BMI and explicit-implicit cues on food choice: The fake food buffet in the United Kingdom and Indonesia.

We examined whether people with high BMI sampled from two different countries were more susceptible to behavioural change via an implicit, rather than explicit, intervention. We measured BMI and used three types of cue interventions (implicit vs explicit healthy lifestyle cue vs neutral cue) to examine their impact on our participants' food choice using the Fake Food Buffet. Healthiness of the meal chosen was measured by the percentage of healthy food items in the meal. Portion size of their chosen meal was operationalised by the total number of food items chosen and its total calorie content was also estimated. Participants were recruited from the United Kingdom (N = 264) and Indonesia (N = 264). Our results indicated that while explicit food cues were overall more effective, implicit cues were a more effective strategy to change food choice behaviours among individuals with high BMI. Participants with high BMI were more likely to regulate the healthiness of their meal and less likely to regulate its portion size or calorie content. The efficacy of our healthy eating interventions was cross-culturally generalizable. Our study supports previous research that implicit cues of a healthy lifestyle might be a more effective behavioural change strategy for individuals with high BMI.

Clinical reasoning in real-world practice: a primer for medical trainees and practitioners.

Clinical reasoning is a crucial skill and defining characteristic of the medical profession, which relates to intricate cognitive and decision-making processes that are needed to solve real-world clinical problems. However, much of our current competency-based medical education systems have focused on imparting swathes of content knowledge and skills to our medical trainees, without an adequate emphasis on strengthening the cognitive schema and psychological processes that govern actual decision-making in clinical environments. Nonetheless, flawed clinical reasoning has serious repercussions on patient care, as it is associated with diagnostic errors, inappropriate investigations, and incongruent or suboptimal management plans that can result in significant morbidity and even mortality. In this article, we discuss the psychological constructs of clinical reasoning in the form of cognitive 'thought processing' models and real-world contextual or emotional influences on clinical decision-making. In addition, we propose practical strategies, including pedagogical development of a personal cognitive schema, mitigating strategies to combat cognitive bias and flawed reasoning, and emotional regulation and self-care techniques, which can be adopted in medical training to optimize physicians' clinical reasoning in real-world practice that effectively translates learnt knowledge and skill sets into good decisions and outcomes.

Neural correlates of performance monitoring vary as a function of competition between automatic and controlled processes: An ERP study.

Dual process theories of attitude formation propose that an evolutionary old associative system automatically generates subjective judgments by processing mere spatiotemporal contiguity between paired objects, subjects, or events. These judgments can potentially contradict our well-reasoned evaluations and highjack decisional or behavioral outcomes. Contrary to this perspective, other models stress the exclusive work of a single propositional system that consciously process co-occurrences between environmental cues and produce propositions, i.e., mental statements that capture the specific manner through which stimuli are linked. We constructed an experiment on the premise that it would be possible, if the associative system does produce attitudes in a parallel non-conscious fashion, to condition two mutually exclusive attitudes (one implicit, the other explicit) toward a same stimulus. Through explicit ratings, inhibition performance, and neural correlates of performance monitoring, we assessed whether there was a discrepancy between stimuli that were conditioned with (1) the two systems working in harmony (i.e., producing congruent attitudes), or (2) the two systems working in competition (i.e., producing incongruent attitudes). Compared with congruent stimuli, incongruent stimuli consistently elicited more neutral liking scores, higher response times and error rates, as well as a diminished amplitudes in two well-studied neural correlates of automatic error detection (i.e., error-related negativity) and conscious appraisal of error commission (i.e., error-related positivity). Our findings are discussed in the light of evolutionary psychology, dual-process theories of attitude formation and theoretical frameworks on the functional significance of error-related neural markers.

Informative and uninformative prestimulus cues at encoding benefit familiarity and source memory.

