According to Bayesian models, both decisions and confidence are based on the same precision-weighted integration of prior expectations (\"priors\") and incoming information (\"likelihoods\"). This assumes that priors are integrated optimally and equally in decisions and confidence, which has not been tested. In three experiments, we quantify how priors inform decisions and confidence. With a dual-decision task we create pairs of conditions that are matched in posterior information, but differ on whether the prior or likelihood is more informative. We find that priors are underweighted in discrimination decisions, but are less underweighted in confidence about those decisions, and this is not due to differences in processing time. The same patterns remain with exogenous probabilistic cues as priors. With a Bayesian model we quantify the weighting parameters for the prior at both levels, and find converging evidence that priors are more optimally used in explicit confidence, even when underused in decisions.

Why did people across the world and throughout history believe that dreams can foretell what will occur in the future? In this paper, I attempt to answer this question within a cultural evolutionary framework by emphasizing the cognitive aspect of dream interpretation; namely, the fact that dreams were often viewed as significant and interpretable has to do with various psychological and social factors that influence how people obtain and process information regarding the validity of dream interpretation as a technique. Through a comprehensive analysis of a large dataset of dream occurrences in the official Chinese historical records, I argue that the ubiquity and persistence of dream interpretation have a strong empirical component (predictively accurate dream cases), which is particularly vulnerable to transmission errors and biases. The overwhelmingly successful records of dream prediction in transmitted texts, I suggest, is largely due to the fabrication and retrospective inference of past dreams, as well as the under-reporting of predictive failures. These \"positive data\" then reinforce individuals\' confidence in the predictive power of dreams. I finally show a potential decline of the popularity of dream interpretation in traditional China and offer a few suggestive explanations drawing on the unique characteristics of oneiromancy compared to other divination techniques.

The population of early-onset Alzheimer\'s disease (EOAD) accounts for 1%-2% of the total population of Alzheimer\'s disease, and genetic mutations are more common in EOAD. The first symptom of the patient in the present case report was the decline in memories of recent events, and the disease progressed rapidly in the following 2 years. Genetic testing has revealed the presence of genetic mutations (c.A479G, p.N160S) of ACE, which causes the 160th codon of the ACE protein to change from aspartic acid to serine, and at the same time genotype of apolipoprotein E (APOE) is ɛ3/ɛ4. We think that this patient carries the mutation type of the sensitive gene ACE and the risk gene APOE of Alzheimer\'s disease, and this is the reason why the disease progressed rapidly. Moreover, we discussed ACE genetic mutation\'s meaning in EOAD progression.

Background Defects in human cognition commonly result in clinical reasoning failures that can lead to diagnostic errors. A metacognitive structured reflection on what clinical findings fit and/or do not fit with likely and \"can\'t miss\" diagnoses may reduce such errors. Case presentation A 57-year-old man was sent to the emergency department from clinic with chest pain, severe shortness of breath, weakness, and cold sweats. Further investigation revealed multiple risk factors for coronary artery disease, sudden onset of exertional dyspnea, and chest pain that incompletely resolved with rest, mild tachycardia and hypoxia, an abnormal electrocardiogram (ECG), elevated serum cardiac biomarkers, and elevated B-type natriuretic peptide (BNP) in the absence of left-sided heart failure. He was treated for acute coronary syndrome (ACS), discharged, and quickly returned with worsening symptoms that eventually led to a diagnosis of submassive pulmonary embolism (PE). Conclusions Through integrated commentary on the diagnostic reasoning process from clinical reasoning experts at two institutions, this case underscores the importance of frequent assessment of fit along with explicit explanation of dissonant features in order to avoid premature closure and diagnostic error. A fishbone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic error. A case discussant describes the importance of diagnostic schema as an analytic reasoning strategy to assist in the creation of a differential diagnosis, problem representation to summarize updated findings, a Popperian analytic approach of attempting to falsify less-likely hypotheses, and matching pertinent positives and negatives to previously learned illness scripts. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl specific to premature closure.

Purpose Developmental dyslexia (DD) has mostly been attributed to arise from phonological impairments; however, several theories indicate a temporal processing deficit as the underlying cause of DD. So far, research examined the influence of temporal cues on concurrent speech sound categorization in DD, but effects of temporal information from a context (e.g., speaking rate) on the perception of subsequent sounds (i.e., \"rate normalization\") have not been considered. This study examined whether individuals with DD are capable of implicitly extracting temporal information embedded in context and use it for phoneme categorization to the same extent as healthy readers. Method Fifteen individuals diagnosed with DD and 16 healthy readers, all native speakers of Hebrew, listened to context sentences followed by target words. They had to indicate whether the target word sounded more like taam (\"taste\"; a long-vowel response) or tam (\"naïve\"; a short-vowel response). Temporal information of the context was manipulated (slow vs. fast speaking rate sentences) as well as the vowel duration of the target in a 5-step continuum. Results Listeners with DD did use the rate context to inform their decisions but to a significantly lesser extent than healthy listeners. In addition, their categorization of the vowel duration continuum was somewhat less distinct than that of the control group. Conclusions Individuals with DD are impaired not only in tasks involving direct temporal processing, as shown in previous studies but also in the use of temporal information of a context that impacts the perception of subsequent target words. This inability to fully utilize rate normalization processes may influence the formation of abstract phonological representations in individuals with DD.

