Natural capital approaches for the optimal design of policies for nature recovery

By embedding a spatially explicit ecosystem services modelling tool within a policy simulator we examine the insights that natural capital analysis can bring to the design of policies for nature recovery. Our study is illustrated through a case example of policies incentivising the establishment of new natural habitat in England. We find that a policy mirroring the current practice of offering payments per hectare of habitat creation fails to break even, delivering less value in improved flows of ecosystem services than public money spent and only 26% of that which is theoretically achievable. Using optimization methods, we discover that progressively more efficient outcomes are delivered by policies that optimally price activities (34%), quantities of environmental change (55%) and ecosystem service value flows (81%). Further, we show that additionally attaining targets for unmonetized ecosystem services (in our case, biodiversity) demands trade-offs in delivery of monetized services. For some policy instruments it is not even possible to achieve the targets. Finally, we establish that extending policy instruments to offer payments for unmonetized services delivers target-achieving and value-maximizing policy designs. Our findings reveal that policy design is of first-order importance in determining the efficiency and efficacy of programmes pursuing nature recovery. This article is part of the theme issue 'Bringing nature into decision-making'.

Preferences reveal dissociable encoding across prefrontal-limbic circuits

Individual preferences for the flavor of different foods and fluids exert a strong influence on behavior. Most current theories posit that preferences are integrated with other state variables in the orbitofrontal cortex (OFC), which is thought to derive the relative subjective value of available options to guide choice behavior. Here, we report that instead of a single integrated valuation system in the OFC, another complementary one is centered in the ventrolateral prefrontal cortex (vlPFC) in macaques. Specifically, we found that the OFC and vlPFC preferentially represent outcome flavor and outcome probability, respectively, and that preferences are separately integrated into value representations in these areas. In addition, the vlPFC, but not the OFC, represented the probability of receiving the available outcome flavors separately, with the difference between these representations reflecting the degree of preference for each flavor. Thus, both the vlPFC and OFC exhibit dissociable but complementary representations of subjective value, both of which are necessary for decision-making.

Therapeutic value in the time of digital brainwaves

This article examines the value of medical technology through the case of electroencephalograms (EEGs), devices used to visualize brain activity and diagnose seizures. Drawing on ethnographic fieldwork, the article shows that EEGs are valued differently by patients and medical practitioners. While practitioners value EEGs for their clinical utility, i.e., ability to inform clinical decisions, patients value EEGs even in the absence of clinical utility. Indeed, patients derive long-lasting therapeutic effects from this diagnostic technology. These findings intervene in the utilitarian calculus of therapeutic value-a mode of reasoning that equates value with clinical utility-commonly deployed in biomedicine and engineering and call for a recognition of alternative notions such as the therapeutic value of being witnessed and cared for by medical experts via EEGs and other technologies that require time to work. Expansive notions of therapeutic value are imperative for including marginalized patients-especially low-income, disabled, and women patients-in debates on automation and the future of healthcare. Studying how multiple stakeholders value a medical technology provides insight into valuation, objectification, expertise, and other concerns central to science and technology studies.

Trust in numbers: Serious numbers and speculative fictions in rare earth elements exploration

In the early 2010s, a spectacular fall in prices for a class of mineral commodities called the rare earth elements (REEs) and the collapse of hundreds of new exploration companies made clear the fragility of the high-risk markets around these companies and the strategies of legitimation that supported them. New regulatory processes built around technical disclosures generated vast stores of geotechnical data. Rather than generating trust among market actors, however, these processes dramatically altered the temporalities of global extraction and energized unruly narrative spaces. In their efforts to keep mineral claims active and companies afloat, REE-focused exploration experts have struggled to navigate different arenas of discussion while holding their respective logics in tension. Drawing on ethnographic fieldwork with exploration geologists and promoters, this article examines how experts federate flows of 'serious' and 'speculative' information in both carefully regulated reports and rumor-filled online forums. Such spaces are organized by aesthetic conventions and social criteria for establishing persuasiveness-forms that STS scholars have long analyzed as literary technologies. Rather than helping to secure experts' authority, however, I argue that the diverse literary technologies that now dominate exploration promotion and finance work have radically redistributed interpretive roles. In their struggles to mediate senses of 'crisis' endemic within venture markets, exploration experts must enact the ideals undergirding new regulatory requirements even as they learn to defer to the speculative musings of others.

