Predictive Capability of an iPad-Based Medical Device (medx) for the Diagnosis of Vertigo and Dizziness.

BACKGROUND: Making the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging. OBJECTIVE: In this study we examined the performance of the iPad based program medx in the prediction of different clinical vertigo and dizziness diagnoses and as a diagnostic tool to distinguish between them. PATIENTS AND METHODS: The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders. The "gold standard diagnosis" was defined as the clinical diagnosis of the specialist during the visit of the patient based on standardized history and clinical examination. Another independent and blinded physician finalized each patient's case in the constellatory diagnostic system of medx based on an algorithm using all available clinical information. These diagnoses were compared to the "gold standard" by retrospective review of the charts of the patients. The accuracy provided by medx was defined as the number of correctly classified diagnoses. In addition, the probability of being test positive when a disease was present (sensitivity), of being test negative when a disease was absent (specificity), of having the disease when the test is positive (positive predictive value) and of not having the disease when the test is negative (negative predictive value) for the most common diagnoses were reported. Sixteen possible different vertigo and dizziness diagnoses could be provided by medx. RESULTS: A total of 610 patients (mean age 58.1 ± 16.3 years, 51.2% female) were included. The accuracy for the most common diagnoses was between 82.1 and 96.6% with a sensitivity of 40 to 80.5% and a specificity of more than 80%. When analyzing the quality of medx in a multiclass problem for the six most common clinical diagnoses, the sensitivity, specificity, positive and negative predictive values were as follows: Bilateral vestibulopathy (81.6, 97.1, 71.1, and 97.5%), Menière's disease (77.8, 97.6, 87.0, and 95.3%), benign paroxysmal positional vertigo (61.7, 98.3, 86.6, and 93.4%), downbeat nystagmus syndrome (69.6, 97.7, 71.1, and 97.5%), vestibular migraine (34.7, 97.8, 76.1, and 88.3%), and phobic postural vertigo (80.5, 82.5, 52.5, and 94.6%). CONCLUSION: This study demonstrates that medx is a new and easy approach to screen for different diagnoses. With the high specificity and negative predictive value, the system helps to rule out differential diagnoses and can therefore also lead to a cost reduction in the health care system. However, the sensitivity was unexpectedly low, especially for vestibular migraine. All in all, this device can only be a complementary tool, in particular for non-experts in the field.

Expectation Violation in Political Decision Making: A Psychological Case Study.

Since the early Gestaltists there has been a strong interest in the question of how problem solvers get stuck in a mental impasse. A key idea is that the repeated activation of a successful strategy from the past results in a mental set ('Einstellung') which determines and constrains the option space to solve a problem. We propose that this phenomenon, which mostly was tested by fairly restricted experiments in the lab, could also be applied to more complex problem constellations and naturalistic decision making. We aim at scrutinizing and reconstructing how a mental set determines the misinterpretation of facts in the field of political decision making and leads in consequence to wrong expectations and an ill-defined problem representation. We will exemplify this psychological mechanism considering a historical example, namely the unexpected stabilization of the Franco regime at the end of World War II and its survival thereafter. A specific focus will be drawn to the significant observation that erroneous expectations were taken as the basis for decisions. This is congruent with the notion that in case of discrepancy between preconceived notions and new information, the former prevails over the new findings. Based on these findings, we suggest a theoretical model for expectation violation in political decision making and develop novel approaches for cognitive empirical research on the mechanisms of expectation violation and its maintenance in political decision making processes.

Search and Coherence-Building in Intuition and Insight Problem Solving.

