Impasse-Driven problem solving: The multidimensional nature of feeling stuck.

This study reports findings across four preregistered experiments (total N = 856) that establish the multidimensional nature of impasse and resolve two paradoxes implicit in the problem-solving literature: how a state of impasse can be at once necessary to solve a problem with insight yet also have appear to have a catastrophic effect on solution rates, and why individuals such as problem-solving and gaming enthusiasts seem to seek out this apparently aversive state. We introduce a new way of measuring impasse based on qualitative reports and subsequently confirmed through quantitative analysis that exploits two aspects of impasse: its dynamic and unstable nature (it can be resolved or unresolved) and its multidimensionality in terms of feelings of cognitive speediness, motivation, and affect. The feeling of being stuck varies between resolved and unresolved impasse in terms of feelings of speediness and positive affect, but not motivation, which remains constant. We demonstrate that the feeling of insight can be reliably elicited by experiencing and resolving impasse but also in the absence of impasse, which suggests that there is more than one path to an insight experience. This adds depths to current proposals of the cognitive mechanisms underlying both insight problem-solving and impasse. Our findings are robust across a range of problem types. The novel conception of impasse in this paper as dynamic and multidimensional has implications for theories of insight problem solving, and also wider implications for understanding how impasse can be resolved across different domains such as education and design.

Retrospective review of the code status of individuals with Down syndrome during the COVID-19 era.

Code status is a label in the medical record indicating a patient's wishes for end-of-life (EOL) care in the event of a cardiopulmonary arrest. People with intellectual disabilities had a higher risk of both diagnosis and mortality from coronavirus infections (COVID-19) than the general population. Clinicians and disability advocates raised concerns that bias, diagnostic overshadowing, and ableism could impact the allocation of code status and treatment options, for patients with intellectual disabilities, including Down syndrome (DS). To study this, retrospective claims data from the Vizient® Clinical Data Base (used with permission of Vizient, all rights reserved.) of inpatient encounters with pneumonia (PNA) and/or COVID-19 at 825 hospitals from January 2019 to June 2022 were included. Claims data was analyzed for risk of mortality and risk of "Do Not Resuscitate" (DNR) status upon admission, considering patient age, admission source, Elixhauser comorbidities (excluding behavioral health), and DS. Logistic regression models with backward selection were created. In total, 1,739,549 inpatient encounters with diagnoses of COVID-19, PNA, or both were included. After controlling for other risk factors, a person with a diagnosis of DS and a diagnosis of COVID-19 PNA had 6.321 odds ratio of having a DNR status ordered at admission to the hospital compared with those with COVID-19 PNA without DS. The diagnosis of DS had the strongest association with DNR status after controlling for other risk factors. Open and honest discussions among healthcare professionals to foster equitable approaches to EOL care and code status are needed.

The experiences of autistic doctors: a cross-sectional study.

Introduction: Medicine may select for autistic characteristics. As awareness and diagnosis of autism are growing, more medical students and doctors may be discovering they are autistic. No studies have explored the experiences of autistic doctors. This study aimed to fill that gap. Methods: This is a cross-sectional study. A participatory approach was used to identify the need for the project and to modify a pre-existing survey for use exploring the experiences of autistic doctors. Results: We received 225 responses. 64% had a formal diagnosis of autism. The mean age of receiving a formal diagnosis was 36 (range 3-61). Most were currently working as doctors (82%). The most common specialties were general practice / family medicine (31%), psychiatry (18%), and anesthesia (11%). Almost half of those working had completed specialty training (46%) and 40% were current trainees. 29% had not disclosed being autistic to anyone at work. 46% had requested adjustments in the workplace but of these, only half had them implemented.Three quarters had considered suicide (77%), one quarter had attempted suicide (24%) and half had engaged in self-harm (49%). 80% reported having worked with another doctor they suspected was autistic, but only 22% reported having worked with another doctor they knew was autistic. Having never worked with a potentially autistic colleague was associated with having considered suicide.Most preferred to be called "autistic doctors" (64%). Most considered autism to be a difference (83%). Considering autism to be a disorder was associated with preference for the term "doctors with autism," and with having attempted suicide. Conclusion: Autistic doctors reported many challenges in the workplace. This may have contributed to a culture of nondisclosure. Mental health was poor with high rates of suicidal ideation, self-harm, and prior suicide attempts. Despite inhospitable environments, most were persevering and working successfully. Viewing autism as a disorder was associated with prior suicide attempts and a preference for person-first language. A neurodiversity-affirmative approach to autism may lead to a more positive self-identity and improved mental health. Furthermore, providing adequate supports and improving awareness of autistic medical professionals may promote inclusion in the medical workforce.

