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Varner-Perez SE, Hoffman SM, Coleman-Phox K, Bhamidipalli S, Monahan PO, Kuppermann M, Tucker Edmonds B. Feasibility and acceptability of chaplain decision coaching on Periviable resuscitation decision quality: A pilot study. PEC Innov 2024; 4:100266. [PMID: 38440389 PMCID: PMC10909622 DOI: 10.1016/j.pecinn.2024.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
Objective To pilot test and assess the feasibility and acceptability of chaplain-led decision coaching alongside the GOALS (Getting Optimal Alignment around Life Support) decision support tool to enhance decision-making in threatened periviable delivery. Methods Pregnant people admitted for threatened periviable delivery and their 'important other' (IO) were enrolled. Decisional conflict, acceptability, and knowledge were measured before and after the intervention. Chaplains journaled their impressions of training and coaching encounters. Descriptive analysis and conventional content analysis were completed. Results Eight pregnant people and two IOs participated. Decisional conflict decreased by a mean of 6.7 (SD = 9.4) and knowledge increased by a mean of 1.4 (SD = 1.8). All rated their experience as "good" or "excellent," and the amount of information was "just right." Participants found it "helpful to have someone to talk to" and noted chaplains helped them reach a decision. Chaplains found the intervention a valuable use of their time and skillset. Conclusion This is the first small-scale pilot study to utilize chaplains as decision coaches. Our results suggest that chaplain coaching with a decision support tool is feasible and well-accepted by parents and chaplains. Innovations Our findings recognize chaplains as an underutilized, yet practical resource in value-laden clinical decision-making.
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Affiliation(s)
- Shelley E. Varner-Perez
- Department of Spiritual Care and Chaplaincy, Indiana University Health, Indianapolis, Indiana, USA
| | - Shelley M. Hoffman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sruthi Bhamidipalli
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patrick O. Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Brownsyne Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Rosa D, Villa G, Amigoni C, Rossetti AM, Guberti M, Ghirotto L, Manara DF. Role of emotions in the clinical decision-making process of the hospital nurse: A multicentre qualitative study. MethodsX 2024; 12:102590. [PMID: 38322133 PMCID: PMC10844854 DOI: 10.1016/j.mex.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
While for a long-time emotional reaction and moral distress, have been primarily investigated for the possible outcomes of the nursing decision-making process rather than in terms of their role as antecedents of the final decision taken. The primary study's aim is to explore how inpatient nurses' decision-making takes place in different care settings, with a special focus on the role played by emotions during decision-making. The secondary aim is to explore the subjective experience of hospital nurses in relation to successful and unsuccessful decision-making situations. Multicentre qualitative study, consisting of three phases with different designs: participatory study, grounded theory study, and phenomenological study. Participants will be nurses and may be doctors with various levels of professional experience working in hospital, outpatient, or ward settings. Participants will be recruited through different sampling (purposive and convenience). Data will be collected through focus groups and in-depth interviews with nurses working in different hospital care settings. The researchers expect to find themes that will contribute to a better understanding of the role of emotions in decision-making. The results of this study have the potential of providing important implications to support nurses in the recognition and management of their emotions during the decision-making process.
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Affiliation(s)
- Debora Rosa
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
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Daniel AM, van Exel J, Chorus CG. Self-interest, positional concerns and distributional considerations in healthcare preferences. Eur J Health Econ 2024; 25:423-446. [PMID: 37212891 DOI: 10.1007/s10198-023-01597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
Efficiently allocating scarce healthcare resources requires nuanced understanding of individual and collective interests as well as relative concerns, which may overlap or conflict. This paper is the first to empirically investigate whether and to what extent self-interest (SI), positional concerns (PC) and distributional considerations (DC) simultaneously explain individual decision making related to access to healthcare services. Our investigation is based on a stated choice experiment conducted in two countries with different healthcare systems, the United States (US) and the United Kingdom (UK). The choice experiment is on allocation of medical treatment waiting times for a hypothetical disease. We carry out the investigation under two different perspectives: (i) in a socially inclusive personal perspective decision makers were asked to choose between waiting time distributions for themselves and (ii) in a social perspective decision makers were asked to make similar choices for a close relative or friend of opposite gender. The results obtained by estimating a variety of advanced choice models indicate that DC, SI and PC, in this order of importance, are significant drivers of choice behaviour in our empirical context. These findings are consistent regardless of the choice perspective and the country where decision makers live. Comparing the results from different choice perspectives, we find that US respondents who chose for their close relative or friend attach significantly larger weight to their close relative's or friend's waiting times as well as to the overall distribution of waiting times than US respondents who chose for themselves. Looking at differences between countries, our results show that UK respondents who made choices for themselves placed significantly larger weight on SI and DC than US respondents, while US respondents, in turn, displayed relatively stronger but not significantly different positional concerns than UK respondents. In addition, we observe that UK respondents who chose for their close relative or friend put a larger weight on DC than their US counterparts. We conclude that the methodological (data collection and analysis) approach allows for disentangling the relative importance of the three motivations and discusses the potential implications of these findings for healthcare decision making.
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Affiliation(s)
- Aemiro Melkamu Daniel
- Department of Economics, Swedish University of Agricultural Sciences, Ulls Väg 27, 756 51, Uppsala, Sweden.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Caspar G Chorus
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE, Delft, The Netherlands
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628BX, Delft, The Netherlands
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4
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Chernoff CS, Hynes TJ, Schumacher JD, Ramaiah S, Avramidis DK, Mortazavi L, Floresco SB, Winstanley CA. Noradrenergic regulation of cue-guided decision making and impulsivity is doubly dissociable across frontal brain regions. Psychopharmacology (Berl) 2024; 241:767-783. [PMID: 38001266 DOI: 10.1007/s00213-023-06508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
RATIONALE Win-paired stimuli can promote risk taking in experimental gambling paradigms in both rats and humans. We previously demonstrated that atomoxetine, a noradrenaline reuptake inhibitor, and guanfacine, a selective α2A adrenergic receptor agonist, reduced risk taking on the cued rat gambling task (crGT), a rodent assay of risky choice in which wins are accompanied by salient cues. Both compounds also decreased impulsive premature responding. OBJECTIVE The key neural loci mediating these effects were unknown. The lateral orbitofrontal cortex (lOFC) and the medial prefrontal cortex (mPFC), which are highly implicated in risk assessment, action selection, and impulse control, receive dense noradrenergic innervation. We therefore infused atomoxetine and guanfacine directly into either the lOFC or prelimbic (PrL) mPFC prior to task performance. RESULTS When infused into the lOFC, atomoxetine improved decision making score and adaptive lose-shift behaviour in males, but not in females, without altering motor impulsivity. Conversely, intra-PrL atomoxetine improved impulse control in risk preferring animals of both sexes, but did not alter decision making. Guanfacine administered into the PrL, but not lOFC, also altered motor impulsivity in all subjects, though in the opposite direction to atomoxetine. CONCLUSIONS These data highlight a double dissociation between the behavioural effects of noradrenergic signaling across frontal regions with respect to risky choice and impulsive action. Given that the influence of noradrenergic manipulations on motor impulsivity could depend on baseline risk preference, these data also suggest that the noradrenaline system may function differently in subjects that are susceptible to the risk-promoting lure of win-associated cues.
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Affiliation(s)
- Chloe S Chernoff
- Graduate Program in Neuroscience, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
- Department of Psychology, Downing Site, University of Cambridge, Cambridge, UK.
| | - Tristan J Hynes
- Graduate Program in Neuroscience, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, Downing Site, University of Cambridge, Cambridge, UK
| | - Jackson D Schumacher
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Shrishti Ramaiah
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Dimitrios K Avramidis
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, University of Concordia, Montreal, QC, Canada
| | - Leili Mortazavi
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Stan B Floresco
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Catharine A Winstanley
- Graduate Program in Neuroscience, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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Ko YH, Zhou A, Niessen E, Stahl J, Weiss PH, Hester R, Bode S, Feuerriegel D. Neural correlates of confidence during decision formation in a perceptual judgment task. Cortex 2024; 173:248-262. [PMID: 38432176 DOI: 10.1016/j.cortex.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 03/05/2024]
Abstract
When we make a decision, we also estimate the probability that our choice is correct or accurate. This probability estimate is termed our degree of decision confidence. Recent work has reported event-related potential (ERP) correlates of confidence both during decision formation (the centro-parietal positivity component; CPP) and after a decision has been made (the error positivity component; Pe). However, there are several measurement confounds that complicate the interpretation of these findings. More recent studies that overcome these issues have so far produced conflicting results. To better characterise the ERP correlates of confidence we presented participants with a comparative brightness judgment task while recording electroencephalography. Participants judged which of two flickering squares (varying in luminance over time) was brighter on average. Participants then gave confidence ratings ranging from "surely incorrect" to "surely correct". To elicit a range of confidence ratings we manipulated both the mean luminance difference between the brighter and darker squares (relative evidence) and the overall luminance of both squares (absolute evidence). We found larger CPP amplitudes in trials with higher confidence ratings. This association was not simply a by-product of differences in relative evidence (which covaries with confidence) across trials. We did not identify postdecisional ERP correlates of confidence, except when they were artificially produced by pre-response ERP baselines. These results provide further evidence for neural correlates of processes that inform confidence judgments during decision formation.
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Affiliation(s)
- Yiu Hong Ko
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany; Department of Psychology, Faculty of Human Sciences, University of Cologne, Germany
| | - Andong Zhou
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Eva Niessen
- Department of Psychology, Faculty of Human Sciences, University of Cologne, Germany
| | - Jutta Stahl
- Department of Psychology, Faculty of Human Sciences, University of Cologne, Germany
| | - Peter H Weiss
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Germany; Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Robert Hester
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Stefan Bode
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Daniel Feuerriegel
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
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Kulbida M, Kemps E, Williamson P, Tiggemann M. The role of decision-making and impulsivity in beverage consumption. Appetite 2024; 195:107233. [PMID: 38301568 DOI: 10.1016/j.appet.2024.107233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/22/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
Soft drink and alcohol consumption have become significant public health issues. This study aimed to explore the mediating role of decision-making processes in the relationship between trait impulsivity and calorie dense beverage consumption. Participants comprised a community sample of 300 adults (aged 19-75). They completed self-report measures assessing impulsivity (SUPPS-P), reward sensitivity (RST-PQ), and participated in decision-making tasks related to risk propensity (BART), short-term strategy preference (IGT), and delay discounting rate. Beverage consumption was calculated using the BEVQ-15. Impulsivity was conceptualised within the framework of the two-factor model as consisting of rash impulsivity and reward sensitivity. Both facets of impulsivity were positively associated with both alcohol and soft drink consumption, and each independently predicted consumption of these beverages. Additionally, there was a significant interaction between rash impulsivity and reward sensitivity on soft drink consumption. Importantly, there were significant indirect effects of both rash impulsivity and reward sensitivity on soft drink consumption via delay discounting. The results support the logic of the two-factor model of impulsivity in the prediction of consumption of unhealthy beverages. Furthermore, the mediating role of delay discounting supports the hypothesis that personality traits can pass through to behaviour via decision-making processes. Further research should extend these findings to other consumption domains in both clinical and non-clinical populations.
