulk of previous neural research has inferred emotional influences on judgment from disadvantageous judgments or non-random individual differences. The current study manipulated the influence of emotional information on judgments of stimuli that were equivocally composed of positive and negative attributes. Emotion-congruent processing was operationalized in two ways: neural activation significantly associated with primes that lead to emotionally congruent judgments and neural activation significantly associated with judgments that were preceded by emotionally congruent primes. Distinct regions of medial orbitofrontal cortex were associated with these patterns of emotion-congruent processing. Judgments that were incongruent with preceding primes were associated with dorsomedial prefrontal cortex, ventrolateral prefrontal cortex and lateral orbitofrontal cortex activity. The current study demonstrates a new approach to investigate the neural systems associated with emotion-congruent judgment. The findings suggest that medial OFC may support attentional processes that underlie emotion-congruent judgment. PMID:21511825

  15. A comparison of four measures of moral reasoning.

    PubMed

    Wilmoth, G H; McFarland, S G

    1977-08-01

    Kohlberg's Moral Judgment Scale, Gilligan et al.'s Sexual Moral Judgment Scale, Maitland and Goldman's Objective Moral Judgment Scale, and Hogan's Maturity of Moral Judgment Scale, were examined for reliability and inter-scale relationships. All measures except the Objective Moral Judgment Scale had good reliabilities. The obtained relations between the Moral Judgment Scale and the Sexual Moral Judgment Scale replicated previous research. The Objective Moral Judgment Scale was not found to validly assess the Kohlberg stages. The Maturity of Moral Judgment Scale scores were strongly related to the subjects's classification on the Kohlberg stages, and the scale appears to offer a reliable, quickly scored, and valid index of mature thought, although the scale's continuous scores do not permit clear stage classification.

  16. The Effect of Information Analysis Automation Display Content on Human Judgment Performance in Noisy Environments

    PubMed Central

    Bass, Ellen J.; Baumgart, Leigh A.; Shepley, Kathryn Klein

    2014-01-01

    Displaying both the strategy that information analysis automation employs to makes its judgments and variability in the task environment may improve human judgment performance, especially in cases where this variability impacts the judgment performance of the information analysis automation. This work investigated the contribution of providing either information analysis automation strategy information, task environment information, or both, on human judgment performance in a domain where noisy sensor data are used by both the human and the information analysis automation to make judgments. In a simplified air traffic conflict prediction experiment, 32 participants made probability of horizontal conflict judgments under different display content conditions. After being exposed to the information analysis automation, judgment achievement significantly improved for all participants as compared to judgments without any of the automation's information. Participants provided with additional display content pertaining to cue variability in the task environment had significantly higher aided judgment achievement compared to those provided with only the automation's judgment of a probability of conflict. When designing information analysis automation for environments where the automation's judgment achievement is impacted by noisy environmental data, it may be beneficial to show additional task environment information to the human judge in order to improve judgment performance. PMID:24847184

  17. Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis.

    PubMed

    Ali, Ather; Kahn, Janet; Rosenberger, Lisa; Perlman, Adam I

    2012-10-04

    Clinical trial design of manual therapies may be especially challenging as techniques are often individualized and practitioner-dependent. This paper describes our methods in creating a standardized Swedish massage protocol tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy, as well as implementation of this protocol in two randomized clinical trials. The manualization process involved a collaborative process between methodologic and clinical experts, with the explicit goals of creating a reproducible semi-structured protocol for massage therapy, while allowing some latitude for therapists' clinical judgment and maintaining consistency with a prior pilot study. The manualized protocol addressed identical specified body regions with distinct 30- and 60-min protocols, using standard Swedish strokes. Each protocol specifies the time allocated to each body region. The manualized 30- and 60-min protocols were implemented in a dual-site 24-week randomized dose-finding trial in patients with osteoarthritis of the knee, and is currently being implemented in a three-site 52-week efficacy trial of manualized Swedish massage therapy. In the dose-finding study, therapists adhered to the protocols and significant treatment effects were demonstrated. The massage protocol was manualized, using standard techniques, and made flexible for individual practitioner and subject needs. The protocol has been applied in two randomized clinical trials. This manualized Swedish massage protocol has real-world utility and can be readily utilized both in the research and clinical settings. Clinicaltrials.gov NCT00970008 (18 August 2009).

  18. Processes of Similarity Judgment

    ERIC Educational Resources Information Center

    Larkey, Levi B.; Markman, Arthur B.

    2005-01-01

    Similarity underlies fundamental cognitive capabilities such as memory, categorization, decision making, problem solving, and reasoning. Although recent approaches to similarity appreciate the structure of mental representations, they differ in the processes posited to operate over these representations. We present an experiment that…

  19. 49 CFR 821.17 - Motions to dismiss, for judgment on the pleadings and for summary judgment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... shall be filed within 10 days after service of the law judge's order on the motion. (b) Motions to... a matter of law. (d) Motions for summary judgment. A party may file a motion for summary judgment on... dismissal, judgment on the pleadings and summary judgment orders. When a law judge grants a motion to...

  20. 49 CFR 821.17 - Motions to dismiss, for judgment on the pleadings and for summary judgment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... shall be filed within 10 days after service of the law judge's order on the motion. (b) Motions to... a matter of law. (d) Motions for summary judgment. A party may file a motion for summary judgment on... dismissal, judgment on the pleadings and summary judgment orders. When a law judge grants a motion to...

  1. 49 CFR 821.17 - Motions to dismiss, for judgment on the pleadings and for summary judgment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... shall be filed within 10 days after service of the law judge's order on the motion. (b) Motions to... a matter of law. (d) Motions for summary judgment. A party may file a motion for summary judgment on... dismissal, judgment on the pleadings and summary judgment orders. When a law judge grants a motion to...

  2. 49 CFR 821.17 - Motions to dismiss, for judgment on the pleadings and for summary judgment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... shall be filed within 10 days after service of the law judge's order on the motion. (b) Motions to... a matter of law. (d) Motions for summary judgment. A party may file a motion for summary judgment on... dismissal, judgment on the pleadings and summary judgment orders. When a law judge grants a motion to...

  3. 49 CFR 821.17 - Motions to dismiss, for judgment on the pleadings and for summary judgment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... shall be filed within 10 days after service of the law judge's order on the motion. (b) Motions to... a matter of law. (d) Motions for summary judgment. A party may file a motion for summary judgment on... dismissal, judgment on the pleadings and summary judgment orders. When a law judge grants a motion to...

  4. Acquisition Strategy Guide,

    DTIC Science & Technology

    1984-07-01

    acquisition stategy for his program. Well informed, educated, and innovative applications and judgments are necessary to structure a successful...program but part of’the Con- operating forces. gress is opposed to it. A case in point is thle MIX missile development. In other instances the Ad...hierarchical format, can be applied to help in The market factors element includes both industrial organizing and structuring an acquisition strategy

  5. Agreement on Child Maltreatment Decisions: A Nonrandomized Study on the Effects of Structured Decision-Making

    ERIC Educational Resources Information Center

    Bartelink, C.; van Yperen, T. A.; ten Berge, I. J.; de Kwaadsteniet, L.; Witteman, C. L. M.

    2014-01-01

    Background: Practitioners investigating cases of suspected child maltreatment often disagree whether a child is subject to or at risk of abuse or neglect in the family and, if so, what to do about such abuse or neglect. Structured decision-making is considered to be a solution to the problem of subjective judgments and decisions. Objective: This…

  6. 40 CFR 194.26 - Expert judgment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... judgment elicitation processes and the reasoning behind those results. Documentation of interviews used to elicit judgments from experts, the questions or issues presented for elicitation of expert judgment... expert judgment elicitation comports with the level of knowledge required by the questions or issues...

  7. 40 CFR 194.26 - Expert judgment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... judgment elicitation processes and the reasoning behind those results. Documentation of interviews used to elicit judgments from experts, the questions or issues presented for elicitation of expert judgment... expert judgment elicitation comports with the level of knowledge required by the questions or issues...

  8. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY 2018 POSITION STATEMENT ON INTEGRATION OF INSULIN PUMPS AND CONTINUOUS GLUCOSE MONITORING IN PATIENTS WITH DIABETES MELLITUS.

    PubMed

    Grunberger, George; Handelsman, Yehuda; Bloomgarden, Zachary T; Fonseca, Vivian A; Garber, Alan J; Haas, Richard A; Roberts, Victor L; Umpierrez, Guillermo E

    2018-03-01

    This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there are no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician. AACE/ACE Task Force on Integration of Insulin Pumps and Continuous Glucose Monitoring in the Management of Patients With Diabetes Mellitus Chair George Grunberger, MD, FACP, FACE Task Force Members Yehuda Handelsman, MD, FACP, FNLA, MACE Zachary T. Bloomgarden, MD, MACE Vivian A. Fonseca, MD, FACE Alan J. Garber, MD, PhD, FACE Richard A. Haas, MD, FACE Victor L. Roberts, MD, MBA, FACP, FACE Guillermo E. Umpierrez, MD, CDE, FACP, FACE Abbreviations: AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology A1C = glycated hemoglobin BGM = blood glucose monitoring CGM = continuous glucose monitoring CSII = continuous subcutaneous insulin infusion DM = diabetes mellitus FDA = Food & Drug Administration MDI = multiple daily injections T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus SAP = sensor-augmented pump SMBG = self-monitoring of blood glucose STAR 3 = Sensor-Augmented Pump Therapy for A1C Reduction phase 3 trial.

  9. Judgments about Judgments: The Dissociation of Consideration Price and Transaction Commitment Judgments

    ERIC Educational Resources Information Center

    Janiszewski, Chris; Lichtenstein, Donald R.; Belyavsky, Julia

    2008-01-01

    There are many contexts in which people make judgments about prior judgments. For example, Internet shopping bots (e.g., NexTag.com) allow consumers to search for products and, if the price is too high, list a price at which they would consider making the purchase (i.e., base judgment). If the price drops to this level, the vendor generates an…

  10. Negativity bias for sad faces in depression: An event-related potential study.

    PubMed

    Dai, Qin; Wei, Juanjuan; Shu, Xiaorui; Feng, Zhengzhi

    2016-12-01

    Negativity bias in depression has been previously confirmed. However, mainly during a valence category task, it remains unclear how happy or unhappy individuals perceive emotional materials. Moreover, cerebral alteration measurements during a valence judgment task is lacking. The present study aimed to explore a valence judgment of a valence rating task, combined with event-related potential (ERP) recording. Healthy controls, individuals with sub-clinical depression, and patients diagnosed with major depressive disorder (MDD) were recruited. Twenty-four subjects in each group completed a valence rating task, during which the ERP amplitudes were recorded. The MDD group had lower valence scores, faster responses, and greater N1 amplitudes for sad faces, whereas individuals with sub-clinical depression had faster responses and greater P1 amplitudes for all faces but lower valence scores and greater P2 amplitudes for happy faces. The findings suggest the tendency toward a negativity bias in valence ratings in patients with depression supported by behavioral and cerebral evidence, which is a latent trait of depression, possibly associated with the vulnerability of depression. The current study offers the first experimental evidence of cognitive and cerebral biomarkers of negativity bias in valence ratings in depression, which confirms Beck's cognitive theory and gives important direction for clinical therapy. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  11. Comparison of ethical judgments exhibited by clients and ethics consultants in Japan

    PubMed Central

    2014-01-01

    Background Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and CEC consultants. Methods The CEC request and response documents of all 60 cases reviewed across Japan between October 2006 and the end of October 2011 were classified in terms of the presence of decisional capacity in the patient. We conducted a qualitative content analysis of the differences in reasoning between client and CEC consultants. Reasoned judgments were verified in individual cases to classify the similarities or differences of opinion between CEC clients and teams. Results As the result of classification of the decisional capacity and the difference of opinion regarding medical care, the most frequent category was 25 cases (41.7%) of “uncertain decisional capacity,” and 23 cases (38.3%) of “withholding of decision-making.” A chi-square analysis was performed on presence of decisional capacity and agreement in decision-making, yielding a statistically significant difference (p < 0.05). The CEC consultants’ reasoning was based on “patient’s preference was ambiguous,” “validity of family as a surrogate,” “estimation of patient preference,” and “patient’s best interest,” whereas the CEC client’s reasoning was based on “consistent family preference was shown/not shown” and “appropriate therapeutic methods to manage patient safety.” Conclusion Differences in opinions were found in cases classified according to decisional capacity. Furthermore, the reasoning behind judgments differed between CEC clients and CEC consultants. The reasoning of CEC consultants was critical and reflective, while for clients it was situational and pragmatic. PMID:24592932

  12. First impressions: making up your mind after a 100-ms exposure to a face.

    PubMed

    Willis, Janine; Todorov, Alexander

    2006-07-01

    People often draw trait inferences from the facial appearance of other people. We investigated the minimal conditions under which people make such inferences. In five experiments, each focusing on a specific trait judgment, we manipulated the exposure time of unfamiliar faces. Judgments made after a 100-ms exposure correlated highly with judgments made in the absence of time constraints, suggesting that this exposure time was sufficient for participants to form an impression. In fact, for all judgments-attractiveness, likeability, trustworthiness, competence, and aggressiveness-increased exposure time did not significantly increase the correlations. When exposure time increased from 100 to 500 ms, participants' judgments became more negative, response times for judgments decreased, and confidence in judgments increased. When exposure time increased from 500 to 1,000 ms, trait judgments and response times did not change significantly (with one exception), but confidence increased for some of the judgments; this result suggests that additional time may simply boost confidence in judgments. However, increased exposure time led to more differentiated person impressions.

  13. The organization of verbs of knowing: evidence for cultural commonality and variation in theory of mind.

    PubMed

    Schwanenflugel, P J; Martin, M; Takahashi, T

    1999-09-01

    Cross-cultural commonality and variation in folk theories of knowing were studied by examining the organization of verbs of knowing in German and Japanese adults. German and Japanese adults performed one of two tasks: a similarity judgment task and an attribute rating task. Organizational structure was assessed for the similarity judgment task using multidimensional scaling and additive similarity tree analyses. The attribute rating task was used to describe the characteristics that organized the dimensions and clusters emerging from the scaling solutions. The folk theory of mind displayed was an information processing model with constructive components, although the constructive aspects were more salient for the Germans than for the Japanese.