Previous research has shown that neural activity elicited by informative prestimulus cues during encoding differ with respect to subsequent memory outcomes. These findings indicate prestimulus cues create a "brain state" associated with subsequent memory that, potentially, also has downstream effects benefitting processes associated with successful encoding and subsequent memory performance. However, previous studies have not included the conditions necessary to appropriately test this latter assumption. The present study examines how informative and uninformative prestimulus encoding cues affect memory accuracy for upcoming stimuli compared to a no cue condition. At encoding, participants made one of two semantic judgments on words preceded by an informative prestimulus cue that identified the upcoming semantic judgment, an uninformative prestimulus cue that signalled an upcoming trial but no information about the semantic judgment, or no cue. Dual process estimates of familiarity, but not recollection, demonstrated a graded pattern with the informativeness of the prestimulus cues (i.e., informative > uninformative > no cues). Moreover, both informative and uninformative prestimulus cues enhanced subsequent source memory accuracy for the encoding task compared to the no cue condition. These findings suggest that prestimulus cues can strengthen the processes that support successful memory encoding and benefit subsequent familiarity and source memory.

Many phish in the C $\mathcal{C}$ : A coexisting-choice-criteria model of security behavior.

Normative decision theory proves inadequate for modeling human responses to the social-engineering campaigns of advanced persistent threat (APT) attacks. Behavioral decision theory fares better, but still falls short of capturing social-engineering attack vectors which operate through emotions and peripheral-route persuasion. We introduce a generalized decision theory, under which any decision will be made according to one of multiple coexisting choice criteria. We denote the set of possible choice criteria by C $\mathcal {C}$ . Thus, the proposed model reduces to conventional Expected Utility theory when | C EU | = 1 $|\mathcal {C}_{\text{EU}}|=1$ , while Dual-Process (thinking fast vs. thinking slow) decision making corresponds to a model with | C DP | = 2 $|\mathcal {C}_{\text{DP}}|=2$ . We consider a more general case with | C | ≥ 2 $|\mathcal {C}|\ge 2$ , which necessitates careful consideration of how, for a particular choice-task instance, one criterion comes to prevail over others. We operationalize this with a probability distribution that is conditional upon traits of the decisionmaker as well as upon the context and the framing of choice options. Whereas existing signal detection theory (SDT) models of phishing detection commingle the different peripheral-route persuasion pathways, in the present descriptive generalization the different pathways are explicitly identified and represented. A number of implications follow immediately from this formulation, ranging from the conditional nature of security-breach risk to delineation of the prerequisites for valid tests of security training. Moreover, the model explains the "stepping-stone" penetration pattern of APT attacks, which has confounded modeling approaches based on normative rationality.

Investigating the clinical decision-making of nursing students using high-fidelity simulation, observation and think aloud: A mixed methods research study.

AIMS: The aim of this study was to investigate nursing students' clinical decision-making by using high-fidelity simulation of a deteriorated patient scenario. DESIGN: A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection. METHODS: Twenty-three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio-video recorded and observations were collected by the researcher. RESULTS: There was a significant moderate increase in the 'deduction' and 'analysis' sub-scale scores and overall test score, suggestive of improved analytical decision-making processes through the simulation experience. Think-aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem. CONCLUSION: Students learn different clinical decision-making skills during the simulation compared to what they learn from debriefing. Using observation and think-aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision-making process.

Reciprocal associations between implicit attitudes and drinking in emerging adulthood.

BACKGROUND: Implicit alcohol attitudes are considered important in the etiology of drinking, and theory posits reciprocal associations between them. Research testing reciprocal associations between implicit attitudes (using the Implicit Association Task, IAT) and drinking is limited by a failure to consider multiple processes influencing performance on the IAT and to disaggregate within- and between-person effects. The current study addressed these limitations by using a diffusion model to analyze IAT data and Latent Curve Models with Structured Residuals to test reciprocal associations. METHODS: The sample included 314 emerging adults from the community (52% female; predominantly non-Hispanic Caucasian (76%) or African American (15%)) assessed annually for three years. Differences between IAT conditions in the drift rate parameter of the EZ-diffusion model (vΔ) were used as an alternative to traditional response-time-based indices from the IAT (d-scores). Differences in drift rate have been found to index implicit attitudes effectively. RESULTS: Within-person reciprocal associations were supported, but between-person associations were not. Positive implicit alcohol attitudes (vΔ) were prospectively associated with heavy drinking, which was positively associated with subsequent positive implicit alcohol attitudes. CONCLUSIONS: We found that positive implicit alcohol attitudes and heavy drinking reinforce each other in a negative cascade within individuals. The results highlight the importance of disaggregating within- and between-person prospective effects when testing dual process models and suggest that the diffusion model may be a fruitful approach to enhance the construct validity of IAT assessed implicit attitudes.

