Contraceptive uptake and compliance after structured contraceptive counseling - secondary outcomes of the LOWE trial

INTRODUCTION

Highly effective long-acting reversible contraceptive (LARC) methods reduce unintended pregnancy rates; however, these methods are underutilized. The LOWE trial intervention provided structured contraceptive counseling resulting in increased uptake of LARC. This longitudinal follow up of the LOWE study assessed the long-term impact of the intervention by investigating the contraceptive use at 12 months with a focus on continued use of LARC.

MATERIAL AND METHODS

In the cluster randomized LOWE trial, abortion, youth, and maternal health clinics were randomized to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of an educational video on contraceptive methods, key questions asked by the health care provider, a tiered effectiveness chart and a box of contraceptive models. Women ≥ age 18, who were sexually active or planned to be in the upcoming 6 months, could participate in the study. We assessed self-reported contraceptive use at three, six and 12 months. Contraceptive choice and switches were analyzed with descriptive statistics. Contraceptive use at 12 months and continued use of LARC were analyzed using mixed logistic regressions, with clinic included as a random effect. Analysis with imputed values were performed for missing data to test the robustness of results.

RESULTS

Overall, at 12 months, women in the intervention group were more likely to be using a LARC method (aOR 1.90, 95% CI: 1.31-2.76) and less likely to be using a short-acting reversible contraceptive (SARC) method (aOR 0.66, 95% CI: 0.46-0.93) compared to the control group. Women counseled at abortion (aOR 2.97, 95% CI: 1.36-6.75) and youth clinics (aOR 1.81, 95% CI: 1.08-3.03) were more likely to be using a LARC method, while no significant difference was seen in maternal health clinics (aOR 1.84, 95% CI: 0.96-3.66). Among women initiating LARC, continuation rates at 12 months did not differ between study groups (63.9% vs. 63.7%). The most common reasons for contraceptive discontinuation were wish for pregnancy, followed by irregular bleeding, and mood changes.

CONCLUSIONS

The LOWE trial intervention resulted in increased LARC use also at 12 months. Strategies on how to sustain LARC use needs to be further investigated.

Noise annoys-But personal choice can attenuate noise effects on cardiac response reflecting effort

Since personal choice fosters commitment and shields action execution against potentially conflicting influences, two laboratory experiments with university students (N = 228) tested whether engaging in action by personal choice versus external assignment of task characteristics moderates the effect of irrelevant acoustic noise on cardiovascular responses reflecting effort. Participants who could personally choose the stimulus color of moderately difficult cognitive tasks were expected to be shielded against the irrelevant noise. By contrast, when the stimulus color was externally assigned, we predicted receptivity for the irrelevant noise to be high. As expected, in both experiments, participants in the assigned color condition showed stronger cardiac pre-ejection period reactivity during task performance when exposed to noise than when working in silence. On the contrary, participants who could choose the stimulus color were shielded against the noise effect on effort. These findings conceptually replicate and extend research on the action shielding effect by personal choice and hold practical implications for occupational health.

Long-Term Effectiveness of a Multi-Strategy Choice Architecture Intervention in Increasing Healthy Food Choices of High-School Students From Online Canteens (Click & Crunch High Schools): Cluster Randomized Controlled Trial

BACKGROUND

School canteens are a recommended setting to influence adolescent nutrition due to their scope to improve student food choices. Online lunch ordering systems ("online canteens") are increasingly used and represent attractive infrastructure to implement choice architecture interventions that nudge users toward healthier food choices. A recent cluster randomized controlled trial demonstrated the short-term effectiveness (2-month follow-up) of a choice architecture intervention to increase the healthiness of foods purchased by high school students from online canteens. However, there is little evidence regarding the long-term effectiveness of choice architecture interventions targeting adolescent food purchases, particularly those delivered online.

OBJECTIVE

This study aimed to determine the long-term effectiveness of a multi-strategy choice architecture intervention embedded within online canteen infrastructure in high schools at a 15-month follow-up.

METHODS

A cluster randomized controlled trial was undertaken with 1331 students (from 9 high schools) in New South Wales, Australia. Schools were randomized to receive the automated choice architecture intervention (including menu labeling, positioning, feedback, and prompting strategies) or the control (standard online ordering). The foods purchased were classified according to the New South Wales Healthy Canteen strategy as either "everyday," "occasional," or "should not be sold." Primary outcomes were the average proportion of "everyday," "occasional," and "should not be sold" items purchased per student. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Outcomes were assessed using routine data collected by the online canteen.

RESULTS

From baseline to 15-month follow-up, on average, students in the intervention group ordered significantly more "everyday" items (+11.5%, 95% CI 7.3% to 15.6%; P<.001), and significantly fewer "occasional" (-5.4%, 95% CI -9.4% to -1.5%; P=.007) and "should not be sold" items (-6%, 95% CI -9.1% to -2.9%; P<.001), relative to controls. There were no between-group differences over time in the mean energy, saturated fat, sugar, or sodium content of lunch orders.

CONCLUSIONS

Given their longer-term effectiveness, choice architecture interventions delivered via online canteens may represent a promising option for policy makers to support healthy eating among high school students.

TRIAL REGISTRATION

Australian Clinical Trials ACTRN12620001338954, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380546 ; Open Science Framework osf.io/h8zfr, https://osf.io/h8zfr/.

Toward a further understanding of assent

Arranging assent opportunities is an increasingly common strategy for involving clients in therapeutic decisions within behavior analysis. Recent behavior-analytic articles have helped create a basic behavioral definition and conceptualization of assent, but much more guidance is needed for practitioners and researchers interested in embedding assent into their practices. The purpose of this article is to advance the conceptualization and understanding of assent and assent practices by refining previous definitions and conceptualizations of assent and providing six essential considerations for embedding assent into practice. The six considerations consist of determining the applicability and feasibility of assent, assessing assent-related skills, arranging assent procedures and teaching assent-related skills, arranging fair choices, selecting opportunities to assess assent, and informally assessing assent. Following the discussion of the considerations for assent practices, we issue a call for specific topics of research on assent.

Relative preference for distinct reinforcers maintaining destructive behavior

The literature offers few recommendations for sequencing exposure to treatment conditions with individuals with multiply maintained destructive behavior. Identifying relative preference for the functional reinforcers maintaining destructive behavior may be one means of guiding that decision. The present study presents a preliminary attempt at developing a robust relative preference and reinforcer assessment for individuals with multiply maintained destructive behavior. Guided and free-choice trials were implemented in which participants chose between two multiple-schedule arrangements, each of which programmed signaled periods of isolated reinforcer availability and unavailability. Consistent participant choice and responding during free-choice trials was then used to thin the corresponding schedule of reinforcement. The results demonstrated a strong preference for one of the two functional reinforcers for all four participants, yet preferences differed across participants and were not well predicted by responding in prior analyses.

Resurgence Following Higher or Lower Quality Alternative Reinforcement

Resurgence is a temporary increase in a previously suppressed target behavior following a worsening in reinforcement conditions. Previous studies have examined how higher rates or magnitudes of alternative reinforcement affect suppression of the target behavior and subsequent resurgence. However, there has been no investigation of the effects of higher versus lower qualities of alternative reinforcement on resurgence. Using a three-phase resurgence preparation with rats, the present experiments examined the effects of an alternative reinforcer that was of higher (Experiment 1) or lower (Experiment 2) quality than the reinforcer that had previously maintained the target behavior. The results of both experiments showed greater reductions in target behavior with a higher quality alternative reinforcer and larger increases in target responding when a higher quality alternative reinforcer was removed. Along with prior findings with higher rates and magnitudes of alternative reinforcement, these findings suggest that variations in reinforcer dimensions that increase the efficacy of alternative reinforcement also tend to increase resurgence when alternative reinforcement is removed. The results are discussed in terms of the resurgence as choice in context model and in terms of potential clinical implications.

