Mental Shortcuts Research Articles

Nudgital: Critique of Behavioral Political Economy

Behavioral Economics revolutionized mainstream neo-classical economics. A wide range of psychological, economic and sociological laboratory and field experiments proved human beings deviating from rational choices as standard neo-classical profit maximization axioms failed to explain how human actually behave. Human beings rather use heuristics in their day-to-day decision making. These mental short cuts enable to cope with a complex world yet also often leave individuals biased and falling astray to decision making failures. What followed was the powerful extension of these behavioral insights for public administration and public policy making. Behavioral economists proposed to nudge and wink citizens to make better choices for them and the community. Many different applications of rational coordination followed ranging from improved organ donations, health, wealth and time management, to name a few. Yet completely undescribed remains that the implicit hidden persuasion opens a gate to deception and is an unprecedented social class division means. Social media forces are captures as unfolding a class dividing nudgital society, in which the provider of social communication tools can reap surplus value from the information shared of social media users. The social media provider is outlined as capitalist-industrialist, who benefits from the information shared by social media users, or so-called consumer-workers, who share private information in their wish to interact with friends and communicate to public. The social media capitalist-industrialist reaps surplus value from the social media consumer-workers’ information sharing, which stems from nudging social media users. For one, social media space can be sold to marketers who can constantly penetrate the consumer-worker in a subliminal way with advertisements. But also nudging occurs as the big data compiled about the social media consumer-worker can be resold to marketers and technocrats to draw inferences about consumer choices, contemporary market trends or individual personality cues used for governance control, such as, for instance, border protection and tax compliance purposes. To draw attention to this implicit struggle within society is important for various reasons: Addressing the nudgital society allows to better understand the laws of motion of governance in the digital age, leading to the potentially unequal accumulation and concentration of power. Technological improvement in the age of information has increased the possibilities to control the innocent social media users and reap the benefits of their existence in hidden persuasion. In the age of populism, nudging can be criticized to be used by the ruling class to exploit the governed populace. In modern democracies, the right to rule was recently plundered in democratic votes through misguiding information of alternative facts and fake news circulated on social media. The socio-ethical crises that are rooted in the contradictory class division of the nudgital society are presented in this paper for the first time and from there on demand for further description and research on capitalism and democracy in the digital age. The paper advocates for a democratisation of information, education about nudges and well-informed distribution of transparent governance control.

Judicial Recusal: Cognitive Biases and Racial Stereotyping

For generations, there had been strenuous resistance to the notion that judges are purely rational beings in their legal decision-making. In 1921, U.S. Supreme Court Justice Benjamin Cardozo — who at the time was a judge on the New York Court of Appeals — agreed. Then, in 1930, legal realist Jerome Frank speculated that judicial decisions could reflect such mundane influences as what the judge ate for breakfast. A decade later, when Frank sat on the federal bench, he continued with this line of reasoning. Contemporary judges and legal scholars have underscored the same sentiment. In recent decades, social scientists have demonstrated that people’s cognitive resources are limited. Accordingly, people often use mental shortcuts — heuristics — to solve complex problems. While useful for approximating solutions to problems that would otherwise prove too difficult if tackled directly, these shortcuts sometimes result in erroneous cognitive biases. Research suggests that these errors may influence judicial decision-making. For example, these types of shortcuts may lead to racial stereotypes such as associating race and crime. In turn, such automatic associations may lead to sentencing disparities. In this Article I explore implicit, subconscious race bias in judicial decision-making and its implications for judicial recusal. In Part I, I describe an unmistakable instance of racial stereotyping and prejudice demonstrated by a federal judge, in order to exemplify that judges harbor such attitudes. In Part II, I explore examples of white judges being racially biased against black litigants and what this may mean for judicial recusal. In Parts III and IV, I explore the extent to which black judges can be racially biased against white and black litigants, respectively. Overall, I contend that in light of the complex nature of subconscious race bias, different recusal standards should be used for black and white judges depending upon other contextual considerations.