Outcome Value and Task Aversiveness Impact Task Procrastination through Separate Neural Pathways.

The temporal decision model of procrastination has proposed that outcome value and task aversiveness are two separate aspects accounting for procrastination. If true, the human brain is likely to implicate separate neural pathways to mediate the effect of outcome value and task aversiveness on procrastination. Outcome value is plausibly constructed via a hippocampus-based pathway because of the hippocampus's unique role in episodic prospection. In contrast, task aversiveness might be represented through an amygdala-involved pathway. In the current study, participants underwent fMRI scanning when viewing both tasks and future outcomes, without any experimental instruction imposed. The results revealed that outcome value increased activations in the caudate, and suppressed procrastination through a hippocampus-caudate pathway. In contrast, task aversiveness increased activations in the anterior insula, and increased procrastination via an amygdala-insula pathway. In sum, this study demonstrates that people can incorporate both outcome value and task aversiveness into task valuation to decide whether to procrastinate or not; and it elucidates the separate neural pathways via which this occurs.

Problem representation and diagnostic accuracy during an OSCE.

PURPOSE: The National Academy of Medicine has called for "identifying opportunities to improve the diagnostic process". We studied the association between problem representation and diagnostic accuracy during an objective structured clinical exam (OSCE). MATERIALS AND METHODS: We conducted a non-randomized controlled trial during a ten-case OSCE. We measured whether a summary statement prompt increased the likelihood that the student listed the correct diagnosis and whether better summary statements were correlated with diagnostic accuracy. RESULTS: 114 students provided 1135 responses. The non-prompted control group yielded 631 responses, listing the correct diagnosis first 73% of the time and within the top three slots 85% of the time. The intervention group exposed to the prompt yielded 453 responses listing the correct diagnosis first 72% of the time (P = 0.617) and within the top three slots 84% of the time (P = 0.760). Summary statements were scored on a 0, 0.5, or 1 rubric. When grouped according to summary statement score, students listed the correct diagnosis first 74%, 70%, and 72% of the time respectively (P = 0.666). The correct diagnosis was included within the top three slots 88%, 82%, and 83% of the time (P = 0.238). CONCLUSIONS: Prompting students to form a summary statement did not improve diagnostic accuracy. Better summary statements were not correlated with diagnostic accuracy.

Types of clinical reasoning in a summative clerkship oral examination.

INTRODUCTION: Dual-process theory characterizes clinical reasoning (CR) as Type 1 (intuitive) and Type 2 (analytical) thinking. This study examined CR on a summative clinical clerkship structured clinical oral examination (SCOE). METHODS AND SUBJECTS: 511 clinical clerks at the University of Toronto underwent SCOEs. Type 1, Type 2, and Global CR performance were compared to other internal medicine clerkship assessments using descriptive statistics and Spearman correlations. RESULTS: Clinical clerks achieved mean marks >75% on the three clinical reasoning stations, on Type 1 and 2 CR tasks, and the overall SCOE. Performance on the SCOE CR stations correlated with each of the other clerkship assessments: written examination, inpatient, and ambulatory clinic assessments. The correlation of performance between Type 1 and Type 2 clinical reasoning tasks was statistically significant but weak (rs = 0.28). This suggests that defined measures of Type 1 and Type 2 reasoning were indeed assessing distinct constructs. CONCLUSION: Clinical clerks used both Type 1 and Type 2 reasoning with success. This study's characterization of Type 1 and Type 2 CR as separate domains, distinct from existing measures on the SCOE as well as the other clerkship assessments, can suggest a further addition to multimodal clerkship assessment.

Dual processes, dual virtues.

