The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of 'knowledge structures' when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

What are tests for? The implications of stuttering steps along the patient pathway

This article explores the implications of how US family physicians make decisions about ordering diagnostic tests for their patients. Data is based on a study of 256 physicians interviewed after viewing a video vignette of a presenting patient. The qualitative analysis of 778 statements relating to trustworthiness of evidence for their decision making, the use of any kind of technology and diagnostic testing suggests a range of internal and external constraints on physician decision making. Test-ordering for family physicians in the United States is significantly influenced by both hidden cognitive processes related to the physician's calculation of patient resources and a health insurance system that requires certain types of evidence in order to permit further tests or particular interventions. The consequence of the need for physicians to meet multiple forms of proof that may not always relate to relevant treatment delays a diagnosis and treatment plan agreed not only by the physician and patient but also the insurance company. This results in a patient journey that is made up of stuttering steps to a confirmed diagnosis and treatment undermining patient-centred practice, compromising patient care, constraining physician autonomy and creating additional expense. © 2014 Elsevier Ltd.

Atypical connectivity in autistic spectrum disorders

Autism is a developmental disorder that is currently defined in terms of a triad of impairments in social interaction, communication, and behavioural flexibility. Psychological models have focussed on deficits in high level social and cognitive processes, such as ‘weak central coherence’ and deficits in ‘theory of mind’. Converging evidence from different fields of neuroscience research indicates that the underlying neural dysfunction is associated with atypical patterns of cortical connectivity (Rippon et al., 2007). This arises very early in development and results in sensory, perceptual and cognitive deficits at a much earlier and more fundamental level than previously suggested, but with cascading effects on higher level psychological and social processes. Earlier research in this sphere has focussed mainly on patterns of underconnectivity in distributed cortical networks underpinning process such as language and executive function. (Just et al., 2007). Such research mainly utilises imaging techniques with high spatial resolution. This paper focuses on evidence associated with local over-connectivity, evident in more low level and transitory processes and hence more easily measurable with techniques with high temporal resolution, such as MEG and EEG. Results are described which provide evidence of such local over-connectivity, characterised by atypical results in the gamma frequency range (Brown et al., 2005) together with discussions about the future directions of such research and its implications for remediation.

Multiple Dipole Source Models for Scalp-Recorded Event-Related Potentials: Example from Complex Visual Processing in the Human Brain

2000 Mathematics Subject Classification: 62P10, 92C20

The recruitment process of the Shining Path and MRTA guerrilla groups: A political psychological perspective

This thesis is an analysis of the recruitment process of the Shining Path -SP- and Revolutionary Movement “Túpac Amaru” -MRTA- guerrilla groups. Although SP was considered more aggressive, it gained more followers than MRTA. This thesis tries to explain why. Social Revolution Theory and Social Movement Theory provide explanations based on issues of “poverty”, disregarding the specific characteristics of the guerrilla groups and their supporters, as well as the influence of specific persuasive processes between the leaders of the groups and their followers. Integrative complexity theory, on the contrary, provides a consistent method to analyze cognitive processes: because people tend to reject complex and sophisticated explanations that require mental efforts, simplicity was the key for success. To prove which guerrilla group provided a simpler worldview, a sample of official documents of SP and MRTA are compared. Finally, content analysis is applied through the Paragraph Completion Test (P.C.T.). ^

A conceptualização de RAIVA na perspectiva da Teoria Cognitiva da Metáfora: uma análise da emergência de sentido

The objective of this research is to describe and analyze in literary corpus, the way we conceptualize emotions, especially anger. Using the assumptions of the call Cognitive Theory of Metaphor, present a general overview of cognition metaphor on the basis of Cognitive Linguistics, and in a deeper way, we analyze the metaphorical conceptualization of anger. The proposal embodied mind, prevalent in current cognitive science, is fundamental for studies involving mental simulation. Recent research shows that the metaphor is the result of cognitive processes that involve our perception sensorimotor combined with socio-cultural experiences. The ability to build via frequency standards for our experiments is crucial to our language, including metaphorical constructions. Such constructions are the result of cognitive processes that involve the relationship between image schemas and frames. Image schemas comes from our sensorimotor experience, which lists the limits of our bodies to the limits of our surroundings, and frames, in turn, comes from our ability to stock sociocultural events. The metaphorical construction is the result of this constant relationship between body, mind and culture, situating us in bodily experiences and cultural. By analyzing five national literary works, we created an analytical framework on how anger is understood, specifically in Portuguese language. The results are important to understand, through language, how culture is part of our cognition, in conjunction with the sensorimotor aspects.

