The malleable impact of non-numeric features in visual number perception.

Non-numeric stimulus features frequently influence observers' number judgments: when judging the number of items in a display, we will often (mis)perceive the set with a larger cumulative surface area as more numerous. These "congruency effects" are often used as evidence for how vision extracts numeric information and have been invoked in arguments surrounding whether non-numeric cues (e.g., cumulative area, density, etc.) are combined for number perception. We test whether congruency effects for one such cue - cumulative area - provide evidence that it is necessarily used and integrated in number perception, or if its influence on number is malleable. In Experiment 1, we replicate and extend prior work showing that the presence of feedback eliminates congruency effects between number and cumulative area, suggesting that the role of cumulative area in number perception is malleable rather than obligatory. In Experiment 2, we test whether this malleable influence is because of use of prior experiences about how number naturalistically correlates with cumulative area, or the result of response competition, with number and cumulative area actively competing for the same behavioral decision. We preserve cumulative area as a visual cue but eliminate response competition with number by replacing one side of the dot array with its corresponding Hindu-Arabic numeral. Independent of the presence or absence of feedback, we do not observe congruency effects in Experiment 2. These experiments suggest that cumulative area is not necessarily integrated in number perception nor a reflection of a rational use of naturalistic correlations, but rather congruency effects between cumulative area and number emerge as a consequence of response competition. Our findings help to elucidate the mechanism through which non-numeric cues and number interact, and provide an explanation for why congruency effects are only sometimes observed across studies.

Learning with certainty in childhood.

Learners use certainty to guide learning. They maintain existing beliefs when certain, but seek further information when they feel uninformed. Here, we review developmental evidence that this metacognitive strategy does not require reportable processing. Uncertainty prompts nonverbal human infants and nonhuman animals to engage in strategies like seeking help, searching for additional information, or opting out. Certainty directs children's attention and active learning strategies and provides a common metric for comparing and integrating conflicting beliefs across people. We conclude that certainty is a continuous, domain-general signal of belief quality even early in life.

Mini managers: Children strategically divide cognitive labor among collaborators, but with a self-serving bias.

Strategic collaboration according to the law of comparative advantage involves dividing tasks based on the relative capabilities of group members. Three experiments (N = 405, primarily White and Asian, 45% female, collected 2016-2019 in Canada) examined how this strategy develops in children when dividing cognitive labor. Children divided questions about numbers between two partners. By 7 years, children allocated difficult questions to the skilled partner (Experiment 1, d = 1.42; Experiment 2, d = 0.87). However, younger children demonstrated a self-serving bias, choosing the easiest questions for themselves. Only when engaging in a third-party collaborative task did 5-year-olds assign harder questions to the more skilled individual (Experiment 3, d = 0.55). These findings demonstrate early understanding of strategic collaboration subject to a self-serving bias.

Are children's judgments of another's accuracy linked to their metacognitive confidence judgments?

The world can be a confusing place, which leads to a significant challenge: how do we figure out what is true? To accomplish this, children possess two relevant skills: reasoning about the likelihood of their own accuracy (metacognitive confidence) and reasoning about the likelihood of others' accuracy (mindreading). Guided by Signal Detection Theory and Simulation Theory, we examine whether these two self- and other-oriented skills are one in the same, relying on a single cognitive process. Specifically, Signal Detection Theory proposes that confidence in a decision is purely derived from the imprecision of that decision, predicting a tight correlation between decision accuracy and confidence. Simulation Theory further proposes that children attribute their own cognitive experience to others when reasoning socially. Together, these theories predict that children's self and other reasoning should be highly correlated and dependent on decision accuracy. In four studies (N = 374), children aged 4-7 completed a confidence reasoning task and selective social learning task each designed to eliminate confounding language and response biases, enabling us to isolate the unique correlation between self and other reasoning. However, in three of the four studies, we did not find that individual differences on the two tasks correlated, nor that decision accuracy explained performance. These findings suggest self and other reasoning are either independent in childhood, or the result of a single process that operates differently for self and others. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11409-021-09263-x.

Children flexibly compare their confidence within and across perceptual domains.