I argue that virtue reliabilism and virtue responsibilism are complementary. They do not give competing accounts of epistemic virtue. Rather they explain the excellent functioning of different parts of our cognitive apparatus. Reliabilist virtue designates the excellent functioning of fast and context-specific Type 1 cognitive processes, while responsibilist virtue means an excellent functioning of effortful and reflective Type 2 cognitive processes. This account unifies reliabilist and responsibilist virtue theory. But the virtues are not unified by designating some epistemic norm that both aim at. Instead, I unify them through their cognitive foundations. Because Type 1 and Type 2 cognition are complementary, reliabilist and responsibilist virtues are complementary. Thereby, this dual-process theory of epistemic virtue gives a naturalised account of virtues as well as an explanation of how reliabilism and responsibilism relate. This approach offers a solution for both the generality problem and the situationist challenge to virtue epistemology; additionally it preserves the epistemological autonomy of each virtue type.

Cognitive and Affective Processes Associated with Social Biases.

BACKGROUND: Our social activities are quite often erroneous and irrational, based on biased judgements and decision-making, known as social biases. However, the cognitive and affective processes that produce such biases remain largely unknown. In this study, we investigated associations between social schemas, such as social judgment and conformity, entailing social biases and psychological measurements relevant to cognitive and affective functions. METHOD: This study recruited 42 healthy adult subjects. A psychological test and a questionnaire were administered to assess biased social judgements by superficial attributes and social conformity by adherence to social norms, respectively, along with additional questionnaires and psychological tests for cognitive and affective measurements, including negative affects, autistic traits, and Theory of Mind (ToM). Associations of social judgment and conformity with cognitive and affective functions were examined using a multiple regression analysis and structural equation modeling. RESULTS: Anxiety and the cognitive realm of ToM were mutually associated with both social judgments and conformity, although social judgements and conformity were still independent processes. Social judgements were also associated with autistic traits and the affective realm of ToM, whereas social conformity was associated with negative affects other than anxiety and an intuitive decision-making style. CONCLUSIONS: These results suggest that ToM and negative affects may play important roles in social judgements and conformity, and the social biases connoted in these social schemas.

The efficacy of mindful practice in improving diagnosis in healthcare: a systematic review and evidence synthesis.

Despite a variety of definitions of mindfulness, over the past 20 years there have been increasing claims that mindful practice is helpful in improving the accuracy of clinical diagnosis. We performed a systematic review and evidence synthesis in order to: determine the nature and definitions of mindful practice and associated terms; evaluate the quality of evidence for the benefits of mindful practice; and conclude whether mindful practice may reduce diagnostic error. We screened 14397 refereed reports from the five common literature databases, to include 33 reports related to the use of mindful practice in clinical diagnosis. Our evidence synthesis contained no randomised controlled trials (level I evidence) of mindful practice, the majority of supporting evidence (26 reports or 79%) comprised conceptual commentary or opinion (level IV evidence). However, 2 supporting reports constituted controlled studies without randomisation (level IIa), 1 report was quasi-experimental (level IIb), and 4 reports were comparative studies (level III). Thus, we may tentatively conclude that mindful practice appears promising as a method of improving diagnostic accuracy, but that further definitive studies of efficacy are required. We identified a taxonomy of 71 terms related to mindful practice, 7 of which were deemed core terms due to being each cited 5 times or more. The 7 core terms appear to be sufficient to describe the findings at higher levels of evidence in our evidence synthesis, suggesting that future definitive studies of mindful practice should focus on these common core terms in order to promote more generalisable findings.

Promotion of knowledge transfer and retention in year 2 medical students using an online training exercise.

