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Metacognition can improve with practice, yet the mechanisms underlying metacognitive skill learning remain unclear and lack a robust theoretical framework. We propose that metacognitive skill learning can be largely explained by the skill acquisition model advanced by Fitts (1964) and Anderson (1982). While this model has been successful within the domains of motor skill and cognitive skill, it has not yet been applied to metacognitive skill. This novel framework can help to explain metacognitive skill learning, its cognitive underpinnings, and shed light on otherwise unexplainable empirical data.

Dennett’s (1981) call to use computational frameworks in philosophical analysis can assist in clarifying the distinction between System-1 and System-2 metacognition. Metacognition has been described as “cognition about cognitive phenomena” (Flavell, 1979) and is renowned for its particularly difficult issues. Understanding its “mysterious mechanisms” (Brown, 1987) has been obscured by the subject’s abstractness and disputed terminology. Computation is uniquely suited to overcome these barriers as it forces definitional clarity. New research is supportive of the Common Model of Cognition as the best candidate for computationally modeling the functional organization of the human brain (Stocco et al., 2021). The Common Model represents a powerful tool for investigating unresolved cognitive issues as it is informed by a convergence of research and is well-defined. We propose that applying the Common Model as a philosophical tool can assist in clarifying the problematic distinction between System-1 and System-2 metacognition.

ObjectiveMany patients with subacute stroke rely on the nonparetic arm and leg to propel manual wheelchairs. We designed a bimanual, lever-driven wheelchair (LARA) to promote overground mobility and hemiparetic arm exercise. This study measured the feasibility of using LARA to increase arm movement, achieve mobility, and improve arm motor recovery (clinicaltrials.gov/ct2/show/NCT02830893).DesignRandomized, assessor-blind, controlled trial.SettingTwo inpatient rehabilitation facilities.SubjectsNineteen patients with subacute stroke (1 week to 2 months post-stroke) received 30 minutes extra arm movement practice daily, while admitted to inpatient rehabilitation (n = 10) or before enrollment in outpatient therapy (n = 9).InterventionsPatients were randomized to train with the LARA wheelchair (n = 11) or conventional exercises with a rehabilitation therapist (n = 8).Main measuresNumber of arm movements per training session; overground speed; Upper Extremity Fugl-Meyer score at three-month follow-up.ResultsParticipants who trained with LARA completed 254 (median) arm movements with the paretic arm each session. For three participants, LARA enabled wheelchair mobility at practical indoor speeds (0.15-0.30 m/s). Fugl-Meyer score increased 19 ± 13 points for patients who trained with LARA compared to 14 ± 7 points with conventional exercises (P = 0.32). Secondary measures including shoulder pain and increased tone did not differ between groups. Mixed model analysis found significant interaction between LARA training and treatment duration (P = 0.037), informing power analysis for future investigation.ConclusionsPractising arm movement with a lever-driven wheelchair is a feasible method for increasing arm movement early after stroke. It enabled wheelchair mobility for a subset of patients and shows potential for improving arm motor recovery.

Metacognitive control is the deliberate manipulation of cognitive states such as attentional control and emotional regulation (Flavell, 1979). Metacognitive control is known to improve with practice to become more skillful, yet the mechanisms for developing metacognitive skills remains unclear. I propose that metacognitive skills can be explained through the skills acquisition model advanced by Fitts and Posner (1967) and Anderson (1982). This account will focus on the process of proceduralization, where declarative task knowledge is converted into procedural knowledge. This model has been well researched in the development of both motor skills and cognitive skills (Ford et al., 2005; Anderson, 2007). To date, the model has not yet been robustly applied to the acquisition of metacognitive skills. As Anderson used an ACT-R model to frame his account of cognitive skills, I will apply an ACT-R model to account for the development of metacognitive skills.