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Affiliation(s)
- Max Kulbida
- Psychology, Flinders University, Adelaide, Australia.
| | - Eva Kemps
- Psychology, Flinders University, Adelaide, Australia
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Smith DV, Wyngaarden J, Sharp CJ, Sazhin D, Zaff O, Fareri D, Jarcho J. An fMRI dataset of social and nonsocial reward processing in young adults. Data Brief 2024; 53:110197. [PMID: 38406247 PMCID: PMC10885710 DOI: 10.1016/j.dib.2024.110197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Trait reward sensitivity, risk for developing substance use, and mood disorders have each been linked with altered striatal responses to reward. Moreover, striatal response to reward is sensitive to social context, such as the presence of a peer, and drugs are often sought out and consumed in social contexts or as a result of social experiences. Thus, mood disorder symptoms, striatal responses to social context and social reward may play a role in substance use. To investigate this possibility, this dataset was collected as part of a National Institute on Drug Abuse (NIDA) grant titled "Aberrant Reward Sensitivity: Mechanisms Underlying Substance Use" (R03-DA046733). The overarching goal was to characterize the associations between neural responses to social and nonsocial rewards, trait reward sensitivity, substance use, and mood disorder symptoms. After obtaining questionnaire data quantifying reward sensitivity, substance use, and other psychosocial characteristics, young adults (N=59; 14 male, 45 female; mean age: 20.89 years ± 1.75 years) completed four fMRI tasks testing different features of social and reward processing. These included: 1) a strategic reward-based decision-making task with Ultimatum and Dictator Game conditions; 2) a task where participants shared rewards or losses with peers, strangers, or non-human partners; 3) a task in which participants received well-matched social and monetary rewards and punishment; and 4) a monetary incentive delay (MID) task in which participants tried to obtain or avoid rewards and losses of different magnitude. This dataset includes sociodemographic questionnaire data, anatomical, task-based fMRI, and corresponding behavioral task-based data. We outline several opportunities for extension and reuse, including exploration of individual differences, cross-task comparisons, and representational similarity analyses.
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Affiliation(s)
| | | | | | | | - Ori Zaff
- Temple University, United States
- University of Pennsylvania, United States
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Molins F, Ben-Hassen Jemni N, Garrote-Petisco D, Serrano MÁ. Highly logical and non-emotional decisions in both risky and social contexts: understanding decision making in autism spectrum disorder through computational modeling. Cogn Process 2024:10.1007/s10339-024-01182-4. [PMID: 38526667 DOI: 10.1007/s10339-024-01182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024]
Abstract
In risky contexts, autism spectrum disorder (ASD) individuals exhibit more logical consistency and non-emotional decisions than do typical adults (TAs). This way of deciding could be also prevailing in social contexts, leading to maladaptive decisions. This evidence is scarce and inconsistent, and further research is needed. Recent developments in computational modeling allow analysis of decisional subcomponents that could provide valuable information to understand the decision-making and help address inconsistencies. Twenty-seven individuals with ASD and 25 TAs were submitted to a framing-task and the ultimatum game (UG). The Rescorla-Wagner computational model was used to analyze UG decisions. Results showed that in the UG, the ASD group exhibited a higher utilitarianism, characterized by lower aversion to unfairness and higher acceptance of offers. Moreover, this way of deciding was predicted by the higher economic rationality found in the framing task, where people with ASD did not manifest emotional biases such as framing effect. These results could suggest an atypical decision making, highly logical and non-emotional, as a robust feature of ASD.
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Affiliation(s)
- Francisco Molins
- Department of Psychobiology, Universitat de València, Av. Blasco Ibáñez, 13, 46010, Valencia, Spain
| | - Nour Ben-Hassen Jemni
- Department of Psychobiology, Universitat de València, Av. Blasco Ibáñez, 13, 46010, Valencia, Spain
| | - Dolores Garrote-Petisco
- Department of Psychobiology, Universitat de València, Av. Blasco Ibáñez, 13, 46010, Valencia, Spain
| | - Miguel Ángel Serrano
- Department of Psychobiology, Universitat de València, Av. Blasco Ibáñez, 13, 46010, Valencia, Spain.
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9
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Rizopoulos D, Taylor JM, Papageorgiou G, Morgan TM. Using joint models for longitudinal and time-to-event data to investigate the causal effect of salvage therapy after prostatectomy. Stat Methods Med Res 2024:9622802241239003. [PMID: 38502034 DOI: 10.1177/09622802241239003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Prostate cancer patients who undergo prostatectomy are closely monitored for recurrence and metastasis using routine prostate-specific antigen measurements. When prostate-specific antigen levels rise, salvage therapies are recommended in order to decrease the risk of metastasis. However, due to the side effects of these therapies and to avoid over-treatment, it is important to understand which patients and when to initiate these salvage therapies. In this work, we use the University of Michigan Prostatectomy Registry Data to tackle this question. Due to the observational nature of this data, we face the challenge that prostate-specific antigen is simultaneously a time-varying confounder and an intermediate variable for salvage therapy. We define different causal salvage therapy effects defined conditionally on different specifications of the longitudinal prostate-specific antigen history. We then illustrate how these effects can be estimated using the framework of joint models for longitudinal and time-to-event data. All proposed methodology is implemented in the freely-available R package JMbayes2.
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Affiliation(s)
- Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, the Netherlands
| | - Jeremy Mg Taylor
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Grigorios Papageorgiou
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, the Netherlands
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Sherbino J, Sibbald M, Norman G, LoGiudice A, Keuhl A, Lee M, Monteiro S. Crowdsourcing a diagnosis? Exploring the accuracy of the size and type of group diagnosis: an experimental study. BMJ Qual Saf 2024:bmjqs-2023-016695. [PMID: 38503488 DOI: 10.1136/bmjqs-2023-016695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND The consultation process, where a clinician seeks an opinion from another clinician, is foundational in medicine. However, the effectiveness of group diagnosis has not been studied. OBJECTIVE To compare individual diagnosis to group diagnosis on two dimensions: group size (n=3 or 6) and group process (interactive or artificial groups). METHODOLOGY Thirty-six internal or emergency medicine residents participated in the study. Initially, each resident worked through four written cases on their own, providing a primary diagnosis and a differential diagnosis. Next, participants formed into groups of three. Using a videoconferencing platform, they worked through four additional cases, collectively providing a single primary diagnosis and differential diagnosis. The process was repeated using a group of six with four new cases. Cases were all counterbalanced. Retrospectively, nominal (ie, artificial) groups were formed by aggregating individual participant data into subgroups of three and six and analytically computing scores. Presence of the correct diagnosis as primary diagnosis or included in the differential diagnosis, as well as the number of diagnoses mentioned, was calculated for all conditions. Means were compared using analysis of variance. RESULTS For both authentic and nominal groups, the diagnostic accuracy of group diagnosis was superior to individual for both the primary diagnosis and differential diagnosis. However, there was no improvement in diagnostic accuracy when comparing a group of three to a group of six. Interactive and nominal groups were equivalent; however, this may be an artefact of the method used to combine data. CONCLUSIONS Group diagnosis improves diagnostic accuracy. However, a larger group is not necessarily superior to a smaller group. In this study, interactive group discussion does not result in improved diagnostic accuracy.
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Affiliation(s)
- Jonathan Sherbino
- Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Matt Sibbald
- Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Geoffrey Norman
- Department of Clinical Epidemiology and Biostatistics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Andrew LoGiudice
- Education Services, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Amy Keuhl
- Education Services, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Mark Lee
- Education Services, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Sandra Monteiro
- Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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11
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Morandi S, Silva B, Pauli G, Martinez D, Bachelard M, Bonsack C, Golay P. How do decision making and fairness mediate the relationship between involuntary hospitalisation and perceived coercion among psychiatric inpatients? J Psychiatr Res 2024; 173:98-103. [PMID: 38518573 DOI: 10.1016/j.jpsychires.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/19/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Coercion perceived by psychiatric inpatients is not exclusively determined by formal measures such as involuntary admissions, seclusion or restraint, but is also associated with patients' characteristics and professionals' attitude. AIMS This study examined how inpatients' involvement in the decision making process, the respect of their decision making preference, and their feeling of having been treated fairly mediate the relationship between involuntary hospitalisation and perceived coercion both at admission and during hospital stay. METHODS Mediation analysis were performed in order to study the relationship between involuntary hospitalisation and perceived coercion among 230 patients, voluntarily and involuntarily admitted in six psychiatric hospitals. RESULTS 32.2% of the participants were involuntarily hospitalised. Taken individually, stronger participants' involvement in decision making process, better respect for their decision making preference and higher level of perceived fairness partially mediated the relationship between involuntary hospitalisation and perceived coercion by reducing the level of the latter both at admission and during the hospitalisation. In multiple mediator models, only involvement and respect played an important role at admission. During the hospitalisation, perceived fairness was the most relevant mediator, followed by involvement in decision making. CONCLUSIONS During psychiatric hospitalisation patients' involvement in decision making, respect of their decision making preference and perceived fairness determined the relationship between involuntary hospitalisation and perceived coercion, but not in the same way at admission and during the stay. Involving patients in decision making and treating them fairly may be more relevant than taking account of their decision making preference in order to reduce perceived coercion.
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Affiliation(s)
- Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Cantonal Medical Office, Directorate General for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014, Lausanne, Switzerland.
| | - Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Cantonal Medical Office, Directorate General for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014, Lausanne, Switzerland
| | - Guillaume Pauli
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Debora Martinez
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mizué Bachelard
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Switzerland; General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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12
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Paganini A, Westesson LM, Hansson E, Karlsson SA. Women's decision process when actively choosing to 'go flat' after breast cancer: a constructivist grounded theory study. BMC Womens Health 2024; 24:178. [PMID: 38491353 PMCID: PMC10941362 DOI: 10.1186/s12905-024-03015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE This study aims to describe a conceptual model that could illuminate the decision process women go through when choosing to go flat on one or both sides due to breast cancer. METHODS A qualitative design, with constructivist grounded theory was used. Eighteen women were individually interviewed, digitally or by telephone, until saturation was reached. Data were analysed using a constant comparative iterative method in accordance with grounded theory. By examining the text data to identify the decision process for going flat and rejecting reconstructive surgery open coding was obtained. As the study proceeded patterns were explored and categories developed into a core category. RESULTS The overall decision process for women choosing to go flat on one or both sides emerged in three phases: Phase 1, where the women are forced to "Face the cancer", Phase 2 comprising "Reflections on health and motivation" and Phase 3, described as "Hobson's choice". The fundament of the decision process was found in the core category "Establishing and safeguarding the chosen self". CONCLUSIONS The decision process involved in actively going flat and rejecting reconstructive surgery is founded in the individual woman's motivations, such as view of femininity and apprehensions about the offered reconstructive surgery.
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Affiliation(s)
- Anna Paganini
- Region Västra Götaland, Department of Plastic and Reconstructive Surgery, Sahlgrenska University hospital, Gothenburg, Sweden.
- Sahlgrenska Academy, Institution for Health and Care Sciences at Gothenburg University, Gothenburg, Sweden.
- Sahlgrenska Academy, Institution for Clinical Sciences at Gothenburg University, Gothenburg, Sweden.
| | - Linda Myrin Westesson
- Sahlgrenska Academy, Institution for Health and Care Sciences at Gothenburg University, Gothenburg, Sweden
- Region Västra Götaland, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Region Västra Götaland, Department of Plastic and Reconstructive Surgery, Sahlgrenska University hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Institution for Clinical Sciences at Gothenburg University, Gothenburg, Sweden
| | - Susanne Ahlstedt Karlsson
- Sahlgrenska Academy, Institution for Health and Care Sciences at Gothenburg University, Gothenburg, Sweden
- Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Kohl AT, Sauer JD, Palmer MA, Brooks J, Heathcote A. The effects of non-diagnostic information on confidence and decision making. Mem Cognit 2024:10.3758/s13421-024-01535-6. [PMID: 38489145 DOI: 10.3758/s13421-024-01535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/17/2024]
Abstract
Many decision-making tasks are characterized by a combination of diagnostic and non-diagnostic information, yet models of responding and confidence almost exclusively focus on the contribution of diagnostic information (e.g., evidence associated with stimulus discriminability), largely ignoring the contribution of non-diagnostic information. An exception is Baranski and Petrusic's Journal of Experimental Psychology: Human Perception and Performance, 24(3), 929-945, (1998) doubt-scaling model, which predicts a negative relationship between non-diagnostic information and confidence, and between non-diagnostic information and accuracy. In two perceptual-choice tasks, we tested the effects of manipulating non-diagnostic information on confidence, accuracy and response time (RT). In Experiment 1, participants viewed a dynamic grid consisting of flashing blue, orange and white pixels and indicated whether the stimulus was predominantly blue or orange (using a response scale ranging from low-confidence blue to high-confidence orange), with the white pixels constituting non-diagnostic information. Increasing non-diagnostic information reduced both confidence and accuracy, generally slowed RTs, and led to an increase in the speed of errors. Experiment 2 replicated these results for a decision-only task, providing further support for the doubt-scaling model of confidence.
