Cognitive Heuristics and AIDS Risk Assessment Among Physicians1

Physicians (N= 331) reported perceived risk of HIV exposure, worry about on-the-job HIV exposure, and experience with patients who test seropositive for the HIV. In addition, the use of the availability heuristic was examined by responses to questions about talking and reading about AIDS, and the use of the simulation heuristic was examined by responses to questions about imagining oneself being exposed to HIV on the job. Simulation of the HIV-exposure experience related significantly to perceived risk (p < .001), even after variance attributable to actual experience and use of the availability heuristic was taken into account. Availability of AIDS information related marginally to perceived risk after variance attributable to actual experience and use of the simulation heuristic was taken into account. Simulation related strongly with worry about on-the-job exposure (p < .001), and availability was not significantly related to worry after variance associated with simulation and experience with AIDS was removed. Implications of these results for physician training are discussed.     

Case vignette -- mandated child abuse reporting

Case Vignette: Martha Harris has been a licensed mental health professional for nearly a decade. As she arrived at her office early this morning, the phone was ringing. Speaking in a tremulous voice, the caller stated, "I was given your name by my internist, Dr. Williams. I think my husband may be abusing our 5-year-old sexually. Can you help?" After a few minutes of conversation, Martha offers to schedule a prompt appointment. The caller interrupts and asks, "You won't have to report this will you?" As a mandated reporter under the state's child protection statute, Martha has no choice but to inform the authorities; she tells the caller, who immediately hangs up. Suddenly, Martha realizes that she does not have the name or any other identifying information about the caller. A call to Dr. Williams results in a response that the internist does not want to "get involved." Commentators on this case are Richard Bourne, JD, PhD, one of whose special areas of expertise is child protection and related professional obligations; Eli H. Newberger, MD, a pediatrician with a special interest in child maltreatment; and C. Sue White, PhD, one of whose primary interests is how clinicians may inappropriately use techniques to interview children suspected of child sexual abuse, causing contaminating influences to interfere with children's memories for their own experiences.     

Stimulus and reinforcer relativity in multiple schedules: Local and dimensional effects on sensitivity to reinforcement

Pigeons' responses in two successive components of multiple schedules were reinforced according to variable-interval schedules of reinforcement that varied over five different conditions. Within each session of all conditions, line orientations of 0°, 30°, or 45° in Component 1 alternated with orientations of 45°, 60°, or 90° in Component 2. Response rates were recorded in three successive subintervals of each component. Ratios were taken between the response rate in each Component 1 line orientation and the response rate in each Component 2 orientation. These ratios were found to be power functions of the corresponding ratios of obtained reinforcement rates. Sensitivity of response ratios to changes in reinforcer ratios, given by the value of the exponent of the power function, increased systematically with increasing disparity between the dimensional values of orientation stimuli. In addition, sensitivity decreased systematically over successive subintervals of components, that is, with increasing time since component alternation. Dimensional and local (subinterval) effects interacted in that sensitivity increased with stimulus disparity to a far greater extent in the first subinterval than later in components. The data could be described by a combination of rectangular hyperbolae which attributed the interaction between local and dimensional effects to limits set by local effects on the extent that stimulus differences could affect sensitivity.     

The discourse of being ‘triggered’: Uses and meanings among counselling students

Despite the initial understanding of the word ‘triggered’ as relating to the clinical phenomenon of post-traumatic stress disorder (PTSD), this language has become a common part of the vernacular today, used by many people to apply to a wide variety of experiences and events. Counselling students are particularly sensitised to trauma, as well as identity politics, and are familiar with trigger warnings at college. They themselves have experienced trauma at high rates. Therefore, we were interested to understand how they might be using the word and interpreting the experience of being ‘triggered’, whether different sources of being triggered are related to emotional reactions, and whether a discourse analysis might indicate how and why the term has become useful and for what other experiences it might be serving as a stand-in. In this mixed-methods study, 79 counselling students from around the country shared their definitions and experiences of being ‘triggered’. Participants completed surveys and wrote narratives, which, via thematic qualitative analysis, were coded into five themes. The quantitative analysis focused on the relationship of feelings to themes and the relationship between anger suppression and coping with each theme. Discourse analysis explored how individuals wrote about responsibility and anger. It was discovered that those who wrote about being triggered from a past sexual assault did not discuss anger, nor the responsibility of others to protect them (as those who wrote about microaggressions did), but positioned themselves as overreactors. Results are discussed with regard to training and practice.     

The role of the natural history museum in promoting word learning for young children

Although strong claims have been made about museums being ideal word learning environments, these are yet to be empirically supported. In the current study, 152 four- to five-year-olds children (81-M, 71-F) from minority backgrounds were taught six vocabulary items either in a museum, in their classroom with museum resources, or in their classroom with classroom resources. At test, children taught in their classroom with museum resources produced significantly more correct responses than children taught in the museum or in their classroom with classroom resources. Children were also significantly better at retaining the target vocabulary items than recalling them. These data demonstrate how context can impact word learning and point to the benefits of a collaborative relationship between schools and museums to support children's language development.     