I present a novel method of conceptualizing metacognition in a computational hierarchy. Metacognition is commonlydescribed as cognition acting on itself, and correlates with enhanced performance in memory, reasoning, emotional reg-ulation, and motor skills. Understanding metacognition requires surmounting two barriers: its high-level abstraction anddisputed terminology. To overcome these barriers I employ a computational cognitive architecture to first define the baseunits of cognition and how they come to act on themselves. Well-defined computational units are built up into a hierarchyof cognitive processes. These forms of cognition are then connected back to clarify the research literature. Each formis built into working models within ACT-R to support this hierarchical systems viability. The intention of this hierar-chical model is to help clarify the nature of metacognition by supplementing verbal cognitive definition with rigorouscomputational terminology.

Background Public health unit (PHU) engagement in schools is important for promoting wellness in students. We aimed to investigate if PHU engagement with schools may have provided protection against the risk of depression and anxiety in students during the COVID-19 pandemic. Methods We used longitudinal data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour survey between the 2018/19 and 2020/21 academic years. Multilevel models were used to assess the association between PHU engagement with school mental health programs prior to the COVID-19 pandemic and depressive (Center for Epidemiologic Studies Depression scale Revised) and anxiety symptoms (Generalized Anxiety Disorder scale) during the COVID-19 pandemic. Results The sample included 23 894 students across 104 secondary schools in British Columbia, Alberta, Ontario and Quebec. In confounder-adjusted models, PHU engagement before the pandemic was not associated with student depressive symptoms (B = −0.01, 95% CI = −0.04, 0.02), but was protective against anxiety symptoms (B = −0.03, −0.06, 0.001) during the COVID-19 pandemic. Discussion The results highlight that PHU engagement with mental health programming in schools was protective against anxiety for students during the COVID-19 pandemic. The findings support the importance of PHU engagement for improving student mental health and pandemic recovery. [ABSTRACT FROM AUTHOR]

Background and Aims: Heavy episodic drinking (HED) trends have not been comprehensively examined in Canada. We measured age, period and birth cohort trends in HED in Canada by sex/gender and socioeconomic position. Design and setting. We analyzed repeat cross‐sectional data from the 10 provinces in the Canadian Community Health Surveys from 2000 to 2021 using hierarchical cross‐classified random effects logistic regression. Participants: 1 167 831 respondents aged 12+. Measurements: HED was defined as 4+ standard drinks for women or 5+ for men at least monthly in the past 12 months. Socioeconomic position was measured using household income and education. Findings We observed steeper HED decreases in young adult men (aged 18–29) than women (by 14.4% and 8.7%, respectively, from 2015 to 2021) and HED increases in middle adult women (ages 50–64) (by 8.0% from 2000 to 2014). Sex/gender‐specific age‐period‐cohort models revealed strong age and birth cohort effects. In women and men, respectively, HED peaked in young adulthood (18.2% and 33.8%) and decreased with age, and HED was greatest in the 1980–1989 cohort (20.7% and 35.8%) and decreased in the most recent cohort born in 1990–2009 (15.6% and 19.8%), particularly in men. Higher household incomes had greater HED across age, periods and cohorts, while trends varied by education. Compared with lower education groups, people with a bachelor's degree or above had the lowest HED in middle adulthood. People with a bachelor's degree or above had low HED in earlier cohorts, which converged with other education groups in recent cohorts due to a pronounced HED increase, particularly in women. Conclusion: The sex/gender gap in heavy episodic drinking (HED) appears to be converging in Canada: current young adult men are reducing HED, while high‐risk cohorts of women are aging into middle adulthood with greater HED. Recent birth cohorts with a bachelor's degree or above experienced pronounced HED increases, which among women suggests greater educational attainment contributes to the converging gender gap in HED. [ABSTRACT FROM AUTHOR]