It was recently shown that novice medical students could be trained to demonstrate the speed-to-diagnosis and diagnostic accuracy typical of System-1-type reasoning. However, the effectiveness of this training can only be fully evaluated when considering the extent to which knowledge transfer and long-term retention occur as a result, the former of which is known to be notoriously difficult to achieve. This study aimed to investigate whether knowledge learned during an online training exercise for chest X-ray diagnosis promoted either knowledge transfer or retention, or both. Second year medical students were presented with, and trained to recognise the features of four chest X-ray conditions. Subsequently, they were shown the four trained-for cases again as well as different representations of the same conditions varying in the number of common elements and asked to provide a diagnosis, to test for near-transfer (four cases) and far-transfer (four cases) of knowledge. They were also shown four completely new conditions to diagnose. Two weeks later they were asked to diagnose the 16 aforementioned cases again to assess for knowledge retention. Dependent variables were diagnostic accuracy and time-to-diagnosis. Thirty-six students volunteered. Trained-for cases were diagnosed most accurately and with most speed (mean score = 3.75/4, mean time = 4.95 s). When assessing knowledge transfer, participants were able to diagnose near-transfer cases more accurately (mean score = 2.08/4, mean time = 15.77 s) than far-transfer cases (mean score = 1.31/4, mean time = 18.80 s), which showed similar results to those conditions previously unseen (mean score = 0.72/4, mean time = 19.46 s). Retention tests showed a similar pattern but accuracy scores were lower overall. This study demonstrates that it is possible to successfully promote knowledge transfer and retention in Year 2 medical students, using an online training exercise involving diagnosis of chest X-rays, and is one of the few studies to provide evidence of actual knowledge transfer.

Probing emotional recognition memory: how different response formats affect response behaviour.

Receiver-operating characteristic curves from confidence ratings and remember/know (R/K) judgments are often used to estimate the contribution of familiarity and recollection to recognition memory. Both coming with specific advantages and disadvantages, which could be reduced by their combination. Little is known how the combination of both methods impacts response behaviour. This could be particularly important for emotional memory research, which is susceptible to variation in meta-mnemonic processes. We obtained reference performance indices from the two methods, instructing individuals to give confidence ratings or R/K judgments in one step. Against these, we contrasted R/K judgments in a two-step format and two combined formats, confidence ratings followed by R/K judgments and vice versa. Regarding reference formats, confidence ratings resulted in more liberal response criteria and false alarm rates than R/K judgments. Two-step R/K judgments and confidence ratings followed by R/K judgments resulted in patterns similar to one-step R/K judgments. Reversing the order resulted in more liberal response biases, higher hit and false alarms rates. Recollection and familiarity were unaffected by response formats. Valence effects did not vary with response formats. The present results suggest that confidence ratings followed by R/K judgments provide the advantages of both without biasing response behaviour.

Trust in Autonomous Cars: Exploring the Role of Shared Moral Values, Reasoning, and Emotion in Safety-Critical Decisions.

OBJECTIVE: Autonomous cars (ACs) controlled by artificial intelligence are expected to play a significant role in transportation in the near future. This study investigated determinants of trust in ACs. BACKGROUND: Trust in ACs influences different variables, including the intention to adopt AC technology. Several studies on risk perception have verified that shared value determines trust in risk managers. Previous research has confirmed the effect of value similarity on trust in artificial intelligence. We focused on moral beliefs, specifically utilitarianism (belief in promoting a greater good) and deontology (belief in condemning deliberate harm), and tested the effects of shared moral beliefs on trust in ACs. METHOD: We conducted three experiments (N = 128, 71, and 196, for each), adopting a thought experiment similar to the well-known trolley problem. We manipulated shared moral beliefs (shared vs. unshared) and driver (AC vs. human), providing participants with different moral dilemma scenarios. Trust in ACs was measured through a questionnaire. RESULTS: The results of Experiment 1 showed that shared utilitarian belief strongly influenced trust in ACs. In Experiment 2 and Experiment 3, however, we did not find statistical evidence that shared deontological belief had an effect on trust in ACs. CONCLUSION: The results of the three experiments suggest that the effect of shared moral beliefs on trust varies depending on the values that ACs share with humans. APPLICATION: To promote AC implementation, policymakers and developers need to understand which values are shared between ACs and humans to enhance trust in ACs.

Use numbers not words! Communicating hotels' cleaning programs for COVID-19 from the brand perspective.

