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Dhaliwal BK, Weeks R, Huber J, Fofana A, Bobe M, Mbailamen AD, Legge G, Cisse G, Shet A. Introduction of the pneumococcal conjugate vaccine in humanitarian and fragile contexts: Perspectives from stakeholders in four African countries. Hum Vaccin Immunother 2024; 20:2314828. [PMID: 38439691 PMCID: PMC10936592 DOI: 10.1080/21645515.2024.2314828] [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: 11/07/2023] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Childhood pneumonia causes a significant burden of preventable child morbidity and mortality in Chad, Guinea, Somalia/Somaliland, and South Sudan. Leaders from these countries have committed to reducing this burden and are preparing to introduce the pneumococcal conjugate vaccine (PCV) into their immunization programs. To support long-term sustainability for expected PCV introductions in settings afflicted by prolonged humanitarian crises this research explores national stakeholders' perspectives on contextual factors that may influence optimal vaccine implementation. This qualitative study used purposive sampling to identify and interview stakeholders involved in vaccine decision-making. Interview transcripts were analyzed through the framework method, an approach involving charting data into pre-populated matrices. Findings from interviews with 16 key informants from government, partner organizations, and international health agencies fit within the following four overarching themes: (1) population-level vulnerabilities to pneumonia, exacerbated by climatic risks and low levels of maternal education; (2) disease burden and the interest in enhancing surveillance to monitor vaccine impact and integrate disease control efforts; (3) policy processes, including formalizing vaccine decision-making; and (4) vaccine implementation preparation, including the conduct of robust communication campaigns, training, and cold chain upgrades. This research explores perspectives from leaders in these countries which are at pivotal moments in their journeys toward introducing PCV. Widespread commitment among leaders, in addition to financial support, will facilitate vaccine introduction. Further, fostering a shared understanding among partners about context-specific determinants of program success will help build tailored implementation strategies for each country.
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Affiliation(s)
- Baldeep K. Dhaliwal
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rose Weeks
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jasmine Huber
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aminata Fofana
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohamed Bobe
- Somalia/Somaliland Country Office, Save the Children, Mogadishu, Somalia
| | | | - George Legge
- Expanded Programme on Immunisation (EPI), National Ministry of Health, Juba, Republic of South Sudan
- Expanded Programme on Immunisation (EPI), Ministry of Health and Public Hygiene, Conakry, Republic of Guinea
| | - Gassim Cisse
- Expanded Programme on Immunisation (EPI), Ministry of Health and Public Hygiene, Conakry, Republic of Guinea
| | - Anita Shet
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cohen M, Banerjee D. Biomarkers in Sepsis: A Current Review of New Technologies. J Intensive Care Med 2024; 39:399-405. [PMID: 37593782 DOI: 10.1177/08850666231194535] [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] [Indexed: 08/19/2023]
Abstract
Sepsis syndromes have been recognized since antiquity yet still pose significant challenges to modern medicine. One of the biggest challenges lies in the heterogeneity of triggers and its protean clinical manifestations, as well as its rapidly progressive and lethal nature. Thus, there is a critical need for biomarkers that can quickly and accurately detect sepsis onset and predict treatment response. In this review, we will briefly describe the current consensus definitions of sepsis and the ideal features of a biomarker. We will then delve into currently available and in-development markers of pathogens, hosts, and their interactions that together comprise the sepsis syndrome.
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Affiliation(s)
- Maya Cohen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert/Brown Medical School, Providence, RI, USA
| | - Debasree Banerjee
- Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert/Brown Medical School, Providence, RI, USA
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White S, O'Cathain A, Halliday V, Bradburn M, McDermott CJ. Supporting people with Motor Neuron Disease (MND) to make decisions about gastrostomy feeding tube placement: a survey of UK healthcare professionals' practice and beliefs. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:290-298. [PMID: 38337170 DOI: 10.1080/21678421.2024.2314061] [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: 10/17/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Understand the practice and beliefs of healthcare professionals (HCPs) supporting the decision-making of people with MND (pwMND) about gastrostomy placement, including identifying differences between professions. METHODS An online cross-sectional survey disseminated to HCPs who support the decision-making of pwMND about gastrostomy placement. RESULTS A total of 139 participants completed the survey including representation from a range of healthcare professions. A third (36/101, 36%) initiated discussions about gastrostomy later in practice than they believed was ideal. In relation to the outcome of declining compared to accepting gastrostomy, participants were more likely to discuss aspiration (80% vs. 68%), choking (76% vs. 58%) and prognosis (36% vs. 22%). Participants believed gastrostomies should be placed after a mean 8.1% weight loss since symptom-onset. More participants favored gastrostomy placement before pwMND presented with respiratory symptoms (45%) compared to onset of dysphagia (11%). Half believed pwMND placed gastrostomies too late. Participants were more likely to 'often'/'always' recommend pwMND to have a gastrostomy (23%) than continue without (7%) or decline (4%) gastrostomy, when believing these were the best option for pwMND. Nurses and dietitians discussed the broadest range of information, while doctors were more likely to discuss mortality risk and prognosis. CONCLUSION There is variation in HCPs practice and beliefs about initiating discussions, the sharing of information and recommendations, and timing, about gastrostomy placement. The information shared varies by profession and there is evidence of sub-optimal communication between HCPs. Further research is required to understand how these findings may impact on the decision-making of pwMND about gastrostomy.
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Affiliation(s)
- Sean White
- Division of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK, and
| | - Vanessa Halliday
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK, and
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Murali M, Ni M, Karbing DS, Rees SE, Komorowski M, Marshall D, Ramnarayan P, Patel BV. Clinical practice, decision-making, and use of clinical decision support systems in invasive mechanical ventilation: a narrative review. Br J Anaesth 2024:S0007-0912(24)00142-9. [PMID: 38637268 DOI: 10.1016/j.bja.2024.03.011] [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: 11/24/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 04/20/2024] Open
Abstract
Invasive mechanical ventilation is a key supportive therapy for patients on intensive care. There is increasing emphasis on personalised ventilation strategies. Clinical decision support systems (CDSS) have been developed to support this. We conducted a narrative review to assess evidence that could inform device implementation. A search was conducted in MEDLINE (Ovid) and EMBASE. Twenty-nine studies met the inclusion criteria. Role allocation is well described, with interprofessional collaboration dependent on culture, nurse:patient ratio, the use of protocols, and perception of responsibility. There were no descriptions of process measures, quality metrics, or clinical workflow. Nurse-led weaning is well-described, with factors grouped by patient, nurse, and system. Physician-led weaning is heterogenous, guided by subjective and objective information, and 'gestalt'. No studies explored decision-making with CDSS. Several explored facilitators and barriers to implementation, grouped by clinician (facilitators: confidence using CDSS, retaining decision-making ownership; barriers: undermining clinician's role, ambiguity moving off protocol), intervention (facilitators: user-friendly interface, ease of workflow integration, minimal training requirement; barriers: increased documentation time), and organisation (facilitators: system-level mandate; barriers: poor communication, inconsistent training, lack of technical support). One study described factors that support CDSS implementation. There are gaps in our understanding of ventilation practice. A coordinated approach grounded in implementation science is required to support CDSS implementation. Future research should describe factors that guide clinical decision-making throughout mechanical ventilation, with and without CDSS, map clinical workflow, and devise implementation toolkits. Novel research design analogous to a learning organisation, that considers the commercial aspects of device design, is required.
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Affiliation(s)
- Mayur Murali
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Melody Ni
- NIHR London In Vitro Diagnostics Cooperative, London, UK
| | - Dan S Karbing
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stephen E Rees
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Matthieu Komorowski
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Dominic Marshall
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Padmanabhan Ramnarayan
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Imperial Centre for Paediatrics and Child Health, London, UK
| | - Brijesh V Patel
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Anaesthesia & Critical Care, Royal Brompton Hospital, London, UK
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Adie JM, Renshaw I, Russell S, Polman R, Mann DL. That's out! How expert umpires make leg-before-wicket judgements in cricket. J Sports Sci 2024:1-10. [PMID: 38630902 DOI: 10.1080/02640414.2024.2338024] [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: 06/30/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Despite evidence that elite-level cricket umpires are highly accurate in making leg-before-wicket (LBW) judgements, there is limited understanding as to how they make these judgements. In this study, we explored the explicit LBW decision-making expertise of elite-level cricket umpires (N = 10) via 10 individual semi-structured interviews. Using thematic analysis, we aimed to identify the sources of information that umpires incorporate into their decision-making process. Results indicated that umpires engage in intentional pre-delivery information-gathering to guide their expectations, and to set context-specific parameters as to what would constitute an LBW dismissal. Not only do umpires use information about the ball trajectory, but they also use additional information about the condition of the pitch, the action-capabilities and susceptibilities of players, and the unique requirements of different match formats. Umpires reported employing a gaze-anchor strategy when gathering information for each delivery and described the process of this information as initially intuitive, before engaging in deeper post-hoc reasoning. Findings highlight the importance of including contextual information when exploring officials' decisions and may inform future training interventions for cricket umpires.
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Affiliation(s)
- Joshua M Adie
- School of Psychology & Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Ian Renshaw
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Scott Russell
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Remco Polman
- Institute of Health and Wellbeing, Federation University, Berwick, Australia
| | - David L Mann
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Kietzman HW, Trinoskey-Rice G, Seo EH, Guo J, Gourley SL. Neuronal Ensembles in the Amygdala Allow Social Information to Motivate Later Decisions. J Neurosci 2024; 44:e1848232024. [PMID: 38499360 DOI: 10.1523/jneurosci.1848-23.2024] [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: 09/28/2023] [Revised: 02/02/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Social experiences carry tremendous weight in our decision-making, even when social partners are not present. To determine mechanisms, we trained female mice to respond for two food reinforcers. Then, one food was paired with a novel conspecific. Mice later favored the conspecific-associated food, even in the absence of the conspecific. Chemogenetically silencing projections from the prelimbic subregion (PL) of the medial prefrontal cortex to the basolateral amygdala (BLA) obstructed this preference while leaving social discrimination intact, indicating that these projections are necessary for socially driven choice. Further, mice that performed the task had greater densities of dendritic spines on excitatory BLA neurons relative to mice that did not. We next induced chemogenetic receptors in cells active during social interactions-when mice were encoding information that impacted later behavior. BLA neurons stimulated by social experience were necessary for mice to later favor rewards associated with social conspecifics but not make other choices. This profile contrasted with that of PL neurons stimulated by social experience, which were necessary for choice behavior in social and nonsocial contexts alike. The PL may convey a generalized signal allowing mice to favor particular rewards, while units in the BLA process more specialized information, together supporting choice motivated by social information.