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Affiliation(s)
- Amelia T Kohl
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
| | - James D Sauer
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia
| | - Matthew A Palmer
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia
| | - Jasmin Brooks
- School of Psychological Sciences, University of Tasmania, Tasmania, Australia
| | - Andrew Heathcote
- School of Psychological Sciences, The University of Newcastle, Newcastle, Australia
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14
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Cherkasova MV, Clark L, Barton JJS, Stoessl AJ, Winstanley CA. Risk-promoting effects of reward-paired cues in human sign- and goal-trackers. Behav Brain Res 2024; 461:114865. [PMID: 38220058 DOI: 10.1016/j.bbr.2024.114865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
Animal research suggests trait-like individual variation in the degree of incentive salience attribution to reward-predictive cues, defined phenotypically as sign-tracking (high) and goal-tracking (low incentive salience attribution). While these phenotypes have been linked to addiction features in rodents, their translational validity is less clear. Here, we examined whether sign- and goal-tracking in healthy human volunteers modulates the effects of reward-paired cues on decision making. Sign-tracking was measured in a Pavlovian conditioning paradigm as the amount of eye gaze fixation on the reward-predictive cue versus the location of impending reward delivery. In Study 1 (Cherkasova et al., 2018), participants were randomly assigned to perform a binary choice task in which rewards were either accompanied (cued, n = 63) or unaccompanied (uncued, n = 68) by money images and casino jingles. In Study 2, participants (n = 58) performed cued and uncued versions of the task in a within-subjects design. Across both studies, cues promoted riskier choice. Sign-tracking was not associated with risky choice in either study. Goal-tracking rather than sign-tracking was significantly associated with greater risk-promoting effects of cues in Study 1 but not in Study 2, although the direction of findings was consistent across both studies. These findings are at odds with the notion of sign-trackers being preferentially susceptible to the influence of reward cues on behavior and point to the role of mechanisms besides incentive salience in mediating such influences.
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Affiliation(s)
- Mariya V Cherkasova
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Luke Clark
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason J S Barton
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Jon Stoessl
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catharine A Winstanley
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.
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15
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Bisbal GA. The decision maker's lament: If I only had some science! Ambio 2024:10.1007/s13280-024-01986-w. [PMID: 38468119 DOI: 10.1007/s13280-024-01986-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/24/2023] [Accepted: 01/17/2024] [Indexed: 03/13/2024]
Abstract
Environmental decision makers lament instances in which the lack of actionable science limits confident decision-making. Their reaction when the needed scientific information is of poor quality, uninformative, unintelligible, or altogether absent is often to criticize scientists, their work, or science in general. The considerations offered here encourage decision makers to explore alternative approaches to alleviate their disappointment. Ironically, many researchers lament the lack of support for the science they wish to deliver and accuse decision makers of failing to realize the value of the scientific studies they propose. Both communities would benefit by remembering that producing actionable science for a pending decision requires knowing the context for that decision beforehand. They may also look inward. Only then will they find answers to the question: What can I do within my own capacity to ensure that the necessary actionable science becomes available and facilitate its use to inform decisions?
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Affiliation(s)
- Gustavo A Bisbal
- United States Department of the Interior, United States Geological Survey, 917 National Center Room 3A400, 12201 Sunrise Valley Drive, Reston, VA, 20192, USA.
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16
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Achola R, Atuyambe L, Nabiwemba E, Fredrick M, Orach CG. Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study. BMC Public Health 2024; 24:754. [PMID: 38468212 DOI: 10.1186/s12889-024-18103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Uganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda. METHODS A comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed. RESULTS We found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27-2.16], acquired skills [AOR = 2.28, 95% CI: 2.11-2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3-5 years [AOR = 2.24, 95% CI: 1.46-3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods. CONCLUSION Our findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.
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Affiliation(s)
- Roselline Achola
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Elizabeth Nabiwemba
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Makumbi Fredrick
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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17
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Rogy N, Pastor A, Sferratore A, Géhéniau N, Hélias A, Loiseau E. Taking the spatio-temporal effects of climate change into account for Life Cycle Assessment of prospective scenarios to secure water supplies in agricultural areas. Sci Total Environ 2024; 915:169345. [PMID: 38097082 DOI: 10.1016/j.scitotenv.2023.169345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/13/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
To cope with climate change, agricultural territories are forced to implement adaptation strategies, including the implementation of irrigation infrastructures. These strategies are deployed over a long term, and their environmental performance may vary in time and space due to climate change. Environmental assessment methods that include spatio-temporal dynamics must be developed to identify long term "no-regret" scenarios. This study proposes an innovative approach based on the coupling between a crop model, i.e. AquaCrop, and the Territorial-Life Cycle Assessment (T-LCA) framework. Results are exemplified and discussed, with comparison of scenarios with or without irrigation, between 1981 and 2099, at six contrasting locations in terms of climate and soil conditions for the Shared Socioeconomic Pathways 5-8.5 scenario developed by the Intergovernmental Panel on Climate Change. The assessments report that climate change can affect the eco-efficiency of irrigated perimeters over time. Moreover, climate change may alter the conclusions of the comparison of scenarios with or without irrigation infrastructure at a given location. Additionally, a sensitivity analysis is performed on key parameters of the study highlighting the importance of the electricity mix. Finally, spatio-temporal dynamics need to be considered to assess the environmental performance of long-term land planning scenarios and account for environmental effects such as climate change.
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Affiliation(s)
- Nicolas Rogy
- ITAP, Univ Montpellier, INRAE, Institut Agro, Montpellier, France; Elsa, Research Group for Environmental Lifecycle and Sustainability Assessment, Montpellier, France
| | - Amandine Pastor
- ITAP, Univ Montpellier, INRAE, Institut Agro, Montpellier, France; Elsa, Research Group for Environmental Lifecycle and Sustainability Assessment, Montpellier, France
| | - Agata Sferratore
- Société du Canal de Provence et d'Aménagement de la Région Provençale, CS 70064, Le Tholonet, Cedex 5 Aix-en-Provence 13182, France
| | - Nicolas Géhéniau
- BRL Ingénierie, 1105 avenue Pierre Mendès France BP 94001, Nîmes F-30001, France
| | - Arnaud Hélias
- ITAP, Univ Montpellier, INRAE, Institut Agro, Montpellier, France; Elsa, Research Group for Environmental Lifecycle and Sustainability Assessment, Montpellier, France
| | - Eléonore Loiseau
- ITAP, Univ Montpellier, INRAE, Institut Agro, Montpellier, France; Elsa, Research Group for Environmental Lifecycle and Sustainability Assessment, Montpellier, France.
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18
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Ramebäck H, Tovedal A, Norlin K. On the significance of the measurement evaluation method in decision making: A synthesis of JCGM 101 and JCGM 106 applied to gross alpha and gross beta measurements using LSC. Appl Radiat Isot 2024; 208:111282. [PMID: 38493563 DOI: 10.1016/j.apradiso.2024.111282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
In decision making, e.g. conformity to a specification like a reference value or a requirement, the decision rule applied shall be documented. Furthermore, if the measurement uncertainty is considered in the decision process the associated probability, or risk, that a measurement result is above (or below) a reference value shall be taken into account. In this work it is shown that for gross alpha and gross beta measurements the evaluation method, GUMUF (GUM Uncertainty Framework) or MC (Monte Carlo), may also be important and influence the decisions taken when measurement results are very close to the reference value. Therefore the evaluation method and assumptions of the input quantities may also be important to document. Moreover, decision makers or users of measurement results should be aware of possible differences and/or consequences due to the evaluation method regardless of the decision rule and the choice of evaluation method.
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Affiliation(s)
- H Ramebäck
- Swedish Defense Research Agency (FOI), CBRN Defense and Security, SE-164 90, Stockholm, Sweden.
| | - A Tovedal
- Swedish Defense Research Agency (FOI), CBRN Defense and Security, SE-164 90, Stockholm, Sweden
| | - K Norlin
- Swedish Defense Research Agency (FOI), CBRN Defense and Security, SE-164 90, Stockholm, Sweden
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19
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Vo K, Sun QJ, Nunez MD, Vandekerckhove J, Srinivasan R. Deep latent variable joint cognitive modeling of neural signals and human behavior. Neuroimage 2024:120559. [PMID: 38447682 DOI: 10.1016/j.neuroimage.2024.120559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
As the field of computational cognitive neuroscience continues to expand and generate new theories, there is a growing need for more advanced methods to test the hypothesis of brain-behavior relationships. Recent progress in Bayesian cognitive modeling has enabled the combination of neural and behavioral models into a single unifying framework. However, these approaches require manual feature extraction, and lack the capability to discover previously unknown neural features in more complex data. Consequently, this would hinder the expressiveness of the models. To address these challenges, we propose a Neurocognitive Variational Autoencoder (NCVA) to conjoin high-dimensional EEG with a cognitive model in both generative and predictive modeling analyses. Importantly, our NCVA enables both the prediction of EEG signals given behavioral data and the estimation of cognitive model parameters from EEG signals. This novel approach can allow for a more comprehensive understanding of the triplet relationship between behavior, brain activity, and cognitive processes.
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Affiliation(s)
- Khuong Vo
- Department of Computer Science, University of California, Irvine, USA.
| | - Qinhua Jenny Sun
- Department of Cognitive Sciences, University of California, Irvine, USA.
| | - Michael D Nunez
- Psychological Methods, University of Amsterdam, The Netherlands.
| | - Joachim Vandekerckhove
- Department of Cognitive Sciences, University of California, Irvine, USA; Department of Statistics, University of California, Irvine, USA.
| | - Ramesh Srinivasan
- Department of Cognitive Sciences, University of California, Irvine, USA; Department of Biomedical Engineering, University of California, Irvine, USA.
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20
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Ramanayaka ND, Dickson G, Rayne D. Heuristics in sport: A scoping review. Psychol Sport Exerc 2024; 71:102589. [PMID: 38163513 DOI: 10.1016/j.psychsport.2023.102589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/06/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
Judgement and decision-making under uncertainty often rely on simplistic" rules of thumb", known as "heuristics". The purpose of this scoping review is to explore the extant literature focussed on heuristics and sport. This study employed a five-stage scoping review methodology. The databases searched were Scopus, Web of Science, SPORTDiscus, and PsycInfo. The search terms were sport*, heuristic* (and its synonyms: cognitive shortcut, shortcut, rule of thumb, mental rule, cognitive rule) plus cognitive bias. The search identified 2019 studies, of which 38 were included in the analysis. Studies based in USA and Germany were most common. The use of heuristics by players were most common, while football (soccer) and basketball were the most frequently researched sport contexts. Both males and females were commonly included in most studies, but there were no studies with an explicit focus on females. The research was contextualized within several academic disciplines (e.g., psychology, forecasting, JDM, organization behavior, sports marketing and sponsorship, coaching science, risk analysis and sociology). Approximately 80 % of the studies were quantitative. Sixteen studies examined the fast and frugal heuristics approach (i.e., take-the-first heuristic (n = 8), recognition heuristic (n = 7), or gut instinct (n = 1), whereas eleven articles embraced the heuristics and biases approach. Future research should pursue a greater variety of heuristics, investigate the use of heuristics by selectors and boards of directors, and how best to design, implement, and evaluate heuristic education programs.
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Affiliation(s)
- Nilantha Dinesh Ramanayaka
- Department of Management and Marketing, La Trobe University, Australia; Department of Sport Science and Physical Education, University of Kelaniya, Sri Lanka
| | - Geoff Dickson
- Department of Management and Marketing, La Trobe University, Australia.