Coherence-building is a key concept for a better understanding of the underlying mechanisms of intuition and insight problem solving. There are several accounts that address certain aspects of coherence-building. However, there is still no proper framework defining the general principles of coherence-building. We propose a four-stage model of coherence-building. The first stage starts with spreading activation restricted by constraints. This dynamic is a well-defined rule based process. The second stage is characterized by detecting a coherent state. We adopted a fluency account assuming that the ease of information processing indicates the realization of a coherent state. The third stage is designated to evaluate the result of the coherence-building process and assess whether the given problem is solved or not. If the coherent state does not fit the requirements of the task, the process re-enters at stage 1. These three stages characterize intuition. For insight problem solving a fourth stage is necessary, which restructures the given representation after repeated failure, so that a new search space results. The new search space enables new coherent states. We provide a review of the most important findings, outline our model, present a large number of examples, deduce potential new paradigms and measures that might help to decipher the underlying cognitive processes.

It's a kind of magic-what self-reports can reveal about the phenomenology of insight problem solving.

Magic tricks usually remain a mystery to the observer. For the sake of science, we offered participants the opportunity to discover the magician's secret method by repeatedly presenting the same trick and asking them to find out how the trick worked. In the context of insightful problem solving, the present work investigated the emotions that participants experience upon solving a magic trick. We assumed that these emotions form the typical "Aha! experience" that accompanies insightful solutions to difficult problems. We aimed to show that Aha! experiences can be triggered by magic tricks and to systematically explore the phenomenology of the Aha! experience by breaking it down into five previously postulated dimensions. 34 video clips of different magic tricks were presented up to three times to 50 participants who had to find out how the trick was accomplished, and to indicate whether they had experienced an Aha! during the solving process. Participants then performed a comprehensive quantitative and qualitative assessment of their Aha! experiences which was repeated after 14 days to control for its reliability. 41% of all suggested solutions were accompanied by an Aha! experience. The quantitative assessment remained stable across time in all five dimensions. Happiness was rated as the most important dimension. This primacy of positive emotions was also reflected in participants' qualitative self-reports which contained more emotional than cognitive aspects. Implementing magic tricks as problem solving task, we could show that strong Aha! experiences can be triggered if a trick is solved. We could at least partially capture the phenomenology of Aha! by identifying one prevailing aspect (positive emotions), a new aspect (release of tension upon gaining insight into a magic trick) and one less important aspect (impasse).

Working wonders? investigating insight with magic tricks.

We propose a new approach to differentiate between insight and noninsight problem solving, by introducing magic tricks as problem solving domain. We argue that magic tricks are ideally suited to investigate representational change, the key mechanism that yields sudden insight into the solution of a problem, because in order to gain insight into the magicians' secret method, observers must overcome implicit constraints and thus change their problem representation. In Experiment 1, 50 participants were exposed to 34 different magic tricks, asking them to find out how the trick was accomplished. Upon solving a trick, participants indicated if they had reached the solution either with or without insight. Insight was reported in 41.1% of solutions. The new task domain revealed differences in solution accuracy, time course and solution confidence with insight solutions being more likely to be true, reached earlier, and obtaining higher confidence ratings. In Experiment 2, we explored which role self-imposed constraints actually play in magic tricks. 62 participants were presented with 12 magic tricks. One group received verbal cues, providing solution relevant information without giving the solution away. The control group received no informative cue. Experiment 2 showed that participants' constraints were suggestible to verbal cues, resulting in higher solution rates. Thus, magic tricks provide more detailed information about the differences between insightful and noninsightful problem solving, and the underlying mechanisms that are necessary to have an insight.

Aha! experiences leave a mark: facilitated recall of insight solutions.

The present study investigates a possible memory advantage for solutions that were reached through insightful problem solving. We hypothesized that insight solutions (with Aha! experience) would be remembered better than noninsight solutions (without Aha! experience). 34 video clips of magic tricks were presented to 50 participants as a novel problem-solving task, asking them to find out how the trick was achieved. Upon discovering the solution, participants had to indicate whether they had experienced insight during the solving process. After a delay of 14 days, a recall of solutions was conducted. Overall, 55 % of previously solved tricks were recalled correctly. Comparing insight and noninsight solutions, 64.4 % of all insight solutions were recalled correctly, whereas only 52.4 % of all noninsight solutions were recalled correctly. We interpret this finding as a facilitating effect of previous insight experiences on the recall of solutions.