The effects of working memory training on working memory, self-regulation, and analogical reasoning of preschool children.

BACKGROUND AND AIMS: This study examined the effects of working memory training (WMT) on WM and fluid intelligence. A novel four-pronged model of mediated learning, cognitive functions, task characteristics and metacognition is presented as a conceptual basis for the Modifiability of a Working Memory Program (MWMP). Our basic assumption is that increasing WM depends on a synchronized combination of the four components. SAMPLE: A group of typically developed preschool children (n = 62) participated in the experimental group, receiving the MWMP. They were compared with a control group (n = 56) of preschool children who engaged in a substitute program. This comparison allowed us to discern the specific effects of the MWMP. METHODS: All participants received tests of WM, self-regulation and analogical reasoning before and after the intervention. The MWMP was administered to children in the experimental group for 10 weekly sessions, each lasting 40 minutes, in small groups of two children. The children in the control group engaged in didactic activities that were part of a school curriculum routine for kindergartners for the same length of time. RESULTS: We used ANCOVA analysis to compare the Treatment x Time with age and socioeconomic status as covariates. The findings revealed a higher improvement in some WM and self-regulation tests among children in the experimental group compared to those in the control group. However, no significant transfer effects were observed in analogical thinking. CONCLUSION: The findings confirm the effectiveness of a non-computerized WMT among kindergartners and support our four-pronged theoretical model. We also discuss earlier findings on far-transfer effects and educational implications. We suggest that future WM studies adopt the following: (1) the development of training methods that are theoretically anchored; (2) training procedures should not rely heavily on computerized exercises but can be adapted to group characteristics, educational settings and cost-effectiveness aspects; (3) varying the task characteristics and training strategies to stimulate task-intrinsic motivation; (4) identifying training strategies to produce cognitive improvements underlying WM; (5) intervention should target individuals in early development as much as possible; (6) development of training procedures that facilitate motivation; and (7) providing empirical evidence of far-transfer effects for WM training. The empirical evidence should link gains in WM capacity and achievements in academic and other life domains.

Acute care nurses' decisions to recognise and respond to patient improvement: A qualitative study.

AIM: To explore and describe acute care nurses' decisions to recognise and respond to improvement in patients' clinical states as they occurred in the real-world clinical environment. DESIGN: A descriptive study. METHODS: Nine medical and eleven surgical nurses in a large Australian metropolitan hospital were individually observed during nurse-patient interactions and followed up in interview to describe their reasoning and clinical judgements behind observed decisions. Verbal description of observations and interviews were recorded and transcribed. Reflexive thematic analysis was used to analyse the data. RESULTS: The three themes constructed from the data were as follows: nurses checking in; nurses reaching judgements about improvements; and nurses deciding on the best person to respond. Acute care nurses made targeted assessment decisions based on predicted safety risks related to improvement in clinical states. Subjective and objective cues were used to assess for and make judgements about patient improvement. Acute care nurses' judgment of patient safety and a desire to promote patient centred care guided their decisions to select the appropriate person to manage improvement. CONCLUSIONS: The outcomes of this research have demonstrated that the proven safety benefits of acute care nurses' decision making in response to deterioration extend to improvement in patients' clinical states. In response to improvement, acute care nurses' decisions protect patients from harm and promote recovery. IMPLICATIONS FOR PATIENT CARE: Early recognition and response to improvement enable acute care nurses to protect patients from risks of unnecessary treatment and promote recovery. IMPACT: This study makes explicit nurses' essential safety role in recognising and responding to improvement in patients' clinical states. Healthcare policy and education must reflect the equal importance of assessment for and management of deterioration and improvement to ensure patients are protected and provided with safe care.

Predicting Learning: Understanding the Role of Executive Functions in Children's Belief Revision Using Bayesian Models.