A review of the concurrent-chains arrangement to assess intervention choice: 2018-2023

The purpose of this review is to summarize recent literature on the use of concurrent-chains arrangements in the assessment of preference for interventions (or intervention components) in the applied literature. The types of interventions and participants are described briefly, and procedural variations, ethical considerations, and recommendations for future research are discussed.

A Reexamination of the Relationship between Training Practices and Welfare in the Management of Ambassador Animals

There is an ethical need to document and develop best practices for meeting ambassador animals' welfare needs within the context of meeting zoo and aquarium program objectives. This is because ambassador animals experience direct and frequent contact with humans. This paper rigorously synthesizes behavioral research and theory, contemporary practices, and personal experiences to offer key concepts that can be applied to meet ambassador animal welfare needs. These key concepts include addressing an animal's recognition of choice and control, the use of the most positive and least intrusive effective interventions when training animals to participate in programming, and an overall reduction in aversive strategy use. Our model for increasing ambassador animal welfare focuses on seven main areas of concern, including the following: choosing the most suitable animal for the program; choosing the human with the right skills and knowledge for the program; using the most positive, least intrusive, effective training methods; developing a strong trusting relationship between trainer and animal; developing a comprehensive enrichment program; the need for institutional support; and creating opportunities for animals to practice species-appropriate behaviors. Our model will provide guidelines for improved ambassador animal welfare that can be refined with future research.

Effects of different Ficus feeding experiences on host preference of Perina nuda larvae (Lepidoptera: Lymantriidae)

Perina nuda (Lepidoptera: Lymantriidae) is a serious pest of banyan trees (Ficus spp.), which is distributed in South China, but little is known about the host preference on the different banyan tree species. To address this gap, we conducted experiments to investigate larval feeding preferences, assessing the impact of feeding experience in both choice and no-choice conditions. Fifth and sixth instars were exposed to 4 banyan species, and food intake, feeding area, and relative ingestion index were measured. Our findings reveal that Ficus concinna was the preferred host of fifth instars in choice tests, while sixth instars exhibited a preference for this host in no-choice tests. In contrast, fifth instars did not display a significant preference for any of the 4 species in no-choice tests. However, sixth instars fed on F. microcarpa, F. altissima, and F. concinna continued to exhibit a preference for the original host. These observations indicate that larval feeding preference changes with instar, and feeding experience contributes to a preference for the original host. Consequently, the feeding preference of P. nuda larvae is influenced by multiple factors, including instar and previous feeding experience. These findings enhance our understanding of P. nuda's ecological interactions and its potential impact on various banyan tree species.

Medication-Free Treatment in Mental Health Care How Does It Differ from Traditional Treatment?

Background

Norwegian authorities have implemented treatment units devoted to medication-free mental health treatment nationwide to improve people's freedom of choice. This article examines how medication-free treatment differs from treatment as usual across central dimensions.

Methods

The design was mixed methods including questionnaire data on patients from a medication-free unit and two comparison units (n 59 + 124), as well as interviews with patients (n 5) and staff (n 8) in the medication-free unit.

Results

Medication-free treatment involved less reliance on medications and more extensive psychosocial treatment that involved a culture of openness, expression of feelings, and focus on individual responsibility and intensive work. The overall extent of patient influence for medication-free treatment compared with standard treatment was not substantially different to standard treatment but varied on different themes. Patients in medication-free treatment had greater freedom to reduce or not use medication. Medication-free treatment was experienced as more demanding. For patients, this could be connected to a stronger sense of purpose and was experienced as helpful but could also be experienced as a type of pressure and lack of understanding. Patients in medication-free treatment reported greater satisfaction with the treatment, which may be linked to a richer psychosocial treatment package that focuses on patient participation and freedom from pressure to use medication.

Conclusion

The findings provide insights into how a medication-free treatment service might work and demonstrate its worth as a viable alternative for people who are not comfortable with the current medication focus of mental health care. Patients react differently to increased demands and clinicians should be reflexive of the dimensions of individualism-relationism in medication-free treatment services. This knowledge can be used to further develop and improve both medication-free treatment and standard treatment regarding shared decision-making.

Trial Registration

This study was registered with ClinicalTrials.gov (Identifier NCT03499080) on 17 April 2018.

Joint encoding of stimulus and decision in monkey primary visual cortex

We investigated whether neurons in monkey primary visual cortex (V1) exhibit mixed selectivity for sensory input and behavioral choice. Parallel multisite spiking activity was recorded from area V1 of awake monkeys performing a delayed match-to-sample task. The monkeys had to make a forced choice decision of whether the test stimulus matched the preceding sample stimulus. The population responses evoked by the test stimulus contained information about both the identity of the stimulus and with some delay but before the onset of the motor response the forthcoming choice. The results of subspace identification analysis indicate that stimulus-specific and decision-related information coexists in separate subspaces of the high-dimensional population activity, and latency considerations suggest that the decision-related information is conveyed by top-down projections.

A hippocampo-cortical pathway detects changes in the validity of an action as a predictor of reward

Much research has been dedicated to understanding the psychological and neural bases of goal-directed action, yet the relationship between context and goal-directed action is not well understood. Here, we used excitotoxic lesions, chemogenetics, and circuit-specific manipulations to demonstrate the role of the ventral hippocampus (vHPC) in contextual learning that supports sensitivity to action-outcome contingencies, a hallmark of goal-directed action. We found that chemogenetic inhibition of the ventral, but not dorsal, hippocampus attenuated sensitivity to instrumental contingency degradation. We then tested the hypothesis that this deficit was due to an inability to discern the relative validity of the action compared with the context as a predictor of reward. Using latent inhibition and Pavlovian context conditioning, we confirm that degradation of action-outcome contingencies relies on intact context-outcome learning and show that this learning is dependent on vHPC. Finally, we show that chemogenetic inhibition of vHPC terminals in the medial prefrontal cortex also impairs both instrumental contingency degradation and context-outcome learning. These results implicate a hippocampo-cortical pathway in adapting to changes in instrumental contingencies and indicate that the psychological basis of this deficit is an inability to learn the predictive value of the context. Our findings contribute to a broader understanding of the neural bases of goal-directed action and its contextual regulation.

Choice Enhances Placebo Hypoalgesia More in Weaker Placebo Contexts: A Partial Reinforcement Study

Providing individuals with choice over treatment has been found to enhance placebo hypoalgesia. However, this choice effect is not always present. The current study tested whether the strength of the placebo context influenced the effect of choice on placebo hypoalgesia. Using an established electrocutaneous pain paradigm, the choice effect was compared when placebo hypoalgesia was induced by Continuous Reinforcement (CRF) (strong placebo context) versus partial reinforcement (PRF) (weak placebo context). Healthy volunteers (N = 133) were randomized to receive either choice over treatment administration or no choice and then to placebo conditioning under either CRF (placebo always followed by surreptitious pain reduction during training) or PRF (placebo only followed by surreptitious pain reduction on half of the training trials). At the test, placebo hypoalgesia was greater and more resistant to extinction overall for those with choice. Importantly, however, the choice effect in enhancing the magnitude of placebo hypoalgesia was stronger after PRF than CRF. These results indicate that choice may have greater placebo-enhancing power in weaker placebo contexts. Therefore, choice may be a cheap and effective tool for improving clinical outcomes by facilitating placebo hypoalgesia when the existing treatment context is insufficient to produce placebo hypoalgesia itself. PERSPECTIVE: This study demonstrates that the enhancing effect of choice on placebo hypoalgesia is greater in a weaker placebo context. As such, offering choice could be an ethical way to effectively improve pain outcomes when placebo effects cannot be readily produced by the treatment context.