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21
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Colquhoun-Flannery E, Goodwin D, Walshe C. How clinicians recognise people who are dying: An integrative review. Int J Nurs Stud 2024; 151:104666. [PMID: 38134558 DOI: 10.1016/j.ijnurstu.2023.104666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Timely recognition of dying is important for high quality end-of-life care however, little is known about how clinicians recognise dying. Late recognition is common and can lead to futile treatment that can prolong or increase suffering and prevent a change in the focus of care. AIM To explore how clinicians caring for dying people recognise that they are in the last days or hours of life, as well as the factors that influence the recognition of dying. DESIGN A systematically constructed integrative review of the literature. METHODS Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsycInfo and Allied and Complementary Medicine were searched in July 2022. Papers were included if they were original research, discussed how clinicians recognise dying, available in English language and published in 2012 or later. A constant comparison approach was applied to the analysis and synthesis of the literature. RESULTS 24 papers met the inclusion criteria. There were 3 main categories identified: 'Clues and signals' refers to prompts and signs that lead a clinician to believe a person is dying, incorporating the sub-categories 'knowing the patient over time', and 'intuition and experience'. 'Recognition by others' is where clinicians come to recognise someone is dying through others. This can be through a change in the context of care such as a tool or care plan or by communication with the team. 'Culture, system and practice' refers to the cultural beliefs of a setting that influences awareness of dying and denial of death as a possibility and avoidance of naming death and dying directly. System and practice of the setting also impact on recognition of dying. This involves work pace and intensity, shift systems and timing of senior reviews of patients. Uncertainty and its impact on recognition of dying are evident throughout the findings of this review. The seeking of certainty and the absence of the possibility of dying contributes to late recognition of dying. DISCUSSION Recognition of dying is a complex process that occurs over time, involving a combination of intuition and gathering of information, that is influenced by contextual factors. A culture where dying is not openly acknowledged or even named explicitly contributes to late recognition of dying. A shared language and consistent terminology for explicitly naming dying are needed. Uncertainty is intrinsic to the recognition of dying and therefore a shift to recognising the possibility of dying rather than seeking certainty is needed. REGISTRATION (PROSPERO) CRD42022360900. Registered September 2022.
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Affiliation(s)
- Elizabeth Colquhoun-Flannery
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
| | - Dawn Goodwin
- Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
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22
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Noureldin A, Ivankovic V, Delisle M, Wang TF, Auer RC, Carrier M. Extended-duration thromboprophylaxis following major abdominopelvic surgery - For everyone or selected cases only? Thromb Res 2024; 235:175-180. [PMID: 38354471 DOI: 10.1016/j.thromres.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
Major abdominopelvic surgery is an important risk factor for postoperative venous thromboembolism (VTE). VTE is the leading cause of 30-day postoperative mortality in patients with cancer undergoing major abdominopelvic surgery. Randomized controlled trials have shown that extended duration thromboprophylaxis using a low molecular weight heparin or a direct oral anticoagulant significantly decreases the risk of overall VTE (symptomatic events and asymptomatic deep vein thrombosis). Hence, several clinical practice guidelines suggest the use of extended duration thromboprophylaxis for all high-risk patients undergoing major abdominopelvic surgery. Despite these recommendations by clinical practice guidelines, adoption of extended duration thromboprophylaxis in clinical practice remains low and clinical equipoise seems to persist. In this narrative review, we aim is to highlight and summarize the reasons that may explain discrepancy between clinical guideline recommendations and current practice regarding extended duration thromboprophylaxis in this patient population. We also aim to review different personalized approaches based on patients' individualized risk of VTE that may foster shared decision making and improve patient outcomes by reducing decisional conflict, increasing patient knowledge, and increasing risk perception accuracy.
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Affiliation(s)
- A Noureldin
- Faculty of Medicine University of Ottawa, Ottawa, Ontario, Canada
| | - V Ivankovic
- Department of Surgery, University of Ottawa The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - M Delisle
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - T F Wang
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - R C Auer
- Department of Surgery, University of Ottawa The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - M Carrier
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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23
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Rodriguez-Santiago M, Ruppert A, Gall MD, Hoke K, Bee MA, Baugh AT. In your CORT: Corticosterone and its receptors in the brain underlie mate choosiness in female Cope's gray treefrogs (Hyla chrysoscelis). Horm Behav 2024; 159:105477. [PMID: 38245919 DOI: 10.1016/j.yhbeh.2024.105477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
Selecting an attractive mate can involve trade-offs related to investment in sampling effort. Glucocorticoids like corticosterone (CORT) are involved in resolving energetic trade-offs. However, CORT is rarely studied in the context of mate choice, despite its elevated levels during reproductive readiness and the energetic transitions that characterize reproduction. Few systems are as well suited as anuran amphibians to evaluate how females resolve energetic trade-offs during mate choice. Phonotaxis tests provide a robust bioassay of mate choice that permit the precise measurement of inter-individual variation in traits such as choosiness-the willingness to pursue the most attractive mate despite costs. In Cope's gray treefrogs (Hyla chrysoscelis), females exhibit remarkable variation in circulating CORT as well as choosiness during mate choice, and a moderate dose of exogenous CORT rapidly (<1 h) and reliably induce large increases in choosiness. Here we measured the expression of glucocorticoid (GR) and mineralocorticoid (MR) receptors in the brains of females previously treated with exogenous CORT and tested for mate choosiness. We report a large decrease in GR expression in the hindbrain and midbrain of females that were treated with the moderate dosage of CORT-the same treatment group that exhibited a dramatic increase in choosiness following CORT treatment. This association, however, does not appear to be causal, as only forebrain GR levels, which are not affected by CORT injection, are positively associated with variation in choosiness. No strong effects were found for MR. We discuss these findings and suggest future studies to test the influence of glucocorticoids on mate choice.
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Affiliation(s)
| | - Annika Ruppert
- Department of Ecology, Evolution, and Behavior, University of Minnesota - Twin Cities, 1479 Gortner Ave, St. Paul, MN 55108, USA
| | - Megan D Gall
- Department of Biology, Vassar College, 124 Raymond Ave., Poughkeepsie, NY 12604, USA
| | - Kim Hoke
- Department of Biology, Colorado State University, 200 W Lake St., Fort Collins, CO 80523, USA
| | - Mark A Bee
- Department of Ecology, Evolution, and Behavior, University of Minnesota - Twin Cities, 1479 Gortner Ave, St. Paul, MN 55108, USA; Graduate Program in Neuroscience, University of Minnesota - Twin Cities, 321 Church Street SE, Minneapolis, MN 55455, USA
| | - Alexander T Baugh
- Department of Biology, Swarthmore College, 500 College Avenue, Swarthmore, PA 19081, USA.
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24
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Aebersold M, Gonzalez L. Can virtual reality simulations improve macrocognition? BMJ Qual Saf 2024:bmjqs-2023-016858. [PMID: 38429102 DOI: 10.1136/bmjqs-2023-016858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
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25
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Cameron L, Ride J, Devlin N. An Economic Model of Gambling Behaviour: A Two-Stage Approach. J Gambl Stud 2024; 40:65-81. [PMID: 35867267 PMCID: PMC10904484 DOI: 10.1007/s10899-022-10146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
Gambling can cause significant harms and these can result in a net negative utility from participation, although lower levels of participation have potential benefits and can yield positive net utility. It is therefore important to understand and distinguish between these two stages of gambling behaviour. Currently, economic models have had limited focus on explaining why someone would gamble despite it yielding a negative utility. Here, we present a two-stage model, motivated by empirical literature and intuitive assumptions, that improves on existing economic models by distinguishing between the likelihood of gambling participation and of gambling that yields a negative utility. The model's predictions are empirically testable, consistent with existing literature, and add new insights. The model's ability to distinguish between the two stages helps to inform interventions that aim to reduce the prevalence of gambling-related harm while avoiding the need for restrictive approaches that aim to eliminate gambling altogether.
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Affiliation(s)
- Lachlan Cameron
- Health Economics Unit, School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia.
| | - Jemimah Ride
- Health Economics Unit, School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Nancy Devlin
- Health Economics Unit, School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia
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26
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Curtis ET, Curtis JL. Shallow Value Weighting Predicts Problem Gambling: A Parameter Estimation Analysis Using Cumulative Prospect Theory. J Gambl Stud 2024; 40:333-348. [PMID: 37225961 DOI: 10.1007/s10899-023-10218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
Problem gambling is a non-substance-based addictive disorder that can cause significant distress and dramatic consequences. Despite extensive research in neuroscience and clinical/social psychology, few contributions have been made from formal models of behavioural economics. We apply Cumulative Prospect Theory (CPT) to provide a formal analysis of cognitive distortions in problem gambling. In two experiments, participants made decisions between pairs of gambles and completed a standard gambling assessment. We estimated the parameter values specified by CPT for each participant and used those estimates to predict gambling severity. In Experiment 1, severe gambling behaviour was associated with a shallow valuation curve, a reversal of loss aversion, and decreased influence of subjective value on decisions (i.e., more noise or variability in preference). Experiment 2 replicated the effect of shallow valuation but did not demonstrate reversed loss version or noisier decisions. Neither experiment provided evidence of differences in probability weighting. We explore implications of the findings and conclude that problem gambling at least partially reflects a fundamental distortion to subjective valuation.
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Affiliation(s)
- E T Curtis
- Booth University College, 447 Webb Place, Winnipeg, MB, R3B 2P2, Canada.
| | - J L Curtis
- Booth University College, 447 Webb Place, Winnipeg, MB, R3B 2P2, Canada
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27
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Erfanian Abdoust M, Knecht S, Husain M, Le Heron C, Jocham G, Studer B. Effort-based decision making and motivational deficits in stroke patients. Brain Cogn 2024; 175:106123. [PMID: 38183905 DOI: 10.1016/j.bandc.2023.106123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024]
Abstract
Motivational deficits in patients recovering from stroke are common and can reduce active participation in rehabilitation and thereby impede functional recovery. We investigated whether stroke patients with clinically reduced drive, initiation, and endurance during functional rehabilitative training (n = 30) display systematic alterations in effort-based decision making compared to age, sex, and severity-matched stroke patients (n = 30) whose drive appeared unaffected. Notably, the two groups did not differ in self-reported ratings of apathy and depression. However, on an effort-based decision-making task, stroke patients with clinically apparent drive impairment showed intact willingness to accept effort for reward, but were more likely to fail to execute the required effort compared to patients without apparent drive impairments. In other words, the decision behavioural assessment revealed that stroke patients that displayed reduced drive, initiation, and endurance during inpatient neurorehabilitation failed to persist in goal-directed effort production, even over very short periods. These findings indicate that reduced drive during rehabilitative therapy in post-stroke patients is not due to a diminished motivation to invest physical effort, but instead is related to a reduced persistence with effortful behaviour.
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Affiliation(s)
- Mani Erfanian Abdoust
- Biological Psychology of Decision Making, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Mauritius Hospital Meerbusch, Meerbusch, Germany.