Selective Exposure and News Media Brands: Implicit and Explicit Attitudes as Predictors of News Choice

ABSTRACTMedia consumers often lack the motivation, time, or cognitive capacity to select content in a deliberate way; instead, they opt for mental shortcuts. Brands are important in this regard because they simplify decision making. In the present study we investigated whether attitudes toward news media brands predict news choice. It is important that we conceptualized attitudes on two different levels: Although explicit attitudes are defined as overtly expressed, more or less deliberate evaluations, implicit attitudes are defined as automatically activated, gut-level evaluations. The supplementary use of implicit attitudes is consistent with current theorizing highlighting that deeply held and sometimes even unconscious evaluations influence media choice. Using a web-based study, we found that implicit and explicit attitudes toward television brands predicted choice. Each attitude construct predicted variance beyond that predicted by the other. We discuss implications by emphasizing the role of automatic, gut-level decision making in current high-choice media environments.

I’m multimodal, aren’t you? How ego-centric anchoring biases experts’ perceptions of travel patterns

Transport professional process an enormous range of information to help them accurately predict how, when and where people will use the transport system. Yet we know from a long-standing history of psychology research that people draw upon a range of mental shortcuts when making estimates about the world. Ego-centric anchoring and adjustment is a common example of a mental heuristic whereby people draw upon their own beliefs and experiences when estimating the behaviors and attitudes of others. Do transport professionals use ego-centric anchoring when estimating travel patterns? To find out we conducted a survey of transportation professionals (n=247) who were asked to reveal their own travel patterns and residential location and to estimate the travel patterns of millennials, generation X, and baby boomers.We find that relative to the average American, transportation professionals in the US are more likely to use alternative transport modes and live in more urban neighborhoods. Transportation professionals systematically over-estimate the use of alternative modes (and under-estimate driving) among other Americans. This effect is strongest among transportation professionals who themselves are multi-modal.These results raise a note of caution for transport practitioners and policy-makers to be aware of one’s initial ‘anchor’ of personal experience when judging the behavior and desires of the community. For example if practitioners overestimate the proportion of Americans that are already walking, biking, and using transit, they may under-estimate the policy and institutional barriers that have led the majority of Americans to follow the car-dominated path of previous generations.

388 Diagnostic heuristics in dermatology: Definitions, advantages and dangers

Sir William Osler famously and ironically stated that Medicine is a science of uncertainty and an art of probability. Indeed, it is only uncertainty that is the sure thing. Medical diagnosis is significantly error prone, with the majority of diagnostic errors being cognitive in nature. Diagnostic reasoning, or how we make diagnoses, is based upon intuitive (System 1) and analytical (System 2) processes. Heuristics or mental shortcuts play an important role in increasing cognitive ease and the speed of our cognitive work. Diagnostic heuristics are not new to the medical literature, however their use is controversial. This presentation will discuss classic diagnostic heuristics as they pertain to the practice of dermatology. Furthermore, a series of unique heuristics relevant to the dermatologist are proposed. Through metacognition, or thinking about how we think, we hope to improve our diagnostic accuracy.

Reducing speeding in web surveys by providing immediate feedback.

It is well known that some survey respondents reduce the effort they invest in answering questions by taking mental shortcuts - survey satisficing. This is a concern because such shortcuts can reduce the quality of responses and, potentially, the accuracy of survey estimates. This article explores "speeding," an extreme type of satisficing, which we define as answering so quickly that respondents could not have given much, if any, thought to their answers. To reduce speeding among online respondents we implemented an interactive prompting technique. When respondents answered faster than a minimal response time threshold, they received a message encouraging them to answer carefully and take their time. Across six web survey experiments, this prompting technique reduced speeding on subsequent questions compared to a no prompt control. Prompting slowed response times whether the speeding that triggered the prompt occurred early or late in the questionnaire, in the first or later waves of a longitudinal survey, among respondents recruited from non-probability or probability panels, or whether the prompt was delivered on only the first or on all speeding episodes. In addition to reducing speeding, the prompts increased response accuracy on simple arithmetic questions for a key subgroup. Prompting also reduced later straightlining in one experiment, suggesting the benefits may generalize to other types of mental shortcuts. Although the prompting could have annoyed respondents, it was not accompanied by a noticeable increase in breakoffs. As an alternative technique, respondents in one experiment were asked to explicitly commit to responding carefully. This global approach complemented the more local, interactive prompting technique on several measures. Taken together, these results suggest that interactive interventions of this sort may be useful for increasing respondents' conscientiousness in online questionnaires, even though these questionnaires are self-administered.