The multiple-stimulus-without-replacement preference assessment tool and its predictive validity

This study demonstrates the use of two web-based programs, one to identify video preferences and the other to assess their reinforcing effects. We used the Multiple-Stimulus-Without-Replacement Preference Assessment Tool (MSWO PAT) to identify the video preference hierarchies of seven participants, ages 4-11 years old. We then used a customized reinforcer assessment program that arranged a concurrent-chains preparation with programmed conjugate schedules of reinforcement. Button presses emitted by participants modulated the quality (volume and opacity) of selected videos on a moment-to-moment basis, allowing us to identify the reinforcing effects of the videos in little time. The results showed that the preference assessment had predictive value for five of seven participants. We discuss the MSWO PAT, parameters that may affect the identification of preferences and the use of conjugate schedules to identify reinforcers.

A view-based decision mechanism for rewards in the primate amygdala

Primates make decisions visually by shifting their view from one object to the next, comparing values between objects, and choosing the best reward, even before acting. Here, we show that when monkeys make value-guided choices, amygdala neurons encode their decisions in an abstract, purely internal representation defined by the monkey's current view but not by specific object or reward properties. Across amygdala subdivisions, recorded activity patterns evolved gradually from an object-specific value code to a transient, object-independent code in which currently viewed and last-viewed objects competed to reflect the emerging view-based choice. Using neural-network modeling, we identified a sequence of computations by which amygdala neurons implemented view-based decision making and eventually recovered the chosen object's identity when the monkeys acted on their choice. These findings reveal a neural mechanism in the amygdala that derives object choices from abstract, view-based computations, suggesting an efficient solution for decision problems with many objects.

Effects of naltrexone on amphetamine choice in rhesus monkeys and rats

Clinical amphetamine use is constrained by high abuse potential, and amphetamine use disorder is a persistent clinical problem with no approved medications for its treatment. The opioid antagonist naltrexone has been reported to reduce some abuse-related effects of amphetamine. This study used an amphetamine-versus-food choice procedure in rhesus monkeys and rats to test the hypothesis that naltrexone might serve as either (a) a maintenance medication for amphetamine use disorder treatment or (b) an "abuse-deterrent" adjunct to clinical amphetamine formulations. Male rhesus monkeys and male and female rats were trained to choose between increasing unit doses of intravenous amphetamine and an alternative food reinforcer during daily behavioral sessions. Experiment 1 evaluated effectiveness of continuous naltrexone maintenance to reduce amphetamine-versus-food choice in both monkeys and rats. Experiment 2 combined naltrexone with amphetamine in fixed-proportion amphetamine + naltrexone mixtures to evaluate the effectiveness of naltrexone in both species to reduce mixture choice relative to amphetamine-alone choice. Amphetamine maintained a dose-dependent increase in amphetamine choice in both monkeys and rats. Naltrexone maintenance did not significantly decrease amphetamine choice in either species. Addition of naltrexone to amphetamine reduced amphetamine choices per session in monkeys, but behavior was not reallocated to food choice, and in rats, the addition of naltrexone only decreased food choice without significantly affecting amphetamine choice. These results argue against the use of naltrexone as either (a) a maintenance medication for treatment of amphetamine use disorder or (b) an "abuse-deterrent" adjunct to amphetamine for clinical applications. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adherence, safety, and choice of the monthly dapivirine vaginal ring or oral emtricitabine plus tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis among African adolescent girls and young women: a randomised, open-label, crossover trial

BACKGROUND

Half of new HIV acquisitions in Africa occur in adolescent girls and young women. Pre-exposure prophylaxis (PrEP) with oral tenofovir disoproxil fumarate plus emtricitabine or the monthly dapivirine vaginal ring is efficacious but has lower adherence and effectiveness among adolescent girls and young women. We aimed to assess product adherence, safety, and choice of oral PrEP compared with the dapivirine ring among African adolescent girls and young women.

METHODS

MTN-034/REACH was a randomised, open-label, phase 2a crossover trial among HIV-seronegative, non-pregnant adolescent girls and young women aged 16-21 years at four clinical research sites in South Africa, Uganda, and Zimbabwe. Participants were randomly assigned (1:1) to either the dapivirine ring or daily oral PrEP (200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate) for 6 months, then switched to the other product option for 6 months, followed by a third 6-month period in which participants were given a choice of oral PrEP, the dapivirine ring, or neither. Fixed block randomisation was used, stratified by site. The primary adherence endpoint was use of each product during the randomised periods, with high use defined as tenofovir-diphosphate concentrations greater than or equal to 700 fmol/punch (associated with taking an average of four or more tablets per week in the previous month) and greater than or equal to 4 mg dapivirine released from the returned ring (continuous use for 28 days in the previous month) based on residual drug concentrations. The primary safety endpoint was grade 2 or higher adverse events during each randomised period of 24 weeks of ring and oral PrEP. This trial is registered at ClinicalTrials.gov, NCT03593655.

FINDINGS

From Feb 6, 2019 to Sept 9, 2021, 396 adolescent girls and young women were screened, 247 of whom were enrolled and randomly assigned (6 months of the ring followed by 6 months of oral PrEP n=124; 6 months of oral PrEP followed by 6 months of the ring n=123). Median age was 18 years (IQR 17-19). 54 grade 2 or higher product-related adverse events were reported during oral PrEP and five during dapivirine ring use, with no product-related serious adverse events. High adherence was observed in 753 (57%) of the 1316 oral PrEP visits and 806 (57%) of the 1407 dapivirine ring visits. Four women acquired HIV during follow-up.

INTERPRETATION

Adherence was moderately high and similar between oral PrEP and the dapivirine ring with favourable safety and tolerability. Oral PrEP and the dapivirine ring are effective, safe, and well tolerated HIV prevention options for adolescent girls and young women who would benefit from a choice of PrEP formulations to meet their needs and preferences.

FUNDING

National Institutes of Health.

The difficult process of autonomous choice: using I-poems to understand experiences of abortion-seekers in The Netherlands

While key barriers to abortion care accessibility have been established, little is known about the experiences of people having abortions in the Netherlands. Stories of individual abortion-seekers can help counteract stereotyping, diminish abortion stigma, and improve accessibility. This study's research question is: What experiences do abortion-seekers in the Netherlands have with abortion care and what new insights can the I-poem method of analysis provide? This qualitative feminist study used transcripts of semi-structured, in-depth interviews with abortion-seekers from previous research to create I-poems. Using a grounded theory method, the I-poems were coded deductively to validate previous findings, and inductively to generate new insights. The I-poems revealed that although abortion-seekers felt autonomous, their decision-making was complicated by doubt concerning their partner's views and/or suitability as a parent, feelings of shame, and a lack of support. The abortion-seekers were often slowed by obstacles in policy and care; waiting caused feelings of fear and panic and routine pre-abortion ultrasounds led to anxiety. They often did not know what to expect from their body or the abortion procedure. I-poems show how autonomous choice in abortion care is socially constructed rather than purely individual. Abortion providers must pay special attention to external factors complicating the decision-making process such as partner discordance (even in stable relationships) and anxiety due to waiting times and routine pre-abortion ultrasound. Future action on normalisation of information provided on all aspects of choosing an abortion is necessary to realise informed choice and reduction of abortion stigma.Plain language summary Abortion is a medical procedure that ends a pregnancy. In some countries, people can easily get an abortion. In others, it is illegal or difficult to access. In the Netherlands, abortion is accessible and legal before 24 weeks of pregnancy and can be performed upon request of the abortion seeker. This policy is often seen as liberal, as it allows people to make their own decisions about their bodies. Still, abortion stigma is present in Dutch society. Stigma around abortion refers to negative attitudes and beliefs that society has towards people who have had abortions or are considering having one.Research by Holten et al⁷ looked at how easy it is for abortion seekers in the Netherlands to access abortion services. The study highlighted that people in the Netherlands still face barriers to accessing abortion services. For example: the law and regulations regarding abortions and the fact that people had difficulty in talking about their abortion due to stigma.The abovementioned study gives a broad view on challenges in the accessibility of abortion in the Netherlands, but the individual experiences are not portrayed.The goal of this study is to learn about the personal experiences of abortion-seekers in the Netherlands. It aims to understand what it's like for these people to access abortion services and what we can learn from their individual stories by using a method of analysis called I-poem. I-poems are a type of poem created by the researcher by looking for sentences using the first-person pronoun "I" in interview texts. I poems show the personal experience or point of view of the person interviewed. This type of poem is often used to express emotions or share personal stories or observations.This study used interviews with people who have had abortions to create I-poems. The grounded theory method was used to analyse the I-poems in two ways: confirming what was found in previous studies, and also providing new insights from the data.The study found that the people contemplating having an abortion had a hard time making the decision to have an abortion because they had doubts, were worried about what their partner would think, felt ashamed to talk about it with friends and family, and didn't have enough support. They also faced challenges like having to wait for the abortion because of clinic schedules and laws and getting ultrasounds before the procedure, which made them anxious. It was also found that the people contemplating abortion were unsure of what to expect from the abortion procedure and how their body would react, which made the decision even harder.The study concludes that even when people felt in control of their decision, the decision-making process was still difficult. The decision is not just personal, but is also affected by society, partners, and healthcare policies. The waiting time and the ultrasound before the abortion made the process harder, and abortion seekers were not aware of what to expect from the procedure. More information and education on all aspects of having an abortion should be provided to help people to make better informed decisions and reduce the abortion stigma. Further research on experiences of routine ultrasound before abortion in the Netherlands is needed to improve abortion care.