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Affiliation(s)
- Henry W Kietzman
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06510
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30322
- Graduate Program in Neuroscience, Emory University, Atlanta, Georgia 30322
- Emory National Primate Research Center, Emory University, Atlanta, Georgia 30329
| | - Gracy Trinoskey-Rice
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30322
- Emory National Primate Research Center, Emory University, Atlanta, Georgia 30329
| | - Esther H Seo
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30322
- Emory National Primate Research Center, Emory University, Atlanta, Georgia 30329
| | - Jidong Guo
- Emory National Primate Research Center, Emory University, Atlanta, Georgia 30329
| | - Shannon L Gourley
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30322
- Graduate Program in Neuroscience, Emory University, Atlanta, Georgia 30322
- Emory National Primate Research Center, Emory University, Atlanta, Georgia 30329
- Children's Healthcare of Atlanta, Atlanta, Georgia 30322
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van Brussel LD, Boksem MAS, Dietvorst RC, Smidts A. Brain activity of professional investors signals future stock performance. Proc Natl Acad Sci U S A 2024; 121:e2307982121. [PMID: 38593084 DOI: 10.1073/pnas.2307982121] [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: 05/12/2023] [Accepted: 01/12/2024] [Indexed: 04/11/2024] Open
Abstract
A major aspiration of investors is to better forecast stock performance. Interestingly, emerging "neuroforecasting" research suggests that brain activity associated with anticipatory reward relates to market behavior and population-wide preferences, including stock price dynamics. In this study, we extend these findings to professional investors processing comprehensive real-world information on stock investment options while making predictions of long-term stock performance. Using functional MRI, we sampled investors' neural responses to investment cases and assessed whether these responses relate to future performance on the stock market. We found that our sample of investors could not successfully predict future market performance of the investment cases, confirming that stated preferences do not predict the market. Stock metrics of the investment cases were not predictive of future stock performance either. However, as investors processed case information, nucleus accumbens (NAcc) activity was higher for investment cases that ended up overperforming in the market. These findings remained robust, even when controlling for stock metrics and investors' predictions made in the scanner. Cross-validated prediction analysis indicated that NAcc activity could significantly predict future stock performance out-of-sample above chance. Our findings resonate with recent neuroforecasting studies and suggest that brain activity of professional investors may help in forecasting future stock performance.
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Affiliation(s)
- Leonard D van Brussel
- Rotterdam School of Management, Department of Marketing Management, Erasmus University, Rotterdam 3062 PA, The Netherlands
| | - Maarten A S Boksem
- Rotterdam School of Management, Department of Marketing Management, Erasmus University, Rotterdam 3062 PA, The Netherlands
| | | | - Ale Smidts
- Rotterdam School of Management, Department of Marketing Management, Erasmus University, Rotterdam 3062 PA, The Netherlands
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Ryan WH, Baum SM, Evers ERK. Biases in Improvement Decisions: People Focus on the Relative Reduction in Bad Outcomes. Psychol Sci 2024:9567976241232891. [PMID: 38626160 DOI: 10.1177/09567976241232891] [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: 04/18/2024] Open
Abstract
People often decide whether to invest scarce resources-such as time, money, or energy-to improve their chances of a positive outcome. For example, a doctor might decide whether to utilize scarce medicine to improve a patient's chances of recovery, or a student might decide whether to study a few additional hours to increase their chances of passing an exam. We conducted 11 studies (N = 5,342 adults) and found evidence that people behave as if they focus on the relative reduction in bad outcomes caused by such improvements. As a consequence, the same improvements (e.g., 10-percentage-point improvements) are valued very differently depending on whether one's initial chances of success are high or low. This focus on the relative reduction of bad outcomes drives risk preferences that violate normative standards (Studies 1a-1g and 2a), is amplified when decisions become more consequential (Study 2b), and leads even experienced professionals to make suboptimal decisions (Study 3).
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Affiliation(s)
- William H Ryan
- Haas School of Business, University of California, Berkeley
| | - Stephen M Baum
- Olin Business School, Washington University in St. Louis
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Ebell MH, Dale A, Merenstein DJ, Barrett B, Hulme C, Walters S, Sabry A, Bentivegna M. Prospective external validation of the FluScore risk score for influenza in outpatients. Fam Pract 2024; 41:207-211. [PMID: 38466150 DOI: 10.1093/fampra/cmae014] [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] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Testing for influenza in patients with acute lower respiratory tract infection (LRTI) is common and in some cases is performed for all patients with LRTI. A more selective approach to testing could be more efficient. METHODS We used data from two prospective studies in the US primary and urgent care settings that enrolled patients with acute LRTI or influenza-like illness. Data were collected in the 2016, 2019, 2021, and 2022 flu seasons. All patients underwent polymerase chain reaction (PCR) testing for influenza and the FluScore was calculated based on patient-reported symptoms at their initial visit. The probability of influenza in each risk group was reported, as well as stratum-specific likelihood ratios (SSLRs) for each risk level. RESULTS The prevalence of influenza within risk groups varied based on overall differences in flu seasons and populations. However, the FluScore exhibited consistent performance across various seasons and populations based on the SSLRs. The FluScore had a consistent SSLR range of 0.20 to 0.23 for the low-risk group, 0.63 to 0.99 for the moderate-risk group, and 1.46 to 1.67 for the high-risk group. The diagnostic odds ratio based on the midpoints of these ranges was 7.25. CONCLUSIONS The FluScore could streamline patient categorization, identifying patients who could be exempted from testing, while identifying candidates for rapid influenza tests. This has the potential to be more efficient than a "one size fits all" test strategy, as it strategically targets the use of tests on patients most likely to benefit. It is potentially usable in a telehealth setting.
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Affiliation(s)
- Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Ariella Dale
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | - Dan J Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, United States
| | - Bruce Barrett
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, United States
| | - Cassie Hulme
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Sarah Walters
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, United States
| | - Alea Sabry
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, United States
| | - Michelle Bentivegna
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
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Kawamoto S, Morikawa Y, Yahagi N. Novel Approach for Detecting Respiratory Syncytial Virus in Pediatric Patients Using Machine Learning Models Based on Patient-Reported Symptoms: Model Development and Validation Study. JMIR Form Res 2024; 8:e52412. [PMID: 38608268 DOI: 10.2196/52412] [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: 09/13/2023] [Revised: 02/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) affects children, causing serious infections, particularly in high-risk groups. Given the seasonality of RSV and the importance of rapid isolation of infected individuals, there is an urgent need for more efficient diagnostic methods to expedite this process. OBJECTIVE This study aimed to investigate the performance of a machine learning model that leverages the temporal diversity of symptom onset for detecting RSV infections and elucidate its discriminatory ability. METHODS The study was conducted in pediatric and emergency outpatient settings in Japan. We developed a detection model that remotely confirms RSV infection based on patient-reported symptom information obtained using a structured electronic template incorporating the differential points of skilled pediatricians. An extreme gradient boosting-based machine learning model was developed using the data of 4174 patients aged ≤24 months who underwent RSV rapid antigen testing. These patients visited either the pediatric or emergency department of Yokohama City Municipal Hospital between January 1, 2009, and December 31, 2015. The primary outcome was the diagnostic accuracy of the machine learning model for RSV infection, as determined by rapid antigen testing, measured using the area under the receiver operating characteristic curve. The clinical efficacy was evaluated by calculating the discriminative performance based on the number of days elapsed since the onset of the first symptom and exclusion rates based on thresholds of reasonable sensitivity and specificity. RESULTS Our model demonstrated an area under the receiver operating characteristic curve of 0.811 (95% CI 0.784-0.833) with good calibration and 0.746 (95% CI 0.694-0.794) for patients within 3 days of onset. It accurately captured the temporal evolution of symptoms; based on adjusted thresholds equivalent to those of a rapid antigen test, our model predicted that 6.9% (95% CI 5.4%-8.5%) of patients in the entire cohort would be positive and 68.7% (95% CI 65.4%-71.9%) would be negative. Our model could eliminate the need for additional testing in approximately three-quarters of all patients. CONCLUSIONS Our model may facilitate the immediate detection of RSV infection in outpatient settings and, potentially, in home environments. This approach could streamline the diagnostic process, reduce discomfort caused by invasive tests in children, and allow rapid implementation of appropriate treatments and isolation at home. The findings underscore the potential of machine learning in augmenting clinical decision-making in the early detection of RSV infection.
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Affiliation(s)
- Shota Kawamoto
- Graduate School of Media and Governance, Keio University, Fujisawa, Japan
| | - Yoshihiko Morikawa
- Graduate School of Media and Governance, Keio University, Fujisawa, Japan
| | - Naohisa Yahagi
- Graduate School of Media and Governance, Keio University, Fujisawa, Japan
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11
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Kogan JF, Fontanini A. Learning enhances representations of taste-guided decisions in the mouse gustatory insular cortex. Curr Biol 2024:S0960-9822(24)00374-9. [PMID: 38631343 DOI: 10.1016/j.cub.2024.03.034] [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: 10/16/2023] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
Learning to discriminate overlapping gustatory stimuli that predict distinct outcomes-a feat known as discrimination learning-can mean the difference between ingesting a poison or a nutritive meal. Despite the obvious importance of this process, very little is known about the neural basis of taste discrimination learning. In other sensory modalities, this form of learning can be mediated by either the sharpening of sensory representations or the enhanced ability of "decision-making" circuits to interpret sensory information. Given the dual role of the gustatory insular cortex (GC) in encoding both sensory and decision-related variables, this region represents an ideal site for investigating how neural activity changes as animals learn a novel taste discrimination. Here, we present results from experiments relying on two-photon calcium imaging of GC neural activity in mice performing a taste-guided mixture discrimination task. The task allows for the recording of neural activity before and after learning induced by training mice to discriminate increasingly similar pairs of taste mixtures. Single-neuron and population analyses show a time-varying pattern of activity, with early sensory responses emerging after taste delivery and binary, choice-encoding responses emerging later in the delay before a decision is made. Our results demonstrate that, while both sensory and decision-related information is encoded by GC in the context of a taste mixture discrimination task, learning and improved performance are associated with a specific enhancement of decision-related responses.
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Affiliation(s)
- Joshua F Kogan
- Graduate Program in Neuroscience, Stony Brook University, Stony Brook, NY 11794, USA; Medical Scientist Training Program, Stony Brook University, Stony Brook, NY 11794, USA; Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY 11794, USA.
| | - Alfredo Fontanini
- Graduate Program in Neuroscience, Stony Brook University, Stony Brook, NY 11794, USA; Medical Scientist Training Program, Stony Brook University, Stony Brook, NY 11794, USA; Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, NY 11794, USA.
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12
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Turja T, Rosenlund M, Kuusisto H. Subjective Rationalities of Nonadherence to Treatment and Vaccination in Healthcare Decision-Making. Patient Prefer Adherence 2024; 18:821-826. [PMID: 38623311 PMCID: PMC11017982 DOI: 10.2147/ppa.s454661] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Objective In this short report contributing to the literature on treatment and vaccination adherence, nonadherence was examined from the perspective of decision-making (DM) practice in healthcare. The objective of this study was to survey the rationalities given for treatment nonadherence and their association with DM practice. Methods The Ottawa decision Support Framework was used as a theoretical background for the study. Multiple choice and open-text responses indicating nonadherence were drawn from vignette survey data. The results have been analyzed and reported as descriptive statistics and findings of data-driven content analysis. The number of observatory units was 1032 in the within-subject study design. Results DM practice was predominantly associated with nonadherence to vaccination, whereas nonadherence to treatment was consistently associated with attitudinal reasons independent of DM practice. Nonadherence to vaccination was most often rationalized by prior negative experiences in simple DM scenarios. After other DM practices, nonadherence was rationalized by uncertainty and criticism about the benefits of the recommended vaccine. Mistrust toward healthcare providers stood out, first in treatment nonadherence generally and, second, in vaccination nonadherence after simple DM where the final decision was left to the patient. Conclusion In medical DM, adherence to treatment and vaccination may be achieved through a recognition of patients' previous healthcare encounters and potential trust-related concerns, which could pose a risk for nonadherence. To be able to observe these risks, patient engagement and mutual trust should be priorities in decision support in healthcare.