Kahenman and Tversky’s Research on Heuristics and Its Application to Junior Athletic Development and the College Recruiting Process

This paper will apply the work of Amos Tversky and Daniel Kahneman in Prospect theory to the college recruiting process. Prospect theory challenges one of the fundamental ideas of Economics; humans are rational creatures and make rational decisions. The theory demonstrates that in fact, often humans do not make rational decisions and are instead subject to “heuristics”. Heuristics are mental shortcuts individual use to solve problems. The paper will both explain heuristics, as well as demonstrate how coaches, administrators, and junior athletes should be aware of the role of heuristics in both long-termdevelopments, as well as the college recruitment process.

Nudgitize Me! A Behavioral Finance Approach to Minimize Losses and Maximize Profits from Heuristics and Biases

Behavioral Finance is one of the most novel developments in Behavioral Economics. Since the end of the 1970ies a wide range of psychological, economic and sociological laboratory and field experiments proved human beings deviating from rational choices and standard neo-classical profit maximization axioms that fail to explain how human actually behave. Human beings were rather found to use heuristics in the day-to-day decision making. These mental short cuts enable to cope with information overload in a complex world. Behavioral economists proposed to nudge and wink citizens to make better choices for them with many different applications in very many different domains. This paper reviews and proposes how to use mental heuristics, biases and nudges in the finance domain to profit from markets.

Nudgital: Critique of Behavioral Political Economy

Behavioral Economics revolutionized mainstream neo-classical economics. A wide range of psychological, economic and sociological laboratory and field experiments proved human beings deviating from rational choices as standard neo-classical profit maximization axioms failed to explain how human actually behave. Human beings rather use heuristics in their day-to-day decision making. These mental short cuts enable to cope with a complex world yet also often leave individuals biased and falling astray to decision making failures. What followed was the powerful extension of these behavioral insights for public administration and public policy making. Behavioral economists proposed to nudge and wink citizens to make better choices for them and the community. Many different applications of rational coordination followed ranging from improved organ donations, health, wealth and time management, to name a few. Yet completely undescribed remains that the implicit hidden persuasion opens a gate to deception and is an unprecedented social class division means. Social media forces are captures as unfolding a class dividing nudgital society, in which the provider of social communication tools can reap surplus value from the information shared of social media users. The social media provider is outlined as capitalist-industrialist, who benefits from the information shared by social media users, or so-called consumer-workers, who share private information in their wish to interact with friends and communicate to public. The social media capitalist-industrialist reaps surplus value from the social media consumer-workers’ information sharing, which stems from nudging social media users. For one, social media space can be sold to marketers who can constantly penetrate the consumer-worker in a subliminal way with advertisements. But also nudging occurs as the big data compiled about the social media consumer-worker can be resold to marketers and technocrats to draw inferences about consumer choices, contemporary market trends or individual personality cues used for governance control, such as, for instance, border protection and tax compliance purposes. To draw attention to this implicit struggle within society is important for various reasons: Addressing the nudgital society allows to better understand the laws of motion of governance in the digital age, leading to the potentially unequal accumulation and concentration of power. Technological improvement in the age of information has increased the possibilities to control the innocent social media users and reap the benefits of their existence in hidden persuasion. In the age of populism, nudging can be criticized to be used by the ruling class to exploit the governed populace. In modern democracies, the right to rule was recently proven to be plundered in democratic votes through misguiding information of alternative facts and fake news circulated on social media. The socio-ethical crises that are rooted in the contradictory class division of the nudgital society are presented in this paper for the first time and from there on demand for further description and research on capitalism and democracy in the digital age. The paper advocates for a democratisation of information, education about nudges and well-informed distribution of transparent governance control.

Quest for Behavioural Traces the Neural Way : A Study on BSE 100 along with its Oscillators

S&P BSE 100 is a broad-based index in the Indian capital market. They have many a diverse investor groups investing on a daily basis with contrasting ideas, knowledge bases, information inputs, and organic expertise. Presence of cognitive errors or overconfidence in the prediction methodology, heuristic simplification or decisions using mental shortcuts to arrive at quicker but uncertain outcomes, familiarity bias or selecting familiar stuff over more efficient, however, unfamiliar conditions and variables cannot be ruled out. This study, using neural networks on the said index, attempted to identify and determine traces of all the behavioural biases along with the construction of a reasonably accurate prediction model at the same time.