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Proton Beam Therapy (PBT) was developed to minimize the harmful results of radiation therapy as treatment for brain tumors. This study examined the neurocognitive outcomes of PBT in pediatric patients. A total of 8 patients, who received either PBT or photon radiotherapy (XRT), were evaluated with multiple cognitive functions, which include intelligence, memory, executive functions, and attention. Most of patients performed average-to-superior levels of neurocognitive functions (NCF), except that a deterioration of executive functions was revealed in two patients receiving XRT. This study might be the first one to show the maintenance of multidomain NCF after PBT.

The Web 2.0 enabled collaboration at an unprecedented level. In one of the flagships of mass collaboration-Wikipedia-a large number of authors socially negotiate the world\'s largest compendium of knowledge. Several guidelines in Wikipedia restrict contributions to verifiable information from reliable sources to ensure recognized knowledge. Much psychological research demonstrates, however, that individual information processing is biased. This poses the question whether individual biases translate to Wikipedia articles or whether they are prevented by its guidelines. The present research makes use of hindsight bias to examine this question. To this end, we analyzed foresight and hindsight versions of Wikipedia articles regarding a broad variety of events (Study 1). We found the majority of articles not to contain traces of hindsight bias-contrary to prior individual research. However, for a particular category of events-disasters-we found robust evidence for hindsight bias. In a lab experiment (Study 2), we then examined whether individuals\' hindsight bias is translated into articles under controlled conditions and tested whether collaborative writing-as present in Wikipedia-affects the resultant bias (vs. individual writing). Finally, we investigated the impact of biased Wikipedia articles on readers (Study 3). As predicted, biased articles elicited a hindsight bias in readers, who had not known of the event previously. Moreover, biased articles also affected individuals who knew about the event already, and who had already developed a hindsight bias: biased articles further increased their hindsight.

BACKGROUND: The neuropsychological effects of lumbar puncture and shunting in terms of cognitive functioning and quality of life were analyzed prospectively in four patients with malabsorptive hydrocephalus who became symptomatic in the chronic state after aneurysmal subarachnoid haemorrhage (SAH).
METHODS: A comprehensive battery of neuropsychological tests was applied to four patients before and shortly after lumbar puncture and six months later. In three of them a shunt has been inserted, one patient was treated by repeated lumbar punctures. In addition, the patients completed a quality of life and a depression questionnaire before lumbar puncture and after shunting. The data were analyzed using single-case methodology.
RESULTS: Hydrocephalus was associated with pronounced cognitive deficits in terms of functions of attention, short- and long-term memory, concentration and motor fine-coordination but not with a general mental deterioration. Quality of life and affect were also substantially impaired. Neuropsychological tests of fronto-cortical cognitive capacity, motor fine coordination and reaction time proved to be sensitive for the short-term effects of lumbar puncture. Memory functions and the capacity of divided attention needed more time for regeneration and improved substantially after shunt implantation.
CONCLUSIONS: We found a complex pattern of cognitive improvement after lumbar puncture and shunting. Furthermore, our results also show a typical cluster of cognitive deficits associated with malabsorptive hydrocephalus including motor dysfunction. These preliminary findings should be confirmed in larger patient samples.

BACKGROUND: In Western clinical training, formulation of a summary statement (SS) is a core exercise for articulation, evaluation, and improvement of clinical reasoning (CR). In Japanese clinical training, structured guidance in developing CR, including opportunity for SS practice, is uncommon, and the present status of case summarization skills is unclear. We used Virtual Patients (VPs) to explore Japanese junior residents\' SS styles and the effectiveness of VPs on improving SS quality.
METHODS: All first-year junior resident physicians at 4 residency programs (n = 54) were assigned randomized sequences of 5 VP modules, rolled out at 6 day intervals. During each module, participants free-texted a case summary and then reviewed a model summary. Thematic analysis was used to identify SS styles and each SS was categorized accordingly. Frequency of SS styles, and SS CR quality determined by 1) an internally developed Key Feature rubric and 2) demonstration of semantic qualification, were compared across modules.
RESULTS: Four SS styles were identified: numbered features matched to differential diagnoses, differential diagnoses with supportive comments, feature listing, and narrative summarization. From module #1 to #5, significant increases in the narrative summarization SS style (p = 0.016), SS CR quality score (p = 0.021) and percentage of semantically driven SS (p = 0.003) were observed.
CONCLUSIONS: Our study of Japanese junior residents identified distinct clinical case summary statement styles, and observed adoption of the narrative summarization style and improvement in the CR quality of summary statements during a series of VP cases.