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK; Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Campbell Le Heron
- Department of Medicine, University of Otago (Christchurch), New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Gerhard Jocham
- Biological Psychology of Decision Making, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Mauritius Hospital Meerbusch, Meerbusch, Germany
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28
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El Hady A, Takahashi D, Sun R, Akinwale O, Boyd-Meredith T, Zhang Y, Charles AS, Brody CD. Chronic brain functional ultrasound imaging in freely moving rodents performing cognitive tasks. J Neurosci Methods 2024; 403:110033. [PMID: 38056633 PMCID: PMC10872377 DOI: 10.1016/j.jneumeth.2023.110033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Functional ultrasound imaging (fUS) is an emerging imaging technique that indirectly measures neural activity via changes in blood volume. Chronic fUS imaging during cognitive tasks in freely moving animals faces multiple exceptional challenges: performing large durable craniotomies with chronic implants, designing behavioral experiments matching the hemodynamic timescale, stabilizing the ultrasound probe during freely moving behavior, accurately assessing motion artifacts, and validating that the animal can perform cognitive tasks while tethered. NEW METHOD We provide validated solutions for those technical challenges. In addition, we present standardized step-by-step reproducible protocols, procedures, and data processing pipelines. Finally, we present proof-of-concept analysis of brain dynamics during a decision making task. RESULTS We obtain stable recordings from which we can robustly decode task variables from fUS data over multiple months. Moreover, we find that brain wide imaging through hemodynamic response is nonlinearly related to cognitive variables, such as task difficulty, as compared to sensory responses previously explored. COMPARISON WITH EXISTING METHODS Computational pipelines in fUS are nascent and we present an initial development of a full processing pathway to correct and segment fUS data. CONCLUSIONS Our methods provide stable imaging and analysis of behavior with fUS that will enable new experimental paradigms in understanding brain-wide dynamics in naturalistic behaviors.
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Affiliation(s)
- Ahmed El Hady
- Princeton Neuroscience Institute, Princeton University, Princeton, United States; Center for advanced study of collective behavior, University of Konstanz, Germany; Max Planck Institute of Animal Behavior, Konstanz, Germany
| | - Daniel Takahashi
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ruolan Sun
- Department of Biomedical Engineering, John Hopkins University, Baltimore, United States
| | - Oluwateniola Akinwale
- Department of Biomedical Engineering, John Hopkins University, Baltimore, United States
| | - Tyler Boyd-Meredith
- Princeton Neuroscience Institute, Princeton University, Princeton, United States
| | - Yisi Zhang
- Princeton Neuroscience Institute, Princeton University, Princeton, United States
| | - Adam S Charles
- Department of Biomedical Engineering, John Hopkins University, Baltimore, United States; Mathematical Institute for Data Science, Kavli Neuroscience Discovery Institute & Center for Imaging Science, John Hopkins University, Baltimore, United States.
| | - Carlos D Brody
- Princeton Neuroscience Institute, Princeton University, Princeton, United States; Howard Hughes Medical Institute, Princeton University, Princeton, United States; Department of Molecular Biology, Princeton University, Princeton, United States.
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29
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Nourmohammadi N, Sadigh G. Patients, practice, and price transparency: The impact of disclosing healthcare costs on consumer decision-making. Clin Imaging 2024; 107:110064. [PMID: 38211396 DOI: 10.1016/j.clinimag.2023.110064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
The introduction of price transparency mandates by the Center for Medicare and Medicaid Services (CMS) aimed to reduce healthcare spending by promoting price comparison and the selection of lower-cost providers. In this brief communication, we will discuss how consumer interests in price comparison are influenced and how price transparency is expected to impact consumer decision-making with specific examples for imaging as a shoppable service.
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Affiliation(s)
- Niki Nourmohammadi
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, United States of America.
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30
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Quan H, Xu Y, Liu Y, Chen X. Design and monitoring of clinical trials with an interim analysis and a negative binomial endpoint. Contemp Clin Trials 2024; 138:107467. [PMID: 38331382 DOI: 10.1016/j.cct.2024.107467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
There are very rich publications devoted to group sequential design, adaptive design and trial monitoring for continuous, binary and time to event endpoints. Many authors also discuss fixed design, blinded sample size re-estimation design and group sequential design for studies with a negative binomial outcome. Nonetheless, literature is sparse in adaptive design for a trial with a negative binomial endpoint. The features of such an endpoint in a flexible trial design setting remains inadequately understood. In this research, we seek to bridge this knowledge gap by offering a thorough examination of utilizing data components from a two-stage adaptive design for unblinded conditional power calculation and corresponding sample size re-estimation. We also provide expression for calculating the probability of meeting the futility criterion to determine the appropriate timing for the interim analysis. To evaluate the performance of the design, we conduct simulations to assess its operation characteristics. Finally, we provide a helpful and illustrative example to demonstrate the practical applications of the methods.
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Affiliation(s)
- Hui Quan
- Biostatistics and Programming, Sanofi, 55 Corporate Drive, Bridgewater, NJ 08807, United States of America.
| | - Yuqing Xu
- Biostatistics and Programming, Sanofi, 55 Corporate Drive, Bridgewater, NJ 08807, United States of America
| | - Ying Liu
- Biostatistics and Programming, Sanofi, 55 Corporate Drive, Bridgewater, NJ 08807, United States of America
| | - Xun Chen
- Biostatistics and Programming, Sanofi, 55 Corporate Drive, Bridgewater, NJ 08807, United States of America
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31
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Gan WY, Raja Ghazilla RA, Yap HJ, Selvarajoo S. Industrial practitioner's perception on the application of exoskeleton system in automotive assembly industries: A Malaysian case study. Heliyon 2024; 10:e26183. [PMID: 38404870 PMCID: PMC10884500 DOI: 10.1016/j.heliyon.2024.e26183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/29/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
The automotive industry is a key manufacturing industry for the Malaysian economy, where manual jobs and task are still common. Hence, Work-related Musculoskeletal Disorders (WMSD) is a common type of injury among workers. Exoskeleton system has gained global traction as a possible solution to reduce the risk of MSD among workers. Nonetheless, the application of exoskeleton in the automotive industry in Malaysia remains unknown. As such, this study attempts to provide insight into the industry's perception on the potential of exoskeleton application within the context of Malaysian automotive assembly sector. Therefore, a total of 52 management level respondents from various manufacturers participated in this study. It is found that, although the technology seems to be relatively new and disruptive, the respondents have a positive perception towards it with an acceptance rate of 86.5%. Cost of implementation exoskeleton technologies seems to be primary concern from the respondents, other concern such as maintenance cost and ease of application into existing application is also highlighted.
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Affiliation(s)
- Woun Yoong Gan
- Department of Mechanical Engineering, Faculty of Engineering, Centre for Sustainable and Smart Manufacturing (CSSM), University of Malaya, Kuala Lumpur, Malaysia
| | - Raja Ariffin Raja Ghazilla
- Department of Mechanical Engineering, Faculty of Engineering, Centre for Sustainable and Smart Manufacturing (CSSM), University of Malaya, Kuala Lumpur, Malaysia
| | - Hwa Jen Yap
- Department of Mechanical Engineering, Faculty of Engineering, Centre for Sustainable and Smart Manufacturing (CSSM), University of Malaya, Kuala Lumpur, Malaysia
| | - Suman Selvarajoo
- Department of Mechanical Engineering, Faculty of Engineering, Centre for Sustainable and Smart Manufacturing (CSSM), University of Malaya, Kuala Lumpur, Malaysia
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Bukar UA, Sayeed MS, Razak SFA, Yogarayan S, Amodu OA. An integrative decision-making framework to guide policies on regulating ChatGPT usage. PeerJ Comput Sci 2024; 10:e1845. [PMID: 38440047 PMCID: PMC10911759 DOI: 10.7717/peerj-cs.1845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/09/2024] [Indexed: 03/06/2024]
Abstract
Generative artificial intelligence has created a moment in history where human beings have begin to closely interact with artificial intelligence (AI) tools, putting policymakers in a position to restrict or legislate such tools. One particular example of such a tool is ChatGPT which is the first and world's most popular multipurpose generative AI tool. This study aims to put forward a policy-making framework of generative artificial intelligence based on the risk, reward, and resilience framework. A systematic search was conducted, by using carefully chosen keywords, excluding non-English content, conference articles, book chapters, and editorials. Published research were filtered based on their relevance to ChatGPT ethics, yielding a total of 41 articles. Key elements surrounding ChatGPT concerns and motivations were systematically deduced and classified under the risk, reward, and resilience categories to serve as ingredients for the proposed decision-making framework. The decision-making process and rules were developed as a primer to help policymakers navigate decision-making conundrums. Then, the framework was practically tailored towards some of the concerns surrounding ChatGPT in the context of higher education. In the case of the interconnection between risk and reward, the findings show that providing students with access to ChatGPT presents an opportunity for increased efficiency in tasks such as text summarization and workload reduction. However, this exposes them to risks such as plagiarism and cheating. Similarly, pursuing certain opportunities such as accessing vast amounts of information, can lead to rewards, but it also introduces risks like misinformation and copyright issues. Likewise, focusing on specific capabilities of ChatGPT, such as developing tools to detect plagiarism and misinformation, may enhance resilience in some areas (e.g., academic integrity). However, it may also create vulnerabilities in other domains, such as the digital divide, educational equity, and job losses. Furthermore, the finding indicates second-order effects of legislation regarding ChatGPT which have implications both positively and negatively. One potential effect is a decrease in rewards due to the limitations imposed by the legislation, which may hinder individuals from fully capitalizing on the opportunities provided by ChatGPT. Hence, the risk, reward, and resilience framework provides a comprehensive and flexible decision-making model that allows policymakers and in this use case, higher education institutions to navigate the complexities and trade-offs associated with ChatGPT, which have theoretical and practical implications for the future.
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Affiliation(s)
- Umar Ali Bukar
- Centre for Intelligent Cloud Computing (CICC), Faculty of Information Science & Technology, Multimedia University, Melaka, Malaysia
| | - Md Shohel Sayeed
- Centre for Intelligent Cloud Computing (CICC), Faculty of Information Science & Technology, Multimedia University, Melaka, Malaysia
| | - Siti Fatimah Abdul Razak
- Centre for Intelligent Cloud Computing (CICC), Faculty of Information Science & Technology, Multimedia University, Melaka, Malaysia
| | - Sumendra Yogarayan
- Centre for Intelligent Cloud Computing (CICC), Faculty of Information Science & Technology, Multimedia University, Melaka, Malaysia
| | - Oluwatosin Ahmed Amodu
- Information and Communication Engineering Department, Elizade University, Ilara-Mokin, Ondo State, Nigeria
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Hernandez C, Giral D, Martínez F. Decision-making analysis in cooperative environments for decentralized cognitive radio networks. Heliyon 2024; 10:e25977. [PMID: 38390111 PMCID: PMC10881842 DOI: 10.1016/j.heliyon.2024.e25977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Currently, there are saturated frequency bands that affect the quality of service for new users. Cognitive radio provides an alternative solution to this problem through dynamic spectrum access. However, the solutions proposed in the current literature are focused on a centralized network and do not allow demonstrating the behavior in a multi-user environment, much less the effect that cooperation between secondary users can have. This article establishes a decision-making model for the best spectral opportunity selection with a cooperative approach in decentralized cognitive radio networks and contrasts its results with three multi-criteria decision-making algorithms: SAW, TOPSIS, and VIKOR. So, this research suggests a cooperative decision-making model based on four main modules. (1) a collaborative module for the exchange of information between SU; (2) a module for PU characterization; (3) a module of the probability of SU arrival; and (4) the SO feedback selection module. The results are obtained through simulations fed with experimental spectral occupancy data captured in a measurement campaign. Handoff and throughput were used as evaluation metrics, along with five levels of collaboration: 10%, 20%, 50%, 80%, and 100%, and eight different scenarios based on the type of network: GSM and Wi-Fi, the application type: real-time and best-effort, and the level of traffic: high and low. The contribution of this study lies in the fact that no current work includes the following relevant aspects for an adequate validation and evaluation of this proposal: First, the consideration of a decentralized cognitive radio network; second, the decision-making with cooperative strategies; third, different techniques for SO selection; fourth, the validation and evaluation with experimental spectral occupancy data captured in measurement campaigns; finally, the performance analysis in diverse networks, traffic levels, and types of applications.