The reflection of crowd behaviour in Indian bourses

Behaviour of investors in stock market continues to be a topic of study for many researchers. When faced with complex situations, investors often rely on mental shortcuts and end up in a biased decision. Of all irrational behaviours, 'herding' is considered as one of the most significant one. The present study aims to identify the presence of herding in Indian stock market during the period 1st April 2005 to 31st March 2015, by taking Sensex as market index and the sectoral indices of BSE. Result shows that there was no indication of herding during the global crisis period of 2007-2008, but market showed the presence of herding during the volatile period of 2011-2012 and to some extent during 2014-2015 period. Overall, the result of the study is an indication of great resilience and rationality of Indian market.

Predicting Perception of Risks and Benefits within Novel Domains

IntroductionRisk perception is inevitably biased. For instance, the relationship between benefits and risks is likely to be inversed in the human mind, even though they are usually positively correlated in real-life environment. People tend to believe that beneficial activities and objects involve only low risks, and vice versa (Sunstein, 2002). Typical examples of this tendency are rather controversial topics, such as GMO, stem cell research, tuition payment, possession of handguns, euthanasia, abortions, vaccination or helping refugees. At the same time, such domains often represent major public health and policy issues since refusing child vaccination or engaging in xenophobic reactions are potentially dangerous tendencies.Thus, analyzing how people assess risks and benefits in such public-interest domains has highly important practical implications. Indeed, behavioral (e.g., Brewer et al., 2007; Renner & Reuter, 2012) and neuroscientific evidence (e.g., Chua et al., 2011; Falk, Berkman, Mann, Harrison, & Lieberman, 2010) on how worried or threatened people feel, predicts real-life behavior with severe consequences for both individuals and society.People often evaluate risks and benefits in complex domains, even though they lack the necessary competence, experience, information and time. They engage in heuristic reasoning, using mental shortcuts based on simple rules such as similarity of the cases or ease of example recall from memory (Tversky & Kahneman, 1974). Employing these principles, they are able to make accurate judgments and decisions, but only in appropriate environments. However, heuristic reasoning can also lead to illusions and errors, especially when it crowds out more systematic thinking. Two of the many well-documented heuristic mechanisms of human reasoning are confirmation bias and credibility heuristic.Confirmation bias is a tendency to favor, seek, interpret, remember and recall information in a way that corresponds to prior expectations, beliefs or hypotheses of the reasoner (Nickerson, 1998). This is a substantial cognitive difficulty, since open-minded critical thinkers should be capable of decoupling their existing views and attitudes from systematic evaluation of arguments and evidence (Stanovich, West, & Toplak, 2013). Distorted information search, interpretation and recall due to confirmation bias have been suggested to explain several robust phenomena of human cognition, e.g. illusory correlation or belief persistence. Highly relevant consequences of this cognitive deviation range from biased evidenceevaluation of jurors to conservativism among scientists (Nickerson, 1998). Interestingly, susceptibility to confirmation bias is unrelated to intelligence (Stanovich et al., 2013).The concept of credibility has been defined in numerous ways: trustworthiness and attractiveness of a source of influence, its prestige, or the history of its previous accuracy (Nesler, Aguinis, Quigley, & Tedeschi, 1993). An important factor closely related to perceptions of trustworthiness, accuracy and validity, and judgments on credibility, is expertise (Hilligoss & Rieh, 2008). People rely on credibility of the source, especially when they lack prior attitudes toward the issues and knowledge about the phenomena (Kumkale, Albarracin, & Seignourel, 2010). Thus, a rule of thumb suggests: the more credible the source of an argument, the stronger the argument.According to recent studies, the use of particular heuristic principles in processing information on risks and benefits is also closely related to people's cultural worldviews.The Cultural Cognition Thesis of Risk PerceptionAccording to the cultural theory of risk (Douglas & Wildavsky, 1983), individuals form beliefs about risks and benefits in a way that reflects and reinforces their commitments to an idealized form of social order. According to their group and grid typology, people can be placed on a two-dimensional scale of individualism/communitarianism and hierarchism/egalitarianism, as depicted in Figure 1. …

Judging the Judiciary by the Numbers: Empirical Research on Judges

Do judges make decisions that are truly impartial? A wide range of experimental and field studies reveal that several extralegal factors influence judicial decision making. Demographic characteristics of judges and litigants affect judges' decisions. Judges also rely heavily on intuitive reasoning in deciding cases, making them vulnerable to the use of mental shortcuts that can lead to mistakes. Furthermore, judges sometimes rely on facts outside the record and rule more favorably toward litigants who are more sympathetic or with whom they share demographic characteristics. On the whole, judges are excellent decision makers and sometimes resist common errors of judgment that influence ordinary adults. The weight of the evidence, however, suggests that judges are vulnerable to systematic deviations from the ideal of judicial impartiality.