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Affiliation(s)
- Tuuli Turja
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Milla Rosenlund
- Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Hanna Kuusisto
- Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine, Tampere University, Tampere, Finland
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Goldfarb MJ, Saylor MA, Bozkurt B, Code J, Di Palo KE, Durante A, Flanary K, Masterson Creber R, Ogunniyi MO, Rodriguez F, Gulati M. Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation 2024. [PMID: 38602110 DOI: 10.1161/cir.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Patient-centered care is gaining widespread acceptance by the medical and lay communities and is increasingly recognized as a goal of high-quality health care delivery. Patient-centered care is based on ethical principles and aims at establishing a partnership between the health care team and patient, family member, or both in the care planning and decision-making process. Patient-centered care involves providing respectful care by tailoring management decisions to patients' beliefs, preferences, and values. A collaborative care approach can enhance patient engagement, foster shared decision-making that aligns with patient values and goals, promote more personalized and effective cardiovascular care, and potentially improve patient outcomes. The objective of this scientific statement is to inform health care professionals and stakeholders about the role and impact of patient-centered care in adult cardiovascular medicine. This scientific statement describes the background and rationale for patient-centered care in cardiovascular medicine, provides insight into patient-oriented medication management and patient-reported outcome measures, highlights opportunities and strategies to overcome challenges in patient-centered care, and outlines knowledge gaps and future directions.
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Griffiths T, Judge S, Souto D. Use of eye-gaze technology feedback by assistive technology professionals: findings from a thematic analysis. Disabil Rehabil Assist Technol 2024:1-18. [PMID: 38592954 DOI: 10.1080/17483107.2024.2338125] [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: 09/15/2023] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Purpose: Eye-gaze technology offers professionals a range of feedback tools, but it is not well understood how these are used to support decision-making or how professionals understand their purpose and function. This paper explores how professionals use a variety of feedback tools and provides commentary on their current use and ideas for future tool development.Methods and Materials: The study adopted a focus group methodology with two groups of professional participants: those involved in the assessment and provision of eye-gaze technology (n = 6) and those who interact with individuals using eye-gaze technology on an ongoing basis (n = 5). Template analysis was used to provide qualitative insight into the research questions.Results: Professionals highlighted several issues with existing tools and gave suggestions on how these could be made better. It is generally felt that existing tools highlight the existence of problems but offer little in the way of solutions or suggestions. Some differences of opinion related to professional perspective were highlighted. Questions about automating certain processes were raised by both groups.Conclusions: Discussion highlighted the need for different levels of feedback for users and professionals. Professionals agreed that current tools are useful to identify problems but do not offer insight into potential solutions. Some tools are being used to draw inferences about vision and cognition which are not supported by existing literature. New tools may be needed to better meet the needs of professionals and an increased understanding of how existing tools function may support such development.
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Affiliation(s)
- Tom Griffiths
- School of Computing, University of Dundee, Dundee, UK
| | - Simon Judge
- Barnsley Assistive Technology Team, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - David Souto
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
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15
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Tamrat T, Zhao Y, Schalet D, AlSalamah S, Pujari S, Say L. Exploring the Use and Implications of AI in Sexual and Reproductive Health and Rights: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e53888. [PMID: 38593433 DOI: 10.2196/53888] [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] [Revised: 01/23/2024] [Accepted: 02/09/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) has emerged as a transformative force across the health sector and has garnered significant attention within sexual and reproductive health and rights (SRHR) due to polarizing views on its opportunities to advance care and the heightened risks and implications it brings to people's well-being and bodily autonomy. As the fields of AI and SRHR evolve, clarity is needed to bridge our understanding of how AI is being used within this historically politicized health area and raise visibility on the critical issues that can facilitate its responsible and meaningful use. OBJECTIVE This paper presents the protocol for a scoping review to synthesize empirical studies that focus on the intersection of AI and SRHR. The review aims to identify the characteristics of AI systems and tools applied within SRHR, regarding health domains, intended purpose, target users, AI data life cycle, and evidence on benefits and harms. METHODS The scoping review follows the standard methodology developed by Arksey and O'Malley. We will search the following electronic databases: MEDLINE (PubMed), Scopus, Web of Science, and CINAHL. Inclusion criteria comprise the use of AI systems and tools in sexual and reproductive health and clear methodology describing either quantitative or qualitative approaches, including program descriptions. Studies will be excluded if they focus entirely on digital interventions that do not explicitly use AI systems and tools, are about robotics or nonhuman subjects, or are commentaries. We will not exclude articles based on geographic location, language, or publication date. The study will present the uses of AI across sexual and reproductive health domains, the intended purpose of the AI system and tools, and maturity within the AI life cycle. Outcome measures will be reported on the effect, accuracy, acceptability, resource use, and feasibility of studies that have deployed and evaluated AI systems and tools. Ethical and legal considerations, as well as findings from qualitative studies, will be synthesized through a narrative thematic analysis. We will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) format for the publication of the findings. RESULTS The database searches resulted in 12,793 records when the searches were conducted in October 2023. Screening is underway, and the analysis is expected to be completed by July 2024. CONCLUSIONS The findings will provide key insights on usage patterns and evidence on the use of AI in SRHR, as well as convey key ethical, safety, and legal considerations. The outcomes of this scoping review are contributing to a technical brief developed by the World Health Organization and will guide future research and practice in this highly charged area of work. TRIAL REGISTRATION OSF Registries osf.io/ma4d9; https://osf.io/ma4d9. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53888.
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Affiliation(s)
- Tigest Tamrat
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Yu Zhao
- Department of Digital Health and Innovations, Science Division, World Health Organization, Geneva, Switzerland
| | - Denise Schalet
- Department of Digital Health and Innovations, Science Division, World Health Organization, Geneva, Switzerland
| | - Shada AlSalamah
- Department of Digital Health and Innovations, Science Division, World Health Organization, Geneva, Switzerland
- Information Systems Department, College of Computer and Information Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sameer Pujari
- Department of Digital Health and Innovations, Science Division, World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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16
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Ko CJ, Gehlhausen JR, Cohen JM, Croskerry P. Cognitive Bias in the Patient Encounter: Part I. Background and significance. J Am Acad Dermatol 2024:S0190-9622(24)00557-7. [PMID: 38588821 DOI: 10.1016/j.jaad.2024.01.091] [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: 09/28/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 04/10/2024]
Abstract
Cognitive bias may lead to diagnostic error in the patient encounter. There are hundreds of different cognitive biases, but certain biases are more likely to affect patient diagnosis and management. As during morbidity and mortality rounds, retrospective evaluation of a given case, with comparison to an optimal diagnosis, can pinpoint errors in judgment and decision-making. The study of cognitive bias also illuminates how we might improve the diagnostic process. In Part 1 of this series, cognitive bias is defined and placed within the background of dual process theory, emotion, heuristics, and the more neutral term judgment and decision-making bias.
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17
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Jones-Webster S, Davenport M, Weerakkody S, Smith E, Reed P, Tree JJ, Osborne LA, Bosanquet DC. Patient perceptions of surveillance of small abdominal aortic aneurysms in the over 85s. Ann Vasc Surg 2024:S0890-5096(24)00178-X. [PMID: 38588953 DOI: 10.1016/j.avsg.2024.02.012] [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: 12/19/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Recently instigated local practice for patients with small abdominal aortic aneurysms (AAAs) involves contacting all patients, aged ≥85 years, to discuss with them the advantages and disadvantages of removal from surveillance. However, reasons why patients opt to remain on, or come off, surveillance, are currently unknown. The current study's objective is to explore patient perception of surveillance decision-making. METHODS A mixed-methods exploratory evaluation was undertaken using patient feedback obtained from a telephone survey. All patients aged ≥85 years, who had a consultation regarding ongoing surveillance of small AAAs (30-49mm), and consented, were contacted by researchers, who conducted semi-structured interviews concerning factors influencing decision-making. RESULTS A total of 24 patients (20 male; mean age = 86.9 years) were interviewed; 16/24 (66%) had opted to remain on surveillance, with no age difference between those opting-in or out. Most felt surveillance was important (91%), and that it made them feel safer (73%). The majority (73%) thought they knew what happened when their AAA reached threshold (5.5cm), what happened when a threshold AAA is not fixed (64%), and how major AAA surgery is (59%). However, actual knowledge was poor: most (91%) correctly understood surgery was major; but 56% thought that threshold AAA meant certain death or rupture; and 38% thought immediate surgery was required. Thematic analysis expounded patients' beliefs regarding surveillance, which were summarised in three distinct sub-groups: reliance on professionals' opinions; needing peace of mind; and poor understanding. CONCLUSION Whilst most patients find surveillance reassuring, patient knowledge of AAA management at threshold is poor, potentially impacting surveillance decision-making. Elderly patients, with small AAAs contemplating ongoing surveillance, need to be better informed about AAA management at threshold to support shared decision-making.
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Affiliation(s)
| | | | | | - Elisabeth Smith
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Newport, NP20 2UB.
| | - Phil Reed
- Psychology Department, Swansea University
| | | | - Lisa A Osborne
- Swansea Bay University Health Board; The Open University
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Newport, NP20 2UB
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18
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Kaşıkçı M, Yıldırım Z. Interventions to improve ethical decision-making skills in nursing students: A systematic review. Nurs Ethics 2024:9697330241239917. [PMID: 38576333 DOI: 10.1177/09697330241239917] [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: 04/06/2024]
Abstract
BACKGROUND Interventions to improve ethical decision-making are available in nursing education. Evidence of its effectiveness is essential. OBJECTIVE This review examined the effectiveness of interventions to improve nursing students' ethical decision-making skills. METHODS A structured search was performed in Google Scholar, Web of Science, Science Direct, Pubmed, Scopus, Cochrane Library, Elsevier, CINAHL EBSCO, and ULAKBIM. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI) was used to assess the quality of studies. ETHICAL CONSIDERATIONS Ethical approval was not required for this systematic review. FINDINGS The final review was composed of six studies of published between January 2013 and 2023. Nine different teaching methods applied to students. Although the importance of ethical decision-making skills in solving ethical problems that nurses may encounter at any time is known, it is thought that there is a lack of data in the literature in the last 10 years. The last 10 years were chosen as this aims to provide a review based on the most current, relevant and quality information. The review indicated that all of the teaching methods improved ethical decision-making. CONCLUSION Different teaching methods can be used in the nursing education curriculum to meet the learning needs of nursing students in ethical decision-making.
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19
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Gilmour W, Mackenzie G, Feile M, Tayler-Grint L, Suveges S, Macfarlane JA, Macleod AD, Marshall V, Grunwald IQ, Steele JD, Gilbertson T. Impaired value-based decision-making in Parkinson's disease apathy. Brain 2024; 147:1362-1376. [PMID: 38305691 PMCID: PMC10994558 DOI: 10.1093/brain/awae025] [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: 07/28/2023] [Revised: 12/07/2023] [Accepted: 01/13/2024] [Indexed: 02/03/2024] Open
Abstract
Apathy is a common and disabling complication of Parkinson's disease characterized by reduced goal-directed behaviour. Several studies have reported dysfunction within prefrontal cortical regions and projections from brainstem nuclei whose neuromodulators include dopamine, serotonin and noradrenaline. Work in animal and human neuroscience have confirmed contributions of these neuromodulators on aspects of motivated decision-making. Specifically, these neuromodulators have overlapping contributions to encoding the value of decisions, and influence whether to explore alternative courses of action or persist in an existing strategy to achieve a rewarding goal. Building upon this work, we hypothesized that apathy in Parkinson's disease should be associated with an impairment in value-based learning. Using a four-armed restless bandit reinforcement learning task, we studied decision-making in 75 volunteers; 53 patients with Parkinson's disease, with and without clinical apathy, and 22 age-matched healthy control subjects. Patients with apathy exhibited impaired ability to choose the highest value bandit. Task performance predicted an individual patient's apathy severity measured using the Lille Apathy Rating Scale (R = -0.46, P < 0.001). Computational modelling of the patient's choices confirmed the apathy group made decisions that were indifferent to the learnt value of the options, consistent with previous reports of reward insensitivity. Further analysis demonstrated a shift away from exploiting the highest value option and a reduction in perseveration, which also correlated with apathy scores (R = -0.5, P < 0.001). We went on to acquire functional MRI in 59 volunteers; a group of 19 patients with and 20 without apathy and 20 age-matched controls performing the Restless Bandit Task. Analysis of the functional MRI signal at the point of reward feedback confirmed diminished signal within ventromedial prefrontal cortex in Parkinson's disease, which was more marked in apathy, but not predictive of their individual apathy severity. Using a model-based categorization of choice type, decisions to explore lower value bandits in the apathy group activated prefrontal cortex to a similar degree to the age-matched controls. In contrast, Parkinson's patients without apathy demonstrated significantly increased activation across a distributed thalamo-cortical network. Enhanced activity in the thalamus predicted individual apathy severity across both patient groups and exhibited functional connectivity with dorsal anterior cingulate cortex and anterior insula. Given that task performance in patients without apathy was no different to the age-matched control subjects, we interpret the recruitment of this network as a possible compensatory mechanism, which compensates against symptomatic manifestation of apathy in Parkinson's disease.
