Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Thinking fast and slow.

Following the 2016 U.S. presidential election, many have expressed concern about the effects of false stories (“fake news”), circulated largely through social media. We discuss the economics of fake news and present new data on its consumption prior to the election. Drawing on web browsing data, archives of fact-checking websites, and results from a new online survey, we find: (i) social media was an important but not dominant source of election news, with 14 percent of Americans calling social media their “most important” source; (ii) of the known false news stories that appeared in the three months before the election, those favoring Trump were shared a total of 30 million times on Facebook, while those favoring Clinton were shared 8 million times; (iii) the average American adult saw on the order of one or perhaps several fake news stories in the months around the election, with just over half of those who recalled seeing them believing them; and (iv) people are much more likely to believe stories that favor their preferred candidate, especially if they have ideologically segregated social media networks.

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Social Media and Fake News in the 2016 Election

NUDGE: IMPROVING DECISIONS ABOUT HEALTH, WEALTH, AND HAPPINESS by Richard H. Thaler and Cass R. Sunstein Penguin Books, 2009, 312 pp, ISBN 978-0-14-311526-7This book is best described formally as a general explanation of and advocacy for libertarian paternalism, a term coined by the authors in earlier publications. Informally, it is about how leaders, systems, organizations, and governments can nudge people to do the things the nudgers want and need done for the betterment of the nudgees, or of society. It is paternalism in the sense that "it is legitimate for choice architects to try to influence people's behavior in order to make their lives longer, healthier, and better", (p. 5) It is libertarian in that "people should be free to do what they like - and to opt out of undesirable arrangements if they want to do so", (p. 5) The built-in possibility of opting out or making a different choice preserves freedom of choice even though people's behavior has been influenced by the nature of the presentation of the information or by the structure of the decisionmaking system. I had never heard of libertarian paternalism before reading this book, and I now find it fascinating.Written for a general audience, this book contains mostly social and behavioral science theory and models, but there is considerable discussion of structure and process that has roots in mathematical and quantitative modeling. One of the main applications of this social system is economic choice in investing, selecting and purchasing products and services, systems of taxes, banking (mortgages, borrowing, savings), and retirement systems. Other quantitative social choice systems discussed include environmental effects, health care plans, gambling, and organ donations. Softer issues that are also subject to a nudge-based approach are marriage, education, eating, drinking, smoking, influence, spread of information, and politics. There is something in this book for everyone.The basis for this libertarian paternalism concept is in the social theory called "science of choice", the study of the design and implementation of influence systems on various kinds of people. The terms Econs and Humans, are used to refer to people with either considerable or little rational decision-making talent, respectively. The various libertarian paternalism concepts and systems presented are tested and compared in light of these two types of people. Two foundational issues that this book has in common with another book, Network of Echoes: Imitation, Innovation and Invisible Leaders, that was also reviewed for this issue of the Journal are that 1 ) there are two modes of thinking (or components of the brain) - an automatic (intuitive) process and a reflective (rational) process and 2) the need for conformity and the desire for imitation are powerful forces in human behavior. …

Nudge: Improving Decisions about Health, Wealth, and Happiness

The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.

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Using social and behavioural science to support COVID-19 pandemic response.

Base-rate neglect refers to the tendency for people to underweight base-rate probabilities in favor of diagnostic information. It is commonly held that base-rate neglect occurs because effortful (Type 2) reasoning is required to process base-rate information, whereas diagnostic information is accessible to fast, intuitive (Type 1) processing (e.g., Kahneman & Frederick, 2002). To test this account, we instructed participants to respond to base-rate problems on the basis of "beliefs" or "statistics," both in free time (Experiments 1 and 3) and under a time limit (Experiment 2). Participants were given problems with salient stereotypes (e.g., "Jake lives in a beautiful home in a posh suburb") that either conflicted or coincided with base-rate probabilities (e.g., "Jake was randomly selected from a sample of 5 doctors and 995 nurses for conflict; 995 doctors and 5 nurses for nonconflict"). If utilizing base-rates requires Type 2 processing, they should not interfere with the processing of the presumably faster belief-based judgments, whereas belief-based judgments should always interfere with statistics judgments. However, base-rates interfered with belief judgments to the same extent as the stereotypes interfered with statistical judgments, as indexed by increased response time and decreased confidence for conflict problems relative to nonconflict. These data suggest that base-rates, while typically underweighted or neglected, do not require Type 2 processing and may, in fact, be accessible to Type 1 processing.