Efeito agudo do exercício aeróbio vigoroso sobre as funções executivas em adolescentes

Executive functions are determinant cognitive processes for student success, since they execute and control complex cognitive activities such as reasoning, planning and solving problems. The development of the executive functions performances begin early at childhood going through the adolescence until adulthood, concomitant with the neuroanatomical, functional and blood perfusion changes over the brain. In this scenario, exercise has been considered an important environmental factor for neurodevelopment, as well as for the promotion of cognitive and brain health. However, there are no large scientific studies investigating the effects of a single vigorous aerobic exercise session on executive functions in adolescents. Objective: To verify the acute effect of vigorous aerobic exercise on executive functions in adolescents. Methods: A randomized controlled trial (RCT) with crossover design was used. 20 pubescent from both sexes/gender with age between 10 and 16 years were submitted to two sessions of 30min each: 1) The aerobic exercise session intensity was between 65 and 75% of heart rate reserve, in which 5min for warm-up, 20min at the target intensity and 5min of cool down; and 2) control session watching cartoons. The computerized Stroop test – Testinpacs and trail making test were used to evaluate the inhibitory control and cognitive flexibility assessment respectively, before and after both experimental and control sessions. The reaction time (RT) and number of errors (n) of Stroop test were recorded. The total time (TT) and the number of errors (n) of the trail making test were also recorded. Results: The control session’s RT did not present significant differences in the Stroop test. On the other hand, the exercise session’s RT decreased significantly (p<0.01) after the session. The number of errors made at the Stroop test had no significant differences in control and exercise sessions. The ΔTT of trail making test of exercise session was significantly (p<0.001) lower than the control session’s. Errors made in trail making test did not show significant differences between control and exercise sessions. Additionally, there was significant and positive association among the Stroop test ΔRT of exercise session with xiii chronological age (r= 0.635, p=0.001; r 2 = 0.404, p=0.003) and sexual maturation (rs= 0.580, p=0.007; r 2 = 0.408, p=0.002). Differently, there was no association among the control session ΔRT and chronological age (r= – 0.144, p=0.273; r 2 = 0.021, p=0.545) or sexual maturation (rs= –0.155, p=0.513; r 2 = 0.015, p=0.610). Conclusion: Vigorous aerobic exercise seems to improve acutely executive functions in adolescents. The effect of exercise on inhibitory control performance was associated to pubertal stage and chronological age. In other words, the benefits of exercise were more evident in early adolescence (↑ ΔRT) and its magnitude decreases along the growing up process.

A neuromodulação do córtex pré-frontal dorsolateral na percepção de tempo em contexto neutro ou emocionalmente ativo

The time perception is critical for environmental adaptation in humans and other species. The temporal processing, has evolved through different neural systems, each responsible for processing different time scales. Among the most studied scales is that spans the arrangement of seconds to minutes. Evidence suggests that the dorsolateral prefrontal (DLPFC) cortex has relationship with the time perception scale of seconds. However, it is unclear whether the deficit of time perception in patients with brain injuries or even "reversible lesions" caused by transcranial magnetic stimulation (TMS) in this region, whether by disruption of other cognitive processes (such as attention and working memory) or the time perception itself. Studies also link the region of DLPFC in emotional regulation and specifically the judgment and emotional anticipation. Given this, our objective was to study the role of the dorsolateral prefrontal cortex in the time perception intervals of active and emotionally neutral stimuli, from the effects of cortical modulation by transcranial direct current stimulation (tDCS), through the cortical excitation (anodic current), inhibition (cathode current) and control (sham) using the ranges of 4 and 8 seconds. Our results showed that there is an underestimation when the picture was presented by 8 seconds, with the anodic current in the right DLPFC, there is an underestimation and with cathodic current in the left DLPFC, there is an overestimation of the time reproduction with neutral ones. The cathodic current over the left DLPFC leads to an inverse effect of neutral ones, an underestimation of time with negative pictures. Positive or negative pictures improved estimates for 8 second and positive pictures inhibited the effect of tDCS in DLPFC in estimating time to 4 seconds. With this work, we conclude that the DLPFC plays a key role in the o time perception and largely corresponds to the stages of memory and decision on the internal clock model. The left hemisphere participates in the perception of time in both active and emotionally neutral contexts, and we can conclude that the ETCC and an effective method to study the cortical functions in the time perception in terms of cause and effect.