  14. A causal role for V5/MT neurons coding motion-disparity conjunctions in resolving perceptual ambiguity.

    PubMed

    Krug, Kristine; Cicmil, Nela; Parker, Andrew J; Cumming, Bruce G

    2013-08-05

    Judgments about the perceptual appearance of visual objects require the combination of multiple parameters, like location, direction, color, speed, and depth. Our understanding of perceptual judgments has been greatly informed by studies of ambiguous figures, which take on different appearances depending upon the brain state of the observer. Here we probe the neural mechanisms hypothesized as responsible for judging the apparent direction of rotation of ambiguous structure from motion (SFM) stimuli. Resolving the rotation direction of SFM cylinders requires the conjoint decoding of direction of motion and binocular depth signals [1, 2]. Within cortical visual area V5/MT of two macaque monkeys, we applied electrical stimulation at sites with consistent multiunit tuning to combinations of binocular depth and direction of motion, while the monkey made perceptual decisions about the rotation of SFM stimuli. For both ambiguous and unambiguous SFM figures, rotation judgments shifted as if we had added a specific conjunction of disparity and motion signals to the stimulus elements. This is the first causal demonstration that the activity of neurons in V5/MT contributes directly to the perception of SFM stimuli and by implication to decoding the specific conjunction of disparity and motion, the two different visual cues whose combination drives the perceptual judgment. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Improving Adolescent Judgment and Decision Making

    PubMed Central

    Dansereau, Donald F.; Knight, Danica K.; Flynn, Patrick M.

    2013-01-01

    Human judgment and decision making (JDM) has substantial room for improvement, especially among adolescents. Increased technological and social complexity “ups the ante” for developing impactful JDM interventions and aids. Current explanatory advances in this field emphasize dual processing models that incorporate both experiential and analytic processing systems. According to these models, judgment and decisions based on the experiential system are rapid and stem from automatic reference to previously stored episodes. Those based on the analytic system are viewed as slower and consciously developed. These models also hypothesize that metacognitive (self-monitoring) activities embedded in the analytic system influence how and when the two systems are used. What is not included in these models is the development of an intersection between the two systems. Because such an intersection is strongly suggested by memory and educational research as the basis of wisdom/expertise, the present paper describes an Integrated Judgment and Decision-Making Model (IJDM) that incorporates this component. Wisdom/expertise is hypothesized to contain a collection of schematic structures that can emerge from the accumulation of similar episodes or repeated analytic practice. As will be argued, in comparisons to dual system models, the addition of this component provides a broader basis for selecting and designing interventions to improve adolescent JDM. Its development also has implications for generally enhancing cognitive interventions by adopting principles from athletic training to create automated, expert behaviors. PMID:24391350

  16. New evidence of a rhythmic priming effect that enhances grammaticality judgments in children.

    PubMed

    Chern, Alexander; Tillmann, Barbara; Vaughan, Chloe; Gordon, Reyna L

    2018-09-01

    Musical rhythm and the grammatical structure of language share a surprising number of characteristics that may be intrinsically related in child development. The current study aimed to understand the potential influence of musical rhythmic priming on subsequent spoken grammar task performance in children with typical development who were native speakers of English. Participants (ages 5-8 years) listened to rhythmically regular and irregular musical sequences (within-participants design) followed by blocks of grammatically correct and incorrect sentences upon which they were asked to perform a grammaticality judgment task. Rhythmically regular musical sequences improved performance in grammaticality judgment compared with rhythmically irregular musical sequences. No such effect of rhythmic priming was found in two nonlinguistic control tasks, suggesting a neural overlap between rhythm processing and mechanisms recruited during grammar processing. These findings build on previous research investigating the effect of rhythmic priming by extending the paradigm to a different language, testing a younger population, and employing nonlanguage control tasks. These findings of an immediate influence of rhythm on grammar states (temporarily augmented grammaticality judgment performance) also converge with previous findings of associations between rhythm and grammar traits (stable generalized grammar abilities) in children. Taken together, the results of this study provide additional evidence for shared neural processing for language and music and warrant future investigations of potentially beneficial effects of innovative musical material on language processing. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. A feasibility study of brain-targeted treatment for people with painful knee osteoarthritis in tertiary care.

    PubMed

    Harms, Anton; Heredia-Rizo, Alberto M; Moseley, G Lorimer; Hau, Raphael; Stanton, Tasha R

    2018-06-11

    To assess the feasibility and clinical impact of brain-targeted treatment (BT; aiming to target sensorimotor processing) in knee osteoarthritis patients attending tertiary care. Randomized replicated case series. The study involved three phases, each of 2 weeks duration: (1) no-treatment phase; (2) BT phase (left/right judgments and touch discrimination training); and (3) usual care (education, strengthening, and stretching training). Primary outcomes were: timely recruitment; number of participants completing the interventions; treatment compliance and barriers; follow-up rates; and treatment impact on pain and function. Fear-avoidance beliefs and clinical measures of cortical body representation (tactile acuity and left/right judgment performance) were secondary outcomes. A total of 5% (19/355) of all assessed patients were eligible to participate and of these, 58% (11/19) agreed to participate. Ten patients completed the study, and 9 were successfully followed up, with treatment compliance varying between interventions. Compliance was poor for the touch discrimination component of BT. No significant effects were observed for pain relief or knee function after any treatment. A positive impact of treatment was found for fear-avoidance beliefs (usual care vs. washout, p = 0.007; BT vs. washout, p = 0.029) and left/right judgment accuracy (usual care vs. washout; p = 0.006). Clear barriers were identified to implementing BT in tertiary care for knee osteoarthritis. Access to all available services (especially the use of interpreters), and treatment options that do not require additional assistance to perform (e.g., touch discrimination training) represent the main lessons learned.

  18. Mindfulness and Psychological Health Outcomes: A Latent Profile Analysis among Military Personnel and College Students.

    PubMed

    Bravo, Adrian J; Pearson, Matthew R; Kelley, Michelle L

    2018-02-01

    Previous research on trait mindfulness facets using person-centered analyses (e.g., latent profile analysis [LPA]) has identified four distinct mindfulness profiles among college students: a high mindfulness group (high on all facets of the Five-Factor Mindfulness Questionnaire [FFMQ]), a judgmentally observing group (highest on observing, but low on non-judging of inner experience and acting with awareness), a non-judgmentally aware group (high on non-judging of inner experience and acting with awareness, but very low on observing), and a low mindfulness group (low on all facets of the FFMQ). In the present study, we used LPA to identify distinct mindfulness profiles in a community based sample of U.S. military personnel (majority veterans; n = 407) and non-military college students ( n = 310) and compare these profiles on symptoms of psychological health outcomes (e.g., suicidality, PTSD, anxiety, rumination) and percentage of participants exceeding clinically significant cut-offs for depressive symptoms, substance use, and alcohol use. In the subsample of college students, we replicated previous research and found four distinct mindfulness profiles; however, in the military subsample we found three distinct mindfulness profiles (a combined low mindfulness/judgmentally observing class). In both subsamples, we found that the most adaptive profile was the "high mindfulness" profile (i.e., demonstrated the lowest scores on all psychological symptoms and the lowest probability of exceeding clinical cut-offs). Based on these findings, we purport that the comprehensive examination of an individual's mindfulness profile could help clinicians tailor interventions/treatments that capitalize on individual's specific strengths and work to address their specific deficits.

  19. Professional Norms versus Managerialism in Campus Mental Health Centers: The Experiences of Eight Clinicians

    ERIC Educational Resources Information Center

    Jodoin, Elizabeth C.; Ayers, David F.

    2013-01-01

    The purpose of this qualitative study was to understand better how, if at all, eight campus-based mental health clinicians experienced and negotiated managerialist practices, and with what outcomes. It was found that managerialism was experienced as challenges to professional ethics, clinical judgment, and challenges related to professional role…

  20. Can Knowledge of Client Birth Order Bias Clinical Judgment?

    ERIC Educational Resources Information Center

    Stewart, Allan E.

    2004-01-01

    Clinicians (N = 308) responded to identical counseling vignettes of a male client that differed only in the client's stated birth order. Clinicians developed different impressions about the client and his family experiences that corresponded with the prototypical descriptions of persons from 1 of 4 birth orders (i.e., first, middle, youngest, and…

  1. The Validity of Computer Audits of Simulated Cases Records.

    ERIC Educational Resources Information Center

    Rippey, Robert M.; And Others

    This paper describes the implementation of a computer-based approach to scoring open-ended problem lists constructed to evaluate student and practitioner clinical judgment from real or simulated records. Based on 62 previously administered and scored problem lists, the program was written in BASIC for a Heathkit H11A computer (equivalent to DEC…

  2. Client Verbal and Nonverbal Reinforcement of Counselor Behavior: Its Impact on Interviewing Behavior and Postinterview Evaluation.

    ERIC Educational Resources Information Center

    Lee, Dong Yul; And Others

    1979-01-01

    Examined effects of client reinforcement on counselor behavior and on attitudinal judgments about the client. Counselor-trainees interviewed a standard client. Counselors in verbal and verbal plus nonverbal conditions showed increases in reflection of feeling statements. Differences in counselor attraction and clinical impression of the client…

  3. The Relationship between Diagnostic Accuracy and Confidence in Medical Students.

    ERIC Educational Resources Information Center

    Mann, Doug

    Studies in psychology and clinical decision making have shown that research subjects and physicians are often overconfident in the accuracy of their judgments. In these studies, groups of 20 first-year and 27 third-year osteopathic medical students at the Ohio University College of Osteopathic Medicine (Athens) were slightly underconfident in…

  4. Violence in American Schools: A Practical Guide for Counselors.

    ERIC Educational Resources Information Center

    Sandhu, Daya Singh, Ed.; Aspy, Cheryl Blalock, Ed.

    The number of students victimized by violent crimes rose by nearly 25% between 1989-1995. Screening, along with good clinical judgment by counselors, should be the source for identifying children and adolescents at risk. This book is designed as a guidebook to help counselors develop skills in learning about the etiology of violence, identifying…

  5. Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Stapleton, Drue; Hawkins, Andrew

    2015-01-01

    Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…

  6. Peer Review: The CHAMPUS Program.

    ERIC Educational Resources Information Center

    Stricker, George

    This paper examines the use of the peer review system in evaluating out-patient clinical services for a third-party payer seeking justification for payment of services. Peer review is defined as a process by which one professional, in an official capacity, makes a judgment about a co-professional in a matter involving professional functioning. The…

  7. 42 CFR 414.902 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... carrier means an entity assigned by CMS to process and pay claims for drugs and biologicals under the CAP... participating CAP physician, in his or her clinical judgment, to require prompt action or attention for purposes... requirements of § 414.906(e) are met. Local carrier means an entity assigned by CMS to process and pay claims...

  8. 42 CFR 414.902 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... carrier means an entity assigned by CMS to process and pay claims for drugs and biologicals under the CAP... participating CAP physician, in his or her clinical judgment, to require prompt action or attention for purposes... requirements of § 414.906(e) are met. Local carrier means an entity assigned by CMS to process and pay claims...

  9. 42 CFR 414.902 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... carrier means an entity assigned by CMS to process and pay claims for drugs and biologicals under the CAP... participating CAP physician, in his or her clinical judgment, to require prompt action or attention for purposes... requirements of § 414.906(e) are met. Local carrier means an entity assigned by CMS to process and pay claims...

  10. Pelvic inflammatory disease and sepsis.

    PubMed

    Dulin, Judy D; Akers, Mary C

    2003-03-01

    Pelvic inflammatory disease affects approximately 1 million women per year in the United States alone and has a variety of causative organisms. Because the diagnosis of PID is based on clinical judgment, health care providers need to be guided by the CDC recommendations for diagnosing and treating PID. Because presenting symptoms are often vague, the health care provider should assess female patients for risky behaviors that may lead to PID and should use screening data when making clinical judgments and differential diagnoses. Whenever possible, female patients with PID should be treated as outpatients. If diagnosis and treatment are not performed in a timely manner, PID may cause sepsis, septic shock, and even death. Even if they survive, as many as 15% to 20% of these women experience long-term sequelae of PID, such as ectopic pregnancy, tubo-ovarian abscess, infertility, dyspareunia, and chronic pelvic pain. The best treatments for PID are interventions that lead to prevention and early detection. The critical care nurse has an important role in recognizing the variables that may lead to PID-related sepsis and in encouraging health-seeking and health-maintenance behaviors among women with these diagnoses.

  11. Perseveration induces dissociative uncertainty in obsessive-compulsive disorder.

    PubMed

    Giele, Catharina L; van den Hout, Marcel A; Engelhard, Iris M; Dek, Eliane C P; Toffolo, Marieke B J; Cath, Danielle C

    2016-09-01

    Obsessive compulsive (OC)-like perseveration paradoxically increases feelings of uncertainty. We studied whether the underlying mechanism between perseveration and uncertainty is a reduced accessibility of meaning ('semantic satiation'). OCD patients (n = 24) and matched non-clinical controls (n = 24) repeated words 2 (non-perseveration) or 20 times (perseveration). They decided whether this word was related to another target word. Speed of relatedness judgments and feelings of dissociative uncertainty were measured. The effects of real-life perseveration on dissociative uncertainty were tested in a smaller subsample of the OCD group (n = 9). Speed of relatedness judgments was not affected by perseveration. However, both groups reported more dissociative uncertainty after perseveration compared to non-perseveration, which was higher in OCD patients. Patients reported more dissociative uncertainty after 'clinical' perseveration compared to non-perseveration.. Both parts of this study are limited by some methodological issues and a small sample size. Although the mechanism behind 'perseveration → uncertainty' is still unclear, results suggest that the effects of perseveration are counterproductive. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Probative value of absolute and relative judgments in eyewitness identification.

    PubMed

    Clark, Steven E; Erickson, Michael A; Breneman, Jesse

    2011-10-01

    It is well-accepted that eyewitness identification decisions based on relative judgments are less accurate than identification decisions based on absolute judgments. However, the theoretical foundation for this view has not been established. In this study relative and absolute judgments were compared through simulations of the WITNESS model (Clark, Appl Cogn Psychol 17:629-654, 2003) to address the question: Do suspect identifications based on absolute judgments have higher probative value than suspect identifications based on relative judgments? Simulations of the WITNESS model showed a consistent advantage for absolute judgments over relative judgments for suspect-matched lineups. However, simulations of same-foils lineups showed a complex interaction based on the accuracy of memory and the similarity relationships among lineup members.