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Affiliation(s)
- William Gilmour
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Graeme Mackenzie
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Mathias Feile
- Rehabilitation Psychiatry, Murray Royal Hospital, Perth PH2 7BH, UK
| | | | - Szabolcs Suveges
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jennifer A Macfarlane
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Medical Physics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
- SINAPSE, University of Glasgow, Imaging Centre of Excellence, Level 2, Queen Elizabeth University Hospital, Glasgow G51 4TF, Scotland, UK
| | - Angus D Macleod
- Institute of Applied Health Sciences, School of Medicine, University of Aberdeen, Foresterhill, Aberdeen AB24 2ZD, UK
- Department of Neurology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB24 2ZD, UK
| | - Vicky Marshall
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Iris Q Grunwald
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - J Douglas Steele
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Tom Gilbertson
- Division of Imaging Science and Technology, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
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20
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Yoon S, Tan CM, Phang JK, Liu VX, Tan WB, Kwan YH, Low LL. Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study. JMIR Form Res 2024; 8:e51848. [PMID: 38573763 DOI: 10.2196/51848] [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: 08/14/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. OBJECTIVE This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. METHODS We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS Participants agreed that the main responsibility of HCPs should be identifying the patient's stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach's personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). CONCLUSIONS The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process.
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Affiliation(s)
| | - Chao Min Tan
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Venice Xi Liu
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Wee Boon Tan
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | | | - Lian Leng Low
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
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21
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Kim JP, Yang HJ, Kim B, Ryan K, Roberts LW. Understanding Physician's Perspectives on AI in Health Care: Protocol for a Sequential Multiple Assignment Randomized Vignette Study. JMIR Res Protoc 2024; 13:e54787. [PMID: 38573756 DOI: 10.2196/54787] [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: 11/21/2023] [Revised: 01/11/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND As the availability and performance of artificial intelligence (AI)-based clinical decision support (CDS) systems improve, physicians and other care providers poised to be on the front lines will be increasingly tasked with using these tools in patient care and incorporating their outputs into clinical decision-making processes. Vignette studies provide a means to explore emerging hypotheses regarding how context-specific factors, such as clinical risk, the amount of information provided about the AI, and the AI result, may impact physician acceptance and use of AI-based CDS tools. To best anticipate how such factors influence the decision-making of frontline physicians in clinical scenarios involving AI decision-support tools, hypothesis-driven research is needed that enables scenario testing before the implementation and deployment of these tools. OBJECTIVE This study's objectives are to (1) design an original, web-based vignette-based survey that features hypothetical scenarios based on emerging or real-world applications of AI-based CDS systems that will vary systematically by features related to clinical risk, the amount of information provided about the AI, and the AI result; and (2) test and determine causal effects of specific factors on the judgments and perceptions salient to physicians' clinical decision-making. METHODS US-based physicians with specialties in family or internal medicine will be recruited through email and mail (target n=420). Through a web-based survey, participants will be randomized to a 3-part "sequential multiple assignment randomization trial (SMART) vignette" detailing a hypothetical clinical scenario involving an AI decision support tool. The SMART vignette design is similar to the SMART design but adapted to a survey design. Each respondent will be randomly assigned to 1 of the possible vignette variations of the factors we are testing at each stage, which include the level of clinical risk, the amount of information provided about the AI, and the certainty of the AI output. Respondents will be given questions regarding their hypothetical decision-making in response to the hypothetical scenarios. RESULTS The study is currently in progress and data collection is anticipated to be completed in 2024. CONCLUSIONS The web-based vignette study will provide information on how contextual factors such as clinical risk, the amount of information provided about an AI tool, and the AI result influence physicians' reactions to hypothetical scenarios that are based on emerging applications of AI in frontline health care settings. Our newly proposed "SMART vignette" design offers several benefits not afforded by the extensively used traditional vignette design, due to the 2 aforementioned features. These advantages are (1) increased validity of analyses targeted at understanding the impact of a factor on the decision outcome, given previous outcomes and other contextual factors; and (2) balanced sample sizes across groups. This study will generate a better understanding of physician decision-making within this context. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54787.
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Affiliation(s)
- Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Hyun-Joon Yang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Katie Ryan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Zaupa M, Nagaraj N, Sylenko A, Baier H, Sawamiphak S, Filosa A. The Calmodulin-interacting peptide Pcp4a regulates feeding state-dependent behavioral choice in zebrafish. Neuron 2024; 112:1150-1164.e6. [PMID: 38295792 DOI: 10.1016/j.neuron.2024.01.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/06/2023] [Accepted: 01/02/2024] [Indexed: 04/06/2024]
Abstract
Animals constantly need to judge the valence of an object in their environment: is it potential food or a threat? The brain makes fundamental decisions on the appropriate behavioral strategy by integrating external information from sensory organs and internal signals related to physiological needs. For example, a hungry animal may take more risks than a satiated one when deciding to approach or avoid an object. Using a proteomic profiling approach, we identified the Calmodulin-interacting peptide Pcp4a as a key regulator of foraging-related decisions. Food intake reduced abundance of protein and mRNA of pcp4a via dopamine D2-like receptor-mediated repression of adenylate cyclase. Accordingly, deleting the pcp4a gene made zebrafish larvae more risk averse in a binary decision assay. Strikingly, neurons in the tectum became less responsive to prey-like visual stimuli in pcp4a mutants, thus biasing the behavior toward avoidance. This study pinpoints a molecular mechanism modulating behavioral choice according to internal state.
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Affiliation(s)
- Margherita Zaupa
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13092 Berlin, Germany; Freie Universität Berlin, Institute for Biology, 14195 Berlin, Germany
| | - Nagarjuna Nagaraj
- Biochemistry Core Facility, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - Anna Sylenko
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13092 Berlin, Germany; Freie Universität Berlin, Institute for Biology, 14195 Berlin, Germany
| | - Herwig Baier
- Max Planck Institute for Biological Intelligence, 82152 Martinsried, Germany
| | - Suphansa Sawamiphak
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13092 Berlin, Germany
| | - Alessandro Filosa
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13092 Berlin, Germany.
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Nieuwenhuis S. Arousal and performance: revisiting the famous inverted-U-shaped curve. Trends Cogn Sci 2024:S1364-6613(24)00078-0. [PMID: 38570252 DOI: 10.1016/j.tics.2024.03.011] [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: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Arousal level is thought to be a key determinant of variability in cognitive performance. In a recent study, Beerendonk, Mejías et al. show that peak performance in decision-making tasks is reached at moderate levels of arousal. They also propose a neurobiologically informed computational model that can explain the inverted-U-shaped relationship.
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Affiliation(s)
- Sander Nieuwenhuis
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
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Filipponi C, Pizzoli SFM, Masiero M, Cutica I, Pravettoni G. The Partial Mediator Role of Satisficing Decision-Making Style Between Trait Emotional Intelligence and Compassion Fatigue in Healthcare Professionals. Psychol Rep 2024; 127:868-886. [PMID: 36134764 DOI: 10.1177/00332941221129127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022]
Abstract
Background: Compassion fatigue (CF) represents a relevant issue for healthcare professionals. Currently, it is still unclear which psychological mechanism might lead to CF and which might protect workers from that. Decision-making styles, as well as emotional intelligence, might partially account for the presence of CF. Specifically, we hypothesized that a satisficing decision-making style would mediate the relationship between emotional intelligence and CF.Methods: A cross-sectional online survey was conducted on physicians and nurses from Italian Medical Departments. Three self-reported questionnaires were administered to collect data in accordance with our aims. A mediation model with Structural Equation Modeling on the relationship between trait emotional intelligence (TEI) and CF through the maximizing decision-making style was performed.Results: We found a significant relationship between TEI and CF (β = -0.28, SE = 0.04, p < .001). The maximizing style partially mediated this relationship (β = -0.04, SE = 0.01, p < .001). Moreover, negative relationships were found between sex (male), working hours, sleep quality, and CF. Conversely, a positive relationship between age and CF was demonstrated.Conclusions: Being emotionally intelligent resulted as a protective factor for developing CF, while the decision-making styles shaped the risk of developing CF.
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Affiliation(s)
- Chiara Filipponi
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Ilaria Cutica
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
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Rajjoub R, Arroyave JS, Zaidat B, Ahmed W, Mejia MR, Tang J, Kim JS, Cho SK. ChatGPT and its Role in the Decision-Making for the Diagnosis and Treatment of Lumbar Spinal Stenosis: A Comparative Analysis and Narrative Review. Global Spine J 2024; 14:998-1017. [PMID: 37560946 DOI: 10.1177/21925682231195783] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 08/11/2023] Open
Abstract
STUDY DESIGN Comparative Analysis and Narrative Review. OBJECTIVE To assess and compare ChatGPT's responses to the clinical questions and recommendations proposed by The 2011 North American Spine Society (NASS) Clinical Guideline for the Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis (LSS). We explore the advantages and disadvantages of ChatGPT's responses through an updated literature review on spinal stenosis. METHODS We prompted ChatGPT with questions from the NASS Evidence-based Clinical Guidelines for LSS and compared its generated responses with the recommendations provided by the guidelines. A review of the literature was performed via PubMed, OVID, and Cochrane on the diagnosis and treatment of lumbar spinal stenosis between January 2012 and April 2023. RESULTS 14 questions proposed by the NASS guidelines for LSS were uploaded into ChatGPT and directly compared to the responses offered by NASS. Three questions were on the definition and history of LSS, one on diagnostic tests, seven on non-surgical interventions and three on surgical interventions. The review process found 40 articles that were selected for inclusion that helped corroborate or contradict the responses that were generated by ChatGPT. CONCLUSIONS ChatGPT's responses were similar to findings in the current literature on LSS. These results demonstrate the potential for implementing ChatGPT into the spine surgeon's workplace as a means of supporting the decision-making process for LSS diagnosis and treatment. However, our narrative summary only provides a limited literature review and additional research is needed to standardize our findings as means of validating ChatGPT's use in the clinical space.