Recent studies suggest that learners who are asked to predict the outcome of an event learn more than learners who are asked to evaluate it retrospectively or not at all. One possible explanation for this "prediction boost" is that it helps learners engage metacognitive reasoning skills that may not be spontaneously leveraged, especially for individuals with still-developing executive functions. In this paper, we combined multiple analytic approaches to investigate the potential role of executive functions in elementary school-aged children's science learning. We performed an experiment that investigates children's science learning during a water displacement task where a "prediction boost" had previously been observed-children either made an explicit prediction or evaluated an event post hoc (i.e., postdiction). We then considered the relation of executive function measures and learning, which were collected following the main experiment. Via mixed effects regression models, we found that stronger executive function skills (i.e., stronger inhibition and switching scores) were associated with higher accuracy in Postdiction but not in the Prediction Condition. Using a theory-based Bayesian model, we simulated children's individual performance on the learning task (capturing "belief flexibility"), and compared this "flexibility" to the other measures to understand the relationship between belief revision, executive function, and prediction. Children in the Prediction Condition showed near-ceiling "belief flexibility" scores, which were significantly higher than among children in the Postdiction Condition. We also found a significant correlation between children's executive function measures to our "belief flexibility" parameter, but only for children in the Postdiction Condition. These results indicate that when children provided responses post hoc, they may have required stronger executive function capacities to navigate the learning task. Additionally, these results suggest that the "prediction boost" in children's science learning could be explained by increased metacognitive flexibility in the belief revision process.

Enhancing Healthcare Informatics: Integrating Category Theory Reasoning into OMOP-CDM Ontology Model.

The task of managing diverse electronic health records requires the consolidation of data from different sources to facilitate clinical research and decision-making support, with the emergence of the Observational Medical Outcomes Partnership - Common Data Model (OMOP-CDM) as a standard relational database schema for structuring health records from different sources. Working with ontologies is strongly associated with reasoners. Implementing them over expansive and intricate Ontologies can pose computational challenges, potentially resulting in slow performance. In this paper, we propose the implementation of a new reasoner based on categorical logic over a translation of OMOP-CDM into an ontology model. This enables enhancements to the efficiency and scalability of implementing such models.

Tracking politically motivated reasoning in the brain: the role of mentalizing, value-encoding, and error-detection networks.

Susceptibility to misinformation and belief polarization often reflect people's tendency to incorporate information in a biased way. Despite the presence of competing theoretical models, the underlying neurocognitive mechanisms of motivated reasoning remain elusive as previous empirical work did not properly track the belief formation process. To address this problem, we employed a design that identifies motivated reasoning as directional deviations from a Bayesian benchmark of unbiased belief updating. We asked members of a pro-immigration or an anti-immigration group how much they endorse factual messages on foreign criminality, a polarizing political topic. Both groups exhibited a desirability bias by over-endorsing attitude-consistent messages and under-endorsing attitude-discrepant messages and an identity bias by over-endorsing messages from ingroup members and under-endorsing messages from outgroup members. In both groups, neural responses to the messages predicted subsequent expression of desirability and identity biases suggesting a common neural basis of motivated reasoning across ideologically opposing groups. Specifically, brain regions implicated in encoding value, error detection, and mentalizing tracked the degree of desirability bias. Less extensive activation in the mentalizing network tracked the degree of identity bias. These findings illustrate the distinct neurocognitive architecture of desirability and identity biases and inform existing cognitive models of politically motivated reasoning.

The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses.

AIMS: To investigate the relationships among communication competence, professional autonomy and clinical reasoning and to identify the factors that influence clinical reasoning competence in oncology nurses. DESIGN: Cross-sectional descriptive design. METHODS: Participants included 147 oncology nurses with more than a year of clinical experience in cancer wards. The Global Interpersonal Communication Competence Scale, Schutzenhofer Professional Autonomy Scale and Nurses Clinical Reasoning Scale (NCRS) were used to collect data. Data were analysed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis and hierarchical multiple regression analysis. RESULTS: Communication competence (r = 0.59) and professional autonomy (r = 0.46) showed significant positive relationships with clinical reasoning competence. Clinical experience, communication competence, age and professional autonomy were statistically significant predictors and explained 48.6% of clinical reasoning competence. CONCLUSIONS: The clinical reasoning competence of oncology nurses increases proportionally with their communication competence and professional autonomy. Therefore, oncology nurses must reinforce their communication competence and professional autonomy to enhance their clinical reasoning competence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The reinforcement of communication competence and professional autonomy is necessary for oncology nurses to enhance their clinical reasoning competence. In order to improve nurses' communication competence, practical-focused communication education programmes must be designed and deployed systematically and periodically. In addition, to increase nurses' professional autonomy, it is necessary to expand their clinical experiences through the regular rotation of working units and to make institutional efforts to retain experienced nurses. REPORTING METHOD: We have adhered to STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: Participants in the study were recruited online. They were informed of the study's purpose, method and usability and the survey could only be conducted if they consented to participate voluntarily.