Putting a price on healthy eating: public perceptions of the need for further food pricing policies in the UK

BACKGROUND

Understand factors that influence food choice and explore public perceptions of the need for government policies to improve diets in the UK, particularly food pricing interventions.

METHODS

A qualitative study design was used with semi-structured interviews. The study was carried out in Greater Manchester, England. In all, 15 participants from a diverse range of backgrounds were recruited.

RESULTS

Food price, lack of time, availability, and food knowledge and culture were key factors that led some study participants towards unhealthy food choices. The UK's individual, willpower-focused approach to tackling obesity was deemed ineffective and many participants supported further government intervention. Product reformulation was supported as a less intrusive and less regressive way of improving diets than taxation. There was also support for increasing cooking classes within schools.

CONCLUSIONS

Whilst the government ambition to half childhood obesity by 2030 is welcome, population level interventions that enable healthier food choices are needed to achieve this goal. Rising global food prices may make reformulation a more practical policy option than further pricing interventions. Mandatory reformulation of convenience meal and snack products and strengthening education in schools may represent a publicly acceptable and effective package of interventions within a comprehensive strategy to tackle obesity.

Women's experiences and views of outpatient and inpatient induction of labor with oral misoprostol: A secondary qualitative study

INTRODUCTION

As labor induction rates continue to increase, so has the interest in performing induction in an outpatient setting for pregnancies defined as low-risk. Twenty women participated in the pilot study of a Randomized Controlled Trial (RCT) comparing inpatient and outpatient labor induction with oral misoprostol. This study aimed to explore women's experiences of outpatient induction of labor and their views on this as an alternative method to inpatient labor induction.

METHODS

Semi-structured interviews were conducted, from November 2021 to January 2022 with eight women randomized to outpatient induction and four women randomized to inpatient induction. Verbatim transcribed interviews were analyzed using Graneheim and Lundman's content analysis.

RESULTS

Three main categories emerged: the required framework around outpatient labor induction, what felt better at home and what felt safer at the hospital. To feel secure at home, women needed sufficient information, close follow-up while at home, and an easy-to-administer induction method. Outpatient labor induction gave women the opportunity of constant support from the partner and increased freedom of movement and self-expression. Some expressed relief over being randomized to inpatient labor induction, because of easy access to health providers, fetal monitoring, and not risking giving birth before arrival to the hospital. Women stressed the importance of being given a choice.

CONCLUSIONS

Outpatient labor induction contributed to a positive birth experience and should be considered as an alternative for women with low-risk pregnancies. Shared decision-making, including the opportunity for women to change their mind, is essential as induction and early labor affects women's whole childbirth experience.

Reliable population code for subjective economic value from heterogeneous neuronal signals in primate orbitofrontal cortex

Behavior-related neuronal signals often vary between neurons, which might reflect the unreliability of individual neurons or a truly heterogeneous code. This notion may also apply to economic ("value-based") choices and the underlying reward signals. Reward value is subjective and can be described by a nonlinearly weighted magnitude (utility) and probability. Defining subjective values relies on the continuity axiom, whose testing involves structured variations of a wide range of reward magnitudes and probabilities. Axiom compliance demonstrates understanding of the stimuli and the meaningful character of choices. Using these tests, we investigated the encoding of subjective economic value by neurons in a key economic-decision structure of the monkey brain, the orbitofrontal cortex (OFC). We found that individual neurons carry heterogeneous neuronal value signals that largely fail to match the animal's choices. However, neuronal population signals matched the animal's choices well, suggesting accurate subjective economic value encoding by a heterogeneous population of unreliable neurons.

Building Human-Like Artificial Agents: A General Cognitive Algorithm for Emulating Human Decision-Making in Dynamic Environments

One of the early goals of artificial intelligence (AI) was to create algorithms that exhibited behavior indistinguishable from human behavior (i.e., human-like behavior). Today, AI has diverged, often aiming to excel in tasks inspired by human capabilities and outperform humans, rather than replicating human cogntion and action. In this paper, I explore the overarching question of whether computational algorithms have achieved this initial goal of AI. I focus on dynamic decision-making, approaching the question from the perspective of computational cognitive science. I present a general cognitive algorithm that intends to emulate human decision-making in dynamic environments, as defined in instance-based learning theory (IBLT). I use the cognitive steps proposed in IBLT to organize and discuss current evidence that supports some of the human-likeness of the decision-making mechanisms. I also highlight the significant gaps in research that are required to improve current models and to create higher fidelity in computational algorithms to represent human decision processes. I conclude with concrete steps toward advancing the construction of algorithms that exhibit human-like behavior with the ultimate goal of supporting human dynamic decision-making.

Effects of Episodic Memory Recall on Reinforcing Value of Physical Activity

OBJECTIVE

Many people prefer a sedentary versus an active lifestyle and have difficulty completing sufficient physical activity to improve health. While exercise can be a powerful reinforcer for some people, many prefer to be sedentary. The relative reinforcing value of physical activity (RRVPA) is influenced by a person's learning history with positive experiences strengthening the motivation to be active. Episodic memories may be critical to determining RRVPA, or RRV of different types of positive behaviors.

METHOD

As a potential way to increase RRVPA we examined if recalling a positive episodic memory would affect RRVPA. One hundred and thirty seven adult participants completed measures of reinforcement history and memory functions and then recalled a single positive episode of either a physical activity or of a cognitively enriching activity, rated subjective memory qualities, and completed tasks to measure the RRV of both types of activity.

RESULTS

Recalling a positive episodic memory increased RRV for the respective activity, and changes in RRVPA were moderated by how much the memory satisfies a basic psychological need.

CONCLUSIONS

This research demonstrates the impact of episodic memory on RRVPA, which could be leveraged to aid behavior change efforts.