Valproate: An Unusual Cause of Hyperammonemic Encephalopathy

Heuristics, or mental shortcuts, are an invaluable resource for quickly making diagnoses and treatment plans for the busy clinician. However, this can sometimes result in incorrect diagnoses unless the clinician actively reassesses his initial diagnosis. We highlight this concept in a patient who presented to the hospital with altered mental status. The patient was initially diagnosed with encephalopathy due to cystitis, but later found to have hyperammonemia due to valproic acid (VPA) toxicity. A 59-year-old female with COPD, hypertension, and bipolar disorder was admitted from a correctional facility with confusion, weakness and nausea. She displayed no signs of encephalopathy prior to her incarceration, which was one month before admission. History could not be obtained as the patient was somnolent. Physical examination revealed generalized abdominal tenderness and asterixis without other stigmata of liver disease. Significant lab results included leukocytosis of 16,000, acute kidney injury with a creatinine of 1.9, and an ALT elevation of 47. A head CT scan was unremarkable and a urinalysis showed pyuria. The patient was treated with IV antibiotics and hydration with a presumptive diagnosis of encephalopathy secondary to cystitis. Further investigation included TSH, ammonia, vitamin B12, RPR, HIV, and urine toxicity screens, of which an elevated ammonia level of 170 umol/L resulted. Given the encephalopathy, hyperammonemia and asterixis, hepatic dysfunction was suspected, but remaining LFTs were within normal range with negative hepatitis serologies. Furthermore, an abdominal USG noted hepatic steatosis without evidence of cirrhosis. It was later found that her dose of VPA was increased two months ago. Of note, the VPA level was within normal limits. VPA was then discontinued and lactulose and L-carnitine were initiated with gradual improvement of her encephalopathy, asterixis, somnolence, and tremor over two days. VPA may cause elevated plasma ammonia resulting in encephalopathy, asterixis and tremor. These symptoms may occur with normal levels mainly seen in chronic therapy, thus creating a misleading presentation suggestive of hepatic dysfunction despite normal LFTs leading to an extensive, yet unnecessary workup. Therefore, clinicians should be aware of these side effects and monitor serum ammonia and VPA levels in patients who present with unexplained encephalopathy or tremors while on VPA.

Understanding pension communications at the organizational level: Insights from bounded rationality theory & implications for HRM

This paper applies concepts from bounded rationality theory to develop an integrative model to understand how pension scheme structure and pension scheme communication impact pension participation and contribution rates at organizational level. Organizational pension policies create framing effects that can have intended and unintended consequences depending on how they impact on employees' cognitive processes. Organizational pension communication policy impacts employee pension outcomes through the interaction between fast-acting, automatic System 1 and deliberative, calculating System 2 that typically endorses and occasionally overrides System 1 judgments. System 1 exhibits mental short-cuts (heuristics) and systematic biases. The likelihood of a System 2 challenge to System 1 depends on the personal, socio-demographic and economic characteristics of the individuals within the workforce. We propose that those within the HR function, who understand framing effects, can develop pension policies that positively affect pension plan outcomes at the organization level, specifically the pension participation and average contribution rates, using a combination of policies that in some cases promote System 2 endorsement and in other cases, System 2 engagement.

Case-based clinical reasoning in feline medicine: 3: Use of heuristics and illness scripts.

This is Article 3 of a three-part series on clinical reasoning that encourages practitioners to explore and understand how they think and make case-based decisions. It is hoped that, in the process, they will learn to trust their intuition but, at the same time, put in place safeguards to diminish the impact of bias and misguided logic on their diagnostic decision-making. Article 1, published in the January 2016 issue of JFMS, discussed the relative merits and shortcomings of System 1 thinking (immediate and unconscious) and System 2 thinking (effortful and analytical). In Article 2, published in the March 2016 issue, ways of managing cognitive error, particularly the negative impact of bias, in making a diagnosis were examined. This final article explores the use of heuristics (mental short cuts) and illness scripts in diagnostic reasoning.