Incorporating patient, caregiver, and provider perspectives in the co-design of an app to guide Hospital at Home admission decisions: a qualitative analysis.

Objective: Hospital at Home (HaH) programs currently lack decision support tools to help efficiently navigate the complex decision-making process surrounding HaH as a care option. We assessed user needs and perspectives to guide early prototyping and co-creation of 4PACS (Partnering Patients and Providers for Personalized Acute Care Selection), a decision support app to help patients make an informed decision when presented with discrete hospitalization options. Methods: From December 2021 to January 2022, we conducted semi-structured interviews via telephone with patients and caregivers recruited from Atrium Health's HaH program and physicians and a nurse with experience referring patients to HaH. Interviews were evaluated using thematic analysis. The findings were synthesized to create illustrative user descriptions to aid 4PACS development. Results: In total, 12 stakeholders participated (3 patients, 2 caregivers, 7 providers [physicians/nurse]). We identified 4 primary themes: attitudes about HaH; 4PACS app content and information needs; barriers to 4PACS implementation; and facilitators to 4PACS implementation. We characterized 3 user descriptions (one per stakeholder group) to support 4PACS design decisions. User needs included patient selection criteria, clear program details, and descriptions of HaH components to inform care expectations. Implementation barriers included conflict between app recommendations and clinical judgement, inability to adequately represent patient-risk profile, and provider burden. Implementation facilitators included ease of use, auto-populating features, and appropriate health literacy. Conclusions: The findings indicate important information gaps and user needs to help inform 4PACS design and barriers and facilitators to implementing 4PACS in the decision-making process of choosing between hospital-level care options.

ICF in Bachelor degree programs-the implementation of the ICF in the clinical reasoning process of physical therapists for neurological patients-optimizing the health curriculum for comprehensive patient care.

The International Classification of Function, Disability, and Health (ICF) is known to be a valuable classification model in interprofessional neurorehabilitation, as it can lead to more patient-centered and self-determined treatment. To acquire the competencies implementing the ICF in the field of neurorehabilitation, it is important to anchor essential skills in the basic training of healthcare professionals. The Institute of Physiotherapy at FH JOANNEUM in Graz/Austria developed a concept to help students learn the necessary skills for implementing the ICF in a structured way. In the area of neurorehabilitation, we linked the ICF model with the Clinical Reasoning Model (CR). Competences are acquired over six semesters. Besides the general topics relating to the ICF (such as history, intention, and language) and CR that are taught in the first year, we focus in the later semesters explicitly on transferring these skills to neurorehabilitation. Therefore, we use interprofessional group work and problem-based courses as essential didactic elements for this transfer of skills. This article aims to show how the ICF could be implemented in Bachelor's degree programs for physiotherapy as well as in other healthcare programs. The authors' experiences are described and some best practice examples when working with the ICF in this field are given.

Anecdotes impact medical decisions even when presented with statistical information or decision aids.

People are inundated with popular press reports about medical research concerning what is healthy, get advice from doctors, and hear personal anecdotes. How do people integrate conflicting anecdotal and statistical information when making medical decisions? In four experiments (N = 4126), we tested how people use conflicting information to judge the efficacy of artificial and real medical treatments. Participants read an anecdote from someone in a clinical trial, or who had undergone a medical treatment previously, for whom the medical treatment was ineffective. We found that reading anecdotes for either artificial or real medical treatments shifted participants' beliefs about the efficacy of a medical treatment. We observed this result even when the anecdote was uninformative, was paired with an icon array, or when participants were provided with thorough medical decision aids about reproductive health procedures. Our findings highlight the pervasive effect of anecdotes on medical decision making.

