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PubMed1984

[The reason of difference, the difference of reason.].

The present article proposes a particular view of psychiatrie in-stitutionalization. The analysis flows from the study of the anthropological hypothesis of René Girard whose cornerstone is mimicry. This approach allows for the exploration of the real motiver which prevails during an institutionalization and brings to light the victimizing mechanism which operates in the internment phenomenon. It uncovers the necessity of the mentally-ill as scapegoats in a society searching for peace and harmony. And the circumscription of what is different becomes, in a way, the source of the alienation of that which is different. In conclusion, and in the light of Girard's perspective, openness to others suggests the creation of new types of human relations between self and other and between self and self.

English Abstract↗
PubMed2001

Fuzzy-trace theory: dual processes in memory, reasoning, and cognitive neuroscience.

Fuzzy-trace theory has evolved in response to counterintuitive data on how memory development influences the development of reasoning. The two traditional perspectives on memory-reasoning relations--the necessity and constructivist hypotheses--stipulate that the accuracy of children's memory for problem information and the accuracy of their reasoning are closely intertwined, albeit for different reasons. However, contrary to necessity, correlational and experimental dissociations have been found between children's memory for problem information that is determinative in solving certain problems and their solutions of those problems. In these same tasks, age changes in memory for problem information appear to be dissociated from age changes in reasoning. Contrary to constructivism, correlational and experimental dissociations also have been found between children's performance on memory tests for actual experience and memory tests for the meaning of experience. As in memory-reasoning studies, age changes in one type of memory performance do not seem to be closely connected to age changes in the other type of performance. Subsequent experiments have led to dual-process accounts in both the memory and reasoning spheres. The account of memory development features four other principles: parallel verbatim-gist storage, dissociated verbatim-gist retrieval, memorial bases of conscious recollection, and identity/similarity processes. The account of the development of reasoning features three principles: gist extraction, fuzzy-to-verbatim continua, and fuzzy-processing preferences. The fuzzy-processing preference is a particularly important notion because it implies that gist-based intuitive reasoning often suffices to deliver "logical" solutions and that such reasoning confers multiple cognitive advantages that enhance accuracy. The explanation of memory-reasoning dissociations in cognitive development then falls out of fuzzy-trace theory's dual-process models of memory and reasoning. More explicitly, in childhood reasoning tasks, it is assumed that both verbatim and gist traces of problem information are stored. Responding accurately to memory tests for presented problem information depends primarily on verbatim memory abilities (preserving traces of that information and accessing them when the appropriate memory probes are administered). However, accurate solutions to reasoning problems depend primarily on gist-memory abilities (extracting the correct gist from problem information, focusing on that gist during reasoning, and accessing reasoning operations that process that gist). Because verbatim and gist memories exhibit considerable dissociation, both during storage and when they are subsequently accessed on memory tests, dissociations of verbatim-based memory performance from gist-based reasoning are predictable. Conversely, associations are predicted in situations in which memory and reasoning are based on the same verbatim traces (Brainerd & Reyna, 1988) and in situations in which memory and reasoning are based on the same gist traces (Reyna & Kiernan, 1994). Fuzzy-trace theory's memory and reasoning principles have been applied in other research domains. Four such domains are developmental cognitive neuroscience studies of false memory, studies of false memory in brain-damaged patients, studies of reasoning errors in judgment and decision making, and studies of retrieval mechanisms in recall. In the first domain, the principles of parallel verbatim-gist storage, dissociated verbatim-gist retrieval, and identity/similarity processes have been used to explain both spontaneous and implanted false reports in children and in the elderly. These explanations have produced some surprising predictions that have been verified: false reports do not merely decline with age during childhood but increase under theoretically specified conditions; reports of events that were not experienced can nevertheless be highly persistent over time; and false reports can be suppressed by retrieving verbatim traces of corresponding true events. In the second domain, the same principles have been invoked to explain why some forms of brain damage lead to elevated levels of false memory and other forms lead to reduced levels of false memory. In the third domain, the principles of gist extraction, fuzzy-to-verbatim continua, and fuzzy-processing preferences have been exploited to formulate a general theory of loci of processing failures in judgment and decision making, cluminating in a developmental account of degrees of rationality that distinguishes more and less advanced reasoning. This theory has in turn been used to formulate local models, such as the inclusion illusions model, that explain the characteristic reasoning errors that are observed on specific judgment and decision-making tasks. Finally, in the fourth domain, a dual-process conception of recall has been derived from the principles of parallel verbatim-gist storage and dissociated verbatim-gist retrieval. In this conception, which has been used to explain cognitive triage effects in recall and robust false recall, targets are recalled either by directly accessing their verbatim traces and reading the retrieved information out of consciousness or by reconstructively processing their gist traces.

Aging↗
PubMed2005

Reasonable suspicion: a study of Pennsylvania pediatricians regarding child abuse.