Top Ten Tips Palliative Care Clinicians Should Know About Navigating the Needs of Adults with Intellectual Disabilities.

As many people with intellectual disabilities (ID) live longer, the need for access to quality palliative care (PC) rises. People with ID realize significant barriers and inequities in accessing health care and PC. The need for integrated disability and PC services with extensive collaboration is great. The following tips are for PC clinicians caring for people with ID, their families, caregivers, and the community. While patient-centered care is difficult to distill into "tips," this article, written by an interdisciplinary team of PC and ID specialists, offers resources and references to improve the care provided to people with ID and serious illnesses.

Catch that word: interactivity, serendipity and verbal fluency in a word production task.

Problem solving outside of the cognitive psychologist's lab unfolds in an environment rich with bodily gesture and material artefacts. We examine this meshwork of internal mental resources, embodied actions and environmental affordances through the lens of a word production task with letter tiles. Forty participants took part in the study which contrasted performance in a high interactivity condition (where participants were able to move letter tiles at will), a low interactivity condition (where movements were restrained) and a shuffle condition (where participants could not move the tiles but were allowed to randomly rearrange the array). Participants were also video recorded to facilitate coding of behaviour. While aggregate performance measures revealed a marginal impact of interactivity on performance, when the participants' behaviour was taken into account, interactivity had a consistent and statistically significant beneficial effect. Detailed, exploratory examination of a subsample of participants informed the formulation of additional hypotheses tested across the full sample: the luckiness of the shuffle in that condition significantly predicted the number of words produced and a more efficient strategy was significantly easier to enact in the high interactivity condition. Additionally, two detailed case studies revealed several moments when accidental changes to the letter tile array offered unplanned words reflecting a serendipitous coagency as well as many moments when environmental chance was ignored. These data and observations indicate that interactivity, serendipity, and internal cognitive resources determine problem-solving performance in this task.

Pediatrician-psychiatrist collaboration to care for children with attention deficit hyperactivity disorder, depression, and anxiety.

OBJECTIVE: To describe pediatrician experiences collaborating with psychiatrists when caring for children with attention deficit hyperactivity disorder (ADHD), depression, and anxiety. METHOD: A random sample of Massachusetts primary care pediatricians completed a mailed self-report survey. RESULTS: Response rate was 50% (100/198). Most pediatricians preferred psychiatrists to initiate medications for anxiety (87%) or depression (85%), but not ADHD (22%). Only 14% of respondents usually received information about a psychiatry consultation. For most (88%), the family was the primary conduit of information from psychiatrists, although few (14%) believed the family to be a dependable informant. Despite this lack of direct communication, most pediatricians reported refilling psychiatry-initiated prescriptions for ADHD (88%), depression (76%), and anxiety (72%). CONCLUSIONS: Pediatricians preferred closer collaboration with psychiatrists for managing children with anxiety and depression, but not ADHD. The communication gap between psychiatrists and pediatricians raises concerns about quality of care for children with psychiatric conditions.

Prognosis of oocyte donation cycles: a prospective comparison of the in vitro fertilization-embryo transfer cycles of recipients who used shared oocytes versus those who used altruistic donors.

OBJECTIVE: To prospectively compare the prognosis of IVF-ET cycles using oocyte sharing vs. cycles using altruistic donors. DESIGN: Prospective cohort prognostic study. SETTING: University teaching hospital. PATIENT(S): A total of 353 consecutive infertile women with premature ovarian failure or diminished ovarian function. INTERVENTION(S): After receipt of institutional ethics approval, IVF-ET was performed with the use of either oocyte sharing (n = 220) or altruistic donors (n = 133). Continuous data (mean + SD [95% confidence interval]) were compared with Student's t test or Mann-Whitney test as appropriate; categoric data were compared with Fisher's exact test, odds ratios (OR), and relative risk (RR). Two-tailed P<.05 was considered significant. Logistic regression was used to adjust for confounding variables. MAIN OUTCOME MEASURE(S): The primary endpoint was clinical pregnancy. The secondary endpoints were E(2) dosage, endometrial thickness, fertilization, embryo quality, and rates of embryo cleavage, transfer, and implantation, positive beta-hCG, and biochemical, ectopic, and multiple pregnancy. RESULT(S): There was no statistically significant difference in clinical pregnancy rates (28.18% vs. 30.08%; OR 0.91 [0.49-1.67]; RR 1.07 [0.69-1.65]; adjusted OR 0.95 [0.51-1.78]). The mean E(2) dosage, endometrial thickness, fertilization rate, embryo score, embryo cleavage, number of embryos transferred, and rates of implantation, positive beta-hCG, and biochemical, ectopic, and multiple pregnancy were similar. CONCLUSION(S): The prognosis with use of shared oocytes is similar to that with altruistic donors.