Distilling mathematical reasoning capabilities into Small Language Models.

This work addresses the challenge of democratizing advanced Large Language Models (LLMs) by compressing their mathematical reasoning capabilities into sub-billion parameter Small Language Models (SLMs) without compromising performance. We introduce Equation-of-Thought Distillation (EoTD), a novel technique that encapsulates the reasoning process into equation-based representations to construct an EoTD dataset for fine-tuning SLMs. Additionally, we propose the Ensemble Thoughts Distillation (ETD) framework to enhance the reasoning performance of SLMs. This involves creating a reasoning dataset with multiple thought processes, including Chain-of-Thought (CoT), Program-of-Thought (PoT), and Equation-of-Thought (EoT), and using it for fine-tuning. Our experimental performance demonstrates that EoTD significantly boosts the reasoning abilities of SLMs, while ETD enables these models to achieve state-of-the-art reasoning performance.

Broad versus narrow research questions in evidence synthesis: A parallel to (and plea for) estimands.

There has been a transition from broad to more specific research questions in the practice of network meta-analysis (NMA). Such convergence is also taking place in the context of individual registrational trials, following the recent introduction of the estimand framework, which is impacting the design, data collection strategy, analysis and interpretation of clinical trials. The language of estimands has much to offer to NMA, particularly given the "narrow" perspective of treatments and target populations taken in health technology assessment.

Development of script concordance test for assessment of clinical reasoning in nursing: Lessons learned regarding construct validity.

Background: The script concordance test (SCT) has been shown to be an effective tool to assess the clinical reasoning skills of nursing students. Various nursing studies have demonstrated the construct validity of this test. However, studies on the barriers that may impede construct validity during the development process are limited. Objective: This evaluation describes the barriers to the development of SCT for Bachelor's nursing students and the lessons learned regarding construct validity. Methods: We conducted a descriptive evaluation of the SCT development and a validation process was performed. The evaluation was based on written comments during the assessment (N = 327), a Student's Perspective Questionnaire (N = 100), and student feedback during three live review sessions (N = 27). Results: Despite consideration of the guidelines during SCT development, we encountered three main barriers that may impede construct validity. We undertook the necessary efforts to recruit an appropriate expert panel. We overestimated the experts' and students' understanding of the SCT methodology. Additionally, four potential causes of invalid item construction were identified. These possible causes were 'questionable intervention, hypothesis, or investigation', 'blurred data in new information', 'regression to the middle', and 'misinterpretation of the midpoint'. Conclusion: The three lessons learned are as follows: 1) The recruitment of an appropriate expert panel must not be underestimated. Besides clinical expertise, experts need training in SCT methodology, including awareness of possible pitfalls; 2) SCT training is a prerequisite for SCT as an assessment; and 3) student feedback may offer a deeper understanding of potential hidden script errors and causes for misinterpretation of SCT. Further studies are necessary to identify additional causes which may impede the construct validity of SCT in nursing education.

Faculty Training on Navigating Gender and Sex in Medical Education.

Introduction: Language that assumes gender and sex are binary and aligned is pervasive in medicine and is often used when teaching on physiology and pathology. Information presented through this lens oversimplifies disease mechanisms and poorly addresses the health of gender and sexually diverse (GSD) individuals. We developed a training session to help faculty reference gender and sex in a manner that would be accurate and inclusive of GSD health. Methods: The 1-hour session for undergraduate and graduate medical educators highlighted cisgender and binary biases in medical teachings and introduced a getting-to-the-root mindset that prioritized teaching the processes underlying differences in disease profiles among gender and sex subpopulations. The training consisted of 30 minutes of didactic teaching and 20 minutes of small-group discussion. Medical education faculty attended and self-reported knowledge and awareness before and after the training. Results were compared using paired t tests. Expenses included fees for consultation and catering. Results: Forty faculty participated (pretraining survey n = 36, posttraining survey n = 21). After the training, there was a significant increase in self-reported awareness of the difference between gender and sex (p = .002), perceived relevance of gender to teachings (p = .04), and readiness to discuss physiological drivers of sex-linked disease (p = .005). Discussion: Participants reported increased understanding and consideration of gender and sex in medical education; feedback emphasized a desire for continued guidance. This easily adaptable session can provide an introduction to a series of medical teachings on gender and sex.

