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Archives of Sexual Behavior Jul 2023Gender transition is undertaken to improve the well-being of people suffering from gender dysphoria. However, some have argued that the evidence supporting medical...
Gender transition is undertaken to improve the well-being of people suffering from gender dysphoria. However, some have argued that the evidence supporting medical interventions for gender transition (e.g., hormonal therapies and surgery) is weak and inconclusive, and an increasing number of people have come forward recently to share their experiences of transition regret and detransition. In this essay, I discuss emerging clinical and research issues related to transition regret and detransition with the aim of arming clinicians with the latest information so they can support patients navigating the challenges of regret and detransition. I begin by describing recent changes in the epidemiology of gender dysphoria, conceptualization of transgender identification, and models of care. I then discuss the potential impact of these changes on regret and detransition; the prevalence of desistance, regret, and detransition; reasons for detransition; and medical and mental healthcare needs of detransitioners. Although recent data have shed light on a complex range of experiences that lead people to detransition, research remains very much in its infancy. Little is known about the medical and mental healthcare needs of these patients, and there is currently no guidance on best practices for clinicians involved in their care. Moreover, the term detransition can hold a wide array of possible meanings for transgender-identifying people, detransitioners, and researchers, leading to inconsistences in its usage. Moving forward, minimizing harm will require conducting robust research, challenging fundamental assumptions, scrutinizing of practice patterns, and embracing debate.
Topics: Humans; Transgender Persons; Transsexualism; Gender Identity; Uncertainty; Gender Dysphoria; Emotions
PubMed: 37266795
DOI: 10.1007/s10508-023-02626-2 -
GMS Journal For Medical Education 2024
Topics: Uncertainty
PubMed: 38504858
DOI: 10.3205/zma001668 -
Neurobiology of Learning and Memory May 2024We and other animals learn because there is some aspect of the world about which we are uncertain. This uncertainty arises from initial ignorance, and from changes in... (Review)
Review
We and other animals learn because there is some aspect of the world about which we are uncertain. This uncertainty arises from initial ignorance, and from changes in the world that we do not perfectly know; the uncertainty often becomes evident when our predictions about the world are found to be erroneous. The Rescorla-Wagner learning rule, which specifies one way that prediction errors can occasion learning, has been hugely influential as a characterization of Pavlovian conditioning and, through its equivalence to the delta rule in engineering, in a much wider class of learning problems. Here, we review the embedding of the Rescorla-Wagner rule in a Bayesian context that is precise about the link between uncertainty and learning, and thereby discuss extensions to such suggestions as the Kalman filter, structure learning, and beyond, that collectively encompass a wider range of uncertainties and accommodate a wider assortment of phenomena in conditioning.
Topics: Bayes Theorem; Reinforcement, Psychology; Animals; Conditioning, Classical; Uncertainty; Humans; Learning; Models, Psychological
PubMed: 38579896
DOI: 10.1016/j.nlm.2024.107924 -
Neuroscience and Biobehavioral Reviews Oct 2023Perhaps it is no accident that insight moments accompany some of humanity's most important discoveries in science, medicine, and art. Here we propose that feelings of... (Review)
Review
Perhaps it is no accident that insight moments accompany some of humanity's most important discoveries in science, medicine, and art. Here we propose that feelings of insight play a central role in (heuristically) selecting an idea from the stream of consciousness by capturing attention and eliciting a sense of intuitive confidence permitting fast action under uncertainty. The mechanisms underlying this Eureka heuristic are explained within an active inference framework. First, implicit restructuring via Bayesian reduction leads to a higher-order prediction error (i.e., the content of insight). Second, dopaminergic precision-weighting of the prediction error accounts for the intuitive confidence, pleasure, and attentional capture (i.e., the feeling of insight). This insight as precision account is consistent with the phenomenology, accuracy, and neural unfolding of insight, as well as its effects on belief and decision-making. We conclude by reflecting on dangers of the Eureka Heuristic, including the arising and entrenchment of false beliefs and the vulnerability of insights under psychoactive substances and misinformation.