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Affiliation(s)
- Cesar Hernandez
- Technological Faculty, Universidad Distrital Francisco José de Caldas, Bogotá, D.C 11021, Colombia
| | - Diego Giral
- Technological Faculty, Universidad Distrital Francisco José de Caldas, Bogotá, D.C 11021, Colombia
| | - Fredy Martínez
- Technological Faculty, Universidad Distrital Francisco José de Caldas, Bogotá, D.C 11021, Colombia
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Wolf M, Emberger-Klein A, Menrad K. Factors influencing the use of natural health products, in particular for concentration and cognition in Germany. BMC Complement Med Ther 2024; 24:103. [PMID: 38414023 PMCID: PMC10898047 DOI: 10.1186/s12906-024-04407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Natural health products (NHP) are an important part of the healthcare system. They are mainly non-prescription and sold over the counter, which requires active decision making by the consumer. Within the framework of the Complementary and Alternative Healthcare Model, this study aims to identify factors that influence NHP usage, in particular related to concentration and cognition (CC), a topic that concerns all ages and social classes within the population. METHODS Data were collected by means of a representative online survey (n = 1,707) in Germany in April 2022. Three user groups were defined: NHPCC users, who used NHP for CC (12 month prevalence); nCC-NHP users, who used NHP but not for CC indications (12 month prevalence); and past NHP users, who have used NHP but not within the previous 12 months. Independent influencing variables were categorized into predisposing, enabling, need, and health service use factors. Data were analyzed with descriptive statistics, inferential statistics, and binary logistic regression models to compare NHPCC users to nCC-NHP users (model 1) and to past NHP users (model 2). RESULTS A higher share of NHPCC and nCC-NHP users compared to past NHP users were women, self-medicated with NHP, and used information about NHP provided by health professionals or on product. Their openness-to-change value orientation was more pronounced than of past users. Compared to nCC-NHP and past NHP users, the probability of being an NHPCC user increased if an individual had more difficulties in daily attention and memory performance, made use of health professionals and literature to seek information about NHP, and used NHP for health support and illness prevention. Additionally, a female gender, NHP self-medication, and having higher values of self-transcendence were significant indicators for NHPCC usage compared to past NHP usage. CONCLUSION NHP manufacturers, health professionals, and policymakers should be aware of the factors that lead to NHP consumption decisions and consider them in the development and optimization of healthcare strategies as well as in the marketing and communication strategies of companies producing NHP, in particular for CC. The current study can contribute to characterizing the target groups and to defining the aims and communication channels of such campaigns.
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Affiliation(s)
- Miriam Wolf
- Department of Marketing and Management of Biogenic Resources, Hochschule Weihenstephan-Triesdorf (University of Applied Sciences), Technical University of Munich Campus Straubing for Biotechnology and Sustainability, Am Essigberg 3, D-94315, Straubing, Bavaria, Germany.
| | - Agnes Emberger-Klein
- Department of Marketing and Management of Biogenic Resources, Hochschule Weihenstephan-Triesdorf (University of Applied Sciences), Technical University of Munich Campus Straubing for Biotechnology and Sustainability, Am Essigberg 3, D-94315, Straubing, Bavaria, Germany
| | - Klaus Menrad
- Department of Marketing and Management of Biogenic Resources, Hochschule Weihenstephan-Triesdorf (University of Applied Sciences), Technical University of Munich Campus Straubing for Biotechnology and Sustainability, Am Essigberg 3, D-94315, Straubing, Bavaria, Germany
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Gholipour Aghdam GM, Alizadeh MH, Minoonejad H, Shirzad E, Wilke J. Knee Biomechanics During Neurocognitively Challenged Drop Landings in Male Elite Soccer Players with Anterior Cruciate Ligament Reconstruction. Sports Med Open 2024; 10:19. [PMID: 38411754 PMCID: PMC10899557 DOI: 10.1186/s40798-024-00685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Reactive decision-making during athletic movement has been demonstrated to evoke unfavorable biomechanics associated with anterior cruciate ligament (ACL) rupture. However, the current evidence is based on assessments of healthy individuals. We aimed to investigate unplanned jump landing kinetics and knee kinematics in ACL-reconstructed (ACLR) and non-injured athletes. METHODS A total of 30 male professional soccer players (n = 15 ACLR after return to play, n = 15 matched controls) performed six drop landings onto a force plate. As a neurocognitive challenge requiring decision-making, a diode flashing in randomly selected colors indicated the requested landing location. Knee joint kinematics (flexion, valgus and tibial rotation angles) assessed with a 10-camera motion capture system, vertical ground reaction force (vGRF), time to stabilization (TTS) and length of the center of pressure (COP) trace (all analyzed from force plate data) were calculated. Cognitive function was assessed using the CNS Vital Signs battery. RESULTS The ACLR group produced lower knee flexion angles than the control group (median [interquartile range] 50.00° [6.60] vs. 55.20° [4.45], p = .02). In addition, path length of the center of pressure (379 mm [56.20] vs. 344 mm [37.00], p = .04) and ground reaction force (3.21 N/kg [0.66] vs. 2.87 N/kg [0.48], p = .01) were higher for the ACLR group. No differences were found for knee valgus (p = .96), tibial rotation (p = .83) and TTS (p = .82). ACLR participants scored lower for reaction time (p = .02) and processing speed (p = .01). Unfavorable knee biomechanics were more often related to cognitive function in the ACLR group than in the control group (p < .05). CONCLUSIONS Impaired reactive decision-making during athletic movement may contribute to the high re-injury risk in individuals with ACLR. Prospective studies confirming potential cause-effect relationships are warranted.
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Affiliation(s)
- Ghazal Mohammad Gholipour Aghdam
- Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
- Department of Movement Sciences, University of Klagenfurt, Universitätsstraße 65-67, 9020, Klagenfurt, Austria
| | - Mohammad Hossein Alizadeh
- Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Hooman Minoonejad
- Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Elham Shirzad
- Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Universitätsstraße 65-67, 9020, Klagenfurt, Austria.
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Nunobe S, Endo H, Honda M, Watanabe M, Yamamoto H, Kanaji S, Kakeji Y, Kodera Y, Kitagawa Y. Impact of treatment guidelines and pivotal clinical trial results on a surgeon's decision regarding treatment for gastric cancer: a retrospective cohort study using the National Clinical Database. Surg Today 2024:10.1007/s00595-024-02814-0. [PMID: 38402328 DOI: 10.1007/s00595-024-02814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/28/2024] [Indexed: 02/26/2024]
Abstract
PURPOSES The present study evaluated the impact of clinical guidelines for gastric cancer surgery on surgeons' choice of procedure in real-world practice. We focused on the 2014 guideline revision recommending laparoscopic surgery and the evidence concerning splenectomy for prophylactic lymphadenectomy reported in 2015 using the National Clinical Database, which is the most comprehensive database in Japan. METHODS We investigated the monthly percentages of laparoscopic distal gastrectomies performed for stage I gastric cancer (LDG%) and splenectomies performed during total gastrectomy for advanced cancer (TGS%) between 2014 and 2017. We evaluated the descriptive statistics of the time-series changes in the LDG%, TGS%, and annual trends of outcomes. RESULTS In total, 124,787 patients were enrolled. The mean LDG% and TGS% were 69.8% and 9.2%, respectively. The LDG% and TGS% were 66.4% and 16.7%, respectively, in January 2014 and 73.1% and 5.9%, respectively, in December 2017. LDG% consistently increased, and TGS% showed a consistent downward trend throughout the observation period. There was no significant change in this trend after the publication of the guideline recommendations or clinical trial results. CONCLUSION No significant changes in surgical procedures were observed after publication of the guidelines or results of clinical trials.
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Affiliation(s)
- Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 8-31, Ariake, 3-Chome, Koto-ku, Tokyo, 135-8550, Japan.
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 8-31, Ariake, 3-Chome, Koto-ku, Tokyo, 135-8550, Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shingo Kanaji
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
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Peterwerth NH, Halek M, Schäfers R. Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:155. [PMID: 38389073 PMCID: PMC10882933 DOI: 10.1186/s12884-024-06338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Risk perception is fundamental to decision-making; therefore its exploration is essential to gaining a comprehensive understanding of the decision-making process for peripartum interventions. The aim of this study was to investigate associations between personal and systemic factors of the work setting and the risk perception of obstetric healthcare professionals, and in turn how this might influence decisions regarding obstetric interventions. METHODS Case vignettes were used to measure risk perception. A quantitative cross-sectional online survey was performed within an exploratory sequential mixed-methods design, and an intervention readiness score created. Associations were calculated using location and dispersion measures, t-tests and correlations in addition to multiple linear regression. RESULTS Risk perception, as measured by the risk assessment score, was significantly lower (average 0.8 points) for midwives than for obstetricians (95%-CI [-0.673; -0.317], p < .001). Statistically significant correlations were found for: years of experience and annual number of births in the current workplace, but this was not clinically relevant; hours worked, with the groups of participants working ≥ 30,5 h showing a statistically significant higher risk perception than participants working 20,5-30 h (p = .005); and level of care of the current workplace, with the groups of participants working in a birth clinic (Level IV) showing a statistically significant lower risk perception than participants working in Level I hospital (highly specialised obstetric and neonatal care; p = .016). The option of midwife-led birthing care showed no correlation with risk perception. The survey identified that risk perception, occupation, years in the profession and number of hours worked (i.e. full or part time) represent significant influences on obstetric healthcare professionals' willingness to intervene. CONCLUSIONS The results of the survey give rise to the hypothesis that the personal and systemic factors of professional qualification, occupation, number of hours worked and level of acuity of the workplace are related to the risk perception of obstetric healthcare professionals. In turn, risk perception itself made a significant contribution to explaining differences in willingness to intervene, suggesting that it influences obstetricians' and midwives' decision-making. Overall, however, the correlations were weak and should be interpreted cautiously. The significant variations in the use of interventions must be addressed in order to provide the highest quality and best possible care for childbearing women and their families. To this end, developing strategies to improve interdisciplinary relationships and collaboration is of great importance. TRIAL REGISTRATION German Clinical Trials Register DRKS00017172 (18.06.2019).
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Affiliation(s)
- Nina H Peterwerth
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Germany.
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Rainhild Schäfers
- Institute of Midwifery Science, Faculty of Medicine, University of Münster, Malmedyweg 17-19, 48149, Münster, Germany
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Mamede S, Zandbergen A, de Carvalho-Filho MA, Choi G, Goeijenbier M, van Ginkel J, Zwaan L, Paas F, Schmidt HG. Role of knowledge and reasoning processes as predictors of resident physicians' susceptibility to anchoring bias in diagnostic reasoning: a randomised controlled experiment. BMJ Qual Saf 2024:bmjqs-2023-016621. [PMID: 38365449 DOI: 10.1136/bmjqs-2023-016621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/26/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Diagnostic errors have been attributed to reasoning flaws caused by cognitive biases. While experiments have shown bias to cause errors, physicians of similar expertise differed in susceptibility to bias. Resisting bias is often said to depend on engaging analytical reasoning, disregarding the influence of knowledge. We examined the role of knowledge and reasoning mode, indicated by diagnosis time and confidence, as predictors of susceptibility to anchoring bias. Anchoring bias occurs when physicians stick to an incorrect diagnosis triggered by early salient distracting features (SDF) despite subsequent conflicting information. METHODS Sixty-eight internal medicine residents from two Dutch university hospitals participated in a two-phase experiment. Phase 1: assessment of knowledge of discriminating features (ie, clinical findings that discriminate between lookalike diseases) for six diseases. Phase 2 (1 week later): diagnosis of six cases of these diseases. Each case had two versions differing exclusively in the presence/absence of SDF. Each participant diagnosed three cases with SDF (SDF+) and three without (SDF-). Participants were randomly allocated to case versions. Based on phase 1 assessment, participants were split into higher knowledge or lower knowledge groups. MAIN OUTCOME MEASUREMENTS frequency of diagnoses associated with SDF; time to diagnose; and confidence in diagnosis. RESULTS While both knowledge groups performed similarly on SDF- cases, higher knowledge physicians succumbed to anchoring bias less frequently than their lower knowledge counterparts on SDF+ cases (p=0.02). Overall, physicians spent more time (p<0.001) and had lower confidence (p=0.02) on SDF+ than SDF- cases (p<0.001). However, when diagnosing SDF+ cases, the groups did not differ in time (p=0.88) nor in confidence (p=0.96). CONCLUSIONS Physicians apparently adopted a more analytical reasoning approach when presented with distracting features, indicated by increased time and lower confidence, trying to combat bias. Yet, extended deliberation alone did not explain the observed performance differences between knowledge groups. Success in mitigating anchoring bias was primarily predicted by knowledge of discriminating features of diagnoses.