Dissociable representations of decision variables within subdivisions of macaque orbitofrontal and ventrolateral frontal cortex

Ventral frontal cortex (VFC) in macaques is involved in many affective and cognitive processes and has a key role in flexibly guiding reward-based decision-making. VFC is composed of a set of anatomically distinct subdivisions that are within the orbitofrontal cortex, ventrolateral prefrontal cortex, and anterior insula. In part, because prior studies have lacked the resolution to test for differences, it is unclear if neural representations related to decision-making are dissociable across these subdivisions. Here we recorded the activity of thousands of neurons within eight anatomically defined subregions of VFC in macaque monkeys performing a two-choice probabilistic task for different fruit juices outcomes. We found substantial variation in the encoding of decision variables across these eight subdivisions. Notably, ventrolateral subdivision 12l was unique relative to the other areas that we recorded from as the activity of single neurons integrated multiple attributes when monkeys evaluated the different choice options. Activity within 12o, by contrast, more closely represented reward probability and whether reward was received on a given trial. Orbitofrontal area 11m/l contained more specific representations of the quality of the outcome that could be earned later on. We also found that reward delivery encoding was highly distributed across all VFC subregions, while the properties of the reward, such as its flavor, were more strongly represented in areas 11m/l and 13m. Taken together, our work reveals the diversity of encoding within the various anatomically distinct subdivisions of VFC in primates.

Struggling over new asset geographies

In this response, we address criticisms of our definition of assetization from an accounting perspective, its overlap with financialization, and the relationship between value and valuation it posits. We reflect on a future agenda around assetization emphasizing the political dimensions of externalizing future costs and the implications of rising inflation.

Working hard but not tired? The influence of task valuation on mental fatigue, effort investment, and task performance

It has been demonstrated in previous studies that prolonged mental effort exertion evokes mental fatigue and leads to impairments in task performance. In the current investigation, we aimed to test the hypothesis that mental fatigue depends on motivational processes and can be influenced by task valuation. In two studies, we experimentally manipulated the value of the task by financial rewards (Study 1) and the sense of autonomy (Study 2). Contrary to our predictions, those manipulations did not influence the main dependent variables. We also introduced additional rewards after prolonged effort exertion. In line with our expectations, the results showed that mental fatigue increases with time spent on effortful tasks. Importantly, however, mental fatigue decreases when the value of the task rises. This effect is accompanied by stronger effort engagement and improvement in task performance. The findings support the motivational theories of mental effort and fatigue, showing that mental fatigue might serve as a signal of diminishing value of the ongoing task.

Land-Use Decisions Have Substantial Air Quality Health Effects

Understanding how best to use limited land without compromising food security, health, and beneficial ecosystem functions is a critical challenge of our time. Ecosystem service assessments increasingly inform land-use decisions but seldom include the effects of land use on air quality, the largest environmental health risk. Here, we estimate and value the air quality health effects of potential land-use policies and projected trends in the United States, alongside carbon sequestration and economic returns to land, until 2051. We show that air quality health effects are of first-order importance in land-use decisions, often larger in value than carbon sequestration and economic returns combined. When air quality is properly accounted for, policies that appeared beneficial are shown to be detrimental and vice versa. Land-use-driven air quality impacts are largely from agricultural emissions and biogenic forest emissions, although incentives for reduced deforestation remain beneficial overall. Without evaluating air quality, we are unable to determine whether land-use decisions make us better or worse off.

Would Altruistic Consumers Place A Higher Value on Sustainable Foods?

