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Some individuals persist in behaviors that incur harm to themselves or others. While adaptive decision-making requires integrating such punishment feedback to update action selection, the mechanisms driving individual differences in this capacity remain unclear. Here, in a sample spanning 24 countries (N = 267), we used a conditioned punishment task to identify how individuals learn from and adapt to punishment. We identified three, behaviorally robust phenotypes: (1) Sensitive, who correctly inferred punishment causality and adaptively updated decisions through direct experience of punishment; (2) Unaware, who failed to correctly infer punishment causality from direct experience but corrected their decisions following an informational intervention clarifying consequences; and (3) Compulsive, who persisted in harmful decisions despite both punishment and informational intervention. These phenotypes were driven by distinct cognitive mechanisms: (1) causal inference deficits, where individuals misinterpreted punishment causality, impairing correct knowledge acquisition (remediable via targeted informational intervention); and (2) integration failure, a deficit in synthesizing causal knowledge, action valuation, and action selection that rendered decision-making inert to punishment feedback, even after targeted informational intervention. Remarkably, these phenotypes predicted longitudinal outcomes (learning trajectories, choice behavior) six months later. By identifying the cognitive mechanisms driving variation in human punishment learning, this work provides a framework to understand why individuals persist in harmful behavior and highlights the need for approaches to address these distinct cognitive barriers to adaptive decision-making.
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http://dx.doi.org/10.1038/s44271-025-00284-9 | DOI Listing |
J Adv Nurs
September 2025
Department of Sociology and Behavioral Sciences, De La Salle University, Manila, Philippines.
Aim: To explore the potential axiological shift in nursing, drawing upon a critical reading of the new definition of 'nursing' published by the International Council of Nurses (ICN) in June 2025, and to articulate its implications for research and doctoral education.
Design: Critical discussion paper.
Methods: Guided by critical inquiry and emancipatory nursing knowledge development approaches, this paper deploys retroductive analysis to interrogate the axiological commitments that inform and are generated by the 2025 ICN definition and how it relates to nursing research.
JMIR Biomed Eng
August 2025
Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan S Rd, Taipei, 100225, Taiwan, 886 2-2312-3456.
Background: Photoplethysmography (PPG) signals captured by wearable devices can provide vascular age information and support pervasive and long-term monitoring of personal health condition.
Objective: In this study, we aimed to estimate brachial-ankle pulse wave velocity (baPWV) from wrist PPG and electrocardiography (ECG) from smartwatch.
Methods: A total of 914 wrist PPG and ECG sequences and 278 baPWV measurements were collected via the smartwatch from 80 men and 82 women with average age of 63.
Circ Cardiovasc Interv
September 2025
Keele Cardiovascular Research Group, Keele University, United Kingdom (M.A.M., R.B.).
Background: Evidence informing clinical guidelines assumes that all transcatheter aortic valve implantation (TAVI) devices have similar effectiveness, in other words, displaying a class effect across TAVI valves. We aimed to assess the comparative effectiveness of different TAVI platforms relative to other TAVI counterparts or surgical aortic valve replacement (SAVR).
Methods: MEDLINE/Embase/CENTRAL were searched from inception until April 2025, for randomized controlled trials comparing outcomes with different commercially available TAVI devices relative to other TAVI counterparts or SAVR.
Circ Arrhythm Electrophysiol
September 2025
Department of Congenital Heart Disease, Evelina London Children's Hospital, United Kingdom (S. Chivers, T.V., V.Z., S.M., G.M., W.R., E.R., D.F.A.L., T.G.D., O.I.M., G.K.S., J.M.S.).
Background: Fetal tachycardias can cause adverse fetal outcomes including ventricular dysfunction, hydrops, and fetal demise. Postnatally, ECG is the gold standard, but, in fetal practice, echocardiography is used most frequently to diagnose and monitor fetal arrhythmias. Noninvasive extraction of the fetal ECG (fECG) may provide additional information about the electrophysiological mechanism and monitoring of intermittent arrhythmias.
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