Creating Order: The Role of Heuristics in Website Selection

ABSTRACTHeuristics, or mental shortcuts, can be efficient tools for decision making; however, they can also lead to biases. This study examines how undergraduate students might use heuristics when evaluating websites retrieved from a Google search. Student participants were asked to review a Google search for “genetically modified food” and select the websites they would likely use for an academic project. The Google search was presented in either the original or reversed order. After indicating initial preferences, students reviewed screen shots of six preselected websites from the Google search and rated each on various content attributes, after which they were asked whether they would use each for their research. The order in which participants saw the results affected their initial choices. Participants were more likely to choose the results near the top of the list. Once students evaluated websites on content attributes, the order effects diminished, but were still detectable. When asked to evaluate the websites, students demonstrated an understanding of what to look for and rated them effectively based on their content.

Case-based clinical reasoning in feline medicine: 2: Managing cognitive error.

This is Article 2 of a three-part series on clinical reasoning that encourages practitioners to explore and understand how they think and make case-based decisions. It is hoped that, in the process, they will learn to trust their intuition but, at the same time, put in place safeguards to diminish the impact of bias and misguided logic on their diagnostic decision-making. Article 1, published in the January 2016 issue of JFMS, discussed the relative merits and shortcomings of System 1 thinking (immediate and unconscious) and System 2 thinking (effortful and analytical). This second article examines ways of managing cognitive error, particularly the negative impact of bias, when making a diagnosis. Article 3, to appear in the May 2016 issue, explores the use of heuristics (mental short cuts) and illness scripts in diagnostic reasoning.

The Future of Behavioural Change: Balancing Public Nudging vs Private Nudging

Public authorities, including the European Union and its Member States, are increasingly interested in exploiting behavioral insights through public action. They increasingly do so through choice architecture, i.e. the alteration of the environment of choice surrounding a particular decision making context in areas as diverse as energy consumption, tax collection and public health. In this regard, it is useful to distinguish between two situations. The first is that of a public authority which seeks to steer behaviour in the public interest, taking into account one or more mental shortcuts. Thus, a default enrollment for organ donation leverages on the power of inertia to enhance the overall prevalence organ donors. Placing an emoticon (sad face) or a set of information about average consumption on a prohibitive energy bill has the potential to nudge consumers towards less energy consumption. I call this pure public nudging. The second perspective is when public authorities react to exploitative uses of mental shortcuts by market forces by regulating private nudging. I call this 'counter-nudging'. Pure public nudging helps people correct mental shortcuts so as to achieve legitimate objectives (e.g. increased availability of organs, environmental protection, etc.), regardless of their exploitative use by market forces. It is against this proposed taxonomy that the 2nd AIM Lecture examines whether also private companies may nudge for good. Are corporations well-placed to nudge their customers towards societal objectives, such as the protection of the environment or the promotion of public health? This is what I call benign corporate nudging. Their record is far from being the most credible. Companies have used behavioural inspired interventions to maximize profits, what led them to sell more and in turn to induce citizens into more consumption. Yet corporate marketing need not always be self-interested. An incipient number of companies are using their brand, generally through their packaging and marketing efforts, to 'nudge for good'. By illustrating some actual examples, this lecture defines the conditions under which companies may genuinely and credibly nudge for good. It argues that benign corporate nudging may have – unlike dominant CSR efforts – a positive long-term, habit-forming effect that influences consumers' future behaviour 'for good'.

Case-based clinical reasoning in feline medicine: 1: Intuitive and analytical systems.

This is Article 1 of a three-part series on clinical reasoning that encourages practitioners to explore and understand how they think and make case-based decisions. It is hoped that, in the process, they will learn to trust their intuition but, at the same time, put in place safeguards to diminish the impact of bias and misguided logic on their diagnostic decision-making. This first article discusses the relative merits and shortcomings of System 1 thinking (immediate and unconscious) and System 2 thinking (effortful and analytical). Articles 2 and 3, to appear in the March and May 2016 issues of JFMS, respectively, will examine managing cognitive error, and use of heuristics (mental short cuts) and illness scripts in diagnostic reasoning.