To advance sustainable food systems, it is necessary to explore consumer preferences and valuations of sustainable food labels. This study utilizes a discrete choice experiment to examine consumers' willingness to pay for various sustainable labels using a 12 oz ground coffee package and investigates the impact of altruism orientation on consumer valuation of sustainable coffee. The results from US consumers surveyed in spring 2020 indicate that the USDA organic claim commands the highest price premium, followed by the Carbon Trust and Fairtrade labels. Furthermore, individuals' altruism orientation positively and significantly influences their preference and willingness to pay for sustainable labels, with selfless individuals valuing them more. These findings offer insights into effectively promoting sustainable food consumption through targeting consumer subgroups and prioritizing fair trade and organic foods over newer green labels.

Changing What You Like: Modifying Contour Properties Shifts Aesthetic Valuations of Scenes

To what extent do aesthetic experiences arise from the human ability to perceive and extract meaning from visual features? Ordinary scenes, such as a beach sunset, can elicit a sense of beauty in most observers. Although it appears that aesthetic responses can be shared among humans, little is known about the cognitive mechanisms that underlie this phenomenon. We developed a contour model of aesthetics that assigns values to visual properties in scenes, allowing us to predict aesthetic responses in adults from around the world. Through a series of experiments, we manipulate contours to increase or decrease aesthetic value while preserving scene semantic identity. Contour manipulations directly shift subjective aesthetic judgments. This provides the first experimental evidence for a causal relationship between contour properties and aesthetic valuation. Our findings support the notion that visual regularities underlie the human capacity to derive pleasure from visual information.

Valuing the Dental Caries Utility Index in Australia

INTRODUCTION

The Dental Caries Utility Index (DCUI) is a new oral health-specific health state classification system for adolescents, consisting of 5 domains: pain/discomfort, difficulty eating food/drinking, worried, ability to participate in activities, and appearance. Each domain has 4 response levels. This study aims to generate an Australian-specific utility algorithm for the DCUI.

METHODS

An online survey was conducted using a representative sample of the adult Australian general population. The discrete choice experiment (DCE) was used to elicit the preferences on 5 domains. Then, the latent utilities were anchored onto the full health-dead scale using the visual analogue scale (VAS). DCE data were modeled using conditional logit, and 2 anchoring procedures were considered: anchor based on the worst health state and a mapping approach. The optimal anchoring procedure was selected based on the model parsimony and the mean absolute error (MAE).

RESULTS

A total of 995 adults from the Australian general population completed the survey. The conditional logit estimates on 5 dimensions and levels were monotonic and statistically significant, except for the second level of the "worried" and "appearance" domains. The mapping approach was selected based on a smaller MAE between the 2 anchoring procedures. The Australian-specific tariff of DCUI ranges from 0.1681 to 1.

CONCLUSION

This study developed a utility algorithm for the DCUI. This value set will facilitate utility value calculations from the participants' responses for DCUI in economic evaluations of dental caries interventions targeted for adolescents.

HIGHLIGHTS

Preference-based quality-of-life measures (PBMs), which consist of a health state classification system and a set of utility values (a scoring algorithm), are used to generate utility weights for economic evaluations.This study is the first to develop an Australian utility value set for the Dental Caries Utility Index (DCUI), a new oral health-specific classification system for adolescents.The availability of a utility value set will enable using DCUI in economic evaluations of oral health interventions targeted for adolescents and may ultimately lead to more effective and efficient planning of oral health care services.

The Opportunity for Impactful Integration of Vascular and Podiatric Care

BACKGROUND

The importance of collaboration between vascular and podiatric surgeons has been well-established. High-level partnerships are integral to the development of multidisciplinary programs and wound care centers, ultimately resulting in improved patient outcomes. This vascular-podiatric integration is not universal, however, and podiatric surgery may not be aligned within a vascular surgery division at many institutions. As one such institution, we reviewed our single-center experience in order to identify opportunities for the impactful integration of vascular-podiatric patient care.

METHODS

Institutional electronic medical records were retrospectively reviewed for all procedures performed by vascular surgeons at a high volume, safety-net academic medical center. Data were collected on all primary and additional procedures, current procedural terminology (CPT) codes, case type (elective, urgent, emergent), surgeon specialty, and date/time of the procedures performed. CPT codes were linked to the Centers for Medicare & Medicaid Services' Physician Fee Schedule to estimate the work relative value unit (wRVU) per procedure.