  13. Implications of Cognitive Load for Hypothesis Generation and Probability Judgment

    PubMed Central

    Sprenger, Amber M.; Dougherty, Michael R.; Atkins, Sharona M.; Franco-Watkins, Ana M.; Thomas, Rick P.; Lange, Nicholas; Abbs, Brandon

    2011-01-01

    We tested the predictions of HyGene (Thomas et al., 2008) that both divided attention at encoding and judgment should affect the degree to which participants’ probability judgments violate the principle of additivity. In two experiments, we showed that divided attention during judgment leads to an increase in subadditivity, suggesting that the comparison process for probability judgments is capacity limited. Contrary to the predictions of HyGene, a third experiment revealed that divided attention during encoding leads to an increase in later probability judgment made under full attention. The effect of divided attention during encoding on judgment was completely mediated by the number of hypotheses participants generated, indicating that limitations in both encoding and recall can cascade into biases in judgments. PMID:21734897

  14. Does ADHD in adults affect the relative accuracy of metamemory judgments?

    PubMed

    Knouse, Laura E; Paradise, Matthew J; Dunlosky, John

    2006-11-01

    Prior research suggests that individuals with ADHD overestimate their performance across domains despite performing more poorly in these domains. The authors introduce measures of accuracy from the larger realm of judgment and decision making--namely, relative accuracy and calibration--to the study of self-evaluative judgment accuracy in adults with ADHD. Twenty-eight adults with ADHD and 28 matched controls participate in a computer-administered paired-associate learning task and predict their future recall using immediate and delayed judgments of learning (JOLs). Retrospective confidence judgments are also collected. Groups perform equally in terms of judgment magnitude and absolute judgment accuracy as measured by discrepancy scores and calibration curves. Both groups benefit equally from making their JOL at a delay, and the group with ADHD show higher relative accuracy for delayed judgments. Results suggest that under certain circumstances, adults with ADHD can make accurate judgments about their future memory.

  15. Individual differences in moral judgment competence influence neural correlates of socio-normative judgments

    PubMed Central

    Wartenburger, Isabell; Mériau, Katja; Scheibe, Christina; Goodenough, Oliver R.; Villringer, Arno; van der Meer, Elke; Heekeren, Hauke R.

    2008-01-01

    To investigate how individual differences in moral judgment competence are reflected in the human brain, we used event-related functional magnetic resonance imaging, while 23 participants made either socio-normative or grammatical judgments. Participants with lower moral judgment competence recruited the left ventromedial prefrontal cortex and the left posterior superior temporal sulcus more than participants with greater competence in this domain when identifying social norm violations. Moreover, moral judgment competence scores were inversely correlated with activity in the right dorsolateral prefrontal cortex (DLPFC) during socio-normative relative to grammatical judgments. Greater activity in right DLPFC in participants with lower moral judgment competence indicates increased recruitment of rule-based knowledge and its controlled application during socio-normative judgments. These data support current models of the neurocognition of morality according to which both emotional and cognitive components play an important role. PMID:19015093

  16. Children's Facial Trustworthiness Judgments: Agreement and Relationship with Facial Attractiveness.

    PubMed

    Ma, Fengling; Xu, Fen; Luo, Xianming

    2016-01-01

    This study examined developmental changes in children's abilities to make trustworthiness judgments based on faces and the relationship between a child's perception of trustworthiness and facial attractiveness. One hundred and one 8-, 10-, and 12-year-olds, along with 37 undergraduates, were asked to judge the trustworthiness of 200 faces. Next, they issued facial attractiveness judgments. The results indicated that children made consistent trustworthiness and attractiveness judgments based on facial appearance, but with-adult and within-age agreement levels of facial judgments increased with age. Additionally, the agreement levels of judgments made by girls were higher than those by boys. Furthermore, the relationship between trustworthiness and attractiveness judgments increased with age, and the relationship between two judgments made by girls was closer than those by boys. These findings suggest that face-based trait judgment ability develops throughout childhood and that, like adults, children may use facial attractiveness as a heuristic cue that signals a stranger's trustworthiness.

  17. The neural basis of intuitive and counterintuitive moral judgment.

    PubMed

    Kahane, Guy; Wiech, Katja; Shackel, Nicholas; Farias, Miguel; Savulescu, Julian; Tracey, Irene

    2012-04-01

    Neuroimaging studies on moral decision-making have thus far largely focused on differences between moral judgments with opposing utilitarian (well-being maximizing) and deontological (duty-based) content. However, these studies have investigated moral dilemmas involving extreme situations, and did not control for two distinct dimensions of moral judgment: whether or not it is intuitive (immediately compelling to most people) and whether it is utilitarian or deontological in content. By contrasting dilemmas where utilitarian judgments are counterintuitive with dilemmas in which they are intuitive, we were able to use functional magnetic resonance imaging to identify the neural correlates of intuitive and counterintuitive judgments across a range of moral situations. Irrespective of content (utilitarian/deontological), counterintuitive moral judgments were associated with greater difficulty and with activation in the rostral anterior cingulate cortex, suggesting that such judgments may involve emotional conflict; intuitive judgments were linked to activation in the visual and premotor cortex. In addition, we obtained evidence that neural differences in moral judgment in such dilemmas are largely due to whether they are intuitive and not, as previously assumed, to differences between utilitarian and deontological judgments. Our findings therefore do not support theories that have generally associated utilitarian and deontological judgments with distinct neural systems.

  18. The neural basis of intuitive and counterintuitive moral judgment

    PubMed Central

    Wiech, Katja; Shackel, Nicholas; Farias, Miguel; Savulescu, Julian; Tracey, Irene

    2012-01-01

    Neuroimaging studies on moral decision-making have thus far largely focused on differences between moral judgments with opposing utilitarian (well-being maximizing) and deontological (duty-based) content. However, these studies have investigated moral dilemmas involving extreme situations, and did not control for two distinct dimensions of moral judgment: whether or not it is intuitive (immediately compelling to most people) and whether it is utilitarian or deontological in content. By contrasting dilemmas where utilitarian judgments are counterintuitive with dilemmas in which they are intuitive, we were able to use functional magnetic resonance imaging to identify the neural correlates of intuitive and counterintuitive judgments across a range of moral situations. Irrespective of content (utilitarian/deontological), counterintuitive moral judgments were associated with greater difficulty and with activation in the rostral anterior cingulate cortex, suggesting that such judgments may involve emotional conflict; intuitive judgments were linked to activation in the visual and premotor cortex. In addition, we obtained evidence that neural differences in moral judgment in such dilemmas are largely due to whether they are intuitive and not, as previously assumed, to differences between utilitarian and deontological judgments. Our findings therefore do not support theories that have generally associated utilitarian and deontological judgments with distinct neural systems. PMID:21421730

  19. Rethinking Familiarity: Remember/Know Judgments in Free Recall

    PubMed Central

    Mickes, Laura; Seale-Carlisle, Travis M.; Wixted, John T.

    2013-01-01

    Although frequently used with recognition, a few studies have used the Remember/Know procedure with free recall. In each case, participants gave Know judgments to a significant number of recalled items (items that were presumably not remembered on the basis of familiarity). What do these Know judgments mean? We investigated this issue using a source memory/free-recall procedure. For each word that was recalled, participants were asked to (a) make a confidence rating on a 5-point scale, (b) make a Remember/Know judgment, and (c) recollect a source detail. The large majority of both Remember judgments and Know judgments were made with high confidence and high accuracy, but source memory was nevertheless higher for Remember judgments than for Know judgments. These source memory results correspond to what is found using recognition, and they raise the possibility that Know judgments in free recall identify the cue-dependent retrieval of item-only information from an episodic memory search set. In agreement with this idea, we also found that the temporal dynamics of free recall were similar for high-confidence Remember and high-confidence Know judgments (as if both judgments reflected retrieval from the same search set). If Know judgments in free recall do in fact reflect the episodic retrieval of item-only information, it seems reasonable to suppose that the same might be true of high-confidence Know judgments in recognition. If so, then a longstanding debate about the role of the hippocampus in recollection and familiarity may have a natural resolution. PMID:23637470

  20. Iranian Clinical Nurses’ Activities for Self-Directed Learning: A Qualitative Study

    PubMed Central

    Ghiyasvandian, Shahrzad; Malekian, Morteza; Cheraghi, Mohammad Ali

    2016-01-01

    Background: Clinical nurses need lifelong learning skills for responding to the rapid changes of clinical settings. One of the best strategies for lifelong learning is self-directed learning. The aim of this study was to explore Iranian clinical nurses’ activities for self-directed learning. Methods: In this qualitative study, 23 semi-structured personal interviews were conducted with nineteen clinical nurses working in all four hospitals affiliated to Isfahan Social Security Organization, Isfahan, Iran. Study data were analyzed by using the content analysis approach. The study was conducted from June 2013 to October 2014. Findings: Study participants’ activities for self-directed learning fell into two main categories of striving for knowledge acquisition and striving for skill development. The main theme of the study was ‘Revising personal performance based on intellectual-experiential activities’. Conclusions: Study findings suggest that Iranian clinical nurses continually revise their personal performance by performing self-directed intellectual and experiential activities to acquire expertise. The process of acquiring expertise is a linear process which includes two key steps of knowledge acquisition and knowledge development. In order to acquire and advance their knowledge, nurses perform mental learning activities such as sensory perception, self-evaluation, and suspended judgment step-by-step. Moreover, they develop their skills through doing activities like apprenticeship, masterly performance, and self-regulation. The absolute prerequisite to expertise acquisition is that a nurse needs to follow these two steps in a sequential manner. PMID:26652072

  1. Clinical evaluation of a novel population-based regression analysis for detecting glaucomatous visual field progression.

    PubMed

    Kovalska, M P; Bürki, E; Schoetzau, A; Orguel, S F; Orguel, S; Grieshaber, M C

    2011-04-01

    The distinction of real progression from test variability in visual field (VF) series may be based on clinical judgment, on trend analysis based on follow-up of test parameters over time, or on identification of a significant change related to the mean of baseline exams (event analysis). The aim of this study was to compare a new population-based method (Octopus field analysis, OFA) with classic regression analyses and clinical judgment for detecting glaucomatous VF changes. 240 VF series of 240 patients with at least 9 consecutive examinations available were included into this study. They were independently classified by two experienced investigators. The results of such a classification served as a reference for comparison for the following statistical tests: (a) t-test global, (b) r-test global, (c) regression analysis of 10 VF clusters and (d) point-wise linear regression analysis. 32.5 % of the VF series were classified as progressive by the investigators. The sensitivity and specificity were 89.7 % and 92.0 % for r-test, and 73.1 % and 93.8 % for the t-test, respectively. In the point-wise linear regression analysis, the specificity was comparable (89.5 % versus 92 %), but the sensitivity was clearly lower than in the r-test (22.4 % versus 89.7 %) at a significance level of p = 0.01. A regression analysis for the 10 VF clusters showed a markedly higher sensitivity for the r-test (37.7 %) than the t-test (14.1 %) at a similar specificity (88.3 % versus 93.8 %) for a significant trend (p = 0.005). In regard to the cluster distribution, the paracentral clusters and the superior nasal hemifield progressed most frequently. The population-based regression analysis seems to be superior to the trend analysis in detecting VF progression in glaucoma, and may eliminate the drawbacks of the event analysis. Further, it may assist the clinician in the evaluation of VF series and may allow better visualization of the correlation between function and structure owing to VF clusters. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Innovations in Second Language Research Methods.

    ERIC Educational Resources Information Center

    Gass, Susan M.

    2001-01-01

    Focuses on two approaches to research in second language acquisition: (1) various types of acceptability judgments or probes aimed at assessing acquisition of syntactic structure; and (2) various types of stimulated recall designed to gather learners' accounts of their own thought processes. (Author/VWL)

  3. Helping Struggling Teachers.

    ERIC Educational Resources Information Center

    Tucker, Pamela

    2001-01-01

    About 5 to 15 percent of teachers in 2.7 million public-education classrooms are marginal or incompetent. Assistance plans offer structure, purpose, and remedial help. Plans have six components: definition of the problem, statement of objectives, intervention strategies, a timeline, data-collection procedures, and final judgment. (MLH)

  4. Diagnosis of chronic gout: evaluating the american college of rheumatology proposal, European league against rheumatism recommendations, and clinical judgment.

    PubMed

    Peláez-Ballestas, Ingris; Hernández Cuevas, Claudia; Burgos-Vargas, Rubén; Hernández Roque, Lizandra; Terán, Leobardo; Espinoza, Jesús; Esquivel-Valerio, Jorge A; Goycochea-Robles, María Victoria; Aceves, Francisco J; Bernard, Ana Guilaisne; Ventura, Lucio; Shumsky, Clara; Hernández Garduño, Adolfo; Vázquez-Mellado, Janitzia

    2010-08-01

    Observation of monosodium urate (MSU) crystal is the gold standard for diagnosis of gout, but is rarely performed in daily clinical practice, and diagnosis is based on clinical judgment. Our aim was to identify clinical and paraclinical data included in the European League Against Rheumatism recommendations (EULARr) and American College of Rheumatology proposed criteria (ACRp) for diagnosis of gout in patients with chronic gout according to their attending rheumatologists. This cross-sectional and multicenter study included consecutive patients from outpatient clinics with a diagnosis of gout by their attending rheumatologists according to their expertise. The frequency of each item from the ACRp and EULARr was determined. Possible combinations of the items that were frequent, clinically relevant, and simple to evaluate in daily practice were determined. We studied 549 patients (96% men), mean age 50 +/- 14 years. Analysis of MSU crystals was performed in 15%. We selected 7 clinical criteria and 1 laboratory measure because of their frequency, importance, and simplicity to obtain: current or past history of: > 1 attack of acute arthritis (93%); mono or oligoarthritis attacks (74%); rapid progression of pain and swelling (< 24 hours; 74%); podagra (70%); erythema (56%); unilateral tarsitis (33%); tophi (52%); and hyperuricemia (93%). The chronic gout diagnosis (CGD) proposal comprised >or= 4/8 of these; 88% of patients had the criteria of the CGD proposal while 75% had 6/11 ACRp criteria (p = 0.001). When analysis of MSU crystals was added, 90.1% (CGD) and 83.9% (ACRp) met the criteria (p = 0.004). Current or past history of >or= 4/8 CGD parameters is highly suggestive of chronic gout.