Worth the Work? Monkeys Discount Rewards by a Subjective Adapting Effort Cost

All life must solve how to allocate limited energy resources to maximize benefits from scarce opportunities. Economic theory posits decision makers optimize choice by maximizing the subjective benefit (utility) of reward minus the subjective cost (disutility) of the required effort. While successful in many settings, this model does not fully account for how experience can alter reward-effort trade-offs. Here, we test how well the subtractive model of effort disutility explains the behavior of two male nonhuman primates (Macaca mulatta) in a binary choice task in which reward quantity and physical effort to obtain were varied. Applying random utility modeling to independently estimate reward utility and effort disutility, we show the subtractive effort model better explains out-of-sample choice behavior when compared with parabolic and exponential effort discounting. Furthermore, we demonstrate that effort disutility depends on previous experience of effort: in analogy to work from behavioral labor economics, we develop a model of reference-dependent effort disutility to explain the increased willingness to expend effort following previous experience of effortful options in a session. The result of this analysis suggests that monkeys discount reward by an effort cost that is measured relative to an expected effort learned from previous trials. When this subjective cost of effort, a function of context and experience, is accounted for, trial-by-trial choices can be explained by the subtractive cost model of effort. Therefore, in searching for net utility signals that may underpin effort-based decision-making in the brain, careful measurement of subjective effort costs is an essential first step.SIGNIFICANCE STATEMENT All decision-makers need to consider how much effort they need to expend when evaluating potential options. Economic theories suggest that the optimal way to choose is by cost-benefit analysis of reward against effort. To be able to do this efficiently over many decision contexts, this needs to be done flexibly, with appropriate adaptation to context and experience. Therefore, in aiming to understand how this might be achieved in the brain, it is important to first carefully measure the subjective cost of effort. Here, we show monkeys make reward-effort cost-benefit decisions, subtracting the subjective cost of effort from the subjective value of rewards. Moreover, the subjective cost of effort is dependent on the monkeys' experience of effort in previous trials.

Reconsidering patient-centred care: Authority, expertise and abandonment

Patient-centred care is commonly framed as a means to guard against the problem of medical paternalism, exemplified in historical attitudes of 'doctor knows best'. In this sense, patient-centred care (PCC) is often regarded as a moral imperative. Reviews of its adoption in healthcare settings do not find any consistent improvement in health outcomes; however, these results are generally interpreted as pointing to the need for more or 'better' training for staff, rather than raising more fundamental questions. Patient autonomy is generally foregrounded in conceptualizations of PCC, to be actualized through the exercising of choice and control. But examining healthcare interaction in practice shows that when professionals attempt to enact these underpinnings, it often results in the sidelining of medical expertise that patients want or need. The outcome is that patients can feel abandoned to make decisions they feel unqualified to make, or even that care standards may not be met. This helps to explain why PCC has not produced the hoped-for improvement in health outcomes. It also suggests that, rather than focusing on scoring individual consultations, we need to consider how medical expertise can be rehabilitated for a 21st century public, and how patient expertise can be better incorporated into co-design and co-production of services and resources rather than being seen as something to be expressed through a binary notion of control. PATIENT AND PUBLIC CONTRIBUTION: This viewpoint draws on research conducted by the author across a range of settings in health and social care, all of which incorporated patient and public involvement when it was conducted.

Social supermarkets, nutritional implications and healthy eating: exploration of members and their views

BACKGROUND

The Covid-19 pandemic has increased the need for food support but simultaneously enabled substantial innovation in food support provision, including the evolution of social supermarkets (SSM). These allow consumers to choose from a range of low-cost products, minimise stigma and reduce food waste. Data from members of two Sussex SSM were gathered for their perspectives and experiences, as well as potential nutritional implications of the SSM.

METHODS

Questionnaires administered face-to-face during site visits and optional telephone interviews were used. Data were collected during three site visits; 111 participants completed questionnaires, and an additional 25 detailed interviews with members of the SSM were completed. All data were gathered between December 2021 and May 2022.

RESULTS

Overall, the SSMs were valued by their members. Social, economic and nutritional benefits were identified. SSM increased consumer choice and reduced stigma. Most members visited regularly, using SSM to supplement other food purchases. They valued the opportunity to choose their own foods and opportunities to socialise, in addition to the range of food and household items offered. The majority agreed that healthy eating was important but time and cost were barriers especially for younger members. SSM introduced members to novel foods and dishes, potentially diversifying dietary intakes. Challenges included restrictions on the amounts of food available, depending on the timing of visits. This was a greater challenge for those more reliant on SSM for household needs.

CONCLUSIONS

SSM represent an innovative and less stigmatising model of food support. Greater variety of food offered suggests their potential to diversify and improve dietary intakes. Challenges include ensuring stability of food supply and reducing stigma further.

Contribution of dorsal versus ventral hippocampus to the hierarchical modulation of goal-directed actions in rats

Adaptive behaviour often necessitates that animals learn about events in a manner that is specific to a particular context or environment. These hierarchical organisations allow the animal to decide which action is the most appropriate when faced with ambiguous or conflicting possibilities. This study examined the role of hippocampus in enabling animals to use the context to guide action selection. We used a hierarchical instrumental outcome devaluation task in which male rats learn that the context provides information about the unique action-outcome relations that are in effect. We first confirmed that rats encode and use hierarchical context-(action-outcome) relations. We then show that chemogenetic inhibition of ventral hippocampus impairs both the encoding and retrieval of these associations, while inhibition of dorsal hippocampus impairs only the retrieval. Importantly, neither dorsal nor ventral hippocampus was required for goal-directed behaviour per se as these impairments only emerged when rats were forced to use the context to identify the current action-outcome relationships. These findings are discussed with respect to the role of the hippocampus and its broader circuitry in the contextual modulation of goal-directed behaviour and the importance of hierarchical associations in flexible behaviour.

Disabled People or Their Support Persons' Perceptions of a Community Based Multi-Sensory Environment (MSE): A Mixed-Method Study

Multi-sensory environments (MSEs) are specialised spaces purposely designed to stimulate the senses, whilst providing a calming and relaxing environment for leisure and enjoyment, predominantly intended for disabled people. Most MSEs are in institutions, hospitals, or educational settings, with a few in community-based settings. We explored disabled users' experiences of a community based MSE in a large metropolitan area in New Zealand, with a view to expanding access to MSE-type environments within the area. We used a convergent mixed method design with a web-based electronic survey (e-survey; n = 105), as well as semi-structured interviews (n = 14) with disabled MSE users (adults and children), who were supported, where necessary, by their support person/s. We collected the MSE users' demographics, frequency of use with respect to age, disability, and ethnicity, and experiences of the room, equipment, and accessibility. The participants and their support persons' perspectives about their experiences of using the MSE were represented by four themes: (i) Self-determination; (ii) Enhancing wellbeing opportunities; (iii) the MSE itself; (iv) Accessibility. While the MSE was considered positively, the MSE experience could be enhanced by addressing access challenges and broadening the scope of equipment to improve the usability and make it a more inclusive environment for all.

Toggling between food-seeking and self-preservation behaviors via hypothalamic response networks

Motivated behaviors are often studied in isolation to assess labeled lines of neural connections underlying innate actions. However, in nature, multiple systems compete for expression of goal-directed behaviors via complex neural networks. Here, we examined flexible survival decisions in animals tasked with food seeking under predation threat. We found that predator exposure rapidly induced physiological, neuronal, and behavioral adaptations in mice highlighted by reduced food seeking and consumption contingent on current threat level. Diminishing conflict via internal state or external environment perturbations shifted feeding strategies. Predator introduction and/or selective manipulation of danger-responsive cholecystokinin (Cck) cells of the dorsal premammilary nucleus (PMd) suppressed hunger-sensitive Agouti-related peptide (AgRP) neurons, providing a mechanism for threat-evoked hypophagia. Increased caloric need enhanced food seeking under duress through AgRP pathways to the bed nucleus of the stria terminalis (BNST) and/or lateral hypothalamus (LH). Our results suggest oscillating interactions between systems underlying self-preservation and food seeking to promote optimal behavior.

