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Brain Imaging, Behavior Research Shows Physicians Learn More by Paying Attention to Failure

By MedImaging International staff writers
Posted on 15 Dec 2011

A recent study on physicians’ decision-making processes has revealed that those who pay attention to failures as well as successes become more skillful at choosing the appropriate treatment. The researchers also discovered that all the physicians in the study included irrelevant criteria in their decisions about treatment.

“We found that all the physicians in the study included irrelevant criteria in their decisions,” said Read Montague, PhD, director of the Human Neuroimaging Laboratory at the Virginia Tech Carilion Research Institute (Roanoke, VA,USA), who led the study. “Notably, however, the most experienced doctors were the poorest learners.”

The research was published in the November 23, 2011, issue of PLoS One, the Public Library of Science open-access journal, and authored by Jonathan Downar, MD, PhD, assistant professor of psychiatry at the University of Toronto (Canada) and Toronto Western Hospital; Meghana Bhatt, PhD, assistant research professor at Beckman Research Institute, the City of Hope Hospital (Duarte, CA, USA) and Dr. Montague.

The researchers employed functional magnetic resonance imaging (fMRI) to image the brain activity of 35 experienced physicians in a range of nonsurgical specialties as they made decisions. The clinicians were told to select between two treatments for a series of simulated patients in an emergency room setting. “First they had a chance to learn by experience which of two medications worked better in a series of 64 simulated heart-attack patients, based on a simplified history with just six factors,” said Dr. Bhatt.

Unknown to the test subjects, of the six factors, only one was actually relevant to the decision: diabetes status. One medication had a 75% success rate in patients with diabetes, but only a 25% success rate in patients without diabetes. The other had the opposite profile. The physicians had 10 seconds to select a treatment. Then they were briefly presented with an outcome of “SUCCESS: (heart attack) aborted” or “FAILURE: No response.”

“After the training, we tested the physicians to see how often they were able to pick the better drug in a second series of 64 simulated patients,” said Dr. Bhatt. “When we looked at their performance, the doctors separated into two distinct groups. One group learned very effectively from experience, and chose the better drug more than 75% of the time. The other group was terrible; they chose the better drug only at coin-flipping levels of accuracy, or half the time, and they also came up with inaccurate systems for deciding how to prescribe the medications, based on factors that didn’t matter at all.”

In fact, all the physicians reported including at least one of the five irrelevant factors, such as age or previous heart attack, in their decision process. “The brain imaging showed us a clear difference in the mental processes of the two groups,” said Dr. Montague. “The high performers activated their frontal lobes when things didn’t go as expected and the treatments failed.” Such activity showed that the doctors learned from their failures, he said. These physicians gradually improved their performance.

In contrast, the low performers activated their frontal lobes when things did go as expected, according to Dr. Bhatt. “In other words, they succumbed to ‘confirmation bias,’ ignoring failures and learning only from the successful cases. Each success confirmed what the low performers falsely believed they already knew about which treatment was better.” The researchers dubbed this counterproductive learning pattern “success-chasing.”

“The problem with remembering successes and ignoring failures is that it doesn’t leave us any way to abandon our faulty ideas. Instead, the ideas gain strength from each chance success, until they evolve into something like a superstition,” said Dr. Downar.

The fMRI scanning revealed that an area of the brain called the nucleus accumbens “showed significant anticipatory activation well before the outcome of the trial was revealed, and this anticipatory activation was significantly greater prior to successful outcomes,” Dr. Montague stated. “Based on the outcome of the training phase, we were actually able to predict results in the testing phase for each low-performing subject’s final set of spurious treatment rules.”

The authors stated in the article that the formation of false beliefs is universal, such as an athlete’s belief in a lucky hat. “But the good news is that physicians can probably be trained to think more like the high performers,” said Dr. Downar. “I tell my students to remember three things: First, when you’re trying to work out a diagnosis, remember to also ask the questions that would prove your hunches wrong. Second, when you think you have the answer, think again, and go through the possible alternatives. Third, if the treatment isn’t going as expected, don't just brush it off ask yourself what you could have missed.”

“These findings underscore the dangers of disregarding past failures when making high-stakes decisions,” concluded Dr. Montague. “‘Success-chasing’ not only can lead doctors to make flawed decisions in diagnosing and treating patients, but it can also distort the thinking of other high-stakes decision-makers, such as military and political strategists, stock market investors, and venture capitalists.”

Related Links:
Virginia Tech Carilion Research Institute
University of Toronto
Beckman Research Institute, the City of Hope Hospital

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55 (58.889389038086): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738486 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (681.87713623047): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738486 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1702.0702362061): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

58 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

59 (104.18891906738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

60 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

61 (77.962875366211): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (524.04403686523): SELECT fid FROM jos_deeppockets WHERE id=294738486 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738486 AND published='1' LIMIT 1

63 (287.05596923828): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (74.148178100586): select jos_twitters.link from jos_twitters where cat=10

65 (69.141387939453): select jos_facebook.link from jos_facebook where cat=10

66 (50.067901611328): select jos_google_plus.link from jos_google_plus where cat=10

67 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

68 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE id=294738486 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738486 AND published='1' LIMIT 1

69 (33.140182495117): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (365.01884460449): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738486 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (247.95532226562): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738486 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (42.915344238281): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (55.074691772461): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738486 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (34.093856811523): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738486 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (32.901763916016): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 1438.1408691406): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

105 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

106 (61.988830566406): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738486 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (74.148178100586): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738486 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

109 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

110 (48.87580871582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294738486 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (621.79565429688): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294738486 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (592.94700622559): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (403.16581726074): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

115 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

116 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

117 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

118 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

119 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

120 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

121 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

122 (339.98489379883): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 21271.944046021): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (504.0168762207): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738486 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738486 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7658.9584350586): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (66.041946411133): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (76.055526733398): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (64.13459777832): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (362.87307739258): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (54.121017456055): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (70.095062255859): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (541.92543029785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (399.82795715332): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (207.18574523926): SELECT name FROM jos_deeppockets WHERE id=212

138 (31.948089599609): SELECT name FROM jos_deeppockets WHERE id=212

139 (691.89071655273): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (470.16143798828): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

142 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

143 (!!!!! 8216.1426544189): TRUNCATE TABLE jos_trademed_module

144 (119.92454528809): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738486 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (61.988830566406): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738486 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (842.80967712402): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

149 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

150 (!!!!! 1143.9323425293): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

152 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

153 (88.930130004883): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738486 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738486 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (46.014785766602): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (52.928924560547): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (59.127807617188): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (178.81393432617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

158 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738486 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738486 AND published='1' LIMIT 1

159 (44.822692871094): select jos_twitters.link from jos_twitters where cat=10

160 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

161 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

163 (338.07754516602): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1054.048538208): insert into jos_banners_delta values (14615,'2025-06-26 21:25:19','216.73.216.249','view'),(14202,'2025-06-26 21:25:19','216.73.216.249','view'),(14203,'2025-06-26 21:25:19','216.73.216.249','view')

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