  5. Revealing and acknowledging value judgments in health technology assessment.

    PubMed

    Hofmann, Bjørn; Cleemput, Irina; Bond, Kenneth; Krones, Tanja; Droste, Sigrid; Sacchini, Dario; Oortwijn, Wija

    2014-12-01

    Although value issues are increasingly addressed in health technology assessment (HTA) reports, HTA is still seen as a scientific endeavor and sometimes contrasted with value judgments, which are considered arbitrary and unscientific. This article aims at illustrating how numerous value judgments are at play in the HTA process, and why it is important to acknowledge and address value judgments. A panel of experts involved in HTA, including ethicists, scrutinized the HTA process with regard to implicit value judgments. It was analyzed whether these value judgments undermine the accountability of HTA results. The final results were obtained after several rounds of deliberation. Value judgments are identified before the assessment when identifying and selecting health technologies to assess, and as part of assessment. They are at play in the processes of deciding on how to select, frame, present, summarize or synthesize information in systematic reviews. Also, in economic analysis, value judgments are ubiquitous. Addressing the ethical, legal, and social issues of a given health technology involves moral, legal, and social value judgments by definition. So do the appraisal and the decision-making process. HTA by and large is a process of value judgments. However, the preponderance of value judgments does not render HTA biased or flawed. On the contrary they are basic elements of the HTA process. Acknowledging and explicitly addressing value judgments may improve the accountability of HTA.

  6. First- and Second-Order Metacognitive Judgments of Semantic Memory Reports: The Influence of Personality Traits and Cognitive Styles

    ERIC Educational Resources Information Center

    Buratti, Sandra; Allwood, Carl Martin; Kleitman, Sabina

    2013-01-01

    In learning contexts, people need to make realistic confidence judgments about their memory performance. The present study investigated whether second-order judgments of first-order confidence judgments could help people improve their confidence judgments of semantic memory information. Furthermore, we assessed whether different personality and…

  7. Impact of a Risk Calculator on Risk Perception and Surgical Decision Making: A Randomized Trial.

    PubMed

    Sacks, Greg D; Dawes, Aaron J; Ettner, Susan L; Brook, Robert H; Fox, Craig R; Russell, Marcia M; Ko, Clifford Y; Maggard-Gibbons, Melinda

    2016-12-01

    The aim of this study was to determine whether exposure to data from a risk calculator influences surgeons' assessments of risk and in turn, their decisions to operate. Little is known about how risk calculators inform clinical judgment and decision-making. We asked a national sample of surgeons to assess the risks (probability of serious complications or death) and benefits (recovery) of operative and nonoperative management and to rate their likelihood of recommending an operation (5-point scale) for 4 detailed clinical vignettes wherein the best treatment strategy was uncertain. Surgeons were randomized to the clinical vignettes alone (control group; n = 384) or supplemented by data from a risk calculator (risk calculator group; n = 395). We compared surgeons' judgments and decisions between the groups. Surgeons exposed to the risk calculator judged levels of operative risk that more closely approximated the risk calculator value (RCV) compared with surgeons in the control group [mesenteric ischemia: 43.7% vs 64.6%, P < 0.001 (RCV = 25%); gastrointestinal bleed: 47.7% vs 53.4%, P < 0.001 (RCV = 38%); small bowel obstruction: 13.6% vs 17.5%, P < 0.001 (RCV = 14%); appendicitis: 13.4% vs 24.4%, P < 0.001 (RCV = 5%)]. Surgeons exposed to the risk calculator also varied less in their assessment of operative risk (standard deviations: mesenteric ischemia 20.2% vs 23.2%, P = 0.01; gastrointestinal bleed 17.4% vs 24.1%, P < 0.001; small bowel obstruction 10.6% vs 14.9%, P < 0.001; appendicitis 15.2% vs 21.8%, P < 0.001). However, averaged across the 4 vignettes, the 2 groups did not differ in their reported likelihood of recommending an operation (mean 3.7 vs 3.7, P = 0.76). Exposure to risk calculator data leads to less varied and more accurate judgments of operative risk among surgeons, and thus may help inform discussions of treatment options between surgeons and patients. Interestingly, it did not alter their reported likelihood of recommending an operation.

  8. Elbow Room for Best Practice? Montgomery, Patients' values, and Balanced Decision-Making in Person-Centred Clinical Care.

    PubMed

    Herring, Jonathan; Fulford, Kmw; Dunn, Michael; Handa, Ashoki

    2017-11-01

    The UK Supreme Court Montgomery judgment marks a decisive shift in the legal test of duty of care in the context of consent to treatment, from the perspective of the clinician (as represented by Bolam rules) to that of the patient. A majority of commentators on Montgomery have focused on the implications of the judgment for disclosure of risk. In this article, we set risk disclosure in context with three further elements of the judgment: benefits, options, and dialogue. These elements, we argue, taken together with risk disclosure, reflect the origins of the Montgomery ruling in a model of consent based on autonomy of patient choice through shared decision-making with their doctor. This model reflects recent developments in both law and medicine and is widely regarded (by the General Medical Council and others) as representing best practice in contemporary person-centred medicine. So understood, we suggest, the shift marked by Montgomery in the basis of duty of care is a shift in underpinning values: it is a shift from the clinician's interpretation about what would be best for patients to the values of (to what is significant or matters from the perspective of) the particular patient concerned in the decision in question. But the values of the particular patient do not thereby become paramount. The Montgomery test of duty of care requires the values of the particular patient to be balanced alongside the values of a reasonable person in the patient's position. We illustrate some of the practical challenges arising from the balance of considerations required by Montgomery with examples from surgical care. These examples show the extent to which Montgomery, in mirroring the realities of clinical decision-making, provides elbowroom for best practice in person-centred clinical care. © The Author 2017. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected With HIV: 2014 Update by the HIV Medicine Association of the Infectious Diseases Society of America

    PubMed Central

    Lucas, Gregory M.; Ross, Michael J.; Stock, Peter G.; Shlipak, Michael G.; Wyatt, Christina M.; Gupta, Samir K.; Atta, Mohamed G.; Wools-Kaloustian, Kara K.; Pham, Paul A.; Bruggeman, Leslie A.; Lennox, Jeffrey L.; Ray, Patricio E.; Kalayjian, Robert C.

    2014-01-01

    It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. PMID:25234519

  10. A nomograph method for assessing body weight.

    PubMed

    Thomas, A E; McKay, D A; Cutlip, M B

    1976-03-01

    The ratio of weight/height emerges from varied epidemiological studies as the most generally useful index of relative body mass in adults. The authors present a nomograph to facilitate use of this relationship in clinical situations. While showing the range of weight given as desirable in life insurance studies, the scale expresses relative weight as a continuous variable. This method encourages use of clinical judgment in interpreting "overweight" and "underweight" and in accounting for muscular and skeletal contributions to measured mass.

  11. Causal judgment from contingency information: relation between subjective reports and individual tendencies in judgment.

    PubMed

    White, P A

    2000-04-01

    In two experiments, participants made causal judgments from contingency information for problems with different objective contingencies. After the judgment task, the participants reported how their judgments had changed following each type of contingency information. Some reported idiosyncratic tendencies--in other words, tendencies contrary to those expected under associative-learning and normative rule induction models of contingency judgment. These idiosyncratic reports tended to be better predictors of the judgments of those who made them than did the models. The results are consistent with the view that causal judgment from contingency information is made, at least in part, by deliberative use of acquired and sometimes idiosyncratic notions of evidential value, the outcomes of which tend, in aggregate, to be highly correlated with the outcomes of normative procedures.

  12. Cognitive Load Selectively Interferes with Utilitarian Moral Judgment

    PubMed Central

    Greene, Joshua D.; Morelli, Sylvia A.; Lowenberg, Kelly; Nystrom, Leigh E.; Cohen, Jonathan D.

    2008-01-01

    Traditional theories of moral development emphasize the role of controlled cognition in mature moral judgment, while a more recent trend emphasizes intuitive and emotional processes. Here we test a dual-process theory synthesizing these perspectives. More specifically, our theory associates utilitarian moral judgment (approving of harmful actions that maximize good consequences) with controlled cognitive processes and associates non-utilitarian moral judgment with automatic emotional responses. Consistent with this theory, we find that a cognitive load manipulation selectively interferes with utilitarian judgment. This interference effect provides direct evidence for the influence of controlled cognitive processes in moral judgment, and utilitarian moral judgment more specifically. PMID:18158145

  13. Effect of congenital blindness on the semantic representation of some everyday concepts.

    PubMed

    Connolly, Andrew C; Gleitman, Lila R; Thompson-Schill, Sharon L

    2007-05-15

    This study explores how the lack of first-hand experience with color, as a result of congenital blindness, affects implicit judgments about "higher-order" concepts, such as "fruits and vegetables" (FV), but not others, such as "household items" (HHI). We demonstrate how the differential diagnosticity of color across our test categories interacts with visual experience to produce, in effect, a category-specific difference in implicit similarity. Implicit pair-wise similarity judgments were collected by using an odd-man-out triad task. Pair-wise similarities for both FV and for HHI were derived from this task and were compared by using cluster analysis and regression analyses. Color was found to be a significant component in the structure of implicit similarity for FV for sighted participants but not for blind participants; and this pattern remained even when the analysis was restricted to blind participants who had good explicit color knowledge of the stimulus items. There was also no evidence that either subject group used color knowledge in making decisions about HHI, nor was there an indication of any qualitative differences between blind and sighted subjects' judgments on HHI.

  14. Bridging the Gap between Human Judgment and Automated Reasoning in Predictive Analytics

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sanfilippo, Antonio P.; Riensche, Roderick M.; Unwin, Stephen D.

    2010-06-07

    Events occur daily that impact the health, security and sustainable growth of our society. If we are to address the challenges that emerge from these events, anticipatory reasoning has to become an everyday activity. Strong advances have been made in using integrated modeling for analysis and decision making. However, a wider impact of predictive analytics is currently hindered by the lack of systematic methods for integrating predictive inferences from computer models with human judgment. In this paper, we present a predictive analytics approach that supports anticipatory analysis and decision-making through a concerted reasoning effort that interleaves human judgment and automatedmore » inferences. We describe a systematic methodology for integrating modeling algorithms within a serious gaming environment in which role-playing by human agents provides updates to model nodes and the ensuing model outcomes in turn influence the behavior of the human players. The approach ensures a strong functional partnership between human players and computer models while maintaining a high degree of independence and greatly facilitating the connection between model and game structures.« less

  15. The face of fear and anger: Facial width-to-height ratio biases recognition of angry and fearful expressions.

    PubMed

    Deska, Jason C; Lloyd, E Paige; Hugenberg, Kurt

    2018-04-01

    The ability to rapidly and accurately decode facial expressions is adaptive for human sociality. Although judgments of emotion are primarily determined by musculature, static face structure can also impact emotion judgments. The current work investigates how facial width-to-height ratio (fWHR), a stable feature of all faces, influences perceivers' judgments of expressive displays of anger and fear (Studies 1a, 1b, & 2), and anger and happiness (Study 3). Across 4 studies, we provide evidence consistent with the hypothesis that perceivers more readily see anger on faces with high fWHR compared with those with low fWHR, which instead facilitates the recognition of fear and happiness. This bias emerges when participants are led to believe that targets displaying otherwise neutral faces are attempting to mask an emotion (Studies 1a & 1b), and is evident when faces display an emotion (Studies 2 & 3). Together, these studies suggest that target facial width-to-height ratio biases ascriptions of emotion with consequences for emotion recognition speed and accuracy. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  16. Oculomotor responses and visuospatial perceptual judgments compete for common limited resources

    PubMed Central

    Tibber, Marc S.; Grant, Simon; Morgan, Michael J.

    2010-01-01

    While there is evidence for multiple spatial and attentional maps in the brain it is not clear to what extent visuoperceptual and oculomotor tasks rely on common neural representations and attentional mechanisms. Using a dual-task interference paradigm we tested the hypothesis that eye movements and perceptual judgments made to simultaneously presented visuospatial information compete for shared limited resources. Observers undertook judgments of stimulus collinearity (perceptual extrapolation) using a pointer and Gabor patch and/or performed saccades to a peripheral dot target while their eye movements were recorded. In addition, observers performed a non-spatial control task (contrast discrimination), matched for task difficulty and stimulus structure, which on the basis of previous studies was expected to represent a lesser load on putative shared resources. Greater mutual interference was indeed found between the saccade and extrapolation task pair than between the saccade and contrast discrimination task pair. These data are consistent with visuoperceptual and oculomotor responses competing for common limited resources as well as spatial tasks incurring a relatively high attentional cost. PMID:20053112

  17. Dynamic cultural influences on neural representations of the self.

    PubMed

    Chiao, Joan Y; Harada, Tokiko; Komeda, Hidetsugu; Li, Zhang; Mano, Yoko; Saito, Daisuke; Parrish, Todd B; Sadato, Norihiro; Iidaka, Tetsuya

    2010-01-01

    People living in multicultural environments often encounter situations which require them to acquire different cultural schemas and to switch between these cultural schemas depending on their immediate sociocultural context. Prior behavioral studies show that priming cultural schemas reliably impacts mental processes and behavior underlying self-concept. However, less well understood is whether or not cultural priming affects neurobiological mechanisms underlying the self. Here we examined whether priming cultural values of individualism and collectivism in bicultural individuals affects neural activity in cortical midline structures underlying self-relevant processes using functional magnetic resonance imaging. Biculturals primed with individualistic values showed increased activation within medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC) during general relative to contextual self-judgments, whereas biculturals primed with collectivistic values showed increased response within MPFC and PCC during contextual relative to general self-judgments. Moreover, degree of cultural priming was positively correlated with degree of MPFC and PCC activity during culturally congruent self-judgments. These findings illustrate the dynamic influence of culture on neural representations underlying the self and, more broadly, suggest a neurobiological basis by which people acculturate to novel environments.

  18. A multi-factor Rasch scale for artistic judgment.

    PubMed

    Bezruczko, Nikolaus

    2002-01-01

    Measurement properties are reported for a combined scale of abstract and figurative artistic judgment aptitude items. Abstract items are synthetic, rule-based images from Visual Designs Test which implements a statistical algorithm to control design complexity and redundancy, and figurative items are canvas paintings in five styles, Fauvism, Post-Impressionism, Surrealism, Renaissance, and Baroque especially created for this research. The paintings integrate syntactic structure from VDT Abstract designs with thematic content for each style at four levels of complexity while controlling redundancy. Trained test administrators collected preference for synthetic abstract designs and authentic figurative art from 462 examinees in Johnson O'Connor Research Foundation testing offices in Boston, New York, Chicago, and Dallas. The Rasch model replicated measurement properties for VDT Abstract items and identified an item hierarchy that was statistically invariant between genders and generally stable across age for new, authentic figurative items. Further examination of the figurative item hierarchy revealed that complexity interacts with style and meaning. Sound measurement properties for a combined VDT Abstract and Figurative scale shows promise for a comprehensive artistic judgment construct.