A systematic review of risky-choice framing effects

Classic decision theory requires that rational agents show description invariance: which description is chosen should not matter for judgments, preferences, or choices given the descriptions are co-extensive. Framing research has amply demonstrated a failure of description invariance by showing that the choice of the description has a systematic effect on judgments, preferences, and choices. Specifically, framing research has shown that linguistically different descriptions of seemingly equivalent options frequently lead to preference reversals. I summarize the research on framing in situations entailing risk. This includes the characterization of different research designs used, the size and robustness of the framing effects reported for those designs, and the theoretical accounts put forward to explain framing effects. The theoretical accounts are evaluated with respect to their merits, empirically and theoretically. I end by providing the implications of framing research. My central point is that the existence of framing effects points to the adaptiveness of the processes underlying human judgment and choice rather than simply showing human irrationality.

Contributions of the Basal Ganglia to Visual Perceptual Decisions

The basal ganglia (BG) make up a prominent nexus between visual and motor-related brain regions. In contrast to the BG's well-established roles in movement control and value-based decision making, their contributions to the transformation of visual input into an action remain unclear, especially in the context of perceptual decisions based on uncertain visual evidence. This article reviews recent progress in our understanding of the BG's contributions to the formation, evaluation, and adjustment of such decisions. From theoretical and experimental perspectives, the review focuses on four key stations in the BG network, namely, the striatum, pallidum, subthalamic nucleus, and midbrain dopamine neurons, which can have different roles and together support the decision process.

The welfare problems of wide-ranging Carnivora reflect naturally itinerant lifestyles

Carnivora with naturally small home ranges readily adjust to the evolutionarily new environment of captivity, but wider-ranging species seem prone to stress. Understanding why would advance both collection planning and enclosure design. We therefore investigated which aspects of wide-ranging lifestyles are key. We identified eight correlates of home range size (reflecting energetic needs, movement, intra-specific interactions, and itinerant lifestyles). We systematically assessed whether these correlates predict welfare better than range size per se, using data on captive juvenile mortality (from 13 518 individuals across 42 species) and stereotypic route-tracing (456 individuals, 27 species). Naturally itinerant lifestyles (quantified via ratios of daily to annual travel distances) were found to confer risk, predicting greater captive juvenile losses and stereotypic time-budgets. This finding advances our understanding of the evolutionary basis for welfare problems in captive Carnivora, helping explain why naturally sedentary species (e.g. American mink) may breed even in intensive farm conditions, while others (e.g. polar bears, giant pandas) can struggle even in modern zoos and conservation breeding centres. Naturally itinerant lifestyles involve decision-making, and strategic shifts between locations, suggesting that supplying more novelty, cognitive challenge and/or opportunities for control will be effective ways to meet these animals' welfare needs in captivity.

Examination of Ethical Decision-Making Models Across Disciplines: Common Elements and Application to the Field of Behavior Analysis

Human service practitioners from varying fields make ethical decisions daily. At some point during their careers, many behavior analysts may face ethical decisions outside the range of their previous education, training, and professional experiences. To help practitioners make better decisions, researchers have published ethical decision-making models; however, it is unknown the extent to which published models recommend similar behaviors. Thus, we systematically reviewed and analyzed ethical decision-making models from published peer-reviewed articles in behavior analysis and related allied health professions. We identified 55 ethical decision-making models across 60 peer-reviewed articles, seven primary professions (e.g., medicine, psychology), and 22 subfields (e.g., dentistry, family medicine). Through consensus-based analysis, we identified nine behaviors commonly recommended across the set of reviewed ethical decision-making models with almost all (n = 52) models arranging the recommended behaviors sequentially and less than half (n = 23) including a problem-solving approach. All nine ethical decision-making steps clustered around the ethical decision-making steps in the Ethics Code for Behavior Analysts published by the Behavior Analyst Certification Board (2020) suggesting broad professional consensus for the behaviors likely involved in ethical decision making.

Incomparability and Incommensurability in Choice: No Common Currency of Value?

Models of decision-making typically assume the existence of some common currency of value, such as utility, happiness, or inclusive fitness. This common currency is taken to allow comparison of options and to underpin everyday choice. Here we suggest instead that there is no universal value scale, that incommensurable values pervade everyday choice, and hence that most existing models of decision-making in both economics and psychology are fundamentally limited. We propose that choice objects can be compared only with reference to specific but nonuniversal "covering values." These covering values may reflect decision-makers' goals, motivations, or current states. A complete model of choice must accommodate the range of possible covering values. We show that abandoning the common-currency assumption in models of judgment and decision-making necessitates rank-based and "simple heuristics" models that contrast radically with conventional utility-based approaches. We note that if there is no universal value scale, then Arrow's impossibility theorem places severe bounds on the rationality of individual decision-making and hence that there is a deep link between the incommensurability of value, inconsistencies in human decision-making, and rank-based coding of value. More generally, incommensurability raises the question of whether it will ever be possible to develop single-quantity-maximizing models of decision-making.

Choice, control, and animal welfare: definitions and essential inquiries to advance animal welfare science

The ways in which humans can support good welfare for animals in their care is an ongoing subject of debate: some place emphasis on the animals' physical health; others, on animals' ability to live "natural lives"; and others on animals' affective states or psychological wellbeing. Recently, there has been an increase in interest in how an animal's ability to exercise control over its environment could impact their welfare. In this article, we take the stance that the relevant aspects of the first two concepts of animal welfare (physical health, natural lives) are largely addressed when an animal's psychological wellbeing is prioritized. Through that lens, we review the current state of the literature regarding the psychology of control, and the intersection between choice, control, and welfare. We clarify terms to support future work, and propose future directions that could lead to a better understanding of the psychological benefits of choice and control and ultimately inform animal care decisions.

A decision support tool has similar high PrEP uptake and increases early PrEP persistence in adolescent girls and young women in South Africa: results from a randomized controlled trial

INTRODUCTION

African adolescent girls and young women (AGYW) have high rates of HIV acquisition and are a priority population for HIV pre-exposure prophylaxis (PrEP). PrEP implementation has been limited by AGYW's low perceived HIV risk and provider demands. A decision support tool (DST) with information about PrEP could improve clients' risk perception, knowledge about PrEP, informed decision-making and motivation to use PrEP based on their risk, facilitating PrEP delivery in primary healthcare (PHC) clinics.

METHODS

We designed MyPrEP, a client-facing DST about PrEP and HIV prevention, with youth-friendly information and images. The impact of the MyPrEP tool was assessed among HIV-negative women aged 18-25 years presenting to a PHC clinic in Johannesburg, South Africa from March 2019 to 2020. AGYW were randomized by day to the DST or a general health website as the control condition. A clinician blinded to DST versus control allocation provided standard of care counselling about PrEP, offered PrEP, administered a questionnaire and conducted sexually transmitted infection testing. The primary outcome was PrEP initiation and the secondary outcome was PrEP persistence at 1 month, determined by pharmacy dispensation records.

RESULTS

Of 386 AGYW screened, 353 were randomized (DST n = 172, control n = 181) with a median age of 21 years (interquartile range [IQR] 20, 23) and 56% (199/353) attending the clinic for HIV testing, 46% (164/353) using contraception, 15% (53/353) using condoms consistently and 37% (108/353) with a curable sexually transmitted infection. PrEP was initiated by 97% in the DST group and 94% in the control group (OR 1.79; 95% confidence interval, CI = 0.79-1.53), of whom two-thirds planned to continue PrEP until they decided if they liked PrEP. At 1 month, PrEP persistence was 19% in the DST and 10% in the control group (OR 1.97, 95% CI 1.08-3.69). Ninety-nine percent randomized to the DST reported satisfaction with MyPrEP.

CONCLUSIONS

Among AGYW attending a South African PHC clinic, PrEP uptake was >90% with two-fold higher PrEP persistence at 1 month in those randomized to use the MyPrEP DST. Given the need for strategies to support PrEP implementation and improve low PrEP persistence among African AGYW, a PrEP DST warrants further evaluation.