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Affiliation(s)
- Rami Rajjoub
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan Sebastian Arroyave
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bashar Zaidat
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wasil Ahmed
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mateo Restrepo Mejia
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin Tang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S Kim
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Van Marcke H, Denmat PL, Verguts T, Desender K. Manipulating Prior Beliefs Causally Induces Under- and Overconfidence. Psychol Sci 2024; 35:358-375. [PMID: 38427319 DOI: 10.1177/09567976241231572] [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] [Indexed: 03/02/2024] Open
Abstract
Humans differ vastly in the confidence they assign to decisions. Although such under- and overconfidence relate to fundamental life outcomes, a computational account specifying the underlying mechanisms is currently lacking. We propose that prior beliefs in the ability to perform a task explain confidence differences across participants and tasks, despite similar performance. In two perceptual decision-making experiments, we show that manipulating prior beliefs about performance during training causally influences confidence in healthy adults (N = 50 each; Experiment 1: 8 men, one nonbinary; Experiment 2: 5 men) during a test phase, despite unaffected objective performance. This is true when prior beliefs are induced via manipulated comparative feedback and via manipulated training-phase difficulty. Our results were accounted for within an accumulation-to-bound model, explicitly modeling prior beliefs on the basis of earlier task exposure. Decision confidence is quantified as the probability of being correct conditional on prior beliefs, causing under- or overconfidence. We provide a fundamental mechanistic insight into the computations underlying under- and overconfidence.
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Affiliation(s)
- Hélène Van Marcke
- Brain and Cognition, Faculty of Psychology and Educational Sciences, KU Leuven
- Department of Experimental Psychology, Ghent University
| | - Pierre Le Denmat
- Brain and Cognition, Faculty of Psychology and Educational Sciences, KU Leuven
| | - Tom Verguts
- Department of Experimental Psychology, Ghent University
| | - Kobe Desender
- Brain and Cognition, Faculty of Psychology and Educational Sciences, KU Leuven
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27
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Forbes PA, Chaliani I, Schilbach L, Kalenscher T. Autistic adults show enhanced generosity to socially distant others. Autism 2024; 28:999-1009. [PMID: 37606240 DOI: 10.1177/13623613231190674] [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] [Indexed: 08/23/2023]
Abstract
LAY ABSTRACT Autistic people show differences in their social behaviour. But how autism affects decisions to share resources, an important part of cooperation, was previously unclear. In our study, participants made decisions about how to share money with different people, including people they felt close to, such as a friend, and people they felt less close to, such as a stranger. We found that compared to a group of non-autistic participants, autistic adults shared more money overall and this was driven by greater generosity to strangers. The results suggest that autistic adults were more generous because they made fair decisions (an equal split of the money) more consistently regardless of how close they felt to the person they were sharing with. By showing that autistic adults display greater generosity, our results could help to change public perceptions of autism and potentially improve opportunities for autistic people.
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Affiliation(s)
- Paul Ag Forbes
- Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Germany
| | - Irini Chaliani
- LVR-Klinikum Düsseldorf, Heinrich Heine University Düsseldorf, Germany
| | - Leonhard Schilbach
- LVR-Klinikum Düsseldorf, Heinrich Heine University Düsseldorf, Germany
- Ludwig-Maximilians-Universität, München, Germany
| | - Tobias Kalenscher
- Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Germany
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28
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Warburton M, Brookes J, Hasan M, Leonetti M, Dogar M, Wang H, Cohn AG, Mushtaq F, Mon-Williams M. Getting stuck in a rut as an emergent feature of a dynamic decision-making system. R Soc Open Sci 2024; 11:231550. [PMID: 38577210 PMCID: PMC10987986 DOI: 10.1098/rsos.231550] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/23/2024] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
Human sensorimotor decision making has a tendency to get 'stuck in a rut', being biased towards selecting a previously implemented action structure (hysteresis). Existing explanations propose this is the consequence of an agent efficiently modifying an existing plan, rather than creating a new plan from scratch. Instead, we propose that hysteresis is an emergent property of a system learning from the consequences of its actions. To examine this, 152 participants moved a cursor to a target on a tablet device while avoiding an obstacle. Hysteresis was observed when the obstacle moved sequentially across the screen between trials, whereby the participant continued moving around the same side of the obstacle despite it now requiring a larger movement than the alternative. Two further experiments (n = 20) showed an attenuation when time and resource constraints were eased. We created a simple computational model capturing probabilistic estimate updating that showed the same patterns of results. This provides, to our knowledge, the first computational demonstration of how sensorimotor decision making can get 'stuck in a rut' through the updating of the probability estimates associated with actions.
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Affiliation(s)
| | - Jack Brookes
- School of Psychology, University of Leeds, Leeds, UK
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
| | | | - Matteo Leonetti
- School of Computing, University of Leeds, Leeds, UK
- Department of Informatics, King’s College London, London, UK
| | - Mehmet Dogar
- School of Computing, University of Leeds, Leeds, UK
| | - He Wang
- School of Computing, University of Leeds, Leeds, UK
- Centre for Immersive Technologies, University of Leeds, Leeds, UK
| | | | - Faisal Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
- Centre for Immersive Technologies, University of Leeds, Leeds, UK
| | - Mark Mon-Williams
- School of Psychology, University of Leeds, Leeds, UK
- Centre for Immersive Technologies, University of Leeds, Leeds, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, UK
- National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg3616, Norway
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29
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MacNeil ER, Cox J, Daquin JC, Neal TMS. Gender Role Attitudes and Prosecutorial Decision-Making in a Case of Intimate Partner Violence. J Interpers Violence 2024; 39:1496-1518. [PMID: 37902455 DOI: 10.1177/08862605231207901] [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] [Indexed: 10/31/2023]
Abstract
Intimate Partner Violence (IPV) is a pervasive public health crisis that impacts individuals across the gender spectrum. Traditionally, IPV is conceptualized through a gendered lens, with men as the perpetrators and women as the victims. The current study explored the association between perpetrator/victim sex, prosecutor gender role attitudes, and prosecutorial decision-making in a case of alleged IPV. We hypothesized that prosecutors with more traditional gender role attitudes would be more lenient, and this effect to be exacerbated in cases involving a female perpetrator. Criminal prosecutors across the United States (N = 94) completed the Male Role Norms Inventory-Revised and read case materials describing the alleged IPV between a heterosexual couple (e.g., arrest report, medical records). The victim/perpetrator sex was manipulated to involve either a female- (male victim) or male- (female victim) perpetrated IPV case. Results indicate that gender role attitudes were not associated with prosecutorial decision-making. However, prosecutors perceived the violence as more serious and the perpetrator as more likely to reoffend when the perpetrator was male; further, they attributed more blame to the female victim. An interaction between perpetrator sex and prosecutor gender role attitudes indicates those with more traditional beliefs were more likely to blame the female (rather than male) victim. These data suggest extralegal factors related to the perpetrator (i.e., perpetrator sex), rather than prosecutor individual differences (i.e., gender role attitudes), are associated with prosecutor discretionary decision-making. In tandem with real-world disparities in the prosecution of IPV based on perpetrator sex, the current research stresses the importance of exploring a diversity of factors that account for these observed differences.
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Affiliation(s)
| | | | | | - Tess M S Neal
- Arizona State University, Glendale, USA
- Iowa State University, Ames, USA
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30
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Alister M, McKay KT, Sewell DK, Evans NJ. Uncovering the cognitive mechanisms underlying the gaze cueing effect. Q J Exp Psychol (Hove) 2024; 77:803-827. [PMID: 37246917 PMCID: PMC10960327 DOI: 10.1177/17470218231181238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/31/2022] [Revised: 04/03/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
The gaze cueing effect is the tendency for people to respond faster to targets appearing at locations gazed at by others, compared with locations gazed away from by others. The effect is robust, widely studied, and is an influential finding within social cognition. Formal evidence accumulation models provide the dominant theoretical account of the cognitive processes underlying speeded decision-making, but they have rarely been applied to social cognition research. In this study, using a combination of individual-level and hierarchical computational modelling techniques, we applied evidence accumulation models to gaze cueing data (three data sets total, N = 171, 139,001 trials) for the first time to assess the relative capacity that an attentional orienting mechanism and information processing mechanisms have for explaining the gaze cueing effect. We found that most participants were best described by the attentional orienting mechanism, such that response times were slower at gazed away from locations because they had to reorient to the target before they could process the cue. However, we found evidence for individual differences, whereby the models suggested that some gaze cueing effects were driven by a short allocation of information processing resources to the gazed at location, allowing for a brief period where orienting and processing could occur in parallel. There was exceptionally little evidence to suggest any sustained reallocation of information processing resources neither at the group nor individual level. We discuss how this individual variability might represent credible individual differences in the cognitive mechanisms that subserve behaviourally observed gaze cueing effects.
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Affiliation(s)
- Manikya Alister
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Kate T McKay
- School of Psychology, The University of Queensland, Saint Lucia, QLD, Australia
| | - David K Sewell
- School of Psychology, The University of Queensland, Saint Lucia, QLD, Australia
| | - Nathan J Evans
- School of Psychology, The University of Queensland, Saint Lucia, QLD, Australia
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
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31
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Chapman KE, Smith MT, Gaston KJ, Hempel de Ibarra N. Bumblebee nest departures under low light conditions at sunrise and sunset. Biol Lett 2024; 20:20230518. [PMID: 38593853 PMCID: PMC11003773 DOI: 10.1098/rsbl.2023.0518] [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: 11/07/2023] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
Only a few diurnal animals, such as bumblebees, extend their activity into the time around sunrise and sunset when illumination levels are low. Low light impairs viewing conditions and increases sensory costs, but whether diurnal insects use low light as a cue to make behavioural decisions is uncertain. To investigate how they decide to initiate foraging at these times of day, we observed bumblebee nest-departure behaviours inside a flight net, under naturally changing light conditions. In brighter light bees did not attempt to return to the nest and departed with minimal delay, as expected. In low light the probability of non-departures increased, as a small number of bees attempted to return after spending time on the departure platform. Additionally, in lower illumination bees spent more time on the platform before flying away, up to 68 s. Our results suggest that bees may assess light conditions once outside the colony to inform the decision to depart. These findings give novel insights into how behavioural decisions are made at the start and the end of a foraging day in diurnal animals when the limits of their vision impose additional costs on foraging efficiency.
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Affiliation(s)
- Katherine E. Chapman
- Centre for Research in Animal Behaviour, Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Michael T. Smith
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Kevin J. Gaston
- Environment and Sustainability Institute, University of Exeter, Penryn, Cornwall, UK
| | - Natalie Hempel de Ibarra
- Centre for Research in Animal Behaviour, Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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32
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Sun WN, Kao CY. The Challenges in Using eHealth Decision Resources for Surrogate Decision-Making in the Intensive Care Unit. J Med Internet Res 2024; 26:e47017. [PMID: 38557504 PMCID: PMC11019413 DOI: 10.2196/47017] [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: 03/08/2023] [Revised: 11/23/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024] Open
Abstract
The mortality rate in intensive care units (ICUs) is notably high, with patients often relying on surrogates for critical medical decisions due to their compromised state. This paper provides a comprehensive overview of eHealth. The challenges of applying eHealth tools, including economic disparities and information inaccuracies are addressed. This study then introduces eHealth literacy and the assessment tools to evaluate users' capability and literacy levels in using eHealth resources. A clinical scenario involving surrogate decision-making is presented. This simulated case involves a patient with a hemorrhagic stroke who has lost consciousness and requires medical procedures such as tracheostomy. However, due to the medical surrogate's lack of familiarity with eHealth devices and limited literacy in using eHealth resources, difficulties arise in assisting the patient in making medical decisions. This scenario highlights challenges related to eHealth literacy and solution strategies are proposed. In conclusion, effective ICU decision-making with eHealth tools requires a careful balance between efficiency with inclusivity. Tailoring communication strategies and providing diverse materials are essential for effective eHealth decision resources in the ICU setting. Health professionals should adopt a patient-centered approach to enhance the decision-making experience, particularly for individuals with limited eHealth literacy.