Topics: Humans; Bayes Theorem; Heuristics; Uncertainty; Emotions; Mental Processes
PubMed: 37598874
DOI: 10.1016/j.neubiorev.2023.105363 -
PloS One 2023During ecological decisions, such as when foraging for food or selecting a weekend activity, we often have to balance the costs and benefits of exploiting known options...
During ecological decisions, such as when foraging for food or selecting a weekend activity, we often have to balance the costs and benefits of exploiting known options versus exploring novel ones. Here, we ask how individuals address such cost-benefit tradeoffs during tasks in which we can either explore by ourselves or seek external advice from an oracle (e.g., a domain expert or recommendation system). To answer this question, we designed two studies in which participants chose between inquiring (at a cost) for expert advice from an oracle, or to search for options without guidance, under manipulations affecting the optimal choice. We found that participants showed a greater propensity to seek expert advice when it was instrumental to increase payoff (study A), and when it reduced choice uncertainty, above and beyond payoff maximization (study B). This latter result was especially apparent in participants with greater trait-level intolerance of uncertainty. Taken together, these results suggest that we seek expert advice for both economic goals (i.e., payoff maximization) and epistemic goals (i.e., uncertainty minimization) and that our decisions to ask or not ask for advice are sensitive to cost-benefit tradeoffs.
Topics: Humans; Uncertainty; Cost-Benefit Analysis
PubMed: 38153955
DOI: 10.1371/journal.pone.0295005 -
European Journal of Clinical... Aug 2023Several teams have been publishing global estimates of excess deaths during the COVID-19 pandemic. Here, we examine potential flaws and underappreciated sources of... (Review)
Review
Several teams have been publishing global estimates of excess deaths during the COVID-19 pandemic. Here, we examine potential flaws and underappreciated sources of uncertainty in global excess death calculations. Adjusting for changing population age structure is essential. Otherwise, excess deaths are markedly overestimated in countries with increasingly aging populations. Adjusting for changes in other high-risk indicators, such as residence in long-term facilities, may also make a difference. Death registration is highly incomplete in most countries; completeness corrections should allow for substantial uncertainty and consider that completeness may have changed during pandemic years. Excess death estimates have high sensitivity to modelling choice. Therefore different options should be considered and the full range of results should be shown for different choices of pre-pandemic reference periods and imposed models. Any post-modelling corrections in specific countries should be guided by pre-specified rules. Modelling of all-cause mortality (ACM) in countries that have ACM data and extrapolating these models to other countries is precarious; models may lack transportability. Existing global excess death estimates underestimate the overall uncertainty that is multiplicative across diverse sources of uncertainty. Informative excess death estimates require risk stratification, including age groups and ethnic/racial strata. Data to-date suggest a death deficit among children during the pandemic and marked socioeconomic differences in deaths, widening inequalities. Finally, causal explanations require great caution in disentangling SARS-CoV-2 deaths, indirect pandemic effects and effects from measures taken. We conclude that excess deaths have many uncertainties, but globally deaths from SARS-CoV-2 may be the minority of calculated excess deaths.
Topics: Child; Humans; Cause of Death; Pandemics; Uncertainty; COVID-19; SARS-CoV-2
PubMed: 37067255
DOI: 10.1111/eci.14008 -
Neuroscience and Biobehavioral Reviews Jan 2024This paper concerns the distributed intelligence or federated inference that emerges under belief-sharing among agents who share a common world-and world model. Imagine,... (Review)
Review
This paper concerns the distributed intelligence or federated inference that emerges under belief-sharing among agents who share a common world-and world model. Imagine, for example, several animals keeping a lookout for predators. Their collective surveillance rests upon being able to communicate their beliefs-about what they see-among themselves. But, how is this possible? Here, we show how all the necessary components arise from minimising free energy. We use numerical studies to simulate the generation, acquisition and emergence of language in synthetic agents. Specifically, we consider inference, learning and selection as minimising the variational free energy of posterior (i.e., Bayesian) beliefs about the states, parameters and structure of generative models, respectively. The common theme-that attends these optimisation processes-is the selection of actions that minimise expected free energy, leading to active inference, learning and model selection (a.k.a., structure learning). We first illustrate the role of communication in resolving uncertainty about the latent states of a partially observed world, on which agents have complementary perspectives. We then consider the acquisition of the requisite language-entailed by a likelihood mapping from an agent's beliefs to their overt expression (e.g., speech)-showing that language can be transmitted across generations by active learning. Finally, we show that language is an emergent property of free energy minimisation, when agents operate within the same econiche. We conclude with a discussion of various perspectives on these phenomena; ranging from cultural niche construction, through federated learning, to the emergence of complexity in ensembles of self-organising systems.