A double-blind,sham-controlled,trial of home-administered rhythmic 10-Hz median nerve stimulation for the reduction of tics,and suppression of the urge-to-tic,in individuals with Tourette syndrome and chronic tic disorder

Tourette syndrome (TS) and chronic tic disorder (CTD) are neurological disorders of childhood onset characterized by the occurrence of tics; repetitive, purposeless, movements or vocalizations of short duration which can occur many times throughout a day. Currently, effective treatment for tic disorders is an area of considerable unmet clinical need. We aimed to evaluate the efficacy of a home-administered neuromodulation treatment for tics involving the delivery of rhythmic pulse trains of median nerve stimulation (MNS) delivered via a wearable ‘watch-like’ device worn at the wrist. We conducted a UK-wide parallel double-blind sham-controlled trial for the reduction of tics in individuals with tic disorder. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1–19 mA) electrical stimulation to the median nerve for a pre-determined duration each day, and was intended to be used by each participant in their home once each day, 5 days each week, for a period of 4 weeks. Between 18th March 2022 and 26th September 2022, 135 participants (45 per group) were initially allocated, using stratified randomization, to one of the following groups; active stimulation; sham stimulation or to a waitlist (i.e. treatment as usual) control group. Recruited participants were individuals with confirmed or suspected TS/CTD aged 12 years of age or upward with moderate to severe tics. Researchers involved in the collection or processing of measurement outcomes and assessing the outcomes, as well as participants in the active and sham groups and their legal guardians were all blind to the group allocation. The primary outcome measure used to assess the ‘offline’ or treatment effect of stimulation was the Yale Global Tic Severity Scale–Total Tic Severity Score (YGTSS–TTSS) assessed at the conclusion of 4 weeks of stimulation. The primary outcome measure used to assess the ‘online’ effects of stimulation was tic frequency, measured as the number of tics per minute (TPM) observed, based upon blind analysis of daily video recordings obtained while stimulation was delivered. The results demonstrated that after 4-week stimulation, tic severity (YGTSS-TTSS) had reduced by 7.1 points (35 percentile reduction) for the active stimulation group compared to 2.13/2.11 points for the sham stimulation and waitlist control groups. The reduction in YGTSS–TTSS for the active stimulation group was substantially larger, clinically meaningful (effect size = .5) and statistically significant (p = .02) compared to both the sham stimulation and waitlist control groups, which did not differ from one another (effect size = −.03). Furthermore, blind analyses of video recordings demonstrated that tic frequency (tics per minute) reduced substantially (−15.6 TPM) during active stimulation compared to sham stimulation (−7.7 TPM). This difference represents a statistically significant (p < .03) and clinically meaningful reduction in tic frequency (>25 percentile reduction: effect size = .3). These findings indicate that home-administered rhythmic MNS delivered through a wearable wrist-worn device has the potential to be an effective community-based treatment for tic disorders.     

Why do U.S. conservatives take fewer COVID-19 precautions? The role of worry,perceived risk,and governmental trust

Research suggests a U.S. political ideology gap for taking COVID-19 precautions, but we do not know the role of cognitive risk (assessed here as perceived risk) and affective risk (assessed here as worry) in explaining why conservative Americans participated in fewer recommended precautions (e.g., mask wearing) and whether governmental trust attenuates the effect. We predicted that conservatives (compared with liberals) would take fewer precautions because they thought they were less at risk and were less worried about COVID-19, but that this would be more pronounced for those with low governmental trust. In this study, U.S. adults (representative sample: N = 738; M_age = 46.8; 52% women; 78% white) who had not had COVID-19 took two online surveys 2 weeks apart during the first wave of the pandemic (April 2020). Participants reported ideology, perceived risk of getting or dying of COVID-19, worry about COVID-19, and trust in the CDC and state officials at baseline. At follow-up, participants reported on COVID-19 precautions: (1) prevention behavior participation (e.g., mask wearing) and (2) behavioral willingness for future behaviors (e.g., vaccination). Results showed that, politically conservative Americans took fewer precautions due to lower worry (but unexpectedly not due to lower perceived risk). As predicted, when trust was high, the ideology gap was muted for predicting precautions as well as for predicting perceived risk and worry. In sum, conservatives worried less about COVID-19 which predicted fewer precautions, but trust in governmental institutions reduced this ideological gap. Improving governmental trust could be one fruitful path to increasing COVID-19 precautions.     

Sleep as a mediator of the relationship between social class and health in higher education students

A substantial body of research indicates that higher education students from lower social class backgrounds tend to have poorer health than those from higher social class backgrounds. To investigate sleep as a potential mediator of this relationship, online survey responses of students from five large Australian universities, one Irish university and one large Australian technical college were analysed in three studies (Study 1 N = 628; Study 2 N = 376; Study 3 N = 446). The results revealed that sleep quality, sleep duration, sleep disturbances, pre-sleep worries and sleep schedule variability mediated the relationship between social class and physical and mental health. Sleep remained a significant mediator when controlling for related variables and other mediators. Thus, the findings suggest that sleep partly explains social class differences in health. We discuss the importance of addressing sleep issues among students from lower social class backgrounds.     

Phonological short‐term memory and vocabulary development: further evidence on the nature of the relationship

The nature and generality of the developmental association between phonological short‐term memory and vocabulary knowledge was explored in two studies. Study 1 investigated whether the link between vocabulary and verbal memory arises from the requirement to articulate memory items at recall or from earlier processes involved in the encoding and storage of the verbal material. Four‐year‐old children were tested on immediate memory measures which required either spoken recall (nonword repetition and digit span) or recognition of a sequence of nonwords. The phonological memory–vocabulary association was found to be as strong for the serial recognition as recall‐based measures, favouring the view that it is phonological short‐term memory capacity rather than speech output skills which constrain word learning. In Study 2, the association between phonological memory skills and vocabulary knowledge was found to be strong in teenaged as well as younger children, indicating that phonological memory constraints on word learning remain significant throughout childhood. Copyright © 1999 John Wiley & Sons, Ltd.