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Affiliation(s)
- Wan-Na Sun
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Yin Kao
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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33
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Hoe J, Profyri E, Kemp C, Manela M, Webster L, Anthony J, Costafreda S, Arrojo F, Souris H, Livingston G. Risk assessment for people living with dementia: a systematic review. Int Psychogeriatr 2024; 36:263-288. [PMID: 38053362 DOI: 10.1017/s1041610223004398] [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: 12/07/2023]
Abstract
OBJECTIVE This systematic review identified key components of risk assessment for people with dementia, examined attitudes toward risk identification and risk assessment, and appraised existing risk assessment tools. METHODS Systematic searches of five databases on two platforms (EBSCO, OVID) and gray literature databases (Open Grey, Base) were conducted. Studies were screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. RESULTS Our review found people with dementia, their family carers, and healthcare professionals differed in how risk is conceptualized, with views being shaped by media perceptions, personal experiences, socio-cultural influences, dementia knowledge, and dementia severity. We found that mobilization (causing falls inside and getting lost outside) is the most frequently identified risk factor. Our findings show people with dementia are generally risk-tolerant, while healthcare professionals may adopt risk-averse approaches because of organizational requirements. We found factors that disrupt daily routines, living and caring arrangements, medication management, and unclear care pathways contribute toward adverse risk events. We discovered that most studies about risk and risk assessment scales did not consider insight of the person with dementia into risks although this is important for the impact of a risk. No risk instrument identified had sufficient evidence that it was useful. CONCLUSION Accurate risk assessment and effective communication strategies that include the perspectives of people with dementia are needed to enable risk-tolerant practice. No risk instrument to date was shown to be widely acceptable and useful in practice.
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Affiliation(s)
- Juanita Hoe
- Geller Institute of Ageing and Memory, University of West London, London, UK
- School of Health Sciences, University of London, London, UK
| | - Elena Profyri
- School of Health Sciences, University of London, London, UK
| | - Charlotte Kemp
- School of Health Sciences, University of London, London, UK
| | - Monica Manela
- UCL Division of Psychiatry, University College London, Maple House, London, UK
| | - Lucy Webster
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Justine Anthony
- School of Health Sciences, University of London, London, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Sergi Costafreda
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Frank Arrojo
- Alzheimer's Society Research Network, Alzheimer's Society, London, UK
| | - Helen Souris
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Dementia Clinical Network, NHS England and NHS Improvement (London Region, London, UK
| | - Gill Livingston
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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34
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Gaubert F, Borg C, Roux JC, Chainay H. Decision-making and ageing: everyday life situations under risk and under ambiguity. Q J Exp Psychol (Hove) 2024; 77:747-766. [PMID: 37277919 DOI: 10.1177/17470218231182403] [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] [Indexed: 06/07/2023]
Abstract
Cognitive modifications during ageing can affect decision-making competence (DMC). As this ability is central to the preservation of autonomy, our study aims to investigate how it changes in elderly adults and to determine whether such changes are linked to the deterioration of executive functions and working memory. To this end, 50 young adults and 50 elderly adults were assessed with executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenario task based on situations inspired by everyday life, under conditions of both risk and ambiguity. The results revealed lower performances in old than in young adults for the updating, inhibition, and working memory tasks. The IGT failed to distinguish between the two age groups. However, the scenario task did permit such a distinction, with young adults seeking more risky and ambiguous choices than elderly adults. Moreover, updating and inhibition capacities appeared to influence DMC.
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Affiliation(s)
- Fanny Gaubert
- Laboratoire d'Etude des Mécanismes Cognitifs (EMC), Université Lyon 2, Bron, France
| | - Céline Borg
- CMRR, Hôpital Nord, Saint Priest-en Jarez, France
- Psychology Faculty, Catholic University of Lyon, Lyon, France
- Laboratoire de Psychologie et Neurocognition, University of Grenoble Alpes, Saint Priest-en Jarez, France
| | - Jean-Christophe Roux
- Laboratoire de Tribologie et Dynamique des Systèmes (LTDS), Ecole Nationale d'Ingénieurs Saint-Etienne (ENISE), Saint-Etienne cedex 2, France
| | - Hanna Chainay
- Laboratoire d'Etude des Mécanismes Cognitifs (EMC), Université Lyon 2, Bron, France
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Alrehaili AA. Exploring Parental Knowledge, Attitudes, and Factors Influencing Decision-Making in Stem Cell Banking: Rising the Future of Medical Treatment. Cureus 2024; 16:e58384. [PMID: 38628380 PMCID: PMC11020598 DOI: 10.7759/cureus.58384] [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: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Stem cell banking (SCB) is a promising area of modern medicine with the potential to yield innovative treatments and cures. To effectively educate parents and implement laws and regulations that address parental concerns and encourage informed decision-making, it is imperative to emphasize parental viewpoints and their consequences for future healthcare. The study aims to establish the Saudi Arabian population's level of understanding regarding SCB and to comprehend the elements influencing parental knowledge, attitudes, and SCB decision-making processes. METHODOLOGY A cross-sectional study was conducted among the population in the Makkah region of Saudi Arabia. Demographic data, knowledge levels, attitudes, and decision-making variables were gathered from 380 respondents. RESULTS The study reveals a lack in their comprehension of the objectives and possible uses of SCB, together with the main sources of information on those banks and conveniently available banking choices. It showed varied results regarding attitudes about considering an SCB for their children. In addition, the majority of respondents had not made a consent decision about SCB for their children. It also illuminates the factors that could influence participants' decisions about SCB for their children and shows that a lack of information and understanding is the main obstacle faced by parents regarding SCB. It highlights that participants were generally in favor of learning more about SCB for their children. CONCLUSIONS This study broadens our understanding of parental decision-making toward SCB and clarifies the elements influencing parents' opinions and worries and offers significant ramifications for lawmakers, medical professionals, and SCB. These implications can be utilized to enhance communication strategies, create instructional programs, and ease the fears of concerned parents.
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Affiliation(s)
- Amani A Alrehaili
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, SAU
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36
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Force LM, Hlatywayo L, Salek M, Bhakta M, Bonilla M, Kaye EC, Rodriguez-Galindo C, Baker JN, Bhakta N, Chitsike I. Understanding treatment recommendations at diagnosis of advanced cancer in pediatric oncology: The need to explore decision-making challenges globally. Pediatr Blood Cancer 2024; 71:e30854. [PMID: 38233986 PMCID: PMC10922856 DOI: 10.1002/pbc.30854] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Lisa M. Force
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Loyce Hlatywayo
- Parirenyatwa Hospital and University of Zimbabwe, Harare, Zimbabwe
| | - Marta Salek
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Manoo Bhakta
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Miguel Bonilla
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Erica C. Kaye
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Carlos Rodriguez-Galindo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Justin N. Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Inam Chitsike
- Parirenyatwa Hospital and University of Zimbabwe, Harare, Zimbabwe
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Michaleff ZA, Hattingh L, Greenwood H, Mickan S, Jones M, van der Merwe M, Thomas R, Carlini J, Henry D, Stehlik P, Glasziou P, Keijzers G. Evaluating the use of clinical decision aids in an Australian emergency department: A cross-sectional survey. Emerg Med Australas 2024; 36:221-230. [PMID: 37963836 DOI: 10.1111/1742-6723.14338] [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: 01/30/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To identify healthcare professionals' knowledge, self-reported use, and documentation of clinical decision aids (CDAs) in a large ED in Australia, to identify behavioural determinants influencing the use of CDAs, and healthcare professionals preferences for integrating CDAs into the electronic medical record (EMR) system. METHODS Healthcare professionals (doctors, nurses and physiotherapists) working in the ED at the Gold Coast Hospital, Queensland were invited to complete an online survey. Quantitative data were analysed using descriptive statistics, and where appropriate, mapped to the theoretical domains framework to identify potential barriers to the use of CDAs. Qualitative data were analysed using content analysis. RESULTS Seventy-four healthcare professionals (34 medical officers, 31 nurses and nine physiotherapists) completed the survey. Healthcare professionals' knowledge and self-reported use of 21 validated CDAs was low but differed considerably across CDAs. Only 4 out of 21 CDAs were reported to be used 'sometimes' or 'always' by the majority of respondents (Ottawa Ankle Rule for ankle injury, Wells' criteria for pulmonary embolism, Wells' criteria for deep vein thrombosis and PERC rule for pulmonary embolism). Most respondents wanted to increase their use of valid and reliable CDAs and supported the integration of CDAs into the EMR to facilitate their use and support documentation. Potential barriers impacting the use of CDAs represented three theoretical domains of knowledge, social/professional role and identity, and social influences. CONCLUSIONS CDAs are used variably by healthcare professionals and are inconsistently applied in the clinical encounter. Preferences of healthcare professionals need to be considered to allow the successful integration of CDAs into the EMR.
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Affiliation(s)
- Zoe A Michaleff
- Northern New South Wales Local Health District, Lismore, New South Wales, Australia
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Laetitia Hattingh
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Hannah Greenwood
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Sharon Mickan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Madeleen van der Merwe
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Tropical Australian Academic Health Centre, Townsville, Queensland, Australia
| | - Joan Carlini
- Consumer Advisory Group, Gold Coast Health, Gold Coast, Queensland, Australia
- Department of Marketing, Griffith University, Gold Coast, Queensland, Australia
| | - David Henry
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Paulina Stehlik
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Gerben Keijzers
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Robinson MA, Bowen JL, Aylor M, van Schaik S. Having a Voice: Resident Perceptions of Supervision, Decision-Making and Patient Care Ownership. Acad Pediatr 2024; 24:519-526. [PMID: 37951350 DOI: 10.1016/j.acap.2023.10.012] [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: 07/20/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Heightened resident supervision due to patient safety concerns is increasingly common in pediatrics and may leave residents with fewer opportunities for independent decision-making, a diminished sense of autonomy, and decreased engagement. This may ultimately threaten their development into competent clinicians. Understanding how pediatric residents experience supervision's influence on their involvement in decision-making, engagement in patient care, and learning is crucial to safeguard their transition to independent practice. In relation to supervision, our research investigated: 1) how residents navigated their involvement with clinical decision-making and 2) how opportunities to make clinical decisions influenced their engagement in patient care and learning. METHODS From 2019-2020, we recruited 38 pediatric residents from three different programs for a qualitative interview-based study. Through a constructivist stance, we explored clinical decision-making experiences and performed thematic analysis using an iterative and inductive process. RESULTS We identified three themes: 1) Residents perceived having autonomy when they had space to make independent decisions, regardless of supervisor's presence; 2) Patient care ownership resulted from having a voice in a variety of contributions to patient care; and 3) Supervisors' behaviors modulated patient care ownership and thereby residents' sense of feeling heard, their engagement in patient care, and their learning. CONCLUSIONS Our results suggest that focusing on patient care ownership may better fit with current learning environments than aiming for independence and autonomy. They provide insight on how, in the pediatric learning climate of enhanced supervision, supervisors can preserve resident engagement in patient care and learning by augmenting patient care ownership and ensuring residents have a voice.