Let's not get ahead of ourselves: we have no idea if moral reasoning causes moral progress.

An important question about moral progress is what causes it. One of the most popular proposed mechanisms is moral reasoning: moral progress often happens because lots of people reason their way to improved moral beliefs. Authors who defend moral reasoning as a cause of moral progress have relied on two broad lines of argument: the general and the specific line. The general line presents evidence that moral reasoning is in general a powerful mechanism of moral belief change, while the specific line tries to establish that moral reasoning can explain specific historical examples of moral progress. In this paper, we examine these lines in detail, using Kumar and Campbell's (2022, A Better Ape: The Evolution of the Moral Mind and How It Made Us Human. Oxford University Press) model of rational moral progress to sharpen our focus. For each line, we explain the empirical assumptions it makes; we then argue that the available evidence supports none of these assumptions. We conclude that at this point, we have no idea if moral reasoning causes moral progress.

Baruch Brody and the principle of justifiable homicide.

In a series of papers in the early 1970s and in his important book Abortion and the Sanctity of Human Life (1975), Baruch Brody offered what remains to this day one of the most philosophically rigorous contributions to the debate concerning the morality of abortion and the ethics of homicide more generally. In this paper I would like to critically examine Brody's argument that abortion is sometimes justifiable in some cases even when (1) one cannot claim self-defense, or (2) diminished responsibility, and (3) the abortion is a 'killing' rather than a 'not saving.' This justification, I argue, is limited to certain cases in which the life of the mother is at stake. The cautious principle which he finally formulates merits serious attention and consideration. While I find a great deal of value in Brody's discussion, I will argue that there are several difficulties with the principle of justifiable homicide he constructs. Accordingly, I will further amend and supplement his final version by offering my own alternative principle.

The role of action concepts in physical reasoning: insights from late childhood.

A fundamental component of human cognition is the ability to intuitively reason about behaviours of objects and systems in the physical world without resorting to explicit scientific knowledge. This skill was traditionally considered a symbolic process. However, in the last decades, there has been a shift towards ideas of embodiment, suggesting that accessing physical knowledge and predicting physical outcomes is grounded in bodily interactions with the environment. Infants and children, who learn mainly through their embodied experiences, serve as a model to probe the link between reasoning and physical concepts. Here, we tested school-aged children (5- to 15-year-olds) in online reasoning games that involve different physical action concepts such as supporting, launching and clearing. We assessed changes in children's performance and strategies over development and their relationships with the different action concepts. Children reasoned more accurately in problems that involved supporting actions compared to launching or clearing actions. Moreover, when children failed, they were more strategic in subsequent attempts when problems involved support rather than launching or clearing. Children improved with age, but improvements differed across action concepts. Our findings suggest that accessing physical knowledge and predicting physical events are affected by action concepts, and those effects change over development. This article is part of the theme issue 'Minds in movement: embodied cognition in the age of artificial intelligence'.

Evidence-based scientific thinking and decision-making in everyday life.

In today's knowledge economy, it is critical to make decisions based on high-quality evidence. Science-related decision-making is thought to rely on a complex interplay of reasoning skills, cognitive styles, attitudes, and motivations toward information. By investigating the relationship between individual differences and behaviors related to evidence-based decision-making, our aim was to better understand how adults engage with scientific information in everyday life. First, we used a data-driven exploratory approach to identify four latent factors in a large set of measures related to cognitive skills and epistemic attitudes. The resulting structure suggests that key factors include curiosity and positive attitudes toward science, prosociality, cognitive skills, and openmindedness to new information. Second, we investigated whether these factors predicted behavior in a naturalistic decision-making task. In the task, participants were introduced to a real science-related petition and were asked to read six online articles related to the petition, which varied in scientific quality, while deciding how to vote. We demonstrate that curiosity and positive science attitudes, cognitive flexibility, prosociality and emotional states, were related to engaging with information and discernment of evidence reliability. We further found that that social authority is a powerful cue for source credibility, even above the actual quality and relevance of the sources. Our results highlight that individual motivating factors toward information engagement, like curiosity, and social factors such as social authority are important drivers of how adults judge the credibility of everyday sources of scientific information.