Instrumento de avaliação de processos cognitivos para a aprendizagem de subestações de energia em ambientes 2D e realidade virtual

This study describes the development of a prototype to evaluate the potential of environments based on two-dimensional modeling and virtual reality as power substations learning objects into training environments from a central operation and control of power utility Cemig. Initially, there was an identification modeling features and cognitive processes in 2D and RV, from which it was possible to create frames that serve to guide the preparation of a checklist with assigning a metric weight for measuring cognitive potential learning in the study sites. From these contents twenty-four questions were prepared and each was assigned a weight that was used in the calculation of the metric; the questions were grouped into skill sets and similar cognitive processes called categories. Were then developed two distinct environments: the first, the prototype features an interactive checklist and your individual results. And, second, a system of data management environment for the configuration and editing of the prototype, and the observation and analysis of the survey results. For prototype validation, were invited to access the virtual checklist and answer it, five professionals linked to Cemig's training area. The results confirmed the validity of this instrument application to assess the possible potential of modeling in 2D and RV as learning objects in power substations, as well as provide feedback to developers of virtual environments to improve the system.

Oficina educomunicativa de produção de vídeos: construção de significados sobre problemas socioambientais

This research aims to analyze the meaning making by Elementary Education students from public schools of Uberlândia (Minas Gerais, Brazil) about the social and environmental problems of their surroundings as of audiovisual reading and expression skills. The theoretical framework is based on constructivism, through the study of contributions about: cognitive development; meaningful learning; cognitive processes and types of knowledge; principles of learning with technology; educommunication focused on critical media literacy; and critical environmental education. The study object is a video production workshop organized in nine meetings, from September to November 2015, attended by 15 students. The following data collection instruments were used: the materials produced by the participants, specifically guided critical media literacy, agenda, script and final video; researcher observations from his role as a mediator; and focal interviews. The analysis was divided into two axes: procedural knowledge – technical skills of critical media literacy and production; and conceptual and metacognitive knowledge – representation of social and environmental problems and metacognitive skills of critical media literacy. Data were coded in the form of a skill evaluation rubric and also in the form of graphs. Thus, despite the time constraints, it is inferred that the workshop helped students to deepen their understanding about the discussed content, which is reinforced by observing in the graphs how the constant progressive differentiation of more inclusive concepts occurred along the meetings. It is further considered that the workshop contributed to the students reflect on their way of learning through critical use of techniques of media literacy and production, which can be seen from the satisfactory learners performance in most elements evaluated by the rubrics, as well as from the success in identifying interlocutors, values and actions in the read and built texts, something revealed by the graphs.

On-line puzzle game based assessment & training for ADHD

Attention-deficit hyperactivity disorder (ADHD) is the most prevalent and impairing neurodevelopmental disorder, with worldwide estimates of 5.29%. ADHD is clinically characterized by hyperactivity-impulsivity and inattention, with neuropsychological deficits in executive functions, attention, working memory and inhibition. These cognitive processes rely on prefrontal cortex function; cognitive training programs enhance performance of ADHD participants supporting the idea of neuronal plasticity. Here we propose the development of an on-line puzzle game based assessment and training tool in which participants must deduce the ‘winning symbol’ out of N distracters. To increase ecological validity of assessments strategically triggered Twitter/Facebook notifications will challenge the ability to ignore distracters. In the UK, significant cost for the disorder on health, social and education services, stand at £23m a year. Thus the potential impact of neuropsychological assessment and training to improve our understanding of the pathophysiology of ADHD, and hence our treatment interventions and patient outcomes, cannot be overstated.