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Affiliation(s)
- Sílvia Mamede
- Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adrienne Zandbergen
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Goda Choi
- Department of Hematology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marco Goeijenbier
- Department of Intensive Care, Spaarne Gasthuis, Haarlem, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Joost van Ginkel
- Department of Psychology, Methodology and Statistics, Leiden University, Leiden, The Netherlands
| | - Laura Zwaan
- Institute of Medical Education Research Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fred Paas
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Henk G Schmidt
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Ahmad T, Rahim M, Yang J, Alharbi R, Abd El-Wahed Khalifa H. Development of p,q- quasirung orthopair fuzzy hamacher aggregation operators and its application in decision-making problems. Heliyon 2024; 10:e24726. [PMID: 38318055 PMCID: PMC10838738 DOI: 10.1016/j.heliyon.2024.e24726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024] Open
Abstract
The concept of p , q - quasirung orthopair fuzzy (p , q - QOF) sets is an advanced extension of q - rung orthopair fuzzy sets (q - ROFSs). This paper introduces the adaptation of Hamacher t-norm and t-conorm to the p , q - QOF environment. A series of Hamacher aggregation operators (AOs) and their associated properties are presented. This study extends its application to multi-criteria group decision-making (MCGDM) for practical problem-solving, illustrated through the analysis of mobile payment platforms. The influence of the aggregation operator parameters, denoted as p and q , on the outcomes of decisions is effectively showcased. Moreover, a comparative analysis is carried out to validate the credibility and authenticity of the proposed model. Finally, the advantages and limitations of the proposed model are outlined.
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Affiliation(s)
- Touqeer Ahmad
- School of Mathematical Sciences, Dalian University of Technology, Dalian 116024, China
| | - Muhammad Rahim
- Deparament of Mathematics, Hazara University, Mansehra 21300, PKP, Pakistan
| | - Jie Yang
- School of Mathematical Sciences, Dalian University of Technology, Dalian 116024, China
| | - Rabab Alharbi
- Department of Mathematics, College of Science and Arts, Qassim University, Ar Rass 51452, Saudi Arabia
| | - Hamiden Abd El-Wahed Khalifa
- Department of Mathematics, College of Science and Arts, Qassim University, Al-Badaya 51951, Saudi Arabia
- Department of Operations and Management Research, Faculty of Graduate Studies for Statistical Research, Cairo University, Giza 12613, Egypt
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Singh R, Pathak VK, Kumar R, Dikshit M, Aherwar A, Singh V, Singh T. A historical review and analysis on MOORA and its fuzzy extensions for different applications. Heliyon 2024; 10:e25453. [PMID: 38352792 PMCID: PMC10861981 DOI: 10.1016/j.heliyon.2024.e25453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/10/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
Multi-criteria decision-making (MCDM) methods have been widely used among researchers to provide a trade-off solution between best and worst, considering conflicting criteria and sets of preferences. An efficient and systematic literature review of these methods is needed to maintain their application in distinctive domains. To this end, this paper presents a comprehensive and systematic literature survey on "multi-objective optimization by ratio analysis" (MOORA) method and its fuzzy extensions developed and discussed in recent years. This review includes articles categorized based on the publication name, publishing year, journal name, type of applications, and type of fuzzy extensions. In addition, this review will enhance the understanding of practitioners and decision-makers on the MOORA method, its development, fuzzy hybridization, different application areas, and future work. The study revealed that the MOORA technique was predominantly used with the TOPSIS approach, followed by the AHP and COPRAS methods. Furthermore, 76.28 % use single and hybridization approaches among all MOORA studies, while 23.72 % use MOORA in a fuzzy environment.
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Affiliation(s)
- Ramanpreet Singh
- Department of Mechanical Engineering, Manipal University Jaipur, Jaipur, Rajasthan, 303007, India
| | - Vimal Kumar Pathak
- Department of Mechanical Engineering, Manipal University Jaipur, Jaipur, Rajasthan, 303007, India
| | - Rakesh Kumar
- Department of Mechanical Engineering, Manipal University Jaipur, Jaipur, Rajasthan, 303007, India
| | - Mithilesh Dikshit
- Department of Mechanical & Aero-Space Engineering, Institute of Infrastructure, Technology, Research and Management, Ahmedabad, Gujarat, 380026, India
| | - Amit Aherwar
- Department of Mechanical Engineering, Madhav Institute of Technology and Science, Gwalior, 474005, India
| | - Vedant Singh
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Bengaluru, 560035, India
| | - Tej Singh
- Savaria Institute of Technology, Faculty of Informatics, ELTE Eötvös Loránd University, Budapest 1117, Hungary
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Chan AHY, Tao M, Marsh S, Petousis-Harris H. Vaccine decision making in New Zealand: a discrete choice experiment. BMC Public Health 2024; 24:447. [PMID: 38347498 PMCID: PMC10863187 DOI: 10.1186/s12889-024-17865-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Vaccine hesitancy is a significant threat to global health. A key part of addressing hesitancy is to ensure that public health messaging prioritises information that is considered important to the public. This study aimed to examine how different vaccine characteristics affect public preferences for vaccines in New Zealand, what trade-offs they are willing to make between different vaccine characteristics, and how their preferences are affected by their vaccine-related conspiracy beliefs and COVID-19 vaccination status. METHODS An online discrete choice experiment (DCE) was designed to elicit individual preferences about vaccines using the 1000minds platform. Members of the general population of New Zealand aged ≥ 18 years were invited to complete the DCE. Participants were asked to indicate their preference between two options showing different combinations of vaccine characteristics. Data on sociodemographic characteristics were collected. Beliefs were measured using the vaccine conspiracy beliefs scale (VCBS) with scores ≥ 19 indicating strong vaccine-related conspiracy beliefs. The DCE was analysed using the PAPRIKA method (Potentially All Pairwise RanKings of all possible Alternatives) and preferences compared between respondents with high versus low VCBS scores and vaccinated versus unvaccinated respondents for COVID-19. RESULTS A total of 611 respondents from 15 regions completed the DCE. Mean (SD) age was 45.9 (14.7) years with most having had 2 or more doses of the coronavirus vaccine (86%). Mean (SD) VCBS score was 18.5 (12.4) indicating moderate vaccine-related conspiracy beliefs. Risk of severe adverse effects was the most highly valued vaccine characteristic, followed by vaccine effectiveness and duration of protection. Vaccine origin and route of administration were ranked least important. Respondents scoring high on the VCBS placed less value on the effectiveness of vaccines but greater value on development time and total number of doses (p < 0.001). COVID-19 unvaccinated respondents ranked development time and total number of doses more highly than those vaccinated respondents (p < 0.001). CONCLUSIONS Risk of severe adverse effects, vaccine effectiveness and duration of protection were rated by the New Zealand public as the top three most important vaccine characteristics. This information is important for informing public health messaging to promote vaccine uptake and inform vaccine decision-making.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, University of Auckland, Level 3, Building 505, 85 Park Road, Grafton, 1023, Auckland, New Zealand.
| | - Marvin Tao
- School of Medicine, University of Auckland, Building 505, 85 Park Road, Grafton, 1023, Auckland, New Zealand
| | - Samantha Marsh
- School of Population Health, University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand
| | - Helen Petousis-Harris
- School of Population Health, University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand
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Vinod SK, Merie R, Harden S. Quality of Decision Making in Radiation Oncology. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00067-0. [PMID: 38342658 DOI: 10.1016/j.clon.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/04/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
High-quality decision making in radiation oncology requires the careful consideration of multiple factors. In addition to the evidence-based indications for curative or palliative radiotherapy, this article explores how, in routine clinical practice, we also need to account for many other factors when making high-quality decisions. Foremost are patient-related factors, including preference, and the complex interplay between age, frailty and comorbidities, especially with an ageing cancer population. Whilst clinical practice guidelines inform our decisions, we need to account for their applicability in different patient groups and different resource settings. With particular reference to curative-intent radiotherapy, we explore decisions regarding dose fractionation schedules, use of newer radiotherapy technologies and multimodality treatment considerations that contribute to personalised patient-centred care.
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Affiliation(s)
- S K Vinod
- Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia; South West Sydney Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
| | - R Merie
- Icon Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - S Harden
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Bernklev L, Nilsen JA, Augestad KM, Holme Ø, Pilonis ND. Management of non-curative endoscopic resection of T1 colon cancer. Best Pract Res Clin Gastroenterol 2024; 68:101891. [PMID: 38522886 DOI: 10.1016/j.bpg.2024.101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 03/26/2024]
Abstract
Endoscopic resection techniques enable en-bloc resection of T1 colon cancers. A complete removal of T1 colon cancer can be considered curative when histologic examination of the specimens shows none of the high-risk factors for lymph nodes metastases. Criteria predicting lymph nodes metastases include deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding. In these cases, complete (R0), local endoscopic resection is considered sufficient as negligible risk of lymph nodes metastases does not outweigh morbidity and mortality associated with surgical resection. Challenges arise when endoscopic resection is incomplete (RX/R1) or high-risk histological features are present. The risk of lymph node metastasis in T1 CRC ranges from 1% to 36.4%, depending on histologic risk factors. Presence of any risk factor labels the patient "high risk," warranting oncologic surgery with mesocolic lymphadenectomy. However, even if 70%-80% of T1-CRC patients are classified as high-risk, more than 90% are without lymph node involvement after oncological surgery. Surgical overtreatment in T1 CRC is a challenge, requiring a balance between oncologic safety and minimizing morbidity/mortality. This narrative review explores the landscape of managing non-curative T1 colon cancer, focusing on the choice between advanced endoscopic resection techniques and surgical interventions. We discuss surveillance strategies and shared decision-making, emphasizing the importance of a multidisciplinary approach.
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Affiliation(s)
- Linn Bernklev
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.
| | - Jens Aksel Nilsen
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Vestre Viken Hospital Trust, Bærum Hospital, Norway
| | - Knut Magne Augestad
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway; Division of Surgery Campus Ahus, University of Oslo, Oslo, Norway
| | - Øyvind Holme
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Research, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Nastazja Dagny Pilonis
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Medical Center of Postgraduate Education, Warsaw, Poland; Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
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Rasanan AHH, Rad JA, Sewell DK. Are there jumps in evidence accumulation, and what, if anything, do they reflect psychologically? An analysis of Lévy Flights models of decision-making. Psychon Bull Rev 2024; 31:32-48. [PMID: 37528276 DOI: 10.3758/s13423-023-02284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 08/03/2023]
Abstract
According to existing theories of simple decision-making, decisions are initiated by continuously sampling and accumulating perceptual evidence until a threshold value has been reached. Many models, such as the diffusion decision model, assume a noisy accumulation process, described mathematically as a stochastic Wiener process with Gaussian distributed noise. Recently, an alternative account of decision-making has been proposed in the Lévy Flights (LF) model, in which accumulation noise is characterized by a heavy-tailed power-law distribution, controlled by a parameter, [Formula: see text]. The LF model produces sudden large "jumps" in evidence accumulation that are not produced by the standard Wiener diffusion model, which some have argued provide better fits to data. It remains unclear, however, whether jumps in evidence accumulation have any real psychological meaning. Here, we investigate the conjecture by Voss et al. (Psychonomic Bulletin & Review, 26(3), 813-832, 2019) that jumps might reflect sudden shifts in the source of evidence people rely on to make decisions. We reason that if jumps are psychologically real, we should observe systematic reductions in jumps as people become more practiced with a task (i.e., as people converge on a stable decision strategy with experience). We fitted five versions of the LF model to behavioral data from a study by Evans and Brown (Psychonomic Bulletin & Review, 24(2), 597-606, 2017), using a five-layer deep inference neural network for parameter estimation. The analysis revealed systematic reductions in jumps as a function of practice, such that the LF model more closely approximated the standard Wiener model over time. This trend could not be attributed to other sources of parameter variability, speaking against the possibility of trade-offs with other model parameters. Our analysis suggests that jumps in the LF model might be capturing strategy instability exhibited by relatively inexperienced observers early on in task performance. We conclude that further investigation of a potential psychological interpretation of jumps in evidence accumulation is warranted.