Topics: Animals; Bayes Theorem; Communication; Language; Uncertainty; Speech
PubMed: 38056542
DOI: 10.1016/j.neubiorev.2023.105500 -
Diagnosis (Berlin, Germany) May 2024
Topics: Humans; Uncertainty; Diagnosis
PubMed: 38234284
DOI: 10.1515/dx-2023-0178 -
Swiss Medical Weekly Feb 2024Palliative sedation is defined as the monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) to relieve the burden of... (Review)
Review
Palliative sedation is defined as the monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) to relieve the burden of otherwise intractable suffering in a manner ethically acceptable to the patient, their family, and healthcare providers. In Switzerland, the prevalence of continuous deep sedation until death increased from 4.7% in 2001 to 17.5% of all deceased in 2013, depending on the research method used and on regional variations. Yet, these numbers may be overestimated due to a lack of understanding of the term "continuous deep sedation" by for example respondents of the questionnaire-based study. Inadequately trained and inexperienced healthcare professionals may incorrectly or inappropriately perform palliative sedation due to uncertainties regarding its definitions and practice. Therefore, the expert members of the Bigorio group and the authors of this manuscript believe that national recommendations should be published and made available to healthcare professionals to provide practical, terminological, and ethical guidance. The Bigorio group is the working group of the Swiss Palliative Care Society whose task is to publish clinical recommendations at a national level in Switzerland. These recommendations aim to provide guidance on the most critical questions and issues related to palliative sedation. The Swiss Society of Palliative Care (palliative.ch) mandated a writing board comprising four clinical experts (three physicians and one ethicist) and two national academic experts to revise the 2005 Bigorio guidelines. A first draft was created based on a narrative literature review, which was internally reviewed by five academic institutions (Lausanne, Geneva, Bern, Zürich, and Basel) and the heads of all working groups of the Swiss Society of Palliative Care before finalising the guidelines. The following themes are discussed regarding palliative sedation: (a) definitions and clinical aspects, (b) the decision-making process, (c) communication with patients and families, (d) patient monitoring, (e) pharmacological approaches, and (f) ethical and controversial issues. Palliative sedation must be practised with clinical and ethical accuracy and competence to avoid harm and ethically questionable use. Specialist palliative care teams should be consulted before initiating palliative sedation to avoid overlooking other potential treatment options for the patient's symptoms and suffering.
Topics: Humans; Palliative Care; Uncertainty; Health Personnel; Communication; Physicians; Deep Sedation; Terminal Care; Hypnotics and Sedatives
PubMed: 38579308
DOI: 10.57187/s.3590 -
International Journal of Nursing... Jan 2023This study examined the possible correlation between metacognition and learning experience transfer of nursing students after engaging in an urgent and cognitively...
OBJECTIVES
This study examined the possible correlation between metacognition and learning experience transfer of nursing students after engaging in an urgent and cognitively demanding clinical situation.
METHODS
This is a one-group post-test- only study design in which participants engaged in an emergency care scenario simulation and completed the Meta-Cognitive Awareness Scale - Domain Specific (MCAS-DS).
RESULTS
Study results revealed that participants' metacognitive awareness is significantly correlated to the learning transfer (p=0.0001) and GPA (p=0.006). There is also a positive correlation between learning transfer and GPA (p=0.04), clinical settings-based training experience (p=0.021) and metacognitive confidence (p=0.0001).
CONCLUSIONS
This study may imply that academic achievement can be used as a potential screening tool to identify students requiring metacognitive training. It may also imply that metacognitive abilities can be enhanced indirectly through considering factors that may influence the transfer of learning such as increasing the hours of clinical training.
Topics: Humans; Metacognition; Transfer, Psychology; Uncertainty; Learning; Students, Nursing
PubMed: 38073587
DOI: 10.1515/ijnes-2023-0038