Health locus of control (HLOC) may influence people's behavior regarding their health as well as their desires to be involved in the medical decision-making. Our study aimed to examine HLOC's ...relations with people's control preferences about the medical decision-making. A total of 153 people filled out the self-administered version of the Control Preference Scale and the Multidimensional Health Locus of Control Scale - form C. The most preferred role is the collaborative one. However, HLOC explained heterogeneity in people's control preferences: lower scores in external HLOC were related to a greater preference for the active and the collaborative role. From the personalized medicine perspective, an accurate evaluation of the patient's HLOC could help tailoring the decision-making process within the clinical context.
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DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
It has long been known that human cognitive function improves through young adulthood and then declines across the later life span. Here we examined how decision-making function changes across the ...life span by measuring risk and ambiguity attitudes in the gain and loss domains, as well as choice consistency, in an urban cohort ranging in age from 12 to 90 y. We identified several important age-related patterns in decision making under uncertainty: First, we found that healthy elders between the ages of 65 and 90 were strikingly inconsistent in their choices compared with younger subjects. Just as elders show profound declines in cognitive function, they also show profound declines in choice rationality compared with their younger peers. Second, we found that the widely documented phenomenon of ambiguity aversion is specific to the gain domain and does not occur in the loss domain, except for a slight effect in older adults. Finally, extending an earlier report by our group, we found that risk attitudes across the life span show an inverted U-shaped function; both elders and adolescents are more risk-averse than their midlife counterparts. Taken together, these characterizations of decision-making function across the life span in this urban cohort strengthen the conclusions of previous reports suggesting a profound impact of aging on cognitive function in this domain.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Sleep loss impacts a broad range of brain and cognitive functions. However, how sleep deprivation affects risky decision‐making remains inconclusive. This study used functional MRI to examine the ...impact of one night of total sleep deprivation (TSD) on risky decision‐making behavior and the underlying brain responses in healthy adults. In this study, we analyzed data from N = 56 participants in a strictly controlled 5‐day and 4‐night in‐laboratory study using a modified Balloon Analogue Risk Task. Participants completed two scan sessions in counter‐balanced order, including one scan during rested wakefulness (RW) and another scan after one night of TSD. Results showed no differences in participants' risk‐taking propensity and risk‐induced activation between RW and TSD. However, participants showed significantly reduced neural activity in the anterior cingulate cortex and bilateral insula for loss outcomes, and in bilateral putamen for win outcomes during TSD compared with RW. Moreover, risk‐induced activation in the insula negatively correlated with participants' risk‐taking propensity during RW, while no such correlations were observed after TSD. These findings suggest that sleep loss may impact risky decision‐making by attenuating neural responses to decision outcomes and impairing brain‐behavior associations.
Previous studies have suggested that sleep loss affects various neurobehavioral functions including decision‐making. However, the impact of sleep deprivation on risky decision‐making remains controversial. This study examined the impact of total sleep deprivation on risky decision‐making in the brain through a modified Balloon Analogue Risk Task. Results demonstrate that sleep loss may impact risky decision‐making by attenuating the brain's responses to the decision outcomes and impairing the relationship between brain and behavior.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
During decision making, neurons in multiple brain regions exhibit responses that are correlated with decisions. However, it remains uncertain whether or not various forms of decision-related activity ...are causally related to decision making. Here we address this question by recording and reversibly inactivating the lateral intraparietal (LIP) and middle temporal (MT) areas of rhesus macaques performing a motion direction discrimination task. Neurons in area LIP exhibited firing rate patterns that directly resembled the evidence accumulation process posited to govern decision making, with strong correlations between their response fluctuations and the animal's choices. Neurons in area MT, in contrast, exhibited weak correlations between their response fluctuations and choices, and had firing rate patterns consistent with their sensory role in motion encoding. The behavioural impact of pharmacological inactivation of each area was inversely related to their degree of decision-related activity: while inactivation of neurons in MT profoundly impaired psychophysical performance, inactivation in LIP had no measurable impact on decision-making performance, despite having silenced the very clusters that exhibited strong decision-related activity. Although LIP inactivation did not impair psychophysical behaviour, it did influence spatial selection and oculomotor metrics in a free-choice control task. The absence of an effect on perceptual decision making was stable over trials and sessions and was robust to changes in stimulus type and task geometry, arguing against several forms of compensation. Thus, decision-related signals in LIP do not appear to be critical for computing perceptual decisions, and may instead reflect secondary processes. Our findings highlight a dissociation between decision correlation and causation, showing that strong neuron-decision correlations do not necessarily offer direct access to the neural computations underlying decisions.