After hotels in many countries were forced to close in government-imposed lockdowns during the COVID-19 pandemic, there is an inherent need to communicate how they deal with the coronavirus to motivate guests to visit. However, lack of knowledge about how to persuasively communicate about hotels' cleaning programs for COVID-19 can challenge the industry's survival. We investigated how hotels that position their brand as a particular personality (sincere vs. exciting) could benefit from different communication styles (inclusion of numerical vs. verbal quantifiers) when presenting their COVID-19 cleaning procedures. Study 1 explored tourists' central attitudinal responses toward hotels' cleaning programs. Study 2 demonstrated that sincere hotel brands would benefit from using numerical and verbal quantifiers to communicate their cleaning policies, whereas exciting hotel brands would benefit only from numerical quantifiers. Our results invite hotel managers to use their brand personality positioning to influence tourists' attitudes and intentions in a pandemic context.

Enhancing the Wisdom of the Crowd With Cognitive-Process Diversity: The Benefits of Aggregating Intuitive and Analytical Judgments.

Drawing on dual-process theory, we suggest that the benefits that arise from combining several quantitative individual judgments will be heightened when these judgments are based on different cognitive processes. We tested this hypothesis in three experimental studies in which participants provided estimates for the dates of different historical events (Study 1, N = 152), made probabilistic forecasts for the outcomes of soccer games (Study 2, N = 98), and estimated the weight of individuals on the basis of a photograph (Study 3, N = 3,695). For each of these tasks, participants were prompted to make judgments relying on an analytical process, on their intuition, or (in a control condition) on no specific instructions. Across all three studies, our results show that an aggregation of intuitive and analytical judgments provides more accurate estimates than any other aggregation procedure and that this advantage increases with the number of aggregated judgments.

Preference for Deliberation and Perceived Usefulness of Standard- and Narrative-Style Leaflet Designs: Implications for Equitable Cancer-Screening Communication.

BACKGROUND: In the UK, cancer-screening invitations are mailed with information styled in a standard, didactic way to allow for informed choice. Information processing theory suggests this "standard style" could be more appealing to people who prefer deliberative thinking. People less likely to engage in deliberative thinking may be disenfranchised by the design of current standard-style information. PURPOSE: To examine the distribution of preference for deliberative thinking across demographic groups (Study 1) and explore associations between preference for deliberative thinking and perceived usefulness of standard- and narrative-style screening information (Study 2). METHODS: In Study 1, adults aged 45-59 (n = 4,241) were mailed a questionnaire via primary care assessing preference for deliberative thinking and demographic characteristics. In Study 2, a separate cohort of adults aged 45-59 (n = 2,058) were mailed standard- and narrative-style leaflets and a questionnaire assessing demographic characteristics, preference for deliberative thinking, and perceived leaflet usefulness. Data were analyzed using multiple regression. RESULTS: In Study 1 (n = 1,783) and Study 2 (n = 650), having lower socioeconomic status, being a women, and being of nonwhite ethnicity was associated with lower preference for deliberative thinking. In Study 2, the standard-style leaflet was perceived as less useful among participants with lower preference for deliberative thinking, while perceived usefulness of the narrative-style leaflet did not differ by preference for deliberative thinking. CONCLUSIONS: Information leaflets using a standard style may disadvantage women and those experiencing greater socioeconomic deprivation. More work is required to identify design styles that have a greater appeal for people with low preference for deliberative thinking.

A dimensional summation account of polymorphous category learning.

Polymorphous concepts are hard to learn, and this is perhaps surprising because they, like many natural concepts, have an overall similarity structure. However, the dimensional summation hypothesis (Milton and Wills Journal of Experimental Psychology: Learning, Memory and Cognition, 30, 407-415 2004) predicts this difficulty. It also makes a number of other predictions about polymorphous concept formation, which are tested here. In Experiment 4, we confirm the theory's prediction that polymorphous concept formation should be facilitated by deterministic pretraining on the constituent features of the stimulus. This facilitation is relative to an equivalent amount of training on the polymorphous concept itself. In further experiments, we compare the predictions of the dimensional summation hypothesis with a more general strategic account (Experiment 2), a seriality of training account (Experiment 3), a stimulus decomposition account (also Experiment 3), and an error-based account (Experiment 4). The dimensional summation hypothesis provides the best account of these data. In Experiment 5, a further prediction is confirmed-the single feature pretraining effect is eliminated by a concurrent counting task. The current experiments suggest the hypothesis that natural concepts might be acquired by the deliberate serial summation of evidence. This idea has testable implications for classroom learning.