RESULTS

From 2018 to 2022, vascular surgeons performed a total of 12,206 operations, of which 1102 (9.9%) involved podiatric procedures. The most common vascular-performed podiatry procedures performed were toe amputations (38.1%, n = 420), transmetatarsal foot amputations (20.1%, n = 222), and ankle/foot debridement (16.2%, n = 178). Foot/ankle-specific procedures were identified as the primary procedure in 726 (65.9%) cases and as the adjunct procedure in 376 (34.1%) cases. A substantial proportion of podiatric procedures occurred on an urgent (n = 278, 25.2%) or emergent (n = 28, 2.5%) basis. A total of 163 (14.8%) cases occurred after hours (either before 0600 or after 1800), and 133 (12.1%) cases were performed on a holiday or weekend. Procedure-specific revenue included 4243.39 wRVU for primary procedures and 2108.08 wRVU for additional procedures performed.

CONCLUSIONS

We report our single-center experience in which vascular surgeons provide a significant proportion of podiatric procedures. Our study underscores the potential for integrating podiatric surgeons within a vascular surgical division and presents opportunities for collaboration and enhanced patient care.

Evaluation of EuroQol Valuation Technology (EQ-VT) Designs to Generate National Value Sets: Learnings from the Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study

INTRODUCTION

Countries develop their EQ-5D-5L value sets using the EuroQol Valuation Technology (EQ-VT) protocol. This study aims to assess if extension in the conventional EQ-VT design can lead to development of value sets with improved precision.

METHODS

A cross-sectional survey was undertaken in a representative sample of 3,548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. A novel extended EQ-VT design was created that included 18 blocks of 10 health states, comprising 150 unique health states and 135 observations per health state. In addition to the standard EQ-VT design, which is based on 86 health states and 100 observations per health state, 3 extended designs were assessed for their predictive performance. The extended designs were created by 1) increasing the number of observations per health state in the design, 2) increasing the number of health states in the design, and 3) implementing both 1) and 2) at the same time. Subsamples of the data set were created for separate designs. The root mean squared error (RMSE) and mean absolute error (MAE) were used to measure the predictive accuracy of the conventional and extended designs.

RESULTS

The average RMSE and MAE for the standard EQ-VT design were 0.055 and 0.041, respectively, for the 150 health states. All 3 types of design extensions showed lower RMSE and MAE values as compared with the standard design and hence yielded better predictive performance. RMSE and MAE were lowest (0.051 and 0.039, respectively) for the designs that use a greater number of health states. Extending the design with inclusion of more health states was shown to improve the predictive performance even when the sample size was fixed at 1,000.

CONCLUSION

Although the standard EQ-VT design performs well, its prediction accuracy can be further improved by extending its design. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state.

HIGHLIGHTS

The EQ-5D-5L value sets are developed using the standardized EuroQol Valuation Technology (EQ-VT) protocol. This is the first study to empirically assess how much can be gained from extending the standard EQ-VT design in terms of sample size and/or health states. It not only presents useful insights into the performance of the standard design of the EQ-VT but also tests the potential extensions in the standard EQ-VT design in terms of increasing the health states to be directly valued as well as the number of observations recorded to predict the utility value of each of these health states.The study demonstrates that the standard EQ-VT design performs good, and an extension in the design of the standard EQ-VT can lead to further improvement in its performance. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state. Extending the design with inclusion of more health states marginally improves the predictive performance even when the sample size was fixed at 1,000.The findings of the study will streamline the systematic process for generating precise EQ-5D-5L value sets, thus facilitating the conduct of credible, transparent, and robust outcome valuation in health technology assessments.