How does a person make decisions across perceptual boundaries? Here, we test the account that confidence constitutes a common currency for perceptual decisions even in childhood by examining whether confidence can be compared across distinct perceptual dimensions. We conducted a strict test of domain-generality in confidence reasoning by asking 6- to 7-year-olds to compare their confidence in 2 decisions, either from the same perceptual dimension (e.g., number vs. number) or from two different perceptual dimensions (e.g., area vs. emotion). Not only could children compare their confidence across and within domains but there were no differences in their abilities to make within- and across-domain comparisons. Our findings support the idea that confidence is represented in a common format even in childhood, which could provide an account for perceptual integration in childhood that doesn't necessitate the use of language. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cardiac Rehabilitation Availability and Delivery in Canada: How Does It Compare With Other High-Income Countries?

BACKGROUND: Canada has insufficient cardiac rehabilitation (CR) capacity, yet unmet need is unknown. Moreover, Canada has CR guidelines, but whether delivery conforms has not been characterized by province/territory. This study aimed to establish (1) CR volumes, capacity, and density, as well as (2) the nature of programs, and (3) compare these (a) by province/territory and (b) with other high-income countries (HICs). METHODS: In this cross-sectional study, an online survey was administered to CR programs globally. National cardiac associations were engaged to facilitate program identification where available, or local champions. Density was computed using Canada's Chronic Disease Surveillance System ischemic heart disease incidence estimates. Twenty-eight HICs with CR were selected for comparison (N = 619 programs), and multilevel analyses performed. RESULTS: CR was available in 10 of 13 (76.9%) provinces (no programs in Canada's North), with 74 of 182 programs initiating a survey (40.7% response). Program volumes (median = 250) were greatest in Ontario, but ultimately there was only 1 CR spot per 4.55 patients with ischemic heart disease nationally (similar in other HICs), and 186,187 more spots are needed annually. Most programs were funded by government/hospital sources (n = 48, 66.7%), but in 23 (31.5%), patients paid some or all of program costs out-of-pocket. Guideline-indicated conditions were accepted in more than 90% of programs. Programs had a multidisciplinary team of 6.2 ± 2.1 staff, offering 7.7 ± 1.5/10 core components (varied by province, P = 0.001; return-to-work offered less frequently than other HICs; P = 0.03), over 42.0 ± 26.0 hours (provincial and other HIC differences, P < 0.001). CONCLUSIONS: Canadian CR capacity must be augmented, but where available, services are consistent with other HICs.

Fitting the Message to the Listener: Children Selectively Mention General and Specific Facts.

In three experiments, two hundred and ninety-seven 4- to 6-year-olds were asked to describe objects to a listener, and their answers were coded for the presence of general and specific facts. In Experiments 1 and 2, the listener's knowledge of the kinds of objects was manipulated. This affected references to specific facts at all ages, but only affected references to general facts in children aged 5 and older. In Experiment 3, children's goal in communicating was either pedagogical or not. Pedagogy influenced references to general information from age 4, but not references to specific information. These findings are informative about how children vary general and specific information in conversation, and suggest that listeners' knowledge and children's pedagogical goals influenced children's responses via different mechanisms.

GRACE risk score: Sex-based validity of in-hospital mortality prediction in Canadian patients with acute coronary syndrome.

BACKGROUND: Although there are sex differences in management and outcome of acute coronary syndromes (ACS), sex is not a component of Global Registry of Acute Coronary Events (GRACE) risk score (RS) for in-hospital mortality prediction. We sought to determine the prognostic utility of GRACE RS in men and women, and whether its predictive accuracy would be augmented through sex-based modification of its components. METHODS: Canadian men and women enrolled in GRACE and Canadian Registry of Acute Coronary Events were stratified as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS). GRACE RS was calculated as per original model. Discrimination and calibration were evaluated using the c-statistic and Hosmer-Lemeshow goodness-of-fit test, respectively. Multivariable logistic regression was undertaken to assess potential interactions of sex with GRACE RS components. RESULTS: For the overall cohort (n=14,422), unadjusted in-hospital mortality rate was higher in women than men (4.5% vs. 3.0%, p<0.001). Overall, GRACE RS c-statistic and goodness-of-fit test p-value were 0.85 (95% CI 0.83-0.87) and 0.11, respectively. While the RS had excellent discrimination for all subgroups (c-statistics >0.80), discrimination was lower for women compared to men with STEMI [0.80 (0.75-0.84) vs. 0.86 (0.82-0.89), respectively, p<0.05]. The goodness-of-fit test showed good calibration for women (p=0.86), but suboptimal for men (p=0.031). No significant interaction was evident between sex and RS components (all p>0.25). CONCLUSIONS: The GRACE RS is a valid predictor of in-hospital mortality for both men and women with ACS. The lack of interaction between sex and RS components suggests that sex-based modification is not required.