  19. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Pilat, Joseph F

    The application of the methodology developed by the GenIV International Forum's (GIF's) Proliferation Resistance and Physical Protection (PR&PP) Working Group is an expert elicitation. Although the framework of the methodology is structured and systematic, it does not by itself constitute or require a formal elicitation. However, formal elicitation can be utilized in the PR&PP context to provide a systematic, credible and transparent qualitative analysis and develop input for quantitative analyses. This section provides an overview of expert elicitations, a discussion of the role formal expert elicitations can play in the PR&PP methodology, an outline of the formal expert elicitation processmore » and a brief practical guide to conducting formal expert elicitations. Expert elicitation is a process utilizing knowledgeable people in cases, for example, when an assessment is needed but physically based data is absent or open to interpretation. More specifically, it can be used to: (1) predict future events; (2) provide estimates on new, rare, complex or poorly understood phenomena; (3) integrate or interpret existing information; or (4) determine what is currently known, how well it is known or what is worth learning in a field. Expert elicitation can be informal or formal. The informal application of expert judgment is frequently used. Although it can produce good results, it often provides demonstrably biased or otherwise flawed answers to problems. This along with the absence of transparency can result in a loss of confidence when experts speak on issues. More formal expert elicitation is a structured process that makes use of people knowledgeable in certain areas to make assessments. The reason for advocating formal use is that the quality and accuracy of expert judgment comes from the completeness of the expert's understanding of the phenomena and the process used to elicit and analyze the data. The use of a more formal process to obtain, lU1derstand and analyze expert judgment has led to an improved acceptance of expert judgment because of the rigor and transparency of the results.« less

  20. The development of a concept of mild head injury.

    PubMed

    Wrightson, P

    2000-09-01

    Medical and literary sources have described head injury and its effects from early Egyptian times. Though milder injury - concussion - must have been familiar, there was little specific written about it until the latter part of the 18th century. Descriptions of persisting symptoms appear in the 19th century, and discussion of their origin and management has continued and intensified since then. There have been several major issues. How does mechanical trauma produce a temporary loss of neurological function and is there some lasting damage? When symptoms persist do they follow a pattern which we recognise as occurring with structural lesions, or are the symptoms a functional reaction to the injury and other life events? Are they both?Over the last 50 years these issues have been debated, often with heat. Whatever the final judgment the present task would seem to be to provide a service to deal with the clinical situation. Copyright 2000 Harcourt Publishers Ltd.

  1. Development of parallel scales to measure HIV-related stigma

    PubMed Central

    Visser, Maretha J.; Kershaw, Trace; Makin, Jennifer D.; Forsyth, Brian W.C.

    2014-01-01

    HIV-related stigma is a multidimensional concept which has pervasive effects on the lives of HIV-infected people as well as serious consequences for the management of HIV/AIDS. In this research three parallel stigma scales were developed to assess personal views of stigma, stigma attributed to others, and internalized stigma experienced by HIV-infected individuals. The stigma scales were administered in two samples: a community sample of 1077 respondents and 317 HIV-infected pregnant women recruited at clinics from the same community in Tshwane (South Africa). A two-factor structure referring to moral judgment and interpersonal distancing was confirmed across scales and sample groups. The internal consistency of the scales was acceptable and evidence of validity is reported. Parallel scales to assess and compare different perspectives of stigma provide opportunities for research aimed at understanding of stigma, assessing the consequences or evaluating possible interventions aimed at reducing stigma. PMID:18266101

  2. Do social utility judgments influence attentional processing?

    PubMed

    Shore, Danielle M; Heerey, Erin A

    2013-10-01

    Research shows that social judgments influence decision-making in social environments. For example, judgments about an interaction partners' trustworthiness affect a variety of social behaviors and decisions. One mechanism by which social judgments may influence social decisions is by biasing the automatic allocation of attention toward certain social partners, thereby shaping the information people acquire. Using an attentional blink paradigm, we investigate how trustworthiness judgments alter the allocation of attention to social stimuli in a set of two experiments. The first experiment investigates trustworthiness judgments based solely on a social partner's facial appearance. The second experiment examines the effect of trustworthiness judgments based on experienced behavior. In the first, strong appearance-based judgments (positive and negative) enhanced stimulus recognizability but did not alter the size of the attentional blink, suggesting that appearance-based social judgments enhance face memory but do not affect pre-attentive processing. However, in the second experiment, in which judgments were based on behavioral experience rather than appearance, positive judgments enhanced pre-attentive processing of trustworthy faces. This suggests that a stimulus's potential benefits, rather than its disadvantages, shape the automatic distribution of attentional resources. These results have implications for understanding how appearance- and behavior-based social cues shape attention distribution in social environments. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Neural Correlates of Explicit Social Judgments on Vocal Stimuli

    PubMed Central

    Hensel, Lukas; Bzdok, Danilo; Müller, Veronika I.; Zilles, Karl; Eickhoff, Simon B.

    2015-01-01

    Functional neuroimaging research on the neural basis of social evaluation has traditionally focused on face perception paradigms. Thus, little is known about the neurobiology of social evaluation processes based on auditory cues, such as voices. To investigate the top-down effects of social trait judgments on voices, hemodynamic responses of 44 healthy participants were measured during social trait (trustworthiness [TR] and attractiveness [AT]), emotional (happiness, HA), and cognitive (age, AG) voice judgments. Relative to HA and AG judgments, TR and AT judgments both engaged the bilateral inferior parietal cortex (IPC; area PGa) and the dorsomedial prefrontal cortex (dmPFC) extending into the perigenual anterior cingulate cortex. This dmPFC activation overlapped with previously reported areas specifically involved in social judgments on ‘faces.’ Moreover, social trait judgments were expected to share neural correlates with emotional HA and cognitive AG judgments. Comparison of effects pertaining to social, social–emotional, and social–cognitive appraisal processes revealed a dissociation of the left IPC into 3 functional subregions assigned to distinct cytoarchitectonic subdivisions. In total, the dmPFC is proposed to assume a central role in social attribution processes across sensory qualities. In social judgments on voices, IPC activity shifts from rostral processing of more emotional judgment facets to caudal processing of more cognitive judgment facets. PMID:24243619

  4. 29 CFR 102.179 - Motions for default judgment, summary judgment, or dismissal referred to Chief Administrative Law...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Administrative Law Judge. During any period when the Board lacks a quorum, all motions for default judgment... 29 Labor 2 2012-07-01 2012-07-01 false Motions for default judgment, summary judgment, or dismissal referred to Chief Administrative Law Judge. 102.179 Section 102.179 Labor Regulations Relating to...

  5. 29 CFR 102.179 - Motions for default judgment, summary judgment, or dismissal referred to Chief Administrative Law...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Administrative Law Judge. During any period when the Board lacks a quorum, all motions for default judgment... 29 Labor 2 2014-07-01 2014-07-01 false Motions for default judgment, summary judgment, or dismissal referred to Chief Administrative Law Judge. 102.179 Section 102.179 Labor Regulations Relating to...

  6. 29 CFR 102.179 - Motions for default judgment, summary judgment, or dismissal referred to Chief Administrative Law...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Administrative Law Judge. During any period when the Board lacks a quorum, all motions for default judgment... 29 Labor 2 2013-07-01 2013-07-01 false Motions for default judgment, summary judgment, or dismissal referred to Chief Administrative Law Judge. 102.179 Section 102.179 Labor Regulations Relating to...

  7. Moral judgment as information processing: an integrative review.

    PubMed

    Guglielmo, Steve

    2015-01-01

    How do humans make moral judgments about others' behavior? This article reviews dominant models of moral judgment, organizing them within an overarching framework of information processing. This framework poses two distinct questions: (1) What input information guides moral judgments? and (2) What psychological processes generate these judgments? Information Models address the first question, identifying critical information elements (including causality, intentionality, and mental states) that shape moral judgments. A subclass of Biased Information Models holds that perceptions of these information elements are themselves driven by prior moral judgments. Processing Models address the second question, and existing models have focused on the relative contribution of intuitive versus deliberative processes. This review organizes existing moral judgment models within this framework and critically evaluates them on empirical and theoretical grounds; it then outlines a general integrative model grounded in information processing, and concludes with conceptual and methodological suggestions for future research. The information-processing framework provides a useful theoretical lens through which to organize extant and future work in the rapidly growing field of moral judgment.

  8. Moral judgment as information processing: an integrative review

    PubMed Central

    Guglielmo, Steve

    2015-01-01

    How do humans make moral judgments about others’ behavior? This article reviews dominant models of moral judgment, organizing them within an overarching framework of information processing. This framework poses two distinct questions: (1) What input information guides moral judgments? and (2) What psychological processes generate these judgments? Information Models address the first question, identifying critical information elements (including causality, intentionality, and mental states) that shape moral judgments. A subclass of Biased Information Models holds that perceptions of these information elements are themselves driven by prior moral judgments. Processing Models address the second question, and existing models have focused on the relative contribution of intuitive versus deliberative processes. This review organizes existing moral judgment models within this framework and critically evaluates them on empirical and theoretical grounds; it then outlines a general integrative model grounded in information processing, and concludes with conceptual and methodological suggestions for future research. The information-processing framework provides a useful theoretical lens through which to organize extant and future work in the rapidly growing field of moral judgment. PMID:26579022

  9. Children's Facial Trustworthiness Judgments: Agreement and Relationship with Facial Attractiveness

    PubMed Central

    Ma, Fengling; Xu, Fen; Luo, Xianming

    2016-01-01

    This study examined developmental changes in children's abilities to make trustworthiness judgments based on faces and the relationship between a child's perception of trustworthiness and facial attractiveness. One hundred and one 8-, 10-, and 12-year-olds, along with 37 undergraduates, were asked to judge the trustworthiness of 200 faces. Next, they issued facial attractiveness judgments. The results indicated that children made consistent trustworthiness and attractiveness judgments based on facial appearance, but with-adult and within-age agreement levels of facial judgments increased with age. Additionally, the agreement levels of judgments made by girls were higher than those by boys. Furthermore, the relationship between trustworthiness and attractiveness judgments increased with age, and the relationship between two judgments made by girls was closer than those by boys. These findings suggest that face-based trait judgment ability develops throughout childhood and that, like adults, children may use facial attractiveness as a heuristic cue that signals a stranger's trustworthiness. PMID:27148111

  10. The Causal Structure of Utility Conditionals

    ERIC Educational Resources Information Center

    Bonnefon, Jean-Francois; Sloman, Steven A.

    2013-01-01

    The psychology of reasoning is increasingly considering agents' values and preferences, achieving greater integration with judgment and decision making, social cognition, and moral reasoning. Some of this research investigates utility conditionals, ‘"if 'p' then 'q'’" statements where the realization of "p" or "q" or…

  11. Gender and the Structure and Salience of Values: An Example from Israeli Youth.

    ERIC Educational Resources Information Center

    Maslovaty, Nava; Dor-Shav, Zecharia

    1990-01-01

    Male and female eleventh grade students from 14 schools in Tel Aviv were tested to determine the effect of gender and other factors on values and value judgments. No predominating factor was found, although gender effect could be quantified. (DM)

  12. A Practical Probabilistic Graphical Modeling Tool for Weighing Ecological Risk-Based Evidence

    EPA Science Inventory

    Past weight-of-evidence frameworks for adverse ecological effects have provided soft-scoring procedures for judgments based on the quality and measured attributes of evidence. Here, we provide a flexible probabilistic structure for weighing and integrating lines of evidence for e...

  13. Using structured expert judgment to assess invasive species prevention: Asian carp and the Mississippi-Great Lakes hydrologic connection.

    PubMed

    Wittmann, Marion E; Cooke, Roger M; Rothlisberger, John D; Lodge, David M

    2014-02-18

    Recently, authors have theorized that invasive species prevention is more cost-effective than control in protecting ecosystem services. However, quantification of the effectiveness of prevention is rare because experiments at field scales are expensive or infeasible. We therefore used structured expert judgment to quantify the efficacy of 17 proposed strategies to prevent Asian carp invasion of the Laurentian Great Lakes via the hydrologic connection between the Mississippi and Great Lakes watersheds. Performance-weighted expert estimates indicated that hydrologic separation would prevent 99% (95,100; median, 5th and 95th percentiles) of Asian carp access, while electric and acoustic-bubble-strobe barriers would prevent 92% (85,95) and 92% (75,95), respectively. For all other strategies, estimated effectiveness was lower, with greater uncertainty. When potential invasions by other taxa are considered, the effectiveness of hydrologic separation increases relative to strategies that are effective primarily for fishes. These results could help guide invasive species management in many waterways globally.

  14. Recollection-Based Prospective Metamemory Judgments Are More Accurate than Those Based on Confidence: Judgments of Remembering and Knowing (JORKS)

    ERIC Educational Resources Information Center

    McCabe, David P.; Soderstrom, Nicholas C.

    2011-01-01

    Five experiments were conducted to examine whether the nature of the information that is monitored during prospective metamemory judgments affected the relative accuracy of those judgments. We compared item-by-item judgments of learning (JOLs), which involved participants determining how confident they were that they would remember studied items,…

  15. The Influence of Judgment Calls on Meta-Analytic Findings.

    PubMed

    Tarrahi, Farid; Eisend, Martin

    2016-01-01

    Previous research has suggested that judgment calls (i.e., methodological choices made in the process of conducting a meta-analysis) have a strong influence on meta-analytic findings and question their robustness. However, prior research applies case study comparison or reanalysis of a few meta-analyses with a focus on a few selected judgment calls. These studies neglect the fact that different judgment calls are related to each other and simultaneously influence the outcomes of a meta-analysis, and that meta-analytic findings can vary due to non-judgment call differences between meta-analyses (e.g., variations of effects over time). The current study analyzes the influence of 13 judgment calls in 176 meta-analyses in marketing research by applying a multivariate, multilevel meta-meta-analysis. The analysis considers simultaneous influences from different judgment calls on meta-analytic effect sizes and controls for alternative explanations based on non-judgment call differences between meta-analyses. The findings suggest that judgment calls have only a minor influence on meta-analytic findings, whereas non-judgment call differences between meta-analyses are more likely to explain differences in meta-analytic findings. The findings support the robustness of meta-analytic results and conclusions.