The neurophysiological Behavioral Perspective Model of consumer choice and its contribution to the intentional behaviorist research programme

Cognitive explanations raise epistemological problems not faced by accounts confined to observable variables. Many explanatory components of cognitive models are unobservable: beliefs, attitudes, and intentions, for instance, must be made empirically available to the researcher in the form of measures of observable behavior from which the latent variables are inferred. The explanatory variables are abstract and theoretical and rely, if they are to enter investigations and explanations, on reasoned agreement on how they can be captured by proxy variables derived from what people say and how they behave. Psychometrics must be founded upon a firm, intersubjective agreement among researchers and users of research on the relationship of behavioral measures to the intentional constructs to which they point and the latent variables they seek to operationalize. Only if these considerations are adequately addressed can we arrive at consistent interpretations of the data. This problem provides the substance of the intentional behaviorist research programme which seeks to provide a rationale for the cognitive explanation. Within this programme, two versions of the Behavioral Perspective Model (BPM), an extensional portrayal of socioeconomic behavior and a corresponding intentional approach, address the task of identifying where intentional explanation becomes necessary and the form it should take. This study explores a third version, based on neurophysiological substrates of consumer choice as a contributor to this task. The nature of "value" is closely related to the rationale for a neurophysiological model of consumer choice. The variables involved are operationally specified and measured with high intersubjective agreement. The intentional model (BPM-I), depicting consumer action in terms of mental processes such as perception, deliberation, and choice, extends the purview of the BPM to new situations and areas of explanation.

Preferences reveal separable valuation systems in prefrontal-limbic circuits

Individual preferences for the flavor of different foods and fluids exert a strong influence on behavior. Most current theories posit that preferences are integrated with other state variables in orbitofrontal cortex (OFC), which is thought to derive the relative subjective value of available options to drive choice behavior. Here we report that instead of a single integrated valuation system in OFC, another separate one is centered in ventrolateral prefrontal cortex (vlPFC) in macaque monkeys. Specifically, we found that OFC and vlPFC preferentially represent outcome flavor and outcome probability, respectively, and that preferences are separately integrated into these two aspects of subjective valuation. In addition, vlPFC, but not OFC, represented the outcome probability for the two options separately, with the difference between these representations reflecting the degree of preference. Thus, there are at least two separable valuation systems that work in concert to guide choices and that both are biased by preferences.

Perspectives on valuing water quality improvements using stated preference methods

Improvements to the quality of freshwater rivers and lakes can generate a wide array of benefits, from "use values" such as recreational boating, fishing, and swimming to "nonuse values" such as improved outcomes for aquatic biodiversity. Bringing these nonmarket values into decision-making is crucial to determining appropriate levels of investment in water quality improvements. However, progress in the economic valuation of water quality benefits has lagged similar efforts to value air quality benefits, with implications for water policy. New data sources, modeling techniques, and innovation in stated preference survey methods offer notable improvements to estimates of use and nonuse benefits of improved water quality. Here, we provide a perspective on how recent applications of stated preference techniques to the valuation of the nonmarket benefits of water quality improvements have advanced the field of environmental valuation. This overview is structured around four key questions: i) What is it about water quality that we seek to value? ii) How should we design and implement the surveys which elicit individuals' stated preferences? iii) How do we assess the validity of the findings provided by such studies? and iv) What are the contributions of these valuation exercises to public policy? In answering these questions, we make reference to the contributions provided by the papers in this Symposium.

Efficient Designs for Valuation Studies That Use Time Tradeoff (TTO) Tasks to Map Latent Utilities from Discrete Choice Experiments to the Interval Scale: Selection of Health States for TTO Tasks

BACKGROUND

In eliciting utilities to value multiattribute utility instruments, discrete choice experiments (DCEs) administered online are less costly than interviewer-facilitated time tradeoff (TTO) tasks. DCEs capture utilities on a latent scale and are often coupled with a small number of TTO tasks to anchor utilities to the interval scale. Given the costly nature of TTO data, design strategies that maximize value set precision per TTO response are critical.

METHODS

Under simplifying assumptions, we expressed the mean square prediction error (MSE) of the final value set as a function of the number J of TTO-valued health states and the variance VJ of the states' latent utilities. We hypothesized that even when these assumptions do not hold, the MSE 1) decreases as VJ increases while holding J fixed and 2) decreases as J increases while holding VJ fixed. We used simulation to examine whether there was empirical support for our hypotheses a) assuming an underlying linear relationship between TTO and DCE utilities and b) using published results from the Dutch, US, and Indonesian EQ-5D-5L valuation studies.