Owner-implemented paired-stimulus food preference assessments for companion dogs

Behavioral interventions for animals typically require the inclusion of programmed reinforcers. Although pet owners and human caregivers can often identify items that the animal will consume, preference assessments can more accurately determine relative preference rankings between various stimuli, which is important given that higher preferred items tend to function as more effective reinforcers than lower preferred items. Preference assessments have been developed to identify rankings for a variety of stimuli across species, including the domesticated dog (Canis lupus familiaris). However, previous preference assessments for dogs were developed for laboratory use and could be challenging for dog owners to perform alone. The purpose of this study was to modify existing dog preference assessment methods to produce a valid and feasible preference assessment for dog owners. Results suggest that the preference assessment identified preference rankings for individual dogs. Owners were able to implement the protocol with high integrity and found the protocol acceptable.

Modeling Eye Movements During Decision Making: A Review

This article reviews recent advances in the psychometric and econometric modeling of eye-movements during decision making. Eye movements offer a unique window on unobserved perceptual, cognitive, and evaluative processes of people who are engaged in decision making tasks. They provide new insights into these processes, which are not easily available otherwise, allow for explanations of fundamental search and choice phenomena, and enable predictions of future decisions. We propose a theoretical framework of the search and choice tasks that people commonly engage in and of the underlying cognitive processes involved in those tasks. We discuss how these processes drive specific eye-movement patterns. Our framework emphasizes the central role of task and strategy switching for complex goal attainment. We place the extant literature within that framework, highlight recent advances in modeling eye-movement behaviors during search and choice, discuss limitations, challenges, and open problems. An agenda for further psychometric modeling of eye movements during decision making concludes the review.

The Relationship Between Choice and Injuries of People With Intellectual and Developmental Disabilities

People with IDD are often denied choices based on concerns for their safety, including to prevent and reduce injuries. This study examined the relationship between the service-related choices of people with IDD and their injuries. In this cross-sectional analysis, we analyzed secondary Personal Outcome Measures® interview data and injury data from 251 people with IDD. Our findings revealed, controlling for all demographics, for every one-unit increase in service-related choice outcomes present, there was a 35% decrease in injuries. Expanding people with IDD's choice-making opportunities may result in fewer injuries. We must move beyond custodial models of care and ensure people with IDD are supported to live the lives of their choosing.

Substrate colour guides turquoise killifish's (Nothobranchius furzeri) choice of preferred spawning habitat

Turquoise killifish (Nothobranchius furzeri) is a promising new model species used in biomedical and ecological laboratory experiments, and should be kept under optimal conditions to ensure fish welfare and the quality of science. While the popularity of this model species is rapidly increasing, we need to improve our understanding of how the species interacts with its environment to optimize its husbandry. Specifically, turquoise killifish are substrate spawners that bury their eggs in the sediment, which can be accommodated under captive conditions, but it is not yet known whether or not turquoise killifish have a preference for a specific sediment colour. Here, we performed a laboratory experiment in which fish could choose between white, orange and black sand for spawning, colours which are relevant in both laboratory and field conditions. We assessed their preference in the context of single breeding pairs, as well as in a social group setting. Additionally, we also assessed the preference of individuals for a white versus black background in a nonmating context. Single breeding pairs deposited over 3.5 times more eggs in black compared to orange or white sand. Similarly, fish in social groups deposited over 3.5 times more eggs in black compared to orange sand, which in turn was over two times higher than that in white sand. Fish showed a slight preference for the black compared to the white zone in a nonmating context, but this did not correlate with substrate choice during the spawning tests. The results suggest that turquoise killifish select their preferred spawning location based on the colour of the substrate. These findings contribute to our understanding of the species' biology and can help to guide good welfare and scientific practice.

(2018) and investigation of alternate predictors of reappraisal choice

Reappraisal affordances have recently emerged as an important predictor of emotion regulation choice . In a pre-registered replication of study 4 of Suri et al., 2018, we assessed the role of affordances and several other predictors of regulation choice. Participants (N = 315) read one of eight vignettes that varied in reappraisal affordance (high or low) and intensity (high or low). For each vignette, they rated hedonic and instrumental motives, affordances, intensity, importance, and long-term implications. One week later, participants re-read the vignette, chose between reappraisal and distraction, and rated their likelihood of using each strategy. Unexpectedly, participants rated predicted high affordance vignettes as lower in affordance than predicted low affordance vignettes. This difference from the original study may be due to sample differences: in the original study, participants were employees in a specific workplace and several vignettes targeted workplace activities. Nonetheless, we replicated the original finding that reappraisal affordances predicted reappraisal choice. The result held even when controlling for other contextual variables, which played a limited role in predicting emotion regulation. The results highlight the need to consider multiple aspects of context, including the research setting, when examining predictors of emotion regulation choice.

Neural correlates of changing food choices while bypassing values

Current theories suggest that altering choices requires value modification. To investigate this, normal-weight female participants' food choices and values were tested before and after an approach-avoidance training (AAT), while neural activity was recorded during the choice task using functional magnetic resonance imaging (fMRI). During AAT, participants consistently approached low- while avoiding high-calorie food cues. AAT facilitated low-calorie food choices, leaving food values unchanged. Instead, we observed a shift in indifference points, indicating the decreased contribution of food values in food choices. Training-induced choice shifts were associated with increased activity in the posterior cingulate cortex (PCC). In contrast, the medial PFC activity was not changed. Additionally, PCC grey matter density predicted individual differences in training-induced functional changes, suggesting anatomic predispositions to training impact. Our findings demonstrate neural mechanisms underlying choice modulation independent of valuation-related processes, with substantial theoretical significance for decision-making frameworks and translational implications for health-related decisions resilient to value shifts.

How social information impacts action in rodents and humans: the role of the prefrontal cortex and its connections

Day-to-day choices often involve social information and can be influenced by prior social experience. When making a decision in a social context, a subject might need to: 1) recognize the other individual or individuals, 2) infer their intentions and emotions, and 3) weigh the values of all outcomes, social and non-social, prior to selecting an action. These elements of social information processing all rely, to some extent, on the medial prefrontal cortex (mPFC). Patients with neuropsychiatric disorders often have disruptions in prefrontal cortical function, likely contributing to deficits in social reasoning and decision making. To better understand these deficits, researchers have turned to rodents, which have revealed prefrontal cortical mechanisms for contending with the complex information processing demands inherent to making decisions in social contexts. Here, we first review literature regarding social decision making, and the information processing underlying it, in humans and patient populations. We then turn to research in rodents, discussing current procedures for studying social decision making, and underlying neural correlates.

Midwives' personal and professional attitudes towards women's delivery choices, interventions and neonatal care

OBJECTIVES

Caesarean section (CS) rates in middle- and high-income countries are rising partly due to maternal request. This study aimed to explore the personal and professional attitudes of midwives and nurses towards women's delivery choices, interventions and neonatal care.

METHODS

Midwifery and nursing staff at the Coombe hospital were asked to complete a questionnaire concerning decisions for elective CS and neonatal care. The midwives' responses were divided into multiparous and nulliparous according to their own parity.

RESULTS

Multiparae and nulliparae did not differ on their personal preferences for their own baby. Only 3% wanted an elective CS in a normal, healthy pregnancy but this increased to 80.2% when there was a breech presentation and 42% if the estimated fetal weight was >4.5 kg. These numbers and trends were very close to the midwives' professional recommendations under the same circumstances. The lower threshold for full resuscitation and ICU care was at 23 and 24 weeks gestation for both personal and professional recommendations. In the case of severely premature babies or babies with a poor prognosis, 54% stated that the approach to neonatal care was correct.

CONCLUSIONS

Overall, midwives' professional views reflected what they would want for themselves and their babies. Only 3% recommended an elective CS in a normal, healthy pregnancy making it unlikely that midwives' attitudes are driving the rise in CS rates in Ireland.