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Affiliation(s)
- Margaret A Robinson
- Division of Pediatric Critical Care Medicine (MA Robinson and S van Schaik), Department of Pediatrics, University of California, San Francisco, Calif.
| | - Judith L Bowen
- Elson S. Floyd College of Medicine (JL Bowen), Washington State University, Spokane, Wash
| | - Megan Aylor
- Department of Pediatrics (M Aylor), Oregon Health and Science University, Portland, Ore
| | - Sandrijn van Schaik
- Division of Pediatric Critical Care Medicine (MA Robinson and S van Schaik), Department of Pediatrics, University of California, San Francisco, Calif
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Young BE, Goodmann DR, Hamlin E, Tabaczyk O, Dunn LB, Muñoz RF, Leykin Y. Is it worth it? Greater risk aversion with lower life satisfaction among depressed individuals. PSYCHOL HEALTH MED 2024; 29:732-742. [PMID: 38525913 PMCID: PMC10963881 DOI: 10.1080/13548506.2023.2211805] [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: 08/12/2022] [Accepted: 05/02/2023] [Indexed: 03/26/2024]
Abstract
Decisions of individuals with depression are often risk-averse. Risk-aversion may also extend to decisions regarding treatment, which may cause individuals to forgo or delay treatment. It is also well established that depression is associated with lower satisfaction with life. However, whether life satisfaction is associated with risk aversion for individuals with depression is not yet known. Three groups of participants (Depressed: n = 61; Chronic pain: n = 61; Comorbid depression and pain: n = 58) completed a clinical interview and several self-report questionnaires, including the Satisfaction with Life Scale (SWLS). Participants also completed two utility elicitation tasks: time trade-off (TTO), which measures utilities of health states without implied risks, and standard gamble (SG), which measures utilities of health states in the presence of risk (presented in this study as a hypothetical clinical trial described as having both potential harms and benefits). Risk aversion is defined as the difference in the utility ratings generated via SG and via TTO. For both TTO and SG, individuals evaluated their own depression or pain. When perfect health was used as a hypothetical benefit in TTO and SG tasks, satisfaction with life was not associated with risk preferences, for either depressed participants or participants with chronic pain (all ps ns). However, for participants with depression, when the hypothetical benefit was a more ecologically valid 'mild' depression in TTO and SG tasks, lower satisfaction with life was associated with greater risk aversion (p < .005; p < .03). For depressed individuals, therefore, lower satisfaction with life may be associated with risk aversion regarding treatments when benefits are seen as minor, which may result in treatment avoidance and, consequently, further worsening of both symptoms and life satisfaction.
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Affiliation(s)
| | | | | | | | | | - Ricardo F. Muñoz
- Palo Alto University
- University of California, San Francisco
- Institute for International Internet Interventions for Health
| | - Yan Leykin
- Palo Alto University
- University of California, San Francisco
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Owens OL, Dressler EV, Mayfield A, Winkfield KM, Krane LS, Foust M, Sandberg JC. Considerations from employed African-American and white prostate cancer survivors on prostate cancer treatment and survivorship: a qualitative analysis. Ethn Health 2024; 29:309-327. [PMID: 38317577 PMCID: PMC10987268 DOI: 10.1080/13557858.2024.2312422] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To solicit information/suggestions from prostate cancer survivors to improve survivorship experiences specific to work/workability. DESIGN The study employed a qualitative/phenomenological approach. Black/African-American and white prostate cancer survivors who: (1) had prostatectomy or radiation therapy 6-36 months prior, (2) were working for pay within 30 days before having treatment, and (3) expected to be working for pay 6 months later (n = 45) were eligible for this study. Survivors were engaged in 60-to-90-minute structured interviews. Content analysis was used to ascertain prominent themes. RESULTS Participants had the following recommendations for survivors: ask about research on treatment options and side effects; speak with other survivors about cancer diagnosis; and inform family/friends and employers about needed accommodations. Considerations for family/friends emphasized the significance of instrumental (e.g. help finding information) and emotional support (e.g. encouragement). Employer/co-worker considerations most often related to work-related accommodations/support and avoiding stigmatization of the survivor. Considerations for healthcare providers commonly included the provision of unbiased, plain-language communication about treatment options and side effects. No major differences existed by race. CONCLUSIONS Needs of employed PrCA survivors, regardless of their race or treatment type, are commonly related to their desire for informational, instrumental, and/or emotional support from family/friends, employers/co-workers, and healthcare providers. The requested supports are most often related to the side effects of prostate cancer treatment.
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Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Andrew Mayfield
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Karen M Winkfield
- Meharry-Vanderbilt, Alliance, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Spencer Krane
- Department of Urologic Surgery, Southeastern Louisiana Veterans Health Care Center, New Orleans, LA, USA
| | - Melyssa Foust
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Joanne C Sandberg
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Sinclair C, Yeoh L, Karusoo‐Musumeci A, Auret KA, Clayton JM, Hilgeman M, Halcomb E, Sinclair R, Martini A, Meller A, Walton R, Wei L, Dao‐Tran T, Kurrle S, Comans T. Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults. Health Expect 2024; 27:e14010. [PMID: 38450803 PMCID: PMC10918722 DOI: 10.1111/hex.14010] [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: 07/10/2023] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision-making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life-sustaining treatments and care utilisation to inform their broader use in ACP studies. METHODS Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. RESULTS Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's = .31-.37, p < .001), and ACP engagement (r's = -.41 to -.37, p < .001) indicated convergent validity. CONCLUSION A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. PATIENT OR PUBLIC CONTRIBUTION The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life-limiting conditions and five current or former care partners.
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Affiliation(s)
- Craig Sinclair
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Ling Yeoh
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Kirsten A. Auret
- Rural Clinical School of Western AustraliaUniversity of Western AustraliaAlbanyWestern AustraliaAustralia
| | - Josephine M. Clayton
- The Palliative Centre, HammondCareSydneyNew South WalesAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Michelle Hilgeman
- Tuscaloosa Veterans Affairs Medical CenterTuscaloosaAlabamaUSA
- Department of PsychologyThe University of AlabamaTuscaloosaAlabamaUSA
| | - Elizabeth Halcomb
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Ron Sinclair
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Angelita Martini
- Brightwater GroupPerthWestern AustraliaAustralia
- University of Western AustraliaPerthWestern AustraliaAustralia
| | - Anne Meller
- Prince of Wales Hospital, South Eastern Sydney Local Health DistrictSydneyNew South WalesAustralia
| | | | - Li Wei
- College of Science, Health, Engineering and EducationMurdoch UniversityPerthWestern AustraliaAustralia
| | - Tiet‐Hanh Dao‐Tran
- Centre for Health Services ResearchUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Susan Kurrle
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Tracy Comans
- Centre for Health Services ResearchUniversity of QueenslandBrisbaneQueenslandAustralia
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Corral D, Rutchick AM. The effects of explicit reasoning on moral judgements. Q J Exp Psychol (Hove) 2024; 77:828-845. [PMID: 37211652 DOI: 10.1177/17470218231179685] [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] [Indexed: 05/23/2023]
Abstract
We report four experiments that investigate explicit reasoning and moral judgements. In each experiment, some subjects responded to the "footbridge" version of the trolley problem (which elicits stronger moral intuitions), whereas others responded to the "switch" version (which elicits weaker moral intuitions). Experiments 1-2 crossed the type of trolley problem with four reasoning conditions: control, counter-attitudinal, pro-attitudinal, and mixed reasoning (both types of reasoning). Experiments 3-4 examine whether moral judgements vary based on (a) when reasoners engage in counter-attitudinal reasoning, (b) when they make the moral judgement, and (c) by the type of moral dilemma. These two experiments comprised five conditions: control (judgement only), delay-only (2-minute wait then judgement), reasoning-only (reasoning then judgement), reasoning-delay (reasoning, then 2-minute delay, then judgement), and delayed-reasoning (2-minute delay, then reasoning, then judgement). These conditions were crossed with the type of trolley problem. We find that engaging in some form of counter-attitudinal reasoning led to less typical judgements (regardless of when it occurs), but this effect was mostly restricted to the switch version of the dilemma (and was strongest in the reasoning-delay conditions). Furthermore, neither pro-attitudinal reasoning nor delayed judgements on their own impacted subjects' judgements. Reasoners therefore seem open to modifying their moral judgements when they consider opposing perspectives but might be less likely to do so for dilemmas that elicit relatively strong moral intuitions.
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Affiliation(s)
- Daniel Corral
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Balconi M, Acconito C, Allegretta RA, Angioletti L. Neurophysiological and Autonomic Correlates of Metacognitive Control of and Resistance to Distractors in Ecological Setting: A Pilot Study. Sensors (Basel) 2024; 24:2171. [PMID: 38610382 PMCID: PMC11014065 DOI: 10.3390/s24072171] [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] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
In organisational contexts, professionals are required to decide dynamically and prioritise unexpected external inputs deriving from multiple sources. In the present study, we applied a multimethodological neuroscientific approach to investigate the ability to resist and control ecological distractors during decision-making and to explore whether a specific behavioural, neurophysiological (i.e., delta, theta, alpha and beta EEG band), or autonomic (i.e., heart rate-HR, and skin conductance response-SCR) pattern is correlated with specific personality profiles, collected with the 10-item Big Five Inventory. Twenty-four participants performed a novel Resistance to Ecological Distractors (RED) task aimed at exploring the ability to resist and control distractors and the level of coherence and awareness of behaviour (metacognition ability), while neurophysiological and autonomic measures were collected. The behavioural results highlighted that effectiveness in performance did not require self-control and metacognition behaviour and that being proficient in metacognition can have an impact on performance. Moreover, it was shown that the ability to resist ecological distractors is related to a specific autonomic profile (HR and SCR decrease) and that the neurophysiological and autonomic activations during task execution correlate with specific personality profiles. The agreeableness profile was negatively correlated with the EEG theta band and positively with the EEG beta band, the conscientiousness profile was negatively correlated with the EEG alpha band, and the extroversion profile was positively correlated with the EEG beta band. Taken together, these findings describe and disentangle the hidden relationship that lies beneath individuals' decision to inhibit or activate intentionally a specific behaviour, such as responding, or not, to an external stimulus, in ecological conditions.
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Affiliation(s)
- Michela Balconi
- International Research Center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy; (M.B.); (R.A.A.); (L.A.)
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy
| | - Carlotta Acconito
- International Research Center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy; (M.B.); (R.A.A.); (L.A.)
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy
| | - Roberta A. Allegretta
- International Research Center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy; (M.B.); (R.A.A.); (L.A.)
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy
| | - Laura Angioletti
- International Research Center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy; (M.B.); (R.A.A.); (L.A.)
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy
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He X, Cui X, Zhao Z, Wu R, Zhang Q, Xue L, Zhang H, Ge Q, Leng Y. A generalizable and easy-to-use COVID-19 stratification model for the next pandemic via immune-phenotyping and machine learning. Front Immunol 2024; 15:1372539. [PMID: 38601145 PMCID: PMC11004273 DOI: 10.3389/fimmu.2024.1372539] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected billions of people worldwide, and the lessons learned need to be concluded to get better prepared for the next pandemic. Early identification of high-risk patients is important for appropriate treatment and distribution of medical resources. A generalizable and easy-to-use COVID-19 severity stratification model is vital and may provide references for clinicians. Methods Three COVID-19 cohorts (one discovery cohort and two validation cohorts) were included. Longitudinal peripheral blood mononuclear cells were collected from the discovery cohort (n = 39, mild = 15, critical = 24). The immune characteristics of COVID-19 and critical COVID-19 were analyzed by comparison with those of healthy volunteers (n = 16) and patients with mild COVID-19 using mass cytometry by time of flight (CyTOF). Subsequently, machine learning models were developed based on immune signatures and the most valuable laboratory parameters that performed well in distinguishing mild from critical cases. Finally, single-cell RNA sequencing data from a published study (n = 43) and electronic health records from a prospective cohort study (n = 840) were used to verify the role of crucial clinical laboratory and immune signature parameters in the stratification of COVID-19 severity. Results Patients with COVID-19 were determined with disturbed glucose and tryptophan metabolism in two major innate immune clusters. Critical patients were further characterized by significant depletion of classical dendritic cells (cDCs), regulatory T cells (Tregs), and CD4+ central memory T cells (Tcm), along with increased systemic interleukin-6 (IL-6), interleukin-12 (IL-12), and lactate dehydrogenase (LDH). The machine learning models based on the level of cDCs and LDH showed great potential for predicting critical cases. The model performances in severity stratification were validated in two cohorts (AUC = 0.77 and 0.88, respectively) infected with different strains in different periods. The reference limits of cDCs and LDH as biomarkers for predicting critical COVID-19 were 1.2% and 270.5 U/L, respectively. Conclusion Overall, we developed and validated a generalizable and easy-to-use COVID-19 severity stratification model using machine learning algorithms. The level of cDCs and LDH will assist clinicians in making quick decisions during future pandemics.