OBJECTIVE: It has long been assumed that mandated reporting statutes regarding child abuse are self-explanatory and that broad consensus exists as to the meaning and proper application of reasonable suspicion. However, no systematic investigation has examined how mandated reporters interpret and apply the concept of reasonable suspicion. The purpose of this study was to identify Pennsylvania pediatricians' understanding and interpretation of reasonable suspicion in the context of mandated reporting of suspected child abuse. Methodology. An anonymous survey was sent (Spring 2004) to all members of the Pennsylvania chapter of the American Academy of Pediatrics (n = 2051). Participants were given several operational frameworks to elicit their understanding of the concept of reasonable suspicion, 2 of which are reported here. Respondents were asked to imagine that they had examined a child for an injury that may have been caused by abuse and that they had gathered as much information as they felt was possible. They then were asked to quantify (in 2 different ways) the degree of likelihood needed for suspicion of child abuse to rise to the level of reasonable suspicion. The physicians were asked to identify (using a differential-diagnosis framework) how high on a rank-order list "abuse" would have to be for it to rise to the level of reasonable suspicion (ie, first on the list, second, third, and so on, down to tenth). The second framework, estimated probability, used a visual analog scale of 0% to 100% to determine how likely suspected abuse would have to be for physicians for them to feel that they had reasonable suspicion. That is, would they need to feel that there was a 99% likelihood that abuse occurred before they felt that they had reasonable suspicion, a 1% likelihood, or something in between? In addition to standard demographic features, respondents were queried regarding their education on child abuse, education on reasonable suspicion, frequency of reporting child abuse, and (self-reported) expertise regarding child abuse. The main outcome measures were physician responses on the 2 scales for interpreting reasonable suspicion. RESULTS: Pediatricians (n = 1249) completed the survey (61% response rate). Their mean age was 43 years; 55% were female; and 78% were white. Seventy-six percent were board certified, and 65% reported being in primary care. There were no remarkable differences in responses based on age, gender, expertise with child abuse, frequency of reporting child abuse, or practice type. The responses of pediatric residents were indistinguishable from experienced physicians, and the responses of primary care pediatricians were no different from pediatric subspecialists. Wide variation was found in the thresholds that pediatricians set for what constituted reasonable suspicion. On the differential-diagnosis scale (DDS), 12% of pediatricians responded that abuse would have to rank first or second on the DDS before the possibility rose to the level of reasonable suspicion, 41% indicated a rank of third or fourth, and 47% reported that a rank anywhere from fifth to as low as tenth still qualified as reasonable suspicion. On the estimated-probability scale (EPS), 35% of pediatricians responded that for reasonable suspicion to exist, the probability of abuse needed to be 10% to 35%. By contrast, 25% of respondents identified a 40% to 50% probability, 25% stipulated a 60% to 70% probability, and 15% required a probability of >or=75%. In comparing individual responses for the 2 scales (ie, paired comparisons between each pediatrician's DDS ranking and the estimated probability he or she identified), 85% were found to be internally inconsistent. To be logically consistent, any score >or=50% on the EPS would need to correspond to a DDS ranking of 1; an EPS score of >or=34% would need to correspond with a DDS ranking no lower than 2; an EPS score of >or=25% no lower than a DDS ranking of 3; and so on. What we found, however, was that pediatricians commonly indicated that reasonable suspicion required a 50% to 60% probability that abuse occurred, but at the same time, they responded that child abuse could rank as low as fourth or fifth on the DDS and still qualify as reasonable suspicion. CONCLUSIONS: The majority of states use the term "suspicion" in their mandated reporting statutes, and according to legal experts, "reasonable suspicion" represents an accurate generalization of most mandated reporting thresholds. Our data show significant variability in how pediatricians interpret reasonable suspicion, with a range of responses so broad as to question the assumption that the threshold for mandated reporting is understood, interpreted, or applied in a coherent and consistent manner. If the variability described here proves generalizable, it will require rethinking what society can expect from mandated reporters and what sort of training will be necessary to warrant those expectations.

Adult↗
PubMed2004

Automated linking of free-text complaints to reason-for-visit categories and International Classification of Diseases diagnoses in emergency department patient record databases.