Children's generic interpretation of pretense.

We report two experiments investigating how 3- to 5-year-olds learn general knowledge from pretend play-how they learn about kinds of things (e.g., information about dogs) from information about particular individuals in pretend play (a certain dog in a pretend scenario). Children watched pretend-play enactments in which animals showed certain behaviors or heard utterances conveying the same information. When children were subsequently asked about who shows the behavior, children who watched pretend play were more likely to give generic responses than were children who heard the utterances. These findings show that children generalize information from pretend play to kinds even without being prompted to think about kinds, that pretend play can be informative about familiar kinds, and also that pretend play is a more potent source for general knowledge than are utterances about individuals.

Pre-hospital cardiac arrest in acute coronary syndromes: insights from the global registry of acute coronary events and the canadian registry of acute coronary events.

OBJECTIVES: Cardiac arrest in acute coronary syndromes (ACS) is associated with high morbidity and mortality. We examined the clinical characteristics, contemporary management patterns and outcomes of ACS patients with pre-hospital cardiac arrest. METHODS: The Global Registry of Acute Coronary Events and the Canadian Registry of Acute Coronary Events enrolled 14,010 ACS patients in 1999-2008. We compared the clinical characteristics, in-hospital treatment and outcomes between patients with and without pre-hospital cardiac arrest. RESULTS: Overall, 206 (1.4%) patients had cardiac arrest prior to hospital presentation. ACS patients with pre-hospital cardiac arrest were less frequently treated with aspirin, ß-blocker, angiotensin-converting enzyme inhibitors, and statins within the first 24 h of presentation, but the use of cardiac procedures was similar compared to the group without cardiac arrest. Patients with pre-hospital cardiac arrest had significantly higher rates of in-hospital adverse events. Factors independently associated with pre-hospital cardiac arrest included male gender, current smoker status, tachycardia, higher Killip class and ST-segment deviation. CONCLUSION: ACS patients with pre-hospital cardiac arrest continue to have more in-hospital complications and higher mortality. Their use of evidence-based medical therapies was lower but the use of cardiac procedures was similar compared to the group without cardiac arrest. Better utilization of evidence-based therapies in these patients may translate into improved outcomes.

Temporal changes in the management and outcome of Canadian diabetic patients hospitalized for non-ST-elevation acute coronary syndromes.

BACKGROUND: There are limited data on the contemporary management and outcomes of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients with diabetes in the "real world." We sought to evaluate (1) the temporal changes in the medical and invasive management and (2) in-hospital outcome of NSTE-ACS patients with and without diabetes. METHODS: We included Canadian patients hospitalized for NSTE-ACS enrolled in 4 consecutive, prospective, multicenter registries: Canadian ACS-I (n = 3259; 1999-2001), ACS-II (n = 1,956; 2002-2003), Global Registry of Acute Coronary Events (GRACE/GRACE2 [n = 7,561; 2004-2007]) and Canadian Registry of Acute Coronary Events (n = 1,326; 2008). Participants were stratified by the presence or absence of preexisting diabetes on admission. Temporal changes in patient management and outcomes were evaluated across the 4 registries. Multivariable analyses were performed to determine the independent prognostic significance of diabetes. RESULTS: Of the 14,102 NSTE-ACS patients, 4,046 (28.7%) had previously diagnosed diabetes. Patients with diabetes were older; were more likely to have prior cardiac history including myocardial infarction, revascularization, and heart failure; and had worse Killip class and higher GRACE risk score (all P < .001). Over time, there were significant increases in the use of in-hospital coronary angiography and revascularization. However, diabetic patients were less likely to undergo coronary angiography (52.5% vs 57%, P < .001) or revascularization (28.4% vs 33.4%, P < .001). The underuse of invasive procedures in diabetic patients was seen in all registries and was persistent over time. Overall, compared with the group without diabetes, diabetic patients had higher unadjusted rates of in-hospital mortality (3.0% vs 1.6%, P < .001). In multivariable analysis adjusting for components of the GRACE risk score, diabetes remained an independent predictor of in-hospital death (adjusted odds ratio 1.66, 95% CI 1.30-2.11, P < .001). CONCLUSIONS: Over the last decade, NSTE-ACS patients with diabetes continue to be treated more conservatively, despite evidence that they would derive similar or even greater benefits from aggressive treatment. This underutilization of evidence-based therapies among diabetic patients with NSTE-ACS in the "real world" may partly explain their worse outcome.