Student preference for and performance in fixed- versus mixed-duration schedules

Duration schedules of reinforcement for continuous behavior abide by several preexisting operant behavioral economic equations for reinforcer cost, otherwise known as price, and consumption. Duration schedules require behaviors to occur for a set duration of time prior to accessing reinforcement, unlike interval schedules that produce reinforcement after the first instance of a behavior after a given period. Despite extensive examples of naturally occurring duration schedules, translational research regarding duration schedules is quite limited. Further, a lack of research investigating the implementation of such reinforcement schedules, combined with concepts such as preference, represents a gap in the applied behavior analysis literature. The current study measured three elementary students' preferences for fixed- and mixed-duration schedules of reinforcement during academic work completion. Results suggest students prefer mixed-duration schedules of reinforcement that provide the opportunity to access reinforcement at a reduced price and that such arrangements could be employed to increase work completion and academic-engaged time.

Do zoo animals use off-exhibit areas to avoid noise? A case study exploring the influence of sound on the behavior, physiology, and space use of two pied tamarins (Saguinus bicolor)

Noise can be a known stressor but our understanding of its effects on animals living in zoo environments remains limited. Although exposure to loud, chronic noise may be expected to negatively impact welfare, providing access to quiet areas to escape loud noise may buffer these negative effects. In this study, we explored the benefits of access to quiet, off-exhibit areas for animals living in a chronically loud sound environment. Two pied tamarins (Saguinus bicolor) living near a large waterfall feature that emitted loud, chronic noise were experimentally exposed to varying sound levels during 2-week treatment conditions. Baseline conditions (waterfall feature on and access to quiet, off-exhibit areas), were followed by a Quiet sound condition (waterfall off), a Loud sound condition (waterfall on and a speaker in the off-exhibit area playing volume-matched white noise), and a final Baseline condition. During Baseline conditions, sound levels were greater than 10 dBA higher in the exhibit than in the off-exhibit area (i.e., roughly twice as loud). The number of visitor groups present during behavior observations were consistent throughout the study. Both tamarins modified their space use during treatment conditions. Under Baseline conditions, both individuals showed frequent usage of quiet, off-exhibit areas. During the Quiet and Loud conditions, where sound levels were generally consistent across spaces, both individuals used off-exhibit areas less and their use of exhibit and off-exhibit areas was not significantly different than would be expected by chance, given the size of the areas. Additional behavioral changes were minimal. No significant differences in fecal glucocorticoid metabolites were observed. Although the monkeys in this study appeared to avoid noise, the overall impact on welfare appeared to be minimal considering the limited behavioral and hormonal changes observed. This study highlights the potential benefits of off-exhibit spaces as a quiet refuge from noise in the zoo environment.

Choice dynamics in concurrent ratio schedules of reinforcement

The generalized matching law predicts performance on concurrent schedules when variable-interval schedules are programmed but is trivially applicable when independent ratio schedules are used. Responding usually is exclusive to the schedule with the lowest response requirement. Determining a method to program concurrent ratio schedules such that matching analyses can be usefully employed would extend the generality of matching research and lead to new avenues of research. In the present experiments, ratio schedules were programmed dependently such that responses to either of the two options progressed the requirement on both schedules. Responding is not exclusive because the probability of reinforcement increases on both schedules as responses are allocated to either schedule. In Experiment 1, performance on concurrent variable-ratio schedules was assessed, and reinforcer ratios were varied across conditions to investigate changes in sensitivity. Additionally, the length of a changeover delay was manipulated. In Experiment 2, performance was compared under concurrently available, dependently programmed variable-ratio and fixed-ratio schedules. Performance was well described by the generalized matching law. Increases in the changeover delay decreased sensitivity, whereas sensitivity was higher when variable-ratio schedules were employed, compared with fixed-ratio schedules. Concurrent ratio schedules can be a viable approach to studying functional differences between ratio and interval schedules.

Correlates of Dapivirine Vaginal Ring Acceptance among Women Participating in an Open Label Extension Trial

MTN-025/HOPE was an open-label trial of the dapivirine vaginal ring conducted in four African countries between 2016 and 2018. Women were first offered one ring monthly (at baseline, months 1 and 2), thereafter, transitioned to a more applicable real-world dispensation schedule, - 3 rings quarterly (at months 3, 6 and 9). Logistic regression analysis was used to assess correlates of ring acceptance at baseline and through follow-up. A total of 1456 women (median age 31 years) enrolled, 1342 (92.2%) accepted the ring at baseline and 1163 (79.9%) accepted the ring(s) at all visits. Changing ring dispensation from a monthly to a quarterly schedule had no negative effect on acceptance. Having a primary partner and him knowing about the ring being offered in HOPE, use of long-acting contraception (implants, injections, IUDs) or sterilization were associated with ring acceptance, along with prior strong intention to use the ring in the future. Efforts should consider these factors when rolling out the ring for HIV prevention.

Temporal Dynamics Underlying Prelimbic Prefrontal Cortical Regulation of Action Selection and Outcome Evaluation during Risk/Reward Decision-Making

Risk/reward decision-making is a dynamic process that includes periods of deliberation before action selection and evaluation of the action outcomes that bias subsequent choices. Inactivation of the prelimbic (PL) cortex has revealed its integral role in updating decision biases in the face of changes in probabilistic reward contingencies, yet how phasic PL signals during different phases of the decision process influence choice remains unclear. We used temporally specific optogenetic inhibition to selectively disrupt PL activity coinciding with action selection and outcome phases to examine how these signals influence choice. Male rats expressing the inhibitory opsin eArchT within PL excitatory neurons were well trained on a probabilistic discounting task, entailing choice between small/certain versus large/risky rewards, the probability of which varied over a session (50-12.5%). During testing, brief light pulses suppressed PL activity before choice or after different outcomes. Prechoice suppression reduced bias toward more preferred/higher utility options and disrupted how recent outcomes influenced subsequent choice. Inhibition during risky losses induced a similar profile, but here, the impact of reward omissions were either amplified or diminished, relative to the context of the estimated profitability of the risky option. Inhibition during large or small reward receipt reduced risky choice when this option was more profitable, suggesting these signals can both reinforce rewarded risky choices and also act as a relative value comparator signal that augments incentive for larger rewards. These findings reveal multifaceted contributions by the PL in implementing decisions and integrating action-outcome feedback to assign context to the decision space.SIGNIFICANCE STATEMENT The PL prefrontal cortex plays an integral role in guiding risk/reward decisions, but how activity in this region during different phases of the decision process influences choice is unclear. By using temporally specific optogenetic manipulations of this activity, the present study unveiled previously uncharacterized and differential contributions by PL in implementing decision policies and how evaluation of decision outcomes shape subsequent choice. These findings provide novel insight into the dynamic processes engaged by the PL that underlie action selection in situations involving reward uncertainty that may aid in understanding the mechanism underlying normal and aberrant decision-making processes.

Systematic comparison of risky choices in humans and monkeys

The past decades have seen tremendous progress in fundamental studies on economic choice in humans. However, elucidation of the underlying neuronal processes requires invasive neurophysiological studies that are met with difficulties in humans. Monkeys as evolutionary closest relatives offer a solution. The animals display sophisticated and well-controllable behavior that allows to implement key constructs of proven economic choice theories. However, the similarity of economic choice between the two species has never been systematically investigated. We investigated compliance with the independence axiom (IA) of expected utility theory as one of the most demanding choice tests and compared IA violations between humans and monkeys. Using generalized linear modeling and cumulative prospect theory (CPT), we found that humans and monkeys made comparable risky choices, although their subjective values (utilities) differed. These results suggest similar fundamental choice mechanism across these primate species and encourage to study their underlying neurophysiological mechanisms.