Metacognitive research is integral to understanding cognition, but a problem persists metacognition remains poorly definedand its basic terminology contested. To address this problem, we propose a new philosophical method for understandingmetacognition in a bottom up, computational way. We follow John Andersons principle that complex problems becomesystematic when analyzed within a cognitive model. Researchers agree that metacognition is cognition acting upon itself.Accepting this, we first define the fundamental units of cognition and then define how these units act upon themselves.We ground this within human cognition by using the Standard Model of Cognition (Laird et at. 2017, also known asthe Common Model). This model defines the mechanisms common to all computational architectures modeling humancognition. Our model is then compared to metacognitive theories within psychology, philosophy, and neuroscience. Thismethod clarifies metacognition by grounding it both within a computational cognitive architecture and present researchliterature.

Many people with a stroke have a severely paretic arm, and it is often assumed that they are unable to learn novel, skilled behaviors that incorporate use of that arm. Here, we show that a group of people with chronic stroke (n = 5, upper extremity Fugl-Meyer scores: 31, 30, 26, 22, 8) learned to use their impaired arm to propel a novel, yoked-clutch lever drive wheelchair. Over six daily training sessions, each involving about 134 training movements with their "useless" arm, the users gradually achieved a 3-fold increase in wheelchair speed on average, with a 4-6 fold increase for three of the participants. They did this by learning a bimanual skill: pushing the levers with both arms while activating the yoked-clutches at the right time with their ipsilesional (i.e. "good") hand to propel the wheelchair forward. They perceived the task as highly motivating and useful. The speed improvements exceeded a 1.5-factor improvement observed when young, unimpaired users learned to propel the chair. The learning rate also exceeded a sample of learning rates from a variety of classic learning studies. These results suggest that appropriately-designed assistive technologies (or "unmasking technologies - UTs") can unleash a powerful, latent ability for motor learning even for severely paretic arms. While UTs may not reduce clinical impairment, they may facilitate large improvements in a specific functional ability.

Background and aims: Alcohol retail access is associated with alcohol use and related harms. This study measured whether this association differs for people with and without heavy and disordered patterns of alcohol use. Design: The study used a repeated cross‐sectional analysis of health administrative databases. Setting, participants/cases: All residents of Ontario, Canada aged 10–105 years with universal health coverage (n = 10 677 604 in 2013) were included in the analysis. Measurements Quarterly rates of emergency department (ED) and outpatient visits attributable to alcohol in 464 geographic regions between 2013 and 2019 were measured. Quarterly off‐premises alcohol retail access scores were calculated (average drive to the closest seven stores) for each geographic region. Mixed‐effect linear regression models adjusted for area‐level socio‐demographic covariates were used to examine associations between deciles of alcohol retail access and health‐care visits attributable to alcohol. Stratified analyses were run for individuals with and without prior alcohol‐attributable health‐care use in the past 2 years. Findings We included 437 707 ED visits and 505 271 outpatient visits attributable to alcohol. After adjustment, rates of ED visits were 39% higher [rate ratio (RR) = 1.39, 95% confidence interval (CI) = 1.20–1.61] and rates of outpatient visits were 49% higher (RR = 1.49, 95% CI = 1.26–1.75) in the highest versus lowest decile of alcohol access. There was a positive association between alcohol access and outpatient visits attributable to alcohol for individuals without prior health‐care attributable to alcohol (RR = 1.65, 95% CI = 1.39–1.95 for the highest to lowest decile of alcohol access) but not for individuals with prior health‐care attributable to alcohol (RR = 1.08, 95% CI = 0.90–1.30). There was a positive association between alcohol access and ED visits attributable to alcohol for individuals with and without prior health‐care for alcohol for ED visits. Conclusion: In Ontario, Canada, greater alcohol retail access appears to be associated with higher rates of emergency department (ED) and outpatient health‐care visits attributable to alcohol. Individuals without prior health‐care for alcohol may be more susceptible to greater alcohol retail access for outpatient but not ED visits attributable to alcohol. [ABSTRACT FROM AUTHOR]