  16. Personality at Face Value: Facial Appearance Predicts Self and Other Personality Judgments among Strangers and Spouses

    PubMed Central

    Petrican, Raluca; Todorov, Alexander; Grady, Cheryl

    2016-01-01

    Character judgments, based on facial appearance, impact both perceivers’ and targets’ interpersonal decisions and behaviors. Nonetheless, the resilience of such effects in the face of longer acquaintanceship duration is yet to be determined. To address this question, we had 51 elderly long-term married couples complete self and informant versions of a Big Five Inventory. Participants were also photographed, while they were requested to maintain an emotionally neutral expression. A subset of the initial sample completed a shortened version of the Big Five Inventory in response to the pictures of other opposite sex participants (with whom they were unacquainted). Oosterhof and Todorov’s (2008) computer-based model of face evaluation was used to generate facial trait scores on trustworthiness, dominance, and attractiveness, based on participants’ photographs. Results revealed that structural facial characteristics, suggestive of greater trustworthiness, predicted positively biased, global informant evaluations of a target’s personality, among both spouses and strangers. Among spouses, this effect was impervious to marriage length. There was also evidence suggestive of a Dorian Gray effect on personality, since facial trustworthiness predicted not only spousal and stranger, but also self-ratings of extraversion. Unexpectedly, though, follow-up analyses revealed that (low) facial dominance, rather than (high) trustworthiness, was the strongest predictor of self-rated extraversion. Our present findings suggest that subtle emotional cues, embedded in the structure of emotionally neutral faces, exert long-lasting effects on personality judgments even among very well-acquainted targets and perceivers. PMID:27330234

  17. Do people reason rationally about causally related events? Markov violations, weak inferences, and failures of explaining away.

    PubMed

    Rottman, Benjamin M; Hastie, Reid

    2016-06-01

    Making judgments by relying on beliefs about the causal relationships between events is a fundamental capacity of everyday cognition. In the last decade, Causal Bayesian Networks have been proposed as a framework for modeling causal reasoning. Two experiments were conducted to provide comprehensive data sets with which to evaluate a variety of different types of judgments in comparison to the standard Bayesian networks calculations. Participants were introduced to a fictional system of three events and observed a set of learning trials that instantiated the multivariate distribution relating the three variables. We tested inferences on chains X1→Y→X2, common cause structures X1←Y→X2, and common effect structures X1→Y←X2, on binary and numerical variables, and with high and intermediate causal strengths. We tested transitive inferences, inferences when one variable is irrelevant because it is blocked by an intervening variable (Markov Assumption), inferences from two variables to a middle variable, and inferences about the presence of one cause when the alternative cause was known to have occurred (the normative "explaining away" pattern). Compared to the normative account, in general, when the judgments should change, they change in the normative direction. However, we also discuss a few persistent violations of the standard normative model. In addition, we evaluate the relative success of 12 theoretical explanations for these deviations. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Effects on automatic attention due to exposure to pictures of emotional faces while performing Chinese word judgment tasks.

    PubMed

    Junhong, Huang; Renlai, Zhou; Senqi, Hu

    2013-01-01

    Two experiments were conducted to investigate the automatic processing of emotional facial expressions while performing low or high demand cognitive tasks under unattended conditions. In Experiment 1, 35 subjects performed low (judging the structure of Chinese words) and high (judging the tone of Chinese words) cognitive load tasks while exposed to unattended pictures of fearful, neutral, or happy faces. The results revealed that the reaction time was slower and the performance accuracy was higher while performing the low cognitive load task than while performing the high cognitive load task. Exposure to fearful faces resulted in significantly longer reaction times and lower accuracy than exposure to neutral faces on the low cognitive load task. In Experiment 2, 26 subjects performed the same word judgment tasks and their brain event-related potentials (ERPs) were measured for a period of 800 ms after the onset of the task stimulus. The amplitudes of the early component of ERP around 176 ms (P2) elicited by unattended fearful faces over frontal-central-parietal recording sites was significantly larger than those elicited by unattended neutral faces while performing the word structure judgment task. Together, the findings of the two experiments indicated that unattended fearful faces captured significantly more attention resources than unattended neutral faces on a low cognitive load task, but not on a high cognitive load task. It was concluded that fearful faces could automatically capture attention if residues of attention resources were available under the unattended condition.

  19. Effects on Automatic Attention Due to Exposure to Pictures of Emotional Faces while Performing Chinese Word Judgment Tasks

    PubMed Central

    Junhong, Huang; Renlai, Zhou; Senqi, Hu

    2013-01-01

    Two experiments were conducted to investigate the automatic processing of emotional facial expressions while performing low or high demand cognitive tasks under unattended conditions. In Experiment 1, 35 subjects performed low (judging the structure of Chinese words) and high (judging the tone of Chinese words) cognitive load tasks while exposed to unattended pictures of fearful, neutral, or happy faces. The results revealed that the reaction time was slower and the performance accuracy was higher while performing the low cognitive load task than while performing the high cognitive load task. Exposure to fearful faces resulted in significantly longer reaction times and lower accuracy than exposure to neutral faces on the low cognitive load task. In Experiment 2, 26 subjects performed the same word judgment tasks and their brain event-related potentials (ERPs) were measured for a period of 800 ms after the onset of the task stimulus. The amplitudes of the early component of ERP around 176 ms (P2) elicited by unattended fearful faces over frontal-central-parietal recording sites was significantly larger than those elicited by unattended neutral faces while performing the word structure judgment task. Together, the findings of the two experiments indicated that unattended fearful faces captured significantly more attention resources than unattended neutral faces on a low cognitive load task, but not on a high cognitive load task. It was concluded that fearful faces could automatically capture attention if residues of attention resources were available under the unattended condition. PMID:24124486

  20. Using Instruments to Understand Argument Structure: Evidence for Gradient Representation

    PubMed Central

    Rissman, Lilia; Rawlins, Kyle; Landau, Barbara

    2015-01-01

    The arguments of a verb are commonly assumed to correspond to the event participants specified by the verb. That is, drink has two arguments because drink specifies two participants: someone who drinks and something that gets drunk. This correspondence does not appear to hold, however, in the case of instrumental participants, e.g. John drank the soda with a straw. Verbs such as slice and write have been argued to specify an instrumental participant, even though instruments do not pattern like arguments given other criteria. In this paper, we investigated how instrumental verbs are represented, testing the hypothesis that verbs such as slice encode three participants in the same way that dative verbs such as lend encode three participants. In two experiments English-speakers reported their judgments about the number of participants specified by a verb, e.g. that drink specifies two participants. These judgments indicate that slice does not encode three distinct arguments. Nonetheless, some verbs were systematically more likely to elicit the judgment that the instrument is specified by the verb, a pattern that held across individual subjects. To account for these findings, we propose that instruments are not independent verbal arguments but are represented in a gradient away: an instrument may be a more or less salient part of the force exerted by an agent. These results inform our understanding of the relationship between argument structure and event representation, raising questions concerning the role of arguments in language processing and learning. PMID:26057832

  1. Critical Thinking and Clinical Judgment in Novice Registered Nurses

    ERIC Educational Resources Information Center

    Tyne, Sheila L.

    2018-01-01

    The health care field has become increasingly more complex, requiring new nurses to be prepared upon graduation to respond to a variety of complex situations. Unfortunately, many graduates from associate degree nursing (ADN) programs are not able to think critically upon entering the work force. This presents a major problem for the nurse and for…

  2. Validation of Existing Diagnosis of Autism in Mainland China Using Standardised Diagnostic Instruments

    ERIC Educational Resources Information Center

    Sun, Xiang; Allison, Carrie; Auyeung, Bonnie; Zhang, Zhixiang; Matthews, Fiona E.; Baron-Cohen, Simon; Brayne, Carol

    2015-01-01

    Research to date in mainland China has mainly focused on children with autistic disorder rather than Autism Spectrum Conditions and the diagnosis largely depended on clinical judgment without the use of diagnostic instruments. Whether children who have been diagnosed in China before meet the diagnostic criteria of Autism Spectrum Conditions is not…

  3. Complex Problem Solving in Radiologic Technology: Understanding the Roles of Experience, Reflective Judgment, and Workplace Culture

    ERIC Educational Resources Information Center

    Yates, Jennifer L.

    2011-01-01

    The purpose of this research study was to explore the process of learning and development of problem solving skills in radiologic technologists. The researcher sought to understand the nature of difficult problems encountered in clinical practice, to identify specific learning practices leading to the development of professional expertise, and to…

  4. Patient-Rated Alliance as a Measure of Therapist Performance in Two Clinical Settings

    ERIC Educational Resources Information Center

    Imel, Zac E.; Hubbard, Rebecca A.; Rutter, Carolyn M.; Simon, Gregory

    2013-01-01

    Objective: The ability to form a strong therapeutic alliance is considered a foundational skill across psychotherapies. Patient-rated measures of the alliance are now being used to make judgments about a therapist's tendency to build alliances with their patients. However, whether a patient-rated alliance measure provides a useful index of a…

  5. Thinking Like a Nurse and Perceived Readiness for Professional Practice: A Mixed Methods Study

    ERIC Educational Resources Information Center

    Bowdoin, Carol

    2014-01-01

    Thinking like a nurse (TLN) has been identified as a core competency of professional nursing practice. The term embraces the full context of the daily metacognitive process nurses use to provide competent nursing care and was theorized in this study to have four attributes: critical thinking, clinical judgment, moral reasoning, and professional…

  6. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Myers, D.R.

    The benefit for the child from the judicious use of diagnostic dental radiography is improved dental health. The risk to the child from dental diagnostic radiation exposure appears to be extremely low. Despite the low risk, the dentist must minimize the child's exposure to ionizing radiation by using sound clinical judgment to determine what radiographs are necessary and to provide children with optimal protection from ionizing radiation.

  7. A Psychological Model for Aggregating Judgments of Magnitude

    NASA Astrophysics Data System (ADS)

    Merkle, Edgar C.; Steyvers, Mark

    In this paper, we develop and illustrate a psychologically-motivated model for aggregating judgments of magnitude across experts. The model assumes that experts' judgments are perturbed from the truth by both systematic biases and random error, and it provides aggregated estimates that are implicitly based on the application of nonlinear weights to individual judgments. The model is also easily extended to situations where experts report multiple quantile judgments. We apply the model to expert judgments concerning flange leaks in a chemical plant, illustrating its use and comparing it to baseline measures.

  8. Operationalizing the assessment and management of violence risk in the short-term.

    PubMed

    Doyle, Michael; Logan, Caroline

    2012-01-01

    Assessing risk of violence in the short term is crucial for managing and preventing violence, especially in institutions such as psychiatric units and prisons. Despite a lack of consensus on the definition of "short term", a number of recent tools and guidelines have been developed to aid short-term clinical decision-making. Whereas the supporting evidence for the new tools is impressive, limitations remain in terms of the focus on prediction, limited consideration of strengths, and poor integration with formulation and risk management. The Short-Term Assessment of Risk and Treatability (START) is a brief clinical guide for the dynamic assessment of risks, strengths and treatability. It focuses on short-term risks and the characteristics of the individual that, if changed, might lead to an increase or decrease in risk. The START has the potential to operationalize the structured professional judgment (SPJ) approach in order to inform the evaluation of multiple risk domains relevant to everyday psychiatric clinical practice. However, explicit guidance on integrating risk assessment, formulation and management is limited in the START and this paper describes the SPJ approach, reviews recent developments in approaches to risk, and considers how the START can be used to inform SPJ approaches and link risk assessment, formulation, and management. Copyright © 2012 John Wiley & Sons, Ltd.

  9. Patient-specific finite element modeling of bones.

    PubMed

    Poelert, Sander; Valstar, Edward; Weinans, Harrie; Zadpoor, Amir A

    2013-04-01

    Finite element modeling is an engineering tool for structural analysis that has been used for many years to assess the relationship between load transfer and bone morphology and to optimize the design and fixation of orthopedic implants. Due to recent developments in finite element model generation, for example, improved computed tomography imaging quality, improved segmentation algorithms, and faster computers, the accuracy of finite element modeling has increased vastly and finite element models simulating the anatomy and properties of an individual patient can be constructed. Such so-called patient-specific finite element models are potentially valuable tools for orthopedic surgeons in fracture risk assessment or pre- and intraoperative planning of implant placement. The aim of this article is to provide a critical overview of current themes in patient-specific finite element modeling of bones. In addition, the state-of-the-art in patient-specific modeling of bones is compared with the requirements for a clinically applicable patient-specific finite element method, and judgment is passed on the feasibility of application of patient-specific finite element modeling as a part of clinical orthopedic routine. It is concluded that further development in certain aspects of patient-specific finite element modeling are needed before finite element modeling can be used as a routine clinical tool.

  10. Similarities and differences between eating disorders and obese patients in a virtual environment for normalizing eating patterns.

    PubMed

    Perpiñá, Conxa; Roncero, María

    2016-05-01

    Virtual reality has demonstrated promising results in the treatment of eating disorders (ED); however, few studies have examined its usefulness in treating obesity. The aim of this study was to compare ED and obese patients on their reality judgment of a virtual environment (VE) designed to normalize their eating pattern. A second objective was to study which variables predicted the reality of the experience of eating a virtual forbidden-fattening food. ED patients, obese patients, and a non-clinical group (N=62) experienced a non-immersive VE, and then completed reality judgment and presence measures. All participants rated the VE with similar scores for quality, interaction, engagement, and ecological validity; however, ED patients obtained the highest scores on emotional involvement, attention, reality judgment/presence, and negative effects. The obese group gave the lowest scores to reality judgment/presence, satisfaction and sense of physical space, and they held an intermediate position in the attribution of reality to virtually eating a "fattening" food. The palatability of a virtual food was predicted by attention capturing and belonging to the obese group, while the attribution of reality to the virtual eating was predicted by engagement and belonging to the ED group. This study offers preliminary results about the differential impact on ED and obese patients of the exposure to virtual food, and about the need to implement a VE that can be useful as a virtual lab for studying eating behavior and treating obesity. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Don't Judge a Book by its Cover: Examiner Expectancy Effects Predict Neuropsychological Performance for Individuals Judged as Chronic Cannabis Users.