Comparison of baseline characteristics, management and outcome of patients with non-ST-segment elevation acute coronary syndrome in versus not in clinical trials.

Previous studies have questioned the external validity of randomized controlled trial results of acute coronary syndrome (ACS) because of potential selection bias toward healthier patients. We sought to evaluate differences in clinical characteristics and management of patients admitted with non-ST-elevation ACS according to participation in clinical trials over the previous decade. The Canadian ACS I (1999 to 2001), ACS II (2002-2003), GRACE (2004-2007), and CANRACE (2008) were prospective, multicenter registries of patients admitted to hospitals with ACS. We examined 13,556 patients with non-ST-elevation ACS, of whom 1,126 (8.3%) participated in clinical trials. Data were collected on baseline characteristics, medication use at admission and discharge, in-hospital procedures, and in-hospital adverse events. Patients enrolled in clinical trials were younger, more likely to be men, and had fewer co-morbidities. They were significantly more likely to be on several guideline-recommended medications and were significantly more likely to undergo invasive procedures, including coronary angiography, percutaneous coronary intervention, and coronary bypass surgery (all p values <0.001). Unadjusted in-hospital (2.1% vs 0.7%, p = 0.001) and 1-year (8.9% vs 6.3%, p = 0.037) mortality rates were higher in non-enrolled patients. In multivariable analysis, patients who were older, women, had a history of heart failure, and increased creatinine levels on presentation were less likely to be enrolled into clinical trials. In conclusion, significant differences persist in baseline characteristics, treatment, and outcomes between patients enrolled and those not enrolled in clinical trials. Consequently, generalization of ACS clinical trials over the previous decade to the "real-world" patient may remain in question.

Optimal medical therapy for non-ST-segment-elevation acute coronary syndromes: exploring why physicians do not prescribe evidence-based treatment and why patients discontinue medications after discharge.

BACKGROUND: Acute coronary syndrome (ACS) patients in the highest risk categories are least likely to receive evidence-based treatments (EBTs). We sought to determine why physicians do not prescribe EBTs for patients with non-ST-segment-elevation ACSs and the factors determining use of these treatments after 1 year. METHODS AND RESULTS: One thousand nine hundred fifty-six non-ST-segment-elevation ACS patients were enrolled in the prospective, multicenter Canadian ACS registry II between October 2002 and December 2003. Each patient's physician gave reasons why guideline-indicated medication(s) was not prescribed during hospitalization. Medication use and reason(s) for discontinuation after 1 year were obtained by telephone interview of the patients. The commonest reason for not prescribing EBTs was "not high-enough risk" or "no evidence/guidelines to support use." However, Global Registry of Acute Coronary Events scores of patients not treated for this reason were often similar to or higher than those of patients prescribed such treatment. After 1 year, 77% of patients not on optimal ACS treatment at discharge remained without optimal treatment, and overall antiplatelet, ß-blocker, and angiotensin-converting enzyme inhibitor use declined. Approximately one third of patients not taking EBTs had stopped their medication without instruction from their doctor. CONCLUSIONS: Nonprovision of EBTs may be due to subjective underestimation of patient risk and hence, likely treatment benefit. Oversights in care delivery were also apparent. Objective risk stratification, combined with efforts to ensure provision and adherence to EBTs, should be encouraged.

Chicago medical response to the 2010 earthquake in Haiti: translating academic collaboration into direct humanitarian response.

On January 12, 2010, a major earthquake in Haiti resulted in approximately 212 000 deaths, 300 000 injuries, and more than 1.2 million internally displaced people, making it the most devastating disaster in Haiti's recorded history. Six academic medical centers from the city of Chicago established an interinstitutional collaborative initiative, the Chicago Medical Response, in partnership with nongovernmental organizations (NGOs) in Haiti that provided a sustainable response, sending medical teams to Haiti on a weekly basis for several months. More than 475 medical volunteers were identified, of whom 158 were deployed to Haiti by April 1, 2010. This article presents the shared experiences, observations, and lessons learned by all of the participating institutions. Specifically, it describes the factors that provided the framework for the collaborative initiative, the communication networks that contributed to the ongoing response, the operational aspects of deploying successive medical teams, and the benefits to the institutions as well as to the NGOs and Haitian medical system, along with the challenges facing those institutions individually and collectively. Academic medical institutions can provide a major reservoir of highly qualified volunteer medical personnel that complement the needs of NGOs in disasters for a sustainable medical response. Support of such collaborative initiatives is required to ensure generalizability and sustainability.