Diagnostic reasoning in cardiovascular medicine

ABSTRACT Research in cognitive psychology shows that expert clinicians make a medical diagnosis through a two step process of hypothesis generation and hypothesis testing. Experts generate a list of possible diagnoses quickly and intuitively, drawing on previous experience. Experts remember specific examples of various disease categories as exemplars, which enables rapid access to diagnostic possibilities and gives them an intuitive sense of the base rates of various diagnoses. After generating diagnostic hypotheses, clinicians then test the hypotheses and subjectively estimate the probability of each diagnostic possibility by using a heuristic called anchoring and adjusting. Although both novices and experts use this two step diagnostic process, experts distinguish themselves as better diagnosticians through their ability to mobilize experiential knowledge in a manner that is content specific. Experience is clearly the best teacher, but some educational strategies have been shown to modestly improve diagnostic accuracy. Increased knowledge about the cognitive psychology of the diagnostic process and the pitfalls inherent in the process may inform clinical teachers and help learners and clinicians to improve the accuracy of diagnostic reasoning. This article reviews the literature on the cognitive psychology of diagnostic reasoning in the context of cardiovascular disease.

English non-manner how-clauses as answers to deficient questions

English exhibits a variety of embedded how-clause that, while introduced by a canonically interrogative item, lacks an intuitive sense of interrogativity. This paper offers an analysis of the semantics of these clauses that is grounded interrogative semantics. On this view, how in these clauses introduces a degenerate, necessarily-singleton question set. Further, the paper observes that how here introduces a factive presupposition that cannot be reduced to the matrix predicate’s entailments. Accordingly, this paper supports a view on which factivity can arise from multiple sources. A diachronic-based account is also offered to explain the reccurence of how in non-manner embedded clauses cross-linguistically.

Regionalization of Hydroclimate Variables

We apply a regionalization method to hydroclimate variables using the Parameter-elevation Relationships on Independent Slopes Model (PRISM) temperature and precipitation database. Resulting regions make intuitive sense from the perspective of driving influences on temperature and precipitation averages and anomalies, and are compatible with results from another empirically derived clustering scheme. Regions selected for individual variables show high similarity across different time frames. There is slightly less similarity when comparing regions created for different monthly or daily hydroclimate variables, and relatively low similarity between monthly vs. daily measures. It is unlikely that any one regionalization solution could summarize hydroclimate extremes given the wide range of variables used to describe them, but geographically sensitive datasets like PRISM and flexible algorithms provide useful methods for regionalization that can aid in drought monitoring and forecasting, and with impacts and planning associated with heavy precipitation.

Metainferential Reasoning on Strong Kleene Models

Barrio et al. (Journal of Philosophical Logic, 49(1), 93–120, 2020) and Pailos (Review of Symbolic Logic, 2020(2), 249–268, 2020) develop an approach to define various metainferential hierarchies on strong Kleene models by transferring the idea of distinct standards for premises and conclusions from inferences to metainferences. In particular, they focus on a hierarchy named the $\mathbb {S}\mathbb {T}$ S T -hierarchy where the inferential logic at the bottom of the hierarchy is the non-transitive logic ST but where each subsequent metainferential logic ‘says’ about the former logic that it is transitive. While Barrio et al. (2020) suggests that this hierarchy is such that each subsequent level ‘in some intuitive sense, more classical than’ the previous level, Pailos (2020) proposes an extension of the hierarchy through which a ‘fully classical’ metainferential logic can be defined. Both Barrio et al. (2020) and Pailos (2020) explore the hierarchy in terms of semantic definitions and every proof proceeds by a rather cumbersome reasoning about those semantic definitions. The aim of this paper is to present and illustrate the virtues of a proof-theoretic tool for reasoning about the $\mathbb {S}\mathbb {T}$ S T -hierarchy and the other metainferential hierarchies definable on strong Kleene models. Using the tool, this paper argues that each level in the $\mathbb {S}\mathbb {T}$ S T -hierarchy is non-classical to an equal extent and that the ‘fully classical’ metainferential logic is actually just the original non-transitive logic ST ‘in disguise’. The paper concludes with some remarks about how the various results about the $\mathbb {S}\mathbb {T}$ S T -hierarchy could be seen as a guide to help us imagine what a non-transitive metalogic for ST would tell us about ST. In particular, it teaches us that ST is from the perspective of ST as metatheory not only non-transitive but also transitive.