    PubMed

    Sodos, Louise M; Hirst, Rayna B; Watson, Jessica; Vaughn, Dylan

    2018-01-12

    The experimenter expectancy effect confound remains largely unexplored in neuropsychological research and has never been investigated among cannabis users. This study investigated whether examiner expectancies of cannabis user status affected examinees' neuropsychological performance. Participants included 41 cannabis users and 20 non-users. Before testing, examiners who were blind to participant user status privately rated whether they believed the examinee was a cannabis user or non-user. Examiners then administered a battery of neuropsychological and performance validity measures. Multiple regression analyses compared performance between examinees judged as cannabis users (n = 37) and those judged as non-users (n = 24). Examiners' judgments of cannabis users were 75% accurate; judgments of non-users were at chance. After controlling for age, gender, and actual user status, examiner judgments of cannabis user status predicted performance on two measures (California Verbal Learning Test-II, and Trail Making Test B; p < .05), as individuals judged as cannabis users obtained lower scores than those judged as non-users. Examiners' judgments of cannabis user status predicted performance even after controlling for actual user status, indicating vulnerability to examiner expectancy effects. These findings have important implications for both research and clinical settings, as scores may partially reflect examiners' expectations regarding cannabis effects rather than participants' cognitive abilities. These results demonstrate the need for expectancy effect research in the neuropsychological assessment of all populations, not just cannabis users. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Attribution Theory and Judgment under Uncertainty

    DTIC Science & Technology

    1975-06-13

    that every- cuy learning experiences are typically not structured to develop cognitive control. Much of the problem appears to be related to...people do and should explain past events may be found in the ruminations of historians over the state and nature of their craft (e.g.. Beard, 1935...8217 P- N- Psychology of Reasoning: Structure and Content . London: Bacsford, 19727 gcruccure - Attribution Theory 51 Wyer, R. S. CoRnitive

  13. Assessment of Group Preferences and Group Uncertainty for Decision Making

    DTIC Science & Technology

    1976-06-01

    the individ- uals. decision making , group judgments should be preferred to individual judgments if obtaining group judgments costs more. -26- -YI IV... decision making group . IV. A. 3. Aggregation using conjugate distribution. Arvther procedure for combining indivi(jai probability judgments into a group...statisticized group group decision making group judgment subjective probability Delphi method expected utility nominal group 20. ABSTRACT (Continue on

  14. Validation of consensus panel diagnosis in dementia.

    PubMed

    Gabel, Matthew J; Foster, Norman L; Heidebrink, Judith L; Higdon, Roger; Aizenstein, Howard J; Arnold, Steven E; Barbas, Nancy R; Boeve, Bradley F; Burke, James R; Clark, Christopher M; Dekosky, Steven T; Farlow, Martin R; Jagust, William J; Kawas, Claudia H; Koeppe, Robert A; Leverenz, James B; Lipton, Anne M; Peskind, Elaine R; Turner, R Scott; Womack, Kyle B; Zamrini, Edward Y

    2010-12-01

    The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance. To determine conditions that improve consensus panel diagnosis. Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images. Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography. Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia. Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations. The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules. Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.

  15. Grammar Clinical Marker Yields Substantial Heritability for Language Impairments in 16-Year-Old Twins.

    PubMed

    Dale, Philip S; Rice, Mabel L; Rimfeld, Kaili; Hayiou-Thomas, Marianna E

    2018-01-22

    There is a need for well-defined language phenotypes suitable for adolescents in twin studies and other large-scale research projects. Rice, Hoffman, and Wexler (2009) have developed a grammatical judgment measure as a clinical marker of language impairment, which has an extended developmental range to adolescence. We conducted the first twin analysis, along with associated phenotypic analyses of validity, of an abridged, 20-item version of this grammatical judgment measure (GJ-20), based on telephone administration using prerecorded stimuli to 405 pairs of 16-year-olds (148 monozygotic and 257 dizygotic) drawn from the Twins Early Development Study (Haworth, Davis, & Plomin, 2012). The distribution of scores is markedly skewed negatively, as expected for a potential clinical marker. Low performance on GJ-20 is associated with lower maternal education, reported learning disability (age 7 years), and low scores on language tests administered via the Twins Early Development Study (age 16 years) as well as General Certificate of Secondary Education English and Math examination performance (age 16 years). Liability threshold estimates for the genetic influence on low performance on GJ-20 are substantial, ranging from 36% with a lowest 10% criterion to 74% for a lowest 5% criterion. The heritability of GJ-20 scores, especially at more extreme cutoffs, along with the score distribution and association with other indicators of language impairments, provides additional evidence for the potential value of this measure as a clinical marker of specific language impairment.

  16. Confidence-accuracy calibration in absolute and relative face recognition judgments.

    PubMed

    Weber, Nathan; Brewer, Neil

    2004-09-01

    Confidence-accuracy (CA) calibration was examined for absolute and relative face recognition judgments as well as for recognition judgments from groups of stimuli presented simultaneously or sequentially (i.e., simultaneous or sequential mini-lineups). When the effect of difficulty was controlled, absolute and relative judgments produced negligibly different CA calibration, whereas no significant difference was observed for simultaneous and sequential mini-lineups. Further, the effect of difficulty on CA calibration was equivalent across judgment and mini-lineup types. It is interesting to note that positive (i.e., old) recognition judgments demonstrated strong CA calibration whereas negative (i.e., new) judgments evidenced little or no CA association. Implications for eyewitness identification are discussed. (c) 2004 APA, all rights reserved.

  17. Implicit Social Scaling from an Institutional Perspective

    ERIC Educational Resources Information Center

    D'Epifanio, Giulio

    2009-01-01

    The methodological question concerns constructing a cardinal social index, in order to assess performances of social agents, taking into account implicit political judgments. Based on the formal structure of a Choquet's expected utility, index construction demands quantification of levels of a meaningful ordinal indicator of overall performance.…

  18. Investigating Students' Similarity Judgments in Organic Chemistry

    ERIC Educational Resources Information Center

    Graulich, N.; Bhattacharyya, G.

    2017-01-01

    Organic chemistry is possibly the most visual science of all chemistry disciplines. The process of scientific inquiry in organic chemistry relies on external representations, such as Lewis structures, mechanisms, and electron arrows. Information about chemical properties or driving forces of mechanistic steps is not available through direct…

  19. Morphological Structure in Native and Nonnative Language Processing

    ERIC Educational Resources Information Center

    Clahsen, Harald; Felser, Claudia; Neubauer, Kathleen; Sato, Mikako; Silva, Renita

    2010-01-01

    This article presents a selective overview of studies that have investigated how advanced adult second language (L2) learners process morphologically complex words. The studies reported here have used different kinds of experimental tasks (including speeded grammaticality judgments, lexical decision, and priming) to examine three domains of…

  20. Medical Emergency Exceptions in State Abortion Statutes: The Statistical Record.

    PubMed

    Linton, Paul Benjamin

    2016-01-01

    This article attempts to determine, first, whether emergency exceptions in statutes regulating abortion have been abused and, second, whether the standard used in such an exception--subjective or objective--makes a difference in the reported incidence of such emergencies. A review of the statistical data supports two conclusions. First, physicians who perform abortions and have complied with state reporting requirements have not relied upon the medical emergency exceptions in state abortion statutes to evade the requirements of those statutes. Second, the use of an objective standard for evaluating medical emergencies ("reasonable medical judgment") has not been associated with fewer reported emergencies (per number of abortions performed) than the use of a subjective standard ("good faith clinical judgment"). Both of these conclusions may be relevant in drafting other abortion statutes including prohibitions (e.g., post-viability abortions).

  1. Mayo's Older African Americans Normative Studies: norms for Boston Naming Test, Controlled Oral Word Association, Category Fluency, Animal Naming, Token Test, WRAT-3 Reading, Trail Making Test, Stroop Test, and Judgment of Line Orientation.

    PubMed

    Lucas, John A; Ivnik, Robert J; Smith, Glenn E; Ferman, Tanis J; Willis, Floyd B; Petersen, Ronald C; Graff-Radford, Neill R

    2005-06-01

    Normative data for older African Americans are presented for several clinical neuropsychological measures, including Boston Naming Test, Controlled Oral Word Association, Category Fluency, Token Test, WRAT-3 Reading, Trail Making Test, Stroop Color and Word Test, and Judgment of Line Orientation. Age-adjusted norms were derived from a sample of 309 cognitively normal, community-dwelling individuals, aged 56 through 94, participating in Mayo's Older African Americans Normative Studies (MOAANS). Years of education were modelled on age-scaled scores to derive regression Equations that may be applied for further demographic correction. These data should enhance interpretation of individual test performances and facilitate analysis of neuropsychological profile patterns in older African American patients who present for dementia evaluations.

  2. [Kant and medicine of enlightenment].

    PubMed

    Model, A

    1990-01-01

    Immanuel Kants "Critique of Judgment" (1970) reflects the medicine of the second part of the eighteenth century. Both parts of the "Critique of Judgment" (as well the "Critique of Aesthetic Judgment" as the "Critique of Teleological Judgment") refer to problems of medicine.

  3. Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients.

    PubMed

    Varnell, Charles D; Rich, Kristin L; Nichols, Melissa; Dahale, Devesh; Goebel, Jens W; Pai, Ahna L H; Hooper, David K; Modi, Avani C

    2017-11-01

    Patient-identified barriers to immunosuppressive medications are associated with poor adherence and negative clinical outcomes in transplant patients. Assessment of adherence barriers is not part of routine post-transplant care, and studies regarding implementing such a process in a reliable way are lacking. Using the Model for Improvement and PDSA cycles, we implemented a system to identify adherence barriers, including patient-centered design of a barriers assessment tool, identification of eligible patients, clear roles for clinic staff, and creating a culture of non-judgmental discussion around adherence. We performed time-series analysis of our process measure. Secondary analyses examined the endorsement and concordance of adherence barriers between patient-caregiver dyads. After three methods of testing, the most reliable delivery system was an EHR-integrated tablet that alerted staff of patient eligibility for assessment. Barriers were endorsed by 35% of caregivers (n=85) and 43% of patients (n=60). The most frequently patient-endorsed barriers were forgetting, poor taste, and side effects. Caregivers endorsed forgetting and side effects. Concordance between patient-caregiver dyads was fair (k=0.299). Standardized adherence barriers assessment is feasible in the clinical care of pediatric kidney transplant patients. Features necessary for success included automation, redundant systems with designated staff to identify and mitigate failures, aligned reporting structures, and reliable measurement approaches. Future studies will examine whether barriers predict clinical outcomes (eg, organ rejection, graft loss). © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Implicit Theories and Offender Representativeness in Judgments About Sexual Crime.

    PubMed

    Harper, Craig A; Bartels, Ross M

    2018-04-01

    Implicit theories structure the way people understand and respond to various human actions. Typically, people believe attributes are either fixed (entitists) or malleable (incrementalists). The present study aimed to examine (a) whether attitudes toward sexual offenders differ depending upon one's implicit theory about human nature and sexual offenders, and (b) whether implicit theories are associated with judgments made about different types of child abusers. A sample of 252 community participants was recruited. Their attitudes, implicit theories, and political orientation were assessed via self-report. One of three vignettes describing an incidence of child sexual abuse was then presented. The cases were identical except the perpetrator was either an adult male, an adult female, or a male juvenile. Participants then made judgments about the offender's deserved sentence and moral character. Entitists (across both domains) held more negative attitudes than incrementalists, although the magnitude of the difference was greatest when examining implicit theories about sexual offenders. Compared with those with an incremental theory of sexual offenders, entity theorists judged sexual offending to be more (a) indicative of the perpetrator's moral character and (b) deserving of punishment. However, scores were greater toward the adult male relative to the adult female and juvenile. The findings suggest that implicit theories about sexual offenders are domain specific. They also indicate that judgments made by those with an entity theory (about sexual offenders) are affected by whether a case is representative of a stereotypical sexual offender. Implications of the findings are discussed, along with limitations and future research.

  5. When Assessment Data Are Words: Validity Evidence for Qualitative Educational Assessments.

    PubMed

    Cook, David A; Kuper, Ayelet; Hatala, Rose; Ginsburg, Shiphra

    2016-10-01

    Quantitative scores fail to capture all important features of learner performance. This awareness has led to increased use of qualitative data when assessing health professionals. Yet the use of qualitative assessments is hampered by incomplete understanding of their role in forming judgments, and lack of consensus in how to appraise the rigor of judgments therein derived. The authors articulate the role of qualitative assessment as part of a comprehensive program of assessment, and translate the concept of validity to apply to judgments arising from qualitative assessments. They first identify standards for rigor in qualitative research, and then use two contemporary assessment validity frameworks to reorganize these standards for application to qualitative assessment.Standards for rigor in qualitative research include responsiveness, reflexivity, purposive sampling, thick description, triangulation, transparency, and transferability. These standards can be reframed using Messick's five sources of validity evidence (content, response process, internal structure, relationships with other variables, and consequences) and Kane's four inferences in validation (scoring, generalization, extrapolation, and implications). Evidence can be collected and evaluated for each evidence source or inference. The authors illustrate this approach using published research on learning portfolios.The authors advocate a "methods-neutral" approach to assessment, in which a clearly stated purpose determines the nature of and approach to data collection and analysis. Increased use of qualitative assessments will necessitate more rigorous judgments of the defensibility (validity) of inferences and decisions. Evidence should be strategically sought to inform a coherent validity argument.

  6. The development of adaptive decision making: Recognition-based inference in children and adolescents.

    PubMed

    Horn, Sebastian S; Ruggeri, Azzurra; Pachur, Thorsten

    2016-09-01

    Judgments about objects in the world are often based on probabilistic information (or cues). A frugal judgment strategy that utilizes memory (i.e., the ability to discriminate between known and unknown objects) as a cue for inference is the recognition heuristic (RH). The usefulness of the RH depends on the structure of the environment, particularly the predictive power (validity) of recognition. Little is known about developmental differences in use of the RH. In this study, the authors examined (a) to what extent children and adolescents recruit the RH when making judgments, and (b) around what age adaptive use of the RH emerges. Primary schoolchildren (M = 9 years), younger adolescents (M = 12 years), and older adolescents (M = 17 years) made comparative judgments in task environments with either high or low recognition validity. Reliance on the RH was measured with a hierarchical multinomial model. Results indicated that primary schoolchildren already made systematic use of the RH. However, only older adolescents adaptively adjusted their strategy use between environments and were better able to discriminate between situations in which the RH led to correct versus incorrect inferences. These findings suggest that the use of simple heuristics does not progress unidirectionally across development but strongly depends on the task environment, in line with the perspective of ecological rationality. Moreover, adaptive heuristic inference seems to require experience and a developed base of domain knowledge. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  7. RobotReviewer: evaluation of a system for automatically assessing bias in clinical trials.