RESULTS

Simulation set (a) supported the hypotheses, as did simulations parameterized using valuation data from Indonesia, which showed a linear relationship between TTO and DCE utilities. The US and Dutch valuation data showed nonlinear relationships between TTO and DCE utilities and did not support the hypotheses. Specifically, for fixed J, smaller values of VJ reduced rather than increased the MSE.

CONCLUSIONS

Given that, in practice, the underlying relationship between TTO and DCE utilities may be nonlinear, health states for TTO valuation should be placed evenly across the latent utility scale to avoid systematic bias in some regions of the scale.

HIGHLIGHTS

Valuation studies may feature a large number of respondents completing discrete choice tasks online, with a smaller number of respondents completing time tradeoff (TTO) tasks to anchor the discrete choice utilities to an interval scale.We show that having each TTO respondent complete multiple tasks rather than a single task improves value set precision.Keeping the total number of TTO respondents and the number of tasks per respondent fixed, having 20 health states directly valued through TTO leads to better predictive precision than valuing 10 health states directly.If DCE latent utilities and TTO utilities follow a perfect linear relationship, choosing the TTO states to be valued by weighting on the 2 ends of the latent utility scale leads to better predictive precision than choosing states evenly across the latent utility scale.Conversely, if DCE latent utilities and TTO utilities do not follow a linear relationship, choosing the states to be valued using TTO evenly across the latent utility scale leads to better predictive precision than weighted selection does.In the context of valuation of the EQ-5D-Y-3L, we recommend valuing 20 or more health states using TTO and placing them evenly across the latent utility scale.

Electrophysiological measures of conflict and reward processing are associated with decisions to engage in physical effort

Anterior cingulate cortex (ACC), a key brain region involved in cognitive control and decision making, is suggested to mediate effort- and value-based decision making, but the specific role of ACC in this process remains debated. Here we used frontal midline theta (FMT) and the reward positivity (RewP) to examine ACC function in a value-based decision making task requiring physical effort. We investigated whether (1) FMT power is sensitive to the difficulty of the decision or to selecting effortful actions, and (2) RewP is sensitive to the subjective value of reward outcomes as a function of effort investment. On each trial, participants chose to execute a low-effort or a high-effort behavior (that required squeezing a hand-dynamometer) to obtain smaller or larger rewards, respectively, while their brainwaves were recorded. We replicated prior findings that tonic FMT increased over the course of the hour-long task, which suggests increased application of control in the face of growing fatigue. RewP amplitude also increased following execution of high-effort compared to low-effort behavior, consistent with increased valuation of reward outcomes by ACC. Although neither phasic nor tonic FMT were associated with decision difficulty or effort selection per se, an exploratory analysis revealed that the interaction of phasic FMT and expected value of choice predicted effort choice. This interaction suggests that phasic FMT increases specifically under situations of decision difficulty when participants ultimately select a high-effort choice. These results point to a unique role for ACC in motivating and persisting at effortful behavior when decision conflict is high.

Nutrition claims influence expectations about food attributes, attenuate activity in reward-associated brain regions during tasting, but do not impact pleasantness

INTRODUCTION

Nutrition claims are one of the most common tools used to improve food decisions. Previous research has shown that nutrition claims impact expectations; however, their effects on perceived pleasantness, valuation, and their neural correlates are not well understood. These claims may have both intended and unintended effects on food perception and valuation, which may compromise their effect on food decisions.

METHODS

We investigated the effects of nutrition claims on expectations, perceptions, and valuation of milk-mix drinks in a behavioral (n = 110) and an fMRI (n = 39) study. In the behavioral study, we assessed the effects of a "fat-reduced" and a "protein-rich" nutrition claim on expected and perceived food attributes of otherwise equal food products. In the fMRI study, we investigated the effect of a "protein-rich" claim on taste pleasantness perception and valuation, and on their neural correlates during tasting and swallowing.