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Affiliation(s)
- Amir Hosein Hadian Rasanan
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jamal Amani Rad
- Department of Cognitive Modeling, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - David K Sewell
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Brisbane, Australia.
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Skraastad EJ, Borchgrevink PC, Opøyen LA, Ræder J. Wireless patient monitoring and Efficacy Safety Score in postoperative treatment at the ward: evaluation of time consumption and usability. J Clin Monit Comput 2024; 38:157-164. [PMID: 37460868 PMCID: PMC10879331 DOI: 10.1007/s10877-023-01053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/22/2023] [Indexed: 02/21/2024]
Abstract
To evaluate objective time consumption and how nurses perceived introducing wireless patient monitoring (WPM) and a validated score on patient quality and safety, the Efficacy Safety Score (ESS), at a mixed surgery ward. After fulfilling a randomised controlled trial combining the ESS and WPM, we addressed time consumption and conducted a questionnaire survey among nurses who participated in the study. The questionnaire appraised the nurses' evaluation of introducing these tools for postoperative management. Of 28 invited nurses, 24 responded to the questionnaire, and 92% reported the ESS and WPM-systems to increase patient safety and quality of care. 67% felt the intervention took extra time, but objective workload measurements revealed reduced time to 1/3 using ESS and WPM compared to standard manual assessment. Improved confidence when using the systems was reported by 83% and improved working situation by 75%. In a test situation to measure time consumption, the ESS and pre-attached WPM-systems require less time than the conventional standard of care, and may allow for more frequent clinical monitoring at the post-surgical ward. The combination of the ESS and the WPM systems was perceived as positive by participating nurses and further clinical development and research is warranted.
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Affiliation(s)
- Erlend Johan Skraastad
- Clinic of Anaesthesia and Intensive Care, St. Olavs hospital, Trondheim University Hospital, 3250 Torgarden, 7006, Trondheim, Norway.
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Petter Christian Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lillian Asbøll Opøyen
- Department of Thoracic and Occupational Medicine and Orkdal Dept. of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Johan Ræder
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
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46
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Rodenbach RA, Thordardottir T, Brauer M, Hall AC, Ward E, Smith CB, Campbell TC. Balancing risks and rewards: How hematologists discuss uncertainty in allogeneic hematopoietic cell transplantation outcomes. Patient Educ Couns 2024; 123:108177. [PMID: 38341898 DOI: 10.1016/j.pec.2024.108177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Allogeneic hematopoietic cell transplant (alloHCT) offers many patients with blood cancers a chance of cure but carries risks. We characterized how hematologists discuss the high-risk, high-reward concept of alloHCT. METHODS Qualitative analysis of video-recorded virtual encounters of hematologists who routinely perform alloHCT with actors portraying an older man recently diagnosed with high-risk myelodysplastic syndrome. RESULTS Hematologists (n = 37) were a median age of 44 years, 65% male, and 68% white. They frequently used "teeter-totter" language that juxtaposed alloHCT's risks and rewards in a dynamic, quickly alternating fashion and communicated uncertainty in transplant outcomes. This dialogue oscillated between encouragement about alloHCT's potential for cure and caution about its risks and occurred within single speech turns and in exchanges between hematologist and patient. Fewer hematologists outlined their big-picture stance on transplant's risks and benefits early in the conversation. Meanwhile, hematologists varied in how they counseled patients to manage transplant-related uncertainty and consider treatment decision making. CONCLUSION Hematologists use "teeter-totter" language to express hope and concern, confidence and uncertainty, and encouragement and caution about the high-risk, high-reward nature of alloHCT. PRACTICE IMPLICATIONS Teeter-totter language may help frame big-picture content about alloHCT's risks and benefits that is essential for patient education and decision making.
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Affiliation(s)
| | | | - Markus Brauer
- University of Wisconsin Department of Psychology, Madison, WI, USA
| | - Aric C Hall
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Earlise Ward
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | | | - Toby C Campbell
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
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Pignac S, Sygal N, Biglari M, Olds J, Fitzpatrick EM. Determining cochlear implant candidacy in children with residual hearing: A scoping review. Int J Pediatr Otorhinolaryngol 2024; 177:111855. [PMID: 38190764 DOI: 10.1016/j.ijporl.2024.111855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/20/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVES The purpose of this review was to summarize what is known about criteria, assessments, and recommendations for evaluating cochlear implant (CI) candidacy in children with residual hearing. METHODS Peer-reviewed studies were identified through a systematic search in five electronic databases. Articles were screened and assessed for eligibility. From the eligible studies, data were extracted to summarize and present a narrative synthesis of the findings. RESULTS A total of seven articles (two reviews and five primary studies) were included in the final analysis. Hearing levels better than the moderately severe to severe range (65-90 dB HL) tend to be supported as audiological candidacy criteria for pediatric CI. Recommendations for candidacy consideration based on audiologic thresholds range from 65 to 80 dB Hl pure-tone average as the lower boundary. Our review did not identify any specific assessment protocols. However, additional decision-making considerations related to borderline hearing loss configurations and assessment tools (the Speech Intelligibility Index and the Pediatric Minimum Speech Test Battery) were identified. Supplementary assessment considerations were also reported. CONCLUSION There is limited information regarding specific assessment protocols for children with residual hearing. The literature is primarily focused on guidelines related to audiologic criteria, although it is widely recommended that other areas of functioning should also be considered. Most recommendations appear to be based on expert opinion, clinical expertise, and evidence from overall pediatric CI outcomes rather than empirical evidence targeting children with residual hearing. There is an ongoing need for research to further develop protocols and tools that can assist clinicians and families in making cochlear implantation decisions for children with residual hearing.
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Affiliation(s)
- Sarah Pignac
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Ninell Sygal
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Maryam Biglari
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada
| | - Janet Olds
- Child Hearing Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa, Ontario, K1N 8L1, Canada
| | - Elizabeth M Fitzpatrick
- Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, Ontario, K1N 6N5, Canada; Child Hearing Laboratory, CHEO Research Institute, 401 Smyth Road, Ottawa, Ontario, K1N 8L1, Canada.
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Hughes MT. How to "Do Ethics" in Pediatrics Practice: A Framework for Addressing Everyday Ethics Issues. Pediatr Clin North Am 2024; 71:9-26. [PMID: 37973310 DOI: 10.1016/j.pcl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Pediatricians have a fiduciary responsibility to advocate for the best interests of their patients. They accomplish this through the therapeutic alliance with the patient and their parent. In everyday clinical medicine, the pediatrician may be faced with challenging situations. When a case raises concerns, the pediatrician needs to determine if the issues relate to ethical obligations and whether they are in conflict. To resolve the concerns, a systematic process for gathering, organizing, and analyzing the facts of a case is needed to discern morally permissible options. This article presents a framework for performing an ethics case analysis.
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Affiliation(s)
- Mark T Hughes
- Department of Medicine, Johns Hopkins University School of Medicine; Berman Institute of Bioethics.
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Armstrong AW, Jayade S, Rege S, Joshi N, Patel V, Kalirai S, Wolin D, Boyle K, Patel D, Seigel L. Evaluating Treatment Choice in Patients with Moderate to Severe Psoriasis in the United States: Results from a US Patient Survey. Dermatol Ther (Heidelb) 2024; 14:421-439. [PMID: 38252376 PMCID: PMC10891029 DOI: 10.1007/s13555-023-01089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION While multiple treatments are available for moderate to severe psoriasis, patient preferences are rarely systematically studied. This study aims to identify factors associated with choice of a new once-daily oral psoriasis treatment, elicit patient views on treatment characteristics, and rank treatment characteristics by importance. METHODS This noninterventional, cross-sectional survey study, conducted from December 2021 to June 2022, recruited US adults with moderate to severe psoriasis. Demographics, clinical characteristics, and perspectives on psoriasis treatment were collected. Factors associated with the choice of a new oral treatment were identified using multivariable logistic regression analysis. Treatment characteristics and reasons for treatment choice were ranked using bivariate comparisons. RESULTS The study included 882 participants [mean (standard deviation; SD) age, 45.7 (12.8) years; female, 67.7%; White, 74.9%]; 92.7% were currently receiving treatment [mean (SD) duration, 2.9 (4.8) years]. Half of participants rated their psoriasis symptoms over the past week as mild, very mild, or nonexistent; 36.5% as moderate; and 12.7% as severe or very severe. Most (66.5%) indicated willingness to start a new oral treatment; 65.0% indicated that the new oral treatment would cause less anxiety than injections/infusions. Participants were significantly more likely to start the new oral treatment if they were currently receiving a tumor necrosis factor inhibitor [odds ratio (OR): 2.1, 95% confidence interval (CI): 1.4-3.1] or ustekinumab (OR: 2.7, 95% CI: 1.6-5.0) versus apremilast (P < 0.001) or if they reported mild (OR: 3.2, 95% CI: 2.0-4.9), moderate (OR: 5.0, 95% CI: 3.1-8.2), or severe (OR: 7.6, 95% CI: 3.9-15.0) psoriasis symptoms compared with those who reported no symptoms in the past week (P < 0.001). CONCLUSION Most participants indicated willingness to start a new once-daily oral treatment, viewing it as less anxiety provoking than injections/infusions. Current treatment and psoriasis severity affected participants' willingness to start a new oral treatment.
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Affiliation(s)
- April W Armstrong
- Division of Dermatology, David Geffen Department of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite 450, Los Angeles, CA, 90095, USA.
| | | | - Sanika Rege
- OPEN Health Evidence & Access, Bethesda, MD, USA
| | - Namita Joshi
- OPEN Health Evidence & Access, Bethesda, MD, USA
| | | | | | - Daniel Wolin
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - Dipen Patel
- OPEN Health Evidence & Access, Bethesda, MD, USA
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50
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See ZW, Lee MS, Parolia A, Kanagasingam S, Gunjal S, Patel S. Effect of Dental Practicality Index training using an online video on decision-making and confidence level in treatment planning by dental undergraduates. Restor Dent Endod 2024; 49:e8. [PMID: 38449491 PMCID: PMC10912547 DOI: 10.5395/rde.2024.49.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 03/08/2024] Open
Abstract
Objectives The purpose of this study was to evaluate the effect of Dental Practicality Index (DPI) training using an online video on the treatment planning decisions and confidence level of dental undergraduates (DUs). Materials and Methods Ninety-four DUs were shown 15 clinical case scenarios and asked to decide on treatment plans based on 4 treatment options. The most appropriate treatment plan had been decided by a consensus panel of experienced dentists. DUs then underwent DPI training using an online video. In a post-DPI-training test, DUs were shown the same clinical case scenarios and asked to assign the best treatment option. After 6 weeks, DUs were retested to assess their knowledge retention. In all 3 tests, DUs completed the confidence level scale questionnaire. Data were analyzed using the related-samples Wilcoxon signed rank test and the independent-samples Mann-Whitney U test with the level of significance set at p < 0.05. Results DPI training significantly improved the mean scores of the DUs from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. Conclusions Training DUs using DPI with an online video improved their decision-making and confidence level in treatment planning.
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Affiliation(s)
- Zhai Wei See
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Ming Sern Lee
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Abhishek Parolia
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
- Department of Endodontics, University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Shalini Kanagasingam
- School of Dentistry, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, United Kingdom
| | - Shilpa Gunjal
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Shanon Patel
- Department of Endodontology, King’s College London Dental Institute, London, United Kingdom
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