Mapping cognitive biases in multidisciplinary team (MDT) decision-making for cancer care in Scotland: a cognitive ethnography study protocol.

INTRODUCTION: The efficiency of multidisciplinary teams (MDTs) in cancer care hinges on facilitating clinicians' cognitive processes as they navigate complex and uncertain judgements during treatment planning. When systems and workflows are not designed to adequately support human judgement and decision-making, even experts are prone to fallible reasoning due to cognitive biases. Incomplete integration of information or biased interpretations of patient data can lead to clinical errors and delays in the implementation of treatment recommendations. Though their impact is intuitively recognised, there is currently a paucity of empirical work on cognitive biases in MDT decision-making. Our study aims to explicate the impact of such biases on treatment planning and establish a foundation for targeted investigations and interventions to mitigate their negative effects. METHODS AND ANALYSIS: This is a qualitative, observational study. We employ cognitive ethnography, informed by the Distributed Cognition for Teamwork framework to assess and evaluate MDT decision-making processes. The study involves in-person and virtual field observations of hepatopancreaticobiliary and upper gastrointestinal MDTs and interviews with their members over several months. The data generated will be analysed in a hybrid inductive/deductive fashion to develop a comprehensive map of potential cognitive biases in MDT decision processes identifying antecedents and risk factors of suboptimal treatment planning processes. Further, we will identify components of the MDT environment that can be redesigned to support decision-making via development of an MDT workspace evaluation tool. ETHICS AND DISSEMINATION: This project has received management and ethical approvals from NHS Lothian Research and Development (2023/0245) and the University of Edinburgh Medical School ethical review committee (23-EMREC-049). Findings will be shared with participating MDTs and disseminated via a PhD thesis, international conference presentations and relevant scientific journals.

The adjustment disorder is not a wastebasket diagnosis: a grounded theory study of psychiatrists' and psychologists' clinical reasoning.

Background: the aim of this study is to understand the diagnostic process undertaken by psychiatrists and psychologists regarding adjustment disorder (AD) in their clinical practice and how they differentiate it from major depressive episode (MDE).Methods: A hermeneutic study using grounded theory techniques was carried out. Semi-structured interviews were conducted with twelve psychiatrists and eight psychologists in Colombia, and transcribed verbatim. Initial line-by-line coding was performed, followed by focused and axial coding to construct categories explaining the professionals' reasoning process.Results: The clinical reasoning of professionals regarding AD was understood through four major categories. (1) Difficulty in addressing the experience of stressful events, as there is a risk of pathologizing and medicalizing them. (2) Mental health diagnoses are necessary but not apodictic. (3) The diagnostic category of AD allows for the description of a fluctuating depressive and anxious syndrome occurring in reaction to a stressful event, whose abnormality criteria are based on intersubjective knowledge of the patient's life history and consequential reasoning regarding the need for professional support. (4) The AD label could potentially protect against overdiagnosis of MDE and overuse of antidepressants. Many clinicians in their practice thus subordinate the diagnosis of MDE to ensuring it is not AD, contrary to what is outlined in diagnostic manuals.Conclusion: This study allowed us to understand the clinical reasoning of psychiatrists and psychologists about AD as a diagnosis that inherently indicates the need to work on coping and intervene in the stressor and should be considered as a diagnostic possibility in the same hierarchy as MDE in reactive syndromes, rather than a residual category.

Clinicians use consequential and intersubjective reasoning to diagnose Adjustment Disorder (AD).Systemic pressures lead to overdiagnosis of Major Depressive Episode (MDE) and excessive antidepressant use.AD should be recognized as a valid non-residual diagnostic category.