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Affiliation(s)
- Xinlei He
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China
| | - Xiao Cui
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China
| | - Zhiling Zhao
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China
| | - Rui Wu
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Qiang Zhang
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China
| | - Lei Xue
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- Department of Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Qinggang Ge
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China
| | - Yuxin Leng
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China
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Ulfsdotter Gunnarsson K, Henriksson M, Bendtsen M. Digital Alcohol Interventions Could Be Part of the Societal Response to Harmful Consumption, but We Know Little About Their Long-Term Costs and Health Outcomes. J Med Internet Res 2024; 26:e44574. [PMID: 38536228 PMCID: PMC11007605 DOI: 10.2196/44574] [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] [Revised: 04/19/2023] [Accepted: 02/13/2024] [Indexed: 04/13/2024] Open
Abstract
Alcohol consumption causes both physical and psychological harm and is a leading risk factor for noncommunicable diseases. Digital alcohol interventions have been found to support those looking for help by giving them tools for change. However, whether digital interventions can help tackle the long-term societal consequences of harmful alcohol consumption in a cost-effective manner has not been adequately evaluated. In this Viewpoint, we propose that studies of digital alcohol interventions rarely evaluate the consequences of wider dissemination of the intervention under study, and that when they do, they do not take advantage of modeling techniques that allow for appropriately studying consequences over a longer time horizon than the study period when the intervention is tested. We argue that to help decision-makers to prioritize resources for research and dissemination, it is important to model long-term costs and health outcomes. Further, this type of modeling gives important insights into the context in which interventions are studied and highlights where more research is required and where sufficient evidence is available. The viewpoint therefore invites the researcher not only to reflect on which interventions to study but also how to evaluate their long-term consequences.
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Affiliation(s)
| | - Martin Henriksson
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
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Hernandez CL, Sharpe LM, Jackson CA, Harwell MC, DeWitt TH. Connecting stakeholder priorities and desired environmental attributes for wetland restoration using ecosystem services and a heat map analysis for communications. Front Ecol Evol 2024; 12:1-15. [PMID: 38628570 PMCID: PMC11018255 DOI: 10.3389/fevo.2024.1290090] [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] [Indexed: 04/19/2024] Open
Abstract
Framing ecological restoration and monitoring goals from a human benefits perspective (i.e., ecosystem services) can help inform restoration planners, surrounding communities, and relevant stakeholders about the direct benefits they may obtain from a specific restoration project. We used a case study of tidal wetland restoration in the Tillamook River watershed in Oregon, USA, to demonstrate how to identify and integrate community stakeholders/beneficiaries and the environmental attributes they use to inform the design of and enhance environmental benefits from ecological restoration. Using the U.S. Environmental Protection Agency's Final Ecosystem Goods and Services (FEGS) Scoping Tool, we quantify the types of ecosystem services of greatest common value to stakeholders/beneficiaries that lead to desired benefits that contribute to their well-being in the context of planned uses that can be incorporated into the restoration project. This case study identified priority stakeholders, beneficiaries, and environmental attributes of interest to inform restoration goal selection. This novel decision context application of the FEGS Scoping Tool also included an effort focused on how to communicate the connections between stakeholders, and the environmental attributes of greatest interest to them using heat maps.
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Affiliation(s)
| | - Leah M. Sharpe
- Gulf Ecosystem Measurement and Modeling Division, US Environmental Protection Agency (USEPA), Gulf Breeze, FL, United States
| | - Chloe A. Jackson
- Oak Ridge Institute of Science and Education, Newport, OR, United States
| | - Matthew C. Harwell
- Pacific Ecological Systems Division, US Environmental Protection Agency (USEPA), Newport, OR, United States
| | - Theodore H. DeWitt
- Pacific Ecological Systems Division, US Environmental Protection Agency (USEPA), Newport, OR, United States
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Naidoo L, Pillay M, Naidoo U. Who really decides? Feeding decisions 'made' by caregivers of children with cerebral palsy. S Afr J Commun Disord 2024; 71:e1-e14. [PMID: 38572900 PMCID: PMC11019338 DOI: 10.4102/sajcd.v71i1.1001] [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: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND There are no definitive guidelines for clinical decisions for children with cerebral palsy (CP) requiring enteral feeds. Traditionally, medical doctors made enteral feeding decisions, while patients were essentially treated passively within a paternalistic 'doctor knows best' approach. Although a more collaborative approach to decision-making has been promoted globally as the favoured model among healthcare professionals, little is known about how these decisions are currently made practically. OBJECTIVES This study aimed to identify the significant individuals, factors and views involved in the enteral feeding decision-making process for caregivers of children with CP within the South African public healthcare sector. METHOD A single-case research design was used in this qualitative explorative study. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis. RESULTS Four primary individuals were identified by the caregivers in the decision-making process: doctors, speech therapists, caregivers' families and God. Four factors were identified as extrinsically motivating: (1) physiological factors, (2) nutritional factors, (3) financial factors and (4) environmental factors. Two views were identified as intrinsically motivating: personal beliefs regarding enteral feeding tubes, and feelings of fear and isolation. CONCLUSION Enteral feeding decision-making within the South African public healthcare sector is currently still dominated by a paternalistic approach, endorsed by a lack of caregiver knowledge, distinct patient-healthcare provider power imbalances and prescriptive multidisciplinary healthcare dialogues.Contribution: This study has implications for clinical practice, curriculum development at higher education training facilities, and institutional policy changes and development, thereby contributing to the current knowledge and clinical gap(s) in the area.
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Affiliation(s)
- Lavanya Naidoo
- Discipline of Speech-Language Therapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and Department of Speech Language Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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Malone JR. Ethical considerations in the use of RhD-positive blood products in trauma. Transfusion 2024. [PMID: 38491917 DOI: 10.1111/trf.17787] [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: 01/11/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Prehospital and early in-hospital use of low titer group O whole blood (LTOWB) for life-threatening bleeding has been independently associated with improved survival compared to component therapy. However, when RhD-positive blood products are administered to RhD-negative females of childbearing potential (FCP), there is a small future risk of hemolytic disease of the fetus and newborn (HDFN). This raises important ethical questions that must be explored in order to justify the use of RhD-positive blood products, including LTOWB, both in clinical practice and research. METHODS This essay explores the ethical challenges related to RhD-positive blood product administration to RhD-negative or RhD-unknown FCPs as a first-line resuscitation fluid in the trauma setting. These ethical issues include: issues related to decision-making, ethical analysis based on the doctrine of double effect (DDE), and attendant obligations incurred by hospitals that administer RhD-positive blood to FCPs. RESULTS Ethical analysis through the use of the DDE demonstrates that utilization of RhD-positive blood products, including LTOWB, in the early resuscitation of FCPs is an ethically appropriate approach. By accepting the risk of HDFN, hospitals generate obligations to promote blood donation, evaluate for alloimmunization and counsel patients on the future risk of HDFN, and maintain an understanding of the ethical rationale for RhD-positive blood transfusion.
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Affiliation(s)
- Jay R Malone
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Tomassini A, Cope TE, Zhang J, Rowe JB. Parkinson's disease impairs cortical sensori-motor decision-making cascades. Brain Commun 2024; 6:fcae065. [PMID: 38505233 PMCID: PMC10950052 DOI: 10.1093/braincomms/fcae065] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/21/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
The transformation from perception to action requires a set of neuronal decisions about the nature of the percept, identification and selection of response options and execution of the appropriate motor response. The unfolding of such decisions is mediated by distributed representations of the decision variables-evidence and intentions-that are represented through oscillatory activity across the cortex. Here we combine magneto-electroencephalography and linear ballistic accumulator models of decision-making to reveal the impact of Parkinson's disease during the selection and execution of action. We used a visuomotor task in which we independently manipulated uncertainty in sensory and action domains. A generative accumulator model was optimized to single-trial neurophysiological correlates of human behaviour, mapping the cortical oscillatory signatures of decision-making, and relating these to separate processes accumulating sensory evidence and selecting a motor action. We confirmed the role of widespread beta oscillatory activity in shaping the feed-forward cascade of evidence accumulation from resolution of sensory inputs to selection of appropriate responses. By contrasting the spatiotemporal dynamics of evidence accumulation in age-matched healthy controls and people with Parkinson's disease, we identified disruption of the beta-mediated cascade of evidence accumulation as the hallmark of atypical decision-making in Parkinson's disease. In frontal cortical regions, there was inefficient processing and transfer of perceptual information. Our findings emphasize the intimate connection between abnormal visuomotor function and pathological oscillatory activity in neurodegenerative disease. We propose that disruption of the oscillatory mechanisms governing fast and precise information exchanges between the sensory and motor systems contributes to behavioural changes in people with Parkinson's disease.
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Affiliation(s)
- Alessandro Tomassini
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Thomas E Cope
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Department of Neurology, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
| | - Jiaxiang Zhang
- Department of Computer Science, Swansea University, Swansea SA18EN, UK
| | - James B Rowe
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
- Department of Neurology, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
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Jahn CI, Markov NT, Morea B, Daw ND, Ebitz RB, Buschman TJ. Learning attentional templates for value-based decision-making. Cell 2024; 187:1476-1489.e21. [PMID: 38401541 DOI: 10.1016/j.cell.2024.01.041] [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: 07/10/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 02/26/2024]
Abstract
Attention filters sensory inputs to enhance task-relevant information. It is guided by an "attentional template" that represents the stimulus features that are currently relevant. To understand how the brain learns and uses templates, we trained monkeys to perform a visual search task that required them to repeatedly learn new attentional templates. Neural recordings found that templates were represented across the prefrontal and parietal cortex in a structured manner, such that perceptually neighboring templates had similar neural representations. When the task changed, a new attentional template was learned by incrementally shifting the template toward rewarded features. Finally, we found that attentional templates transformed stimulus features into a common value representation that allowed the same decision-making mechanisms to deploy attention, regardless of the identity of the template. Altogether, our results provide insight into the neural mechanisms by which the brain learns to control attention and how attention can be flexibly deployed across tasks.
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Affiliation(s)
- Caroline I Jahn
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08540, USA.
| | - Nikola T Markov
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08540, USA
| | - Britney Morea
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08540, USA
| | - Nathaniel D Daw
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08540, USA; Department of Psychology, Princeton University, Princeton, NJ 08540, USA
| | - R Becket Ebitz
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08540, USA; Department of Neurosciences, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Timothy J Buschman
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08540, USA; Department of Psychology, Princeton University, Princeton, NJ 08540, USA.
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