Is cognitive conflict really effortful? Conflict priming and shielding effects on cardiac response

Two experiments with N = 221 university students investigated the impact of primed cognitive conflict on effort assessed as cardiac response in tasks that were not conflict-related themselves. Manifest cognitive conflict in cognitive control tasks is confounded with objective response difficulty (e.g., in incongruent Stroop task trials). This makes conclusions about the effortfulness of cognitive conflict itself difficult. We bypassed this problem by administrating pictures of congruent versus incongruent Stroop task stimuli as conflict primes. As predicted, primed cognitive conflict increased cardiac pre-ejection period (PEP) responses in an easy attention task in Experiment 1. Accordingly, cognitive conflict itself is indeed effortful. This effect was replicated in an easy short-term memory task in Experiment 2. Moreover, as further predicted, the primed cognitive conflict effect on PEP reactivity disappeared when participants could personally choose task characteristics. This latter effect corresponds to other recent evidence showing that personal action choice shields against incidental affective influences on action execution and especially on effort-related cardiovascular response.     

How well do healthcare professionals know of the priorities of their older patients regarding treatment outcomes?

ObjectivesFor shared decision making, it is crucial to identify patients’ priorities regarding health outcomes. Our aim was to study whether healthcare professionals know these priorities.MethodsIn this cross-sectional study we included older patients who had to make a treatment decision, their general practitioners (GPs) and their medical specialists. Agreement between the patients’ main health outcome as prioritised by using the Outcome Prioritization Tool (OPT) and the perception of the same outcome by their healthcare professionals.ResultsEighty-seven patients were included. Median age was 76 years, 87.4% of patients presented with malignant disease. The majority prioritised maintaining independence (51.7%), followed by extending life (27.6%). The agreement between patients and healthcare professionals was low (GPs 41.7%, kappa 0.067, p = 0.39), medical specialists 40.3%, kappa 0.074, p = 0.33). Positively related to agreement was patient’s age > 75, and a longer relation with their patients (for GPs), and the patient having no partner (for medical specialist). Having a malignant disease, dependent living and functional deficits were negatively related to agreement.ConclusionsHealthcare professionals have poor perceptions of their patients’ priorities.Practice implicationsTo realise patient-centered care, it is crucial to discuss priorities explicitly with all patients.     

Perceived family climate of black adolescents: A function of parental marital status or perceived conflict?

Real and ideal family climate as perceived by Black lower middle SES adolescents from divorced and intact homes was investigated using the Moos Family Environment Scale. Results revealed that perceived family climate was unrelated to paternal marital status, but significantly related to perceived conflict within the home. High conflict was related to less cohesion, less intellectual-cultural orientation, and less organization than low conflict. Independent of paternal marital status or degree of perceived conflict, adolescents as a group perceived their current family climate as less cohesive, more conflicted, less intellectually oriented and less organized than the ideal family climate.     

The role of the right temporoparietal junction in intersensory conflict: detection or resolution?

The right temporoparietal junction (rTPJ) is a polysensory cortical area that plays a key role in perception and awareness. Neuroimaging evidence shows activation of rTPJ in intersensory and sensorimotor conflict situations, but it remains unclear whether this activity reflects detection or resolution of such conflicts. To address this question, we manipulated the relationship between touch and vision using the so-called mirror-box illusion. Participants’ hands lay on either side of a mirror, which occluded their left hand and reflected their right hand, but created the illusion that they were looking directly at their left hand. The experimenter simultaneously touched either the middle (D3) or the ring finger (D4) of each hand. Participants judged, which finger was touched on their occluded left hand. The visual stimulus corresponding to the touch on the right hand was therefore either congruent (same finger as touch) or incongruent (different finger from touch) with the task-relevant touch on the left hand. Single-pulse transcranial magnetic stimulation (TMS) was delivered to the rTPJ immediately after touch. Accuracy in localizing the left touch was worse for D4 than for D3, particularly when visual stimulation was incongruent. However, following TMS, accuracy improved selectively for D4 in incongruent trials, suggesting that the effects of the conflicting visual information were reduced. These findings suggest a role of rTPJ in detecting, rather than resolving, intersensory conflict.     

Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors?

Objective

Patients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure.

Is “conflict adaptation” driven by conflict? Behavioral and EEG evidence for the underappreciated role of congruent trials

Theories of cognitive control argue that response conflict in speeded performance tasks leads to adaptive changes, such that irrelevant information is better ignored on subsequent trials. This study tested whether trial-by-trial changes are driven primarily by conflict on incongruent trials or instead by congruent trials, in which irrelevant and relevant stimulus dimensions match. In a Stroop task including congruent, incongruent, and neutral trials, interference was greater following congruent compared to incongruent and neutral trials, which did not differ. During the intertrial interval, EEG alpha power, an inverse measure of cerebral activation, was significantly lower following congruent than neutral trials, whereas incongruent and neutral trials did not differ. These results imply that trial-by-trial changes in performance may not be driven solely by conflict, but rather by changes in attention triggered by congruent information.     

