Clinical decision-making and myocardial viability: current perspectives

Not all myocardium involved in a myocardial infarction is dead or irreversibly damaged. The balance between the amount of scar and live tissue, and the nature of the live tissue, determine the likelihood that contractile function will improve after revascularisation. This improvement (which defines viability) may be predicted with about 80% accuracy using several techniques. This review examines the determinants of functional recovery and how they may be integrated in making decisions regarding revascularisation. (Intern Med J 2005; 35: 118–125)

Meaning selection and the subcortex: Evidence of reduced lexical ambiguity repetition effects following subcortical lesions

Recent research indicates that individuals with nonthalamic subcortical (NS) lesions call experience difficulties processing lexical ambiguities in a variety of contexts. This study examined how prior processing of a lexical ambiguity influences subsequent meaning activation in 10 individuals with NS lesions and 10 matched healthy controls. Subjects made speeded lexical decisions oil related or unrelated targets following homophone primes. Homophones were repealed with different targets biasing the same or different meanings oil the second presentation. The effects of prime-target relatedness, interstimulus interval (200 or 1250 ms), and same vs different meaning repetition were examined Both the patient and control groups showed printing when the same homophone meaning was biased oil repetition. When a different meaning was biased on the second presentation. no priming was evident in the controls, while facilitation remained present for the NS group, consistent with aberrant meaning selection and deactivation processes. These findings are discussed in terms of age and task-related repetition effects and current conceptions of frontal-subcortical involvement in cognition.

Testing the protracted lexical restructuring hypothesis: The effects of position and acoustic-phonetic clarity on sensitivity to mispronunciations in children and adults

Although developmental increases in the size of the position effect within a mispronunciation detection task have been interpreted as consistent with a view of the lexical restructuring process as protracted, the position effect itself might not be reliable. The current research examined the effects of position and clarity of acoustic-phonetic information on sensitivity to mispronounced onsets in 5- and 6-year-olds and adults. Both children and adults showed a position effect only when mispronunciations also differed in the amount of relevant acoustic-phonetic information. Adults' sensitivity to mispronounced second-syllable onsets also reflected the availability of acoustic-phonetic information. The implications of these findings are discussed in relation to the lexical restructuring hypothesis. (c) 2006 Elsevier Inc. All rights reserved.

Top-down influences on lexical selection during spoken word production: A 4T fMRI investigation of refractory effects in picture naming

Spoken word production is assumed to involve stages of processing in which activation spreads through layers of units comprising lexical-conceptual knowledge and their corresponding phonological word forms. Using high-field (4T) functional magnetic resonance imagine (fMRI), we assessed whether the relationship between these stages is strictly serial or involves cascaded-interactive processing, and whether central (decision/control) processing mechanisms are involved in lexical selection. Participants performed the competitor priming paradigm in which distractor words, named from a definition and semantically related to a subsequently presented target picture, slow picture-naming latency compared to that with unrelated words. The paradigm intersperses two trials between the definition and the picture to be named, temporally separating activation in the word perception and production networks. Priming semantic competitors of target picture names significantly increased activation in the left posterior temporal cortex, and to a lesser extent the left middle temporal cortex, consistent with the predictions of cascaded-interactive models of lexical access. In addition, extensive activation was detected in the anterior cingulate and pars orbitalis of the inferior frontal gyrus. The findings indicate that lexical selection during competitor priming is biased by top-down mechanisms to reverse associations between primed distractor words and target pictures to select words that meet the current goal of speech.

Searching for the trace: The influence of age, lexical activation and working memory on sentence processing

To investigate the stability of trace reactivation in healthy older adults, 22 older volunteers with no significant neurological history participated in a cross-modal priming task. Whilst both object relative center embedded (ORC) and object relative right branching (ORR) sentences is-ere employed, working memory load was reduced by limiting the number of wordy separating the antecedent front the gap for both sentence types. Analysis of the results did not reveal any significant trace reactivation for the ORC or ORR sentences. The results did reveal, however, a positive correlation between age and semantic printing at the pre-gap position and a negative correlation between age and semantic printing at the gap position for ORC sentences. In contrast, there was no correlation between age and priming effects for the ORR sentences. These results indicated that trace reactivation may be sensitive to a variety of age related factors, including lexical activation and working memory. The implications of these results for sentence processing in the older population arc discussed.