The development of a semantic model for the interpretation of mathematics including the use of technology

The semantic model developed in this research was in response to the difficulty a group of mathematics learners had with conventional mathematical language and their interpretation of mathematical constructs. In order to develop the model ideas from linguistics, psycholinguistics, cognitive psychology, formal languages and natural language processing were investigated. This investigation led to the identification of four main processes: the parsing process, syntactic processing, semantic processing and conceptual processing. The model showed the complex interdependency between these four processes and provided a theoretical framework in which the behaviour of the mathematics learner could be analysed. The model was then extended to include the use of technological artefacts into the learning process. To facilitate this aspect of the research, the theory of instrumentation was incorporated into the semantic model. The conclusion of this research was that although the cognitive processes were interdependent, they could develop at different rates until mastery of a topic was achieved. It also found that the introduction of a technological artefact into the learning environment introduced another layer of complexity, both in terms of the learning process and the underlying relationship between the four cognitive processes.

The Role of Social Cognition and Person Perception in Economic Social Decision-Making

Social decision-making is often complex, requiring the decision-maker to make social inferences about another person in addition to engaging traditional decision-making processes. However, until recently, much research in neuroeconomics and behavioral economics has examined social decision-making while failing to take into account the importance of the social context and social cognitive processes that are engaged when viewing another person. Using social psychological theory to guide our hypotheses, four research studies investigate the role of social cognition and person perception in guiding economic decisions made in social contexts. The first study (Chapter 2) demonstrates that only specific types of social information engage brain regions implicated in social cognition and hinder learning in social contexts. Study 2 (Chapter 3) extends these findings and examines contexts in which this social information is used to generalize across contexts to form predictions about another person’s behavior. Study 3 (Chapter 4) demonstrates that under certain contexts these social cognitive processes may be withheld in order to more effectively complete the task at hand. Last, Study 4 (Chapter 5) examines how this knowledge of social cognitive processing can be used to change behavior in a prosocial group context. Taken together, these studies add to the growing body of literature examining decision-making in social contexts and highlight the importance of social cognitive processing in guiding these decisions. Although social cognitive processing typically facilitates social interactions, these processes may alter economic decision-making in social contexts.

Understanding the work of the city manager

The managerial behaviour approach to understanding managerial work has developed from research over the course of fifty years. The approach represents a marked departure from mainstream (and still prevalent) management approaches that depict management as a set of general composite functions. The managerial behaviour approach is distinctive in its empirical research background, object, focus and methodology. Its objective is to provide the simple answer to the complex question: what do managers do? However, the emphasis in the studies on managerial behaviour represents a limitation in so far as a context for locating and judging that behaviour is largely absent (Hales, 1986). This paper presents the results of initial research into managers operating in a different and largely neglected context - city councils. The research uses Mintzberg’s (1973) concept of behavioural roles as an analytical tool to explain and understand what city managers do. This study assesses whether these roles adequately capture the important features of managerial work in the city council. It is argued that while Mintzberg’s role framework is useful, structured observation alone does not adequately address the complexities of environments and styles of managers or the cognitive processes of managers. However, by integrating this approach with an appreciation of context and cognitive processes and how they can influence or affect managerial behaviour, we develop a more realistic description of what managers actually do and why they do it.

Different domains in abstract concepts

This study is a first attempt to unravel the almost unexplored domain of abstract conceptual knowledge. Four kinds of abstract concepts (nominal kinds, states of the self, cognitive processes, and emotion concepts) were investigated in two experiments. Emotion concepts displayed a specific pattern in both concreteness/abstractness and imagery ratings (cf. Altarriba et al., 1999), as did the other considered domains of abstract knowledge (Experiment 1). In Experiment 2 we highlighted the specific pattern of information (taxonomic, thematic, attributive, etc) these different abstract domains elicited in a definition production task.