What are the priorities in basic asthma research? A United Kingdom perspective

The National Asthma Campaign (in the United Kingdom) has recently completed a strategic review of priorities for basic asthma research over the next 5 to 10 years. Leading asthma experts and representatives of the main funding agencies were involved in a nationwide consultation. Discussions were carried out in 7 thematic areas: Genetics of asthma, early-life events, environmental influences, immunology and immunotherapy, inflammation and anti-inflammation, airway remodeling, and the interface between academia and industry. Discussions were not restricted by considerations of financial affordability but were driven by vision and science.The consultation highlighted a number of generic issues pertaining to the organization of basic asthma research. Phenotypes of asthma require more robust characterization, particularly for genetic studies. Emphasis on longitudinal studies should be encouraged, and more information can still be gained from existing well-characterized asthma cohorts, though this requires some coordination. Human research is particularly strong and should continue, and the use of human tissue is vital to our understanding of the disease at the cellular and molecular levels. Animal models of asthma remain an important tool with which to dissect disease mechanisms, but they must be improved and refined. The consultation covered a wide range of issues and highlighted the need for collaboration at all levels between research groups and with industry and also between funding agencies. The recommendations made have relevance to everyone involved in basic asthma research. This article describes the recommendations and reviews the specific research issues relating to each of the 7 thematic areas.     

Children’s appraisals of interparental conflict predict event-related potential components

Interparental conflict and neural correlates of children’s emotion processing were examined. Event-related potential (ERP) data were collected from 87 children (9–11 years old) with stimuli depicting interpersonal anger, happiness, and neutrality. Three ERP components were modulated by child-reported measures of conflict, reflecting a progression from early sensory attention to cognitive control to stimulus categorization. Negative conflict predicted larger N1 and N2 amplitudes on happy than on angry trials. Greater self-blame for conflict predicted larger N2 amplitudes across emotions and larger P3 amplitudes on angry than on neutral or happy trials. Results suggest conflict-related experiences shape processing of interpersonal emotion.     

Does your diagnostic and clinical expertise conflict with your leadership?

Research evidence demonstrates that more and better medical leadership leads to higher quality patient care and improved clinical outcomes. Well-rehearsed challenges facing the leadership of healthcare systems across the world call for the ability to lead through growing complexity. Evidence suggests this requires different competencies to the well-honed skills which make clinicians so valued in managing clinically complicated problems. Those ‘new’ skills can be learned but that requires a shift in culture within the profession and the system as a whole, starting with recognition of the importance of leadership and recognition of the need to support and develop medical leaders. That will require significant investment and ingenuity to incorporate development into already over-full curricula. As most leadership learning is experiential, the bulk of learning must be at the coal-face, not in the classroom and training the trainers would seem to be an inescapable, urgent early step.     

Treatment priorities in oncology: do we want to live longer or better?

OBJECTIVES:

Despite the progress achieved in the fight against cancer over the past several years, assessing the needs, goals and preferences of patients with cancer is of the utmost importance for the delivery of health care. We sought to assess priorities regarding quantity versus quality of life among Brazilian patients, comparing them with individuals without cancer.

METHODS:

Using a questionnaire presenting four hypothetical cancer cases, we interviewed cancer patients, oncology health-care professionals and laypersons, most of whom had administrative functions in our hospital.

RESULTS:

A total of 214 individuals participated: 101 patients, 44 health-care professionals and 69 laypersons. The mean ages in the three groups were 56, 34 and 31 years old, respectively (p<0.001). The patients had gastrointestinal (25%), breast (22%), hematologic (10%), lung (8%) or other tumors (36%) and the tumor-node- metastasis (TNM) stage was I, II, III or IV in 22%, 13%, 34% and 31% of cases, respectively. Treatment priorities differed significantly among the three groups (p = 0.005), with survival time being a higher priority for patients than for the other two groups and with opposite trends regarding quality of life. In multivariate analysis, the age and sex distributions were not associated with the choice to maximize quality of life. In this limited sample of cancer patients, there were no associations between treatment priorities and disease stages.

CONCLUSIONS:

Both survival time and quality of life appeared to be important to cancer patients, oncology health-care professionals and laypersons, but survival time seemed to have higher priority for people diagnosed with cancer than for healthy people. Additionally, survival seemed to be more important than quality of life for all three groups assessed.