Hemispheric activation differences in novice and expert clinicians during clinical decision making.

The Judiciary and Fiscal Crises: An Institutional Critique

Legal Realism Untamed

This research focus specifically on the eye-gaze movement of novice vs. expert clinicians to perform their clinical reasoning. The eye gaze data are spatiotemporal sequences representing the dynamic of the clinician’s eye movements in the visual space to perform a clinical reasoning tasks. The objective is to do a comparative analyses of the eye movements fixations inside some areas of interest, the saccades trajectory and the scanpath. Taken together, the outcome of those analysis has provided us insights to build a webcam based ITS (Intelligent tutoring system). The aim of the ITS is to help reinforcing gradually the learning stages of novice clinicians with some cues from the behavioral implicit expert knowledge in terms of visual attention to perform a clinical reasoning in critical anesthesiology clinical case. KeywordsEye trackingScanpath comparisonITSBehavioral expertise transferMedical situational awareness tutoring

Infections occur among all clinical domains. The changing nature of microbes, viruses and infections poses a great threat to the overall well-being in medicine. Clinicians in the infectious disease (ID) domain deal with diagnostic as well as treatment uncertainty in their everyday practice. Our current health information technology (HIT) systems do not consider the level of clinician expertise into the system design process. Thus, information is presented to both novice and expert ID clinicians in identical ways. The purpose of this study was to identify the cognitive strategies novice ID clinicians use in managing complex cases to make better recommendations for system design. In the process, we interviewed 14 ID experts and asked them to give us a detailed description of how novice clinicians would have dealt with complex cases. From the interview transcripts, we identified four major themes that expert clinicians suggested about novices' cognitive strategies including: A) dealing with uncertainty, B) lack of higher macrocognition, C) oversimplification of problems through heuristics and D) dealing with peer pressure. Current and future innovative decision support tools embedded in the electronic health record that can match these cognitive strategies may hold the key to cognitively supporting novice clinicians. The results of this study may open up avenues for future research and suggest design directions for better healthcare systems.

The online version of the original article can be found under doi: 10.1007/s10459-015-9648-3 .

How Many Cases are Easy?

Multimethod study of clinical judgment

Hyperactive Error Responses and Altered Connectivity in Ventromedial and Frontoinsular Cortices in Obsessive-Compulsive Disorder

This article shows that we can approach both ‘epistemic’ and ‘conceptual’ problems of causation in tort with the aid of a moral idea sketched out by HLA Hart and developed into a more general account by TM Scanlon. Applied to causation, that idea is that we may justify principles that require people to meet a certain standard of causation and principles that specify a standard of proof for that purpose by appealing to the value for people of the opportunities that the relevant principles make available to them. The idea is developed in the context of epistemic questions, then extended to conceptual ones. The idea explains both why we may apply certain familiar standards of causation in easy cases, and why and how far we ought to relax or modify those standards in hard cases.

Legal Reasoning and Argumentation

Self‐ascriptions of desire seem to differ in their epistemic security. There are easy cases in which a sincere self‐ascription immediately counts as knowledgeable, and there are hard cases in which it is an open question whether an agent actually knows that they have the desire that they take themselves to have. In this paper, I suggest an explanation according to which whether a self‐ascription of desire is easy or hard depends on whether one is familiar with the content of the self‐ascribed desire.

This book chapter compares civil litigation in the courts of first and second instance in Taiwan in 2010–2015 with that in U.S. federal courts in 2010–2013. The two judicial systems, as expected, are different in many ways. Settlement rates in Taiwan, even broadly defined, were below 25%; in U.S. federal court, they exceeded 70%. In Taiwan, summary judgments were basically non-existent; in U.S. federal court, they represented nearly a third of merits judgments. Rates of appeal in Taiwan were nearly 10 times higher (27% versus 3%) than in the U.S. federal courts. And yet judges in Taiwan, at least those in the court of first instance, handled cases more quickly than their colleagues in the U.S. federal courts—indeed, twice as fast. Yet, the two judicial systems responded similarly when encountering simple debt-collection cases. These cases, large in number in both systems, failed to settle as standard theories would predict. Instead, these disputes were frequently resolved through default judgments. This chapter provides suggestions for future empirical comparative studies of civil procedure and litigation.

People are remarkably adroit at understanding other social agents. Quite how these information-processing abilities are realized, however, remains open to debate and empirical scrutiny. In particular, little is known about basic aspects of person perception, such as the operations that support people's ability to categorize (i. e., assign persons to groups) and individuate (i. e., discriminate among group members) others. In an attempt to rectify this situation, the current research focused on the initial perceptual stages of person construal and considered: (i) hemispheric differences in the efficiency of categorization and individuation; and (ii) the neural activity that supports these social-cognitive operations. Noting the greater role played by configural processing in individuation than categorization, it was expected that performance on the former task would be enhanced when stimuli (i. e., faces) were presented to the right rather than to the left cerebral hemisphere. The results of two experiments (Experiment 1--healthy individuals; Experiment 2--split-brain patient) confirmed this prediction. Extending these findings, a final neuroimaging investigation revealed that individuation is accompanied by neural activity in regions of the temporal and prefrontal cortices, especially in the right hemisphere. We consider the implications of these findings for contemporary treatments of person perception.

This paper presents a novel, knowledge-driven approach for pointing device prescription that aims to enhance the prescription process via OSCAR, a Clinical Decision Support System. OSCAR was constructed in a three-stage process: developing a pointing-device ontology; formulating IF-THEN matching rules, and constructing a web-based user interface. Evaluating OSCAR's usability through the System Usability Scale reflected a high satisfaction rate with a mean score = 80.9 (SD = 10.6). OSCAR's effectiveness was evaluated through the prescription results which showed no significant difference between experts using the traditional approach and novices using OSCAR. These results indicate that OSCAR is able to support novice clinicians in the AT prescription process to a level that is comparable to experts. The main contribution of this research is in the development and evaluation of a CDSS which bridges the gap between existing general models for pointing device prescription and a process that can support expert and novice clinicians. Although the system is currently designed for adaptation of a specific device (physically controllable pointing device) it can be expanded to include other AT devices. The results will also serve as an example to demonstrate the utility of using a CDSS in other clinical areas.

V6. Language lateralization – A comparison of three non-invasive methods in healthy adults