RESULTS

We found that both nutrition claims increased expected and perceived healthiness and decreased expected but not perceived taste pleasantness. The "protein-rich" claim increased expected but not perceived satiating quality ratings, while the "fat-reduced" claim decreased both expected and perceived satiating quality ratings. In the absence vs. presence of the "protein-rich" claim, we observed an increased activity in a cluster extending to the left nucleus accumbens during tasting and an increased functional connectivity between this cluster and a cluster in right middle frontal gyrus during swallowing.

CONCLUSION

Altogether, we found that nutrition claims impacted expectations and attenuated reward-related responses during tasting but did not negatively affect perceived pleasantness. Our findings support highlighting the presence of nutrients with positive associations and exposure to foods with nutrition claims to increase their acceptance. Our study offers insights that may be valuable in designing and optimizing the use of nutrition claims.

International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project)

BACKGROUND

Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries.

METHODS

The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers.

RESULTS

The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other.

DISCUSSION

The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.

Valuation of Ecosystem Services Based on EU Carbon Allowances-Optimal Recovery for a Coal Mining Area

This paper presents a new way of valuing ecosystem services based on the price of EU carbon dioxide emission allowances. Its main advantage is that it facilitates the monetisation of non-provisioning ecosystem services, which is the Achilles heel of current frameworks. The research approach is built on the notion that land rehabilitation and ecological restoration involve trade-offs between ecosystem services. A quantitative assessment (valuation) of these trade-offs is necessary to make sound decisions. However, using different valuation methods to estimate monetary values creates a non-comparability in the valuation process that is difficult to correct. To address this problem, in the first place, the propagation of imprecise preference statements in hierarchical weighting is proposed, avoiding the non-comparability caused by the different current approaches while reducing the effort of preference elicitation. In the second place, to achieve consistency, monetisation of all non-provisioning ecosystem services was carried on the above comparison and the monetary valuation of the attribute with the most direct and market-related valuation possible: carbon sequestration, using the EU Emissions Trading System. A former coal mining area exemplifies the valuation of ecosystem services provided by alternative ecological restoration scenarios. The aim is to estimate their contribution to human well-being, understand the incentives faced by decision makers to manage ecosystems in different ways and assess the values of alternative solutions. An exercise is then carried out to show that the price of EU carbon permits (as of December 2021) after the price escalation that coincides with phase 4 of the allocation of allowances under the EU Emissions Trading System can be estimated by prioritising biodiversity over other ecosystem services.

Whose Good Death? Valuation and Standardization as Mechanisms of Inequality in Hospitals

Although most clinicians have come to perceive invasive life-sustaining treatments as overly aggressive at the end of life, some of the public and greater proportions of some socially disadvantaged groups have not. Drawing on 1,500+ hours of observation in four intensive care units and 69 interviews with physicians and patients' family members, I find inequality occurs through two mechanisms complementary to the cultural health capital and fundamental causes explanations prevalent in existing health disparities literature: in valuation, as the attitudes and values of the socially disadvantaged are challenged and ignored, and in standardization, as the outcomes preferred by less advantaged groups are defined as inappropriate and made harder to obtain by the informal and formal practices and policies of racialized organizations. I argue inequality is produced in part because wealthier and White elites shape institutional preferences and practices and, therefore, institutions and clinical standards to reflect their cultural tastes.

Information effects on lay tradeoffs between national regulatory costs and benefits

A novel stated-preference "macro-risk" approach introduced to estimate the life-prolonging benefits of proposed environmental, health, and safety regulations may answer questions unasked or wrongly answered by conventional revealed-preference (e.g., "wage premiums" for high occupational risks) and stated-preference methods (e.g., willingness to pay for tiny reductions in one's own premature death risk). This new approach asks laypeople to appraise directly their preferred tradeoffs between national regulatory costs and lives prolonged nationwide (regulatory benefits). However, this method may suffer from incomplete lay understanding of national-scale consequences (e.g., billions of dollars in regulatory costs; hundreds of lives prolonged) or tradeoffs (e.g., what are lives prolonged worth?). Here we (1) tested effects of numerical contextual examples to ground each hypothetical regulatory tradeoff, and (2) explored why some people implicitly offer "implausible" values (< $10,000 or > $1 billion) for the social benefit of prolonging one life. In Study 1 (n = 356), after testing their separate effects, we combined three contextual-information aids: (1) comparing hypothetical regulatory costs and benefits to real-life higher and lower values; (2) reframing large numbers into smaller, more familiar terms; and (3) framing regulatory costs as having diffuse versus concentrated impacts. Information increased social benefits values on average (from $4.5 million to $13.8 million). Study 2 (n = 402) found that the most common explanations for "implausible" values included inattention, strong attitudes about regulation, and problems translating values into responses. We discuss implications for this novel stated-preferences method, and for comparing it to micro-risk methods.