    PubMed

    Marshall, Iain J; Kuiper, Joël; Wallace, Byron C

    2016-01-01

    To develop and evaluate RobotReviewer, a machine learning (ML) system that automatically assesses bias in clinical trials. From a (PDF-formatted) trial report, the system should determine risks of bias for the domains defined by the Cochrane Risk of Bias (RoB) tool, and extract supporting text for these judgments. We algorithmically annotated 12,808 trial PDFs using data from the Cochrane Database of Systematic Reviews (CDSR). Trials were labeled as being at low or high/unclear risk of bias for each domain, and sentences were labeled as being informative or not. This dataset was used to train a multi-task ML model. We estimated the accuracy of ML judgments versus humans by comparing trials with two or more independent RoB assessments in the CDSR. Twenty blinded experienced reviewers rated the relevance of supporting text, comparing ML output with equivalent (human-extracted) text from the CDSR. By retrieving the top 3 candidate sentences per document (top3 recall), the best ML text was rated more relevant than text from the CDSR, but not significantly (60.4% ML text rated 'highly relevant' v 56.5% of text from reviews; difference +3.9%, [-3.2% to +10.9%]). Model RoB judgments were less accurate than those from published reviews, though the difference was <10% (overall accuracy 71.0% with ML v 78.3% with CDSR). Risk of bias assessment may be automated with reasonable accuracy. Automatically identified text supporting bias assessment is of equal quality to the manually identified text in the CDSR. This technology could substantially reduce reviewer workload and expedite evidence syntheses. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  8. Fall prediction according to nurses' clinical judgment: differences between medical, surgical, and geriatric wards.

    PubMed

    Milisen, Koen; Coussement, Joke; Flamaing, Johan; Vlaeyen, Ellen; Schwendimann, René; Dejaeger, Eddy; Surmont, Kurt; Boonen, Steven

    2012-06-01

    To assess the value of nurses' clinical judgment (NCJ) in predicting hospital inpatient falls. Prospective multicenter study. Six Belgian hospitals. Two thousand four hundred seventy participants (mean age 67.6 ± 18.3; female, 55.7%) on four surgical (n = 812, 32.9%), eight geriatric (n = 666, 27.0%), and four general medical wards (n = 992, 40.1%) were included upon admission. All participants were hospitalized for at least 48 hours. Within 24 hours after admission, nurses gave their judgment on the question "Do you think your patient is at high risk for falling?" Nurses were not trained in assessing fall risk. Falls were documented on a standardized incident report form. During hospitalization, 143 (5.8%) participants experienced one or more falls, accounting for 202 falls and corresponding to an overall rate of 7.9 falls per 1,000 patient days. NCJ of participant's risk of falling had high sensitivity (78-92%) with high negative predictive value (94-100%) but low positive predictive value (4-17%). Although false-negative rates were low (8-22%) for all departments and age groups, false-positive rates were high (55-74%), except on surgical and general medical wards and in participants younger than 75. This analysis, based on multicenter data and a large sample size, suggests that NCJ can be recommended on surgical and general medical wards and in individuals younger than 75, but on geriatric wards and in participants aged 75 and older, NCJ overestimates risk of falling and is thus not recommended because expensive comprehensive fall-prevention measures would be implemented in a large number of individuals who do not need it. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  9. Predictors of agreement between general practitioner detection of dementia and the revised Cambridge Cognitive Assessment (CAMCOG-R).

    PubMed

    Pond, C Dimity; Mate, Karen E; Phillips, Jill; Stocks, Nigel P; Magin, Parker J; Weaver, Natasha; Brodaty, Henry

    2013-10-01

    Dementia is a complex and variable condition which makes recognition of it particularly difficult in a low prevalence primary care setting. This study examined the factors associated with agreement between an objective measure of cognitive function (the revised Cambridge Cognitive Assessment, CAMCOG-R) and general practitioner (GP) clinical judgment of dementia. This was a cross-sectional study involving 165 GPs and 2,024 community-dwelling patients aged 75 years or older. GPs provided their clinical judgment in relation to each of their patient's dementia status. Each patient's cognitive function and depression status was measured by a research nurse using the CAMCOG-R and the 15-item Geriatric Depression Scale (GDS), respectively. GPs correctly identified 44.5% of patients with CAMCOG-R dementia and 90% of patients without CAMCOG-R dementia. In those patients with CAMCOG-R dementia, two patient-dependent factors were most important for predicting agreement between the CAMCOG-R and GP judgment: the CAMCOG-R score (p = 0.006) and patient's mention of subjective memory complaints (SMC) to the GP (p = 0.040). A higher CAMCOG-R (p < 0.001) score, female gender (p = 0.005), and larger practice size (p < 0.001) were positively associated with GP agreement that the patient did not have dementia. Subjective memory complaints (p < 0.001) were more likely to result in a false-positive diagnosis of dementia. Timely recognition of dementia is advocated for optimal dementia management, but early recognition of a possible dementia syndrome needs to be balanced with awareness of the likelihood of false positives in detection. Although GPs correctly agree with dimensions measured by the CAMCOG-R, improvements in sensitivity are required for earlier detection of dementia.

  10. Dignity in end-of-life care: results of a national survey of US physicians

    PubMed Central

    Antiel, Ryan M.; Curlin, Farr A.; James, Katherine M.; Sulmasy, Daniel P.; Tilburt, Jon C.

    2014-01-01

    Context Debates persist about the relevance of “dignity” as an ethical concept in US healthcare, especially in end-of-life care. Objective To describe the attitudes and beliefs regarding the usefulness and meaning of the concept of dignity and to examine judgments about a clinical scenario in which dignity might be relevant. Methods 2000 practicing U.S. physicians, from all specialties, were mailed a survey. Main measures included physician’s judgments about an end-of-life clinical scenario (criterion variable), attitudes about the concept of dignity (predictors), and their religious characteristics (predictors). Results 1032 eligible physicians (54%) responded. Nine out of ten (90%) physicians reported that dignity was relevant to their practice. After controlling for age, gender, region, and specialty, physicians who judged that the case patient had either some dignity or full dignity, and who agreed that dignity is given by a creator, were all positively associated with believing that the patient’s life was worth living [OR 10.2 (5.8–17.8), OR 20.5 (11.4–36.8), OR 4.7 (3.1–7.0), respectively]. Respondents who strongly agreed that “all living humans have the same amount of dignity” were also more likely to believe that the patient’s life was worth living [OR 1.8 (1.2–2.7)]. Religious characteristics were also associated with believing that the case patient’s life was worth living [OR 4.1 (2.4–7.2), OR 3.2 (1.6–6.3), OR 9.2 (4.3–19.5), respectively]. Conclusion US physicians view the concept of dignity as useful. Those views are associated with their judgments about common end-of-life scenarios in which dignity concepts may be relevant. PMID:22762966

  11. Concentrations of rivastigmine and NAP 226-90 and the cognitive response in Taiwanese Alzheimer's disease patients.

    PubMed

    Chou, Mei-Chuan; Chen, Chun-Hung; Liu, Ching-Kuan; Chen, Su-Hwei; Wu, Shyh-Jong; Yang, Yuan-Han

    2012-01-01

    The aim of this small pilot study was to evaluate the association between plasma concentrations of rivastigmine and its metabolite, NAP 226-90, and cognitive function in patients with Alzheimer's disease (AD). Rivastigmine-treated AD patients, who had been maintained on a fixed regimen of twice daily rivastigmine (6 to 12 mg/d) for ≥6 months, were eligible for evaluation. The assessments included cognitive assessment screening instrument (CASI) and clinical dementia rating scale, conducted at baseline and at 6-month follow-up. The 9 subdomains of CASI at baseline and follow-up were analyzed in relation to the plasma concentrations of rivastigmine and NAP 226-90, as measured by capillary electrophoresis. Logistic regression was performed to adjust for age, gender, education level, apolipoprotein E ε4 genotype status, and baseline CASI score to investigate the association between plasma rivastigmine and NAP 226-90 concentrations and the cognitive response. The total sample consisted of 53 clinically diagnosed AD patients taking rivastigmine only at doses of 6 mg to 9 mg/d because of intolerability at 12 mg/d. Higher rivastigmine concentration was significantly associated with improved or preserved short-term memory and worsened abstraction/judgment (p < 0.05), but not with changes in other domains (p > 0.05). Higher NAP 226-90 concentration was significantly associated with worsened abstraction/judgment (p < 0.05), but not with changes in other domains. Higher plasma rivastigmine concentration was significantly associated with improved or preserved short-term memory but worsened abstraction/judgment. An optimal concentration of rivastigmine should be quantified for each patient because of differential cognitive responses.

  12. 5 CFR 919.920 - Civil judgment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Civil judgment. 919.920 Section 919.920 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 919.920 Civil judgment. Civil judgment...

  13. 5 CFR 919.920 - Civil judgment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Civil judgment. 919.920 Section 919.920 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 919.920 Civil judgment. Civil judgment...

  14. 5 CFR 919.920 - Civil judgment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Civil judgment. 919.920 Section 919.920 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 919.920 Civil judgment. Civil judgment...

  15. 5 CFR 919.920 - Civil judgment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Civil judgment. 919.920 Section 919.920 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 919.920 Civil judgment. Civil judgment...

  16. 5 CFR 919.920 - Civil judgment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Civil judgment. 919.920 Section 919.920 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 919.920 Civil judgment. Civil judgment...

  17. Relatively certain! Comparative thinking reduces uncertainty.

    PubMed

    Mussweiler, Thomas; Posten, Ann-Christin

    2012-02-01

    Comparison is one of the most ubiquitous and versatile mechanisms in human information processing. Previous research demonstrates that one consequence of comparative thinking is increased judgmental efficiency: comparison allows for quicker judgments without a loss in accuracy. We hypothesised that a second potential consequence of comparative thinking is reduced judgmental uncertainty. We examined this possibility in three experiments using three different domains of judgment and three different measures of uncertainty. Results consistently demonstrate that procedurally priming participants to rely more heavily on comparative thinking during judgment induces them to feel more certain about their judgment. Copyright © 2011 Elsevier B.V. All rights reserved.

  18. Is moral beauty different from facial beauty? Evidence from an fMRI study.

    PubMed

    Wang, Tingting; Mo, Lei; Mo, Ce; Tan, Li Hai; Cant, Jonathan S; Zhong, Luojin; Cupchik, Gerald

    2015-06-01

    Is moral beauty different from facial beauty? Two functional magnetic resonance imaging experiments were performed to answer this question. Experiment 1 investigated the network of moral aesthetic judgments and facial aesthetic judgments. Participants performed aesthetic judgments and gender judgments on both faces and scenes containing moral acts. The conjunction analysis of the contrasts 'facial aesthetic judgment > facial gender judgment' and 'scene moral aesthetic judgment > scene gender judgment' identified the common involvement of the orbitofrontal cortex (OFC), inferior temporal gyrus and medial superior frontal gyrus, suggesting that both types of aesthetic judgments are based on the orchestration of perceptual, emotional and cognitive components. Experiment 2 examined the network of facial beauty and moral beauty during implicit perception. Participants performed a non-aesthetic judgment task on both faces (beautiful vs common) and scenes (containing morally beautiful vs neutral information). We observed that facial beauty (beautiful faces > common faces) involved both the cortical reward region OFC and the subcortical reward region putamen, whereas moral beauty (moral beauty scenes > moral neutral scenes) only involved the OFC. Moreover, compared with facial beauty, moral beauty spanned a larger-scale cortical network, indicating more advanced and complex cerebral representations characterizing moral beauty. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  19. Implicit moral evaluations: A multinomial modeling approach.

    PubMed

    Cameron, C Daryl; Payne, B Keith; Sinnott-Armstrong, Walter; Scheffer, Julian A; Inzlicht, Michael

    2017-01-01

    Implicit moral evaluations-i.e., immediate, unintentional assessments of the wrongness of actions or persons-play a central role in supporting moral behavior in everyday life. Yet little research has employed methods that rigorously measure individual differences in implicit moral evaluations. In five experiments, we develop a new sequential priming measure-the Moral Categorization Task-and a multinomial model that decomposes judgment on this task into multiple component processes. These include implicit moral evaluations of moral transgression primes (Unintentional Judgment), accurate moral judgments about target actions (Intentional Judgment), and a directional tendency to judge actions as morally wrong (Response Bias). Speeded response deadlines reduced Intentional Judgment but not Unintentional Judgment (Experiment 1). Unintentional Judgment was stronger toward moral transgression primes than non-moral negative primes (Experiments 2-4). Intentional Judgment was associated with increased error-related negativity, a neurophysiological indicator of behavioral control (Experiment 4). Finally, people who voted for an anti-gay marriage amendment had stronger Unintentional Judgment toward gay marriage primes (Experiment 5). Across Experiments 1-4, implicit moral evaluations converged with moral personality: Unintentional Judgment about wrong primes, but not negative primes, was negatively associated with psychopathic tendencies and positively associated with moral identity and guilt proneness. Theoretical and practical applications of formal modeling for moral psychology are discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Implicit and Explicit Representations of Hand Position in Tool Use

    PubMed Central

    Rand, Miya K.; Heuer, Herbert

    2013-01-01

    Understanding the interactions of visual and proprioceptive information in tool use is important as it is the basis for learning of the tool's kinematic transformation and thus skilled performance. This study investigated how the CNS combines seen cursor positions and felt hand positions under a visuo-motor rotation paradigm. Young and older adult participants performed aiming movements on a digitizer while looking at rotated visual feedback on a monitor. After each movement, they judged either the proprioceptively sensed hand direction or the visually sensed cursor direction. We identified asymmetric mutual biases with a strong visual dominance. Furthermore, we found a number of differences between explicit and implicit judgments of hand directions. The explicit judgments had considerably larger variability than the implicit judgments. The bias toward the cursor direction for the explicit judgments was about twice as strong as for the implicit judgments. The individual biases of explicit and implicit judgments were uncorrelated. Biases of these judgments exhibited opposite sequential effects. Moreover, age-related changes were also different between these judgments. The judgment variability was decreased and the bias toward the cursor direction was increased with increasing age only for the explicit judgments. These results indicate distinct explicit and implicit neural representations of hand direction, similar to the notion of distinct visual systems. PMID:23894307

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