Managing the airspace: A task analysis of Australian air traffic control

The aim of this study was to examine the way Australian air traffic controllers manage their airspace. Fourteen controllers ranging from 7 to 30 years experience were sampled from the Brisbane air traffic control centre. All had previously been endorsed for en route radar sectors. Five static pictures varying in workload level (low, medium and high) were presented to participants. Controllers were asked to work through the scenarios and describe aloud how they would resolve any potential conflicts between the aircraft. Following this controllers were asked a set of probe questions based on the critical decision method, to extract further information about the way they manage their airspace. A content analysis was used to assess patterns in the way controllers scan, strategies used in conflict detection and conflict resolution and the effect of workload on strategy choice. Findings revealed that controllers use specific strategies (such as working in a left to right scan or prioritising levels) when managing their airspace. Further analyses are still planned however a model based on the processes controllers used to resolve conflicts has been developed and will be presented as a summary of the results.

Virtual training environments to improve train driver's crisis decision making

This paper reports on a current research project in which virtual reality simulators are being investigated as a means of simulating hazardous Rail work conditions in order to allow train drivers to practice decision-making under stress. When working under high stress conditions train drivers need to move beyond procedural responses into a response activated through their own problem-solving and decision-making skills. This study focuses on the use of stress inoculation training which aims to build driver’s confidence in the use of new decision-making skills by being repeatedly required to respond to hazardous driving conditions. In particular, the study makes use of a train cab driving simulator to reproduce potentially stress inducing real-world scenarios. Initial pilot research has been undertaken in which drivers have experienced the training simulation and subsequently completed surveys on the level of immersion experienced. Concurrently drivers have also participated in a velocity perception experiment designed to objectively measure the fidelity of the virtual training environment. Baseline data, against which decision-making skills post training will be measured, is being gathered via cognitive task analysis designed to identify primary decision requirements for specific rail events. While considerable efforts have been invested in improving Virtual Reality technology, little is known about how to best use this technology for training personnel to respond to workplace conditions in the Rail Industry. To enable the best use of simulators for training in the Rail context the project aims to identify those factors within virtual reality that support required learning outcomes and use this information to design training simulations that reliably and safely train staff in required workplace accident response skills.

Lexical and nonlexical processing in developmental dyslexia: a case for different resources and different impairments

In a group of adult dyslexics word reading and, especially, word spelling are predicted more by what we have called lexical learning (tapped by a paired-associate task with pictures and written nonwords) than by phonological skills. Nonword reading and spelling, instead, are not associated with this task but they are predicted by phonological tasks. Consistently, surface and phonological dyslexics show opposite profiles on lexical learning and phonological tasks. The phonological dyslexics are more impaired on the phonological tasks, while the surface dyslexics are equally or more impaired on the lexical learning tasks. Finally, orthographic lexical learning explains more variation in spelling than in reading, and subtyping based on spelling returns more interpretable results than that based on reading. These results suggest that the quality of lexical representations is crucial to adult literacy skills. This is best measured by spelling and best predicted by a task of lexical learning. We hypothesize that lexical learning taps a uniquely human capacity to form new representations by recombining the units of a restricted set.

Individual differences in cognitive style and their effects on task and social orientations of self-managed work teams

When assembling self-managing work teams, the personalities of team members are often overlooked. One personality variable known to be critical for effective decision making in teams is cognitive style. This study sought to examine how differences and similarities in analytic/intuitive cognitive styles affected the behavior of team members on the task/emotionally expressive dimension identified by Bales. As hypothesized, intuitive individuals and homogeneous intuitive teams were found to initiate more social-emotional acts. Contrary to expectations, intuitive rather than analytic individuals and homogeneous intuitive rather than analytic teams engaged in more task-oriented behaviors. Teams also tended to select intuitive individuals as leaders. The possibility that different combinations of styles may be important for overall team effectiveness was subsequently discussed, and it was suggested that this may depend on whether the nature of the work environment is relatively well structured and mechanistic or relatively unstructured and organic.