The Cost of Mathematical Illiteracy: Review of Innumeracy in the Wild by Ellen Peters (2020)

In Innumeracy in the Wild (Oxford University Press, 2020), Ellen Peters, a researcher in decision science, persuasively argues that numeracy skills, numeric confidence, and our intuitive sense for numbers impact our lifelong outcomes in health and wellbeing. Peters draws from research and real-world examples to show how daily life for innumerate people is different from that of numerate people and makes practical recommendations on improving how we communicate numerical information.

Neuropathic corneal pain and dry eye: a continuum of nociception

Throughout the body, damage to peripheral nerves normally involved in nociception may produce a constellation of symptoms—including irritation, itchiness and pain. The neurobiological processes involved in corneal symptoms of dry eye (DE) and neuropathic corneal pain (NCP) have not been clearly considered in terms of nociceptive processing. The conventional underlying presumption is that a labelled line principle is responsible; that these distinct perceptions are hard coded by primary afferent inputs to the central nervous system. This presumption oversimplifies the neurobiological mechanisms underlying somatosensory perception. The labelled line perspective that DE represents a chronic pain condition does not make intuitive sense: how can an eye condition that is not painful in most cases be considered a pain condition? Does not chronic pain by definition require pain to be present? On the other hand, NCP, a term that clearly denotes a painful condition, has historically seemed to resonate with clinical significance. Both DE and NCP can share similar features, yet their differentiation is not always clear. As is often the case, clinical terms arise from different disciplines, with DE evolving from ophthalmological findings and NCP inspired by pain neurophysiology. This review evaluates the current definition of these terms, the rationale for their overlap and how the neurophysiology of itch impacts our understanding of these conditions as a continuum of the same disease. Despite the complexity of nociceptive physiology, an understanding of these mechanisms will allow us a more precise therapeutic approach.

The Church–Turing Fallacy

The Church–Turing thesis (CT) says that, if a function is computable in the intuitive sense, then it is computable by Turing machines. CT has been employed in arguments for the Computational Theory of Cognition (CTC). One argument is that cognitive functions are Turing-computable because all physical processes are Turing-computable. A second argument is that cognitive functions are Turing-computable because cognitive processes are effective in the sense analyzed by Alan Turing. A third argument is that cognitive functions are Turing-computable because Turing-computable functions are the only type of function permitted by a mechanistic psychology. This chapter scrutinizes these arguments and argues that they are unsound. Although CT does not support CTC, it is not irrelevant to it. By eliminating misunderstandings about the relationship between CT and CTC, we deepen our appreciation of CTC as an empirical hypothesis.

SUSSOL—Using Artificial Intelligence for Greener Solvent Selection and Substitution

Solvents come in many shapes and types. Looking for solvents for a specific application can be hard, and looking for green alternatives for currently used nonbenign solvents can be even harder. We describe a new methodology for solvent selection and substitution, by applying Artificial Intelligence (AI) software to cluster a database of solvents based on their physical properties. The solvents are processed by a neural network, the Self-organizing Map of Kohonen, which results in a 2D map of clusters. The resulting clusters are validated both chemically and statistically and are presented in user-friendly visualizations by the SUSSOL (Sustainable Solvents Selection and Substitution Software) software. The software helps the user in exploring the solvent space and in generating and evaluating a list of possible alternatives for a specific solvent. The alternatives are ranked based on their safety, health, and environment scores. Cases are discussed to demonstrate the possibilities of our approach and to show that it can help in the search for more sustainable and greener solvents. The SUSSOL software makes intuitive sense and in most case studies, the software confirms the findings in literature, thus providing a sound platform for selecting the most sustainable solvent candidate.

The limits of color awareness during active, real-world vision

Color ignites visual experience, imbuing the world with meaning, emotion, and richness. As soon as an observer opens their eyes, they have the immediate impression of a rich, colorful experience that encompasses their entire visual world. Here, we show that this impression is surprisingly inaccurate. We used head-mounted virtual reality (VR) to place observers in immersive, dynamic real-world environments, which they naturally explored via saccades and head turns. Meanwhile, we monitored their gaze with in-headset eye tracking and then systematically altered the visual environments such that only the parts of the scene they were looking at were presented in color and the rest of the scene (i.e., the visual periphery) was entirely desaturated. We found that observers were often completely unaware of these drastic alterations to their visual world. In the most extreme case, almost a third of observers failed to notice when less than 5% of the visual display was presented in color. This limitation on perceptual awareness could not be explained by retinal neuroanatomy or previous studies of peripheral visual processing using more traditional psychophysical approaches. In a second study, we measured color detection thresholds using a staircase procedure while a set of observers intentionally attended to the periphery. Still, we found that observers were unaware when a large portion of their field of view was desaturated. Together, these results show that during active, naturalistic viewing conditions, our intuitive sense of a rich, colorful visual world is largely incorrect.