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IJS, KISLJ, NUK, SBMB, UL, UM, UPUK
Poor indoor air quality indicated by elevated indoor CO2 concentrations has been linked with impaired cognitive function, yet current findings of the cognitive impact of CO2 are inconsistent. This ...review summarizes the results from 37 experimental studies that conducted objective cognitive tests with manipulated CO2 concentrations, either through adding pure CO2 or adjusting ventilation rates (the latter also affects other indoor pollutants). Studies with varied designs suggested that both approaches can affect multiple cognitive functions. In a subset of studies that meet objective criteria for strength and consistency, pure CO2 at a concentration common in indoor environments was only found to affect high‐level decision‐making measured by the Strategic Management Simulation battery in non‐specialized populations, while lower ventilation and accumulation of indoor pollutants, including CO2, could reduce the speed of various functions but leave accuracy unaffected. Major confounding factors include variations in cognitive assessment methods, study designs, individual and populational differences in subjects, and uncertainties in exposure doses. Accordingly, future research is suggested to adopt direct air delivery for precise control of CO2 inhalation, include brain imaging techniques to better understand the underlying mechanisms that link CO2 and cognitive function, and explore the potential interaction between CO2 and other environmental stimuli.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment.
A cross-sectional study based on an online ...questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale.
The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36-4.55)) and were in favour of its implementation (mean 4.58 (4.51-4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37-3.55)) and agreed on policies that improved its implementation (3.96 (3.88-4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients' paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%).
New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.
Background
Clinician bias contributes to healthcare disparities, and the language used to describe a patient may reflect that bias. Although medical records are an integral method of communicating ...about patients, no studies have evaluated patient records as a means of transmitting bias from one clinician to another.
Objective
To assess whether stigmatizing language written in a patient medical record is associated with a subsequent physician-in-training’s attitudes towards the patient and clinical decision-making.
Design
Randomized vignette study of two chart notes employing stigmatizing versus neutral language to describe the same hypothetical patient, a 28-year-old man with sickle cell disease.
Participants
A total of 413 physicians-in-training: medical students and residents in internal and emergency medicine programs at an urban academic medical center (54% response rate).
Main Measures
Attitudes towards the hypothetical patient using the previously validated Positive Attitudes towards Sickle Cell Patients Scale (range 7–35) and pain management decisions (residents only) using two multiple-choice questions (composite range 2–7 representing intensity of pain treatment).
Key Results
Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.6 stigmatizing vs. 25.6 neutral,
p
< 0.001). Furthermore, reading the stigmatizing language note was associated with less aggressive management of the patient’s pain (5.56 stigmatizing vs. 6.22 neutral,
p
= 0.003).
Conclusions
Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior. This is an important and overlooked pathway by which bias can be propagated from one clinician to another. Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We develop a framework to investigate the foundations of an ‘entrepreneurial mindset’ — described by scholars as the ability to sense, act, and mobilize under uncertain conditions. We focus on ...metacognitive processes that enable the entrepreneur to think beyond or re-organize existing knowledge structures and heuristics, promoting adaptable cognitions in the face of novel and uncertain decision contexts. We integrate disparate streams of literature from social and cognitive psychology toward a model that specifies
entrepreneurial metacognition as situated in the entrepreneurial environment. We posit that foundations of an entrepreneurial mindset are metacognitive in nature, and subsequently detail how, and with what consequence, entrepreneurs formulate and inform “higher-order” cognitive strategies in the pursuit of entrepreneurial ends.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Everyday decisions frequently require choosing among multiple alternatives. Yet the optimal policy for such decisions is unknown. Here we derive the normative policy for general multi-alternative ...decisions. This strategy requires evidence accumulation to nonlinear, time-dependent bounds that trigger choices. A geometric symmetry in those boundaries allows the optimal strategy to be implemented by a simple neural circuit involving normalization with fixed decision bounds and an urgency signal. The model captures several key features of the response of decision-making neurons as well as the increase in reaction time as a function of the number of alternatives, known as Hick's law. In addition, we show that in the presence of divisive normalization and internal variability, our model can account for several so-called 'irrational' behaviors, such as the similarity effect as well as the violation of both the independence of irrelevant alternatives principle and the regularity principle.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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