Using secondary knowledge to support decision tree classification of retrospective clinical data

Retrospective clinical data presents many challenges for data mining and machine learning. The transcription of patient records from paper charts and subsequent manipulation of data often results in high volumes of noise as well as a loss of other important information. In addition, such datasets often fail to represent expert medical knowledge and reasoning in any explicit manner. In this research we describe applying data mining methods to retrospective clinical data to build a prediction model for asthma exacerbation severity for pediatric patients in the emergency department. Difficulties in building such a model forced us to investigate alternative strategies for analyzing and processing retrospective data. This paper describes this process together with an approach to mining retrospective clinical data by incorporating formalized external expert knowledge (secondary knowledge sources) into the classification task. This knowledge is used to partition the data into a number of coherent sets, where each set is explicitly described in terms of the secondary knowledge source. Instances from each set are then classified in a manner appropriate for the characteristics of the particular set. We present our methodology and outline a set of experiential results that demonstrate some advantages and some limitations of our approach. © 2008 Springer-Verlag Berlin Heidelberg.

Trait emotional intelligence facilitates responses to a social gambling task

The present study examines facilitative effects of trait emotional intelligence on decision making in a socially moderated, financial context. One hundred participants completed the trait emotional intelligence questionnaire and a computerised gambling card game, designed to simulate financial decision making. The results show that participants scoring high on the sociability factors made significantly better decisions in certain card game conditions compared to lower scoring counterparts. Results are discussed in light of dual-process theories.

Arms, bending discounting functions:how motor actions affect intertemporal decision-making

We demonstrate that task-irrelevant somatic activity influences intertemporal decision making: Arm movements associated with approach (arm flexion), rather than avoidance (arm extension), instigate present-biased preferences. The effect is moderated by the sensitivity of the general reward system and, owing to learning principles, restricted to arm positions of the dominant hand.

Increased salience of gains versus decreased associative learning differentiate bipolar disorder from schizophrenia during incentive decision making

Background Abnormalities in incentive decision making, typically assessed using the Iowa Gambling Task (IGT), have been reported in both schizophrenia (SZ) and bipolar disorder (BD). We applied the Expectancy-Valence (E-V) model to determine whether motivational, cognitive and response selection component processes of IGT performance are differentially affected in SZ and BD. Method Performance on the IGT was assessed in 280 individuals comprising 70 remitted patients with SZ, 70 remitted patients with BD and 140 age-, sex-and IQ-matched healthy individuals. Based on the E-V model, we extracted three parameters, 'attention to gains or loses', 'expectancy learning' and 'response consistency', that respectively reflect motivational, cognitive and response selection influences on IGT performance. Results Both patient groups underperformed in the IGT compared to healthy individuals. However, the source of these deficits was diagnosis specific. Associative learning underlying the representation of expectancies was disrupted in SZ whereas BD was associated with increased incentive salience of gains. These findings were not attributable to non-specific effects of sex, IQ, psychopathology or medication. Conclusions Our results point to dissociable processes underlying abnormal incentive decision making in BD and SZ that could potentially be mapped to different neural circuits. © 2012 Cambridge University Press.

Multiple criteria decision-making techniques in higher education

Purpose: The purpose of this paper is to review the literature which focuses on four major higher education decision problems. These are: resource allocation; performance measurement; budgeting; and scheduling. Design/methodology/approach: Related articles appearing in the international journals from 1996 to 2005 are gathered and analyzed so that the following three questions can be answered: "What kind of decision problems were paid most attention to?"; "Were the multiple criteria decision-making techniques prevalently adopted?"; and "What are the inadequacies of these approaches?" Findings: Based on the inadequacies, some improvements and possible future work are recommended, and a comprehensive resource allocation model is developed taking account of these factors. Finally, a new knowledge-based goal programming technique which integrates some operations of analytic hierarchy process is proposed to tackle the model intelligently. Originality/value: Higher education has faced the problem of budget cuts or constrained budgets for the past 30 years. Managing the process of the higher education system is, therefore, a crucial and urgent task for the decision makers of universities in order to improve their performance or competitiveness. © Emerald Group Publishing Limited.

Operating Model of Knowledge Quantum Engineering for Decision-Making in Conditions of Indeterminacy

The operating model of knowledge quantum engineering for identification and prognostic decision- making in conditions of α-indeterminacy is suggested in the article. The synthesized operating model solves three basic tasks: Аt-task to formalize tk-knowledge; Вt-task to recognize (identify) objects according to observed results; Сt-task to extrapolate (prognosticate) the observed results. Operating derivation of identification and prognostic decisions using authentic different-level algorithmic knowledge quantum (using tRAKZ-method) assumes synthesis of authentic knowledge quantum database (BtkZ) using induction operator as a system of implicative laws, and then using deduction operator according to the observed tk-knowledge and BtkZ a derivation of identification or prognostic decisions in a form of new tk-knowledge.