Base rates: both neglected and intuitive.

Studies on human reasoning have long established that intuitions can bias inference and lead to violations of logical norms. Popular dual-process models, which characterize thinking as an interacti...

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Logic, Fast and Slow: Advances in Dual-Process Theorizing:

The cognitive reflection test (CRT) is a widely used measure of the propensity to engage in analytic or deliberative reasoning in lieu of gut feelings or intuitions. CRT problems are unique because they reliably cue intuitive but incorrect responses and, therefore, appear simple among those who do poorly. By virtue of being composed of so-called “trick problems” that, in theory, could be discovered as such, it is commonly held that the predictive validity of the CRT is undermined by prior experience with the task. Indeed, recent studies have shown that people who have had previous experience with the CRT score higher on the test. Naturally, however, it is not obvious that this actually undermines the predictive validity of the test. Across six studies with ~ 2,500 participants and 17 variables of interest (e.g., religious belief, bullshit receptivity, smartphone usage, susceptibility to heuristics and biases, and numeracy), we did not find a single case in which the predictive power of the CRT was significantly undermined by repeated exposure. This occurred despite the fact that we replicated the previously reported increase in accuracy among individuals who reported previous experience with the CRT. We speculate that the CRT remains robust after multiple exposures because less reflective (more intuitive) individuals fail to realize that being presented with apparently easy problems more than once confers information about the task’s actual difficulty.

https://link.springer.com/content/pdf/10.3758%2Fs13428-017-0963-x.pdf

The cognitive reflection test is robust to multiple exposures

What are the psychological consequences of the increasingly politicized nature of the COVID-19 pandemic in the United States relative to similar Western countries? In a two-wave study completed early (March) and later (December) in the pandemic, we found that polarization was greater in the United States (N = 1,339) than in Canada (N = 644) and the United Kingdom. (N = 1,283). Political conservatism in the United States was strongly associated with engaging in weaker mitigation behaviors, lower COVID-19 risk perceptions, greater misperceptions, and stronger vaccination hesitancy. Although there was some evidence that cognitive sophistication was associated with increased polarization in the United States in December (but not March), cognitive sophistication was nonetheless consistently negatively correlated with misperceptions and vaccination hesitancy across time, countries, and party lines. Furthermore, COVID-19 skepticism in the United States was strongly correlated with distrust in liberal-leaning mainstream news outlets and trust in conservative-leaning news outlets, suggesting that polarization may be driven by differences in information environments.

https://journals.sagepub.com/doi/pdf/10.1177/01461672211023652

Beliefs About COVID-19 in Canada, the United Kingdom, and the United States: A Novel Test of Political Polarization and Motivated Reasoning.

We provide evidence that religious skeptics, as compared to believers, are both more reflective and effective in logical reasoning tasks While recent studies have reported a negative association between an analytic cognitive style and religiosity, they focused exclusively on accuracy, making it difficult to specify potential underlying cognitive mechanisms The present study extends the previous research by assessing both performance and response times on quintessential logical reasoning problems (syllogisms) Those reporting more religious skepticism made fewer reasoning errors than did believers This finding remained significant after controlling for general cognitive ability, time spent on the problems, and various demographic variables Crucial for the purpose of exploring underlying mechanisms, response times indicated that skeptics also spent more time reasoning than did believers This novel finding suggests a possible role of response slowing during analytic problem solving as a component of cognitive style that promotes overriding intuitive first impressions Implications for using additional processing measures, such as response time, to investigate individual differences in cognitive style are discussed

https://link.springer.com/content/pdf/10.3758%2Fs13423-013-0394-3.pdf

Gordon Pennycook

Papers

Base rates: both neglected and intuitive.

Logic, Fast and Slow: Advances in Dual-Process Theorizing:

The cognitive reflection test is robust to multiple exposures

Beliefs About COVID-19 in Canada, the United Kingdom, and the United States: A Novel Test of Political Polarization and Motivated Reasoning.

Belief bias during reasoning among religious believers and skeptics.