STUDY OBJECTIVE: The use of the International Classification of Diseases system to describe emergency department (ED) case mix has disadvantages. We therefore developed computer algorithms that recognize a combination of words, word fragments, and word patterns to link free-text complaint fields to 20 reason-for-visit categories. We examine the feasibility and reliability of applying these reason-for-visit categories to ED patient-visit databases. METHODS: We analyzed a database (containing complaints and International Classification of Diseases diagnoses for 1 year's visits to a single ED) using a 3-step process (create initial terms, maximize sensitivity, maximize specificity) to define inclusion and exclusion terms for 20 reason-for-visit categories. To assess the reliability of the reason-for-visit assignment algorithm, we repeated the final 2 steps on a second database, composed of visits sampled from 21 EDs. For each database, we determined the prevalence of complaints that link to each reason-for-visit category and the distributions of International Classification of Diseases, Ninth Revision diagnoses that resulted for all patients and patients stratified by age. RESULTS: The 20 reason-for-visit categories capture 77% of all patients in database 1 (mean age 33.5 years) and 67% of all patients in database 2 (mean age 38.9 years). The percentage of visits captured by the 20 reason-for-visit categories, by age range, for databases 1 and 2 are (respectively) 0 to 2 years (84% and 76%), 3 to 10 years (82% and 74%), 11 to 65 years (76% and 68%), and 66 years or older (69% and 60%). The proportions of all complaints that link to each reason-for-visit category are largely similar between databases. Every complaint field that is linked to each reason-for-visit category includes at least 1 term that relates it to the category title, and the most frequently assigned diagnoses in each reason-for-visit category are those that one would expect to be associated with the reason-for-visit category complaints. CONCLUSION: The method by which free-text complaint fields are parsed into reason-for-visit categories is feasible and reasonably reliable; the finalized database 1 reason-for-visit category inclusion/exclusion terms lists required only modest changes to work well in database 2. The reason-for-visit categories used here are broadly defined to maximize the proportion of visits that they capture; more narrowly defined reason-for-visit categories will require more extensive revision of their inclusion/exclusion terms lists when used in different databases. A prospective, reason-for-visit-based ED classification system could have several useful applications (including syndromic surveillance), although content validity analysis will be necessary to investigate this hypothesis.

Adolescent↗
PubMed1998

Teaching clinical reasoning as a thinking frame.

OBJECTIVE: Clinical reasoning concepts can be viewed as descriptions of mental operations or as a thinking frame--a structure to organize and support clinical thinking. This study examined an approach for teaching clinical reasoning as a thinking frame to occupational therapy students. METHOD: A quasi-experimental, pretest-posttest design was used with a convenience sample of 10 undergraduate occupational therapy seniors. All participants (a) acquired the thinking frame of clinical reasoning concepts through explicit instruction and (b) practiced that thinking frame with an external aid--the Clinical Reasoning Case Study Format. The accuracy of participants' definitions of clinical reasoning concepts before and after this learning experience were examined to assess their acquisition of the thinking frame. The content of clinical reasoning case studies were examined to assess students' application of the thinking frame to clinical situations. RESULTS: Wilcoxon signed rank tests done on presemester and postsemester definitions ratings indicated that the latter were rated significantly higher than the former for (a) narrative reasoning (p = .008), (b) procedural reasoning (p = .005), (c) interactive reasoning (p = .006), (d) pragmatic reasoning (p = .008), and (e) conditional reasoning (p = .01). The content of participants' clinical reasoning case studies indicated that they were able to apply clinical reasoning concepts. CONCLUSION: The results suggest that using a clinical reasoning thinking frame to organize clinical observations is an effective way to help entry-level occupational therapy students learn and apply clinical reasoning concepts.

Adult↗
PubMedDate not supplied

Reasons for smoking or not smoking in early adolescence.

Previous studies of smokers' and nonsmokers' reasons have not compared their reasons for smoking and their reasons for not smoking, or examined the extent of change or stability in these reasons over time. We examined reasons for smoking and not smoking in a large sample of 13-year-olds from the general population. Factor structures of reasons differed according to whether adolescents were smokers or nonsmokers. Nonsmokers were found to be less discriminating than smokers about the reasons for smoking. Smokers and nonsmokers tended to show more agreement about the reasons for not smoking. Recency of smoking was differentially related to the factors for smoking and the factors for not smoking. "Image" was a more important reason for smoking at age 11 than at age 13. "Friends" as a reason for smoking showed a small degree of consistency across age, whereas reasons involving relaxation and pleasure showed a relatively higher degree of consistency. Health, as a reason not to smoke, showed only a small degree of consistency, while social context, effects and access were moderately consistent as reasons not to smoke at ages 11 and 13.

Adolescent↗
PubMedDate not supplied

The reasons for tooth extractions in adults and their validation.

OBJECTIVES: To investigate the primary reasons for the extraction of permanent teeth in adults and to validate the dentists' reasons for extraction. METHODS: Twenty-one dentists in the Greater Manchester area took part in the study. These dentists provided extracted teeth stored in 10% buffered formal saline together with details of the patient's age, sex, dental attendance pattern and the reason for extraction. In order to validate the reasons for extraction, teeth were examined for the presence or absence of coronal and root caries. A subgroup of 80 teeth, half of which were extracted primarily for caries and half for periodontal reasons were selected, stained and attachment loss measured at six sites per tooth to validate periodontal reasons for extraction. RESULTS: Three hundred and eighty-nine teeth were collected of which 37% were extracted primarily due to caries and 29% due to periodontal disease. Caries was the main reason for extraction in patients under 50 years, whereas periodontal disease was the commonest reason in the over-50 age group. Irregular attenders had more extractions for caries than regular attenders but attendance pattern did not affect the proportion of teeth extracted for periodontal reasons. The mean greatest loss of attachment on teeth extracted for periodontal reasons was 12 mm compared with 6.5 mm for caries. CONCLUSION: In this group of patients caries was the most common reason for extraction of teeth but periodontal disease became a more important reason for extraction after 50 years of age. The study validated the dentists' given reason for extraction.

Adolescent↗