Restoring Coal Mining-Affected Areas: The Missing Ecosystem Services

Multi-criteria decision analysis and cost-benefit analysis, either individually or in combination, have been used as the preferred tools to develop ecosystem services valuation, presenting significant discrepancies and variations between the calculated values. To counteract this problem, a new framework was developed based on a hierarchical weighting of the non-provisioning ecosystem services, using biodiversity as the reference ecosystem service since it is the easiest to apprehend. Their monetisation was made using the average price of EU carbon dioxide emission allowances during 2019 and 2020, obtaining reasonable and comparable results in line with what was expected for the study region. However, the revised EU Emissions Trading System Directive, which will apply from 2021-2030, generated a price escalation of carbon allowances, making it necessary to adjust or rethink the proposed framework. To achieve this goal, the paper proposes the introduction of new vectors or "missing ecosystem services" to counterbalance efforts to eliminate carbon dioxide emissions without necessarily removing humans from the equation: welfare and human health. As the linkages regarding ecosystem health, ecological restoration and human health are not well known, only welfare was incorporated into the framework. The results were highly satisfactory, in line with what was expected for the study region and the ones obtained before the price escalation of carbon allowances that started in 2021.

Believing and social interactions: effects on bodily expressions and personal narratives

The processes of believing integrate external perceptual information from the environment with internal emotional states and prior experience to generate probabilistic neural representations of events, i.e., beliefs. As these neural representations manifest mostly below the level of a person's conscious awareness, they may inadvertently affect the spontaneous person's bodily expressions and prospective behavior. By yet to be understood mechanisms people can become aware of these representations and reflect upon them. Typically, people can communicate the content of their beliefs as personal statements and can summarize the narratives of others to themselves or to other people. Here, we describe that social interactions may benefit from the consistency between a person's bodily expressions and verbal statements because the person appears authentic and ultimately trustworthy. The transmission of narratives can thus lay the groundwork for social cooperation within and between groups and, ultimately, between communities and nations. Conversely, a discrepancy between bodily expressions and narratives may cause distrust in the addressee(s) and eventually may destroy social bonds.

Bumblebees retrieve only the ordinal ranking of foraging options when comparing memories obtained in distinct settings

Are animals’ preferences determined by absolute memories for options (e.g. reward sizes) or by their remembered ranking (better/worse)? The only studies examining this question suggest humans and starlings utilise memories for both absolute and relative information. We show that bumblebees’ learned preferences are based only on memories of ordinal comparisons. A series of experiments showed that after learning to discriminate pairs of different flowers by sucrose concentration, bumblebees preferred flowers (in novel pairings) with (1) higher ranking over equal absolute reward, (2) higher ranking over higher absolute reward, and (3) identical qualitative ranking but different quantitative ranking equally. Bumblebees used absolute information in order to rank different flowers. However, additional experiments revealed that, even when ranking information was absent (i.e. bees learned one flower at a time), memories for absolute information were lost or could no longer be retrieved after at most 1 hr. Our results illuminate a divergent mechanism for bees (compared to starlings and humans) of learned preferences that may have arisen from different adaptations to their natural environment.

An integrated valuation model for payer and investor

BACKGROUND

In order to optimize positioning and associated drug price for both payer and investor, it is for a company essential to forecast the potential market access attractiveness for the new drug for different indications at the early onset of the clinical development program. This analysis must include the constraints from the perspective of the payer, but also the biotech companies, who require a minimum drug price to satisfy their investors. This paper aims to provide an Integrated Valuation Model for payer and investor, bridging concepts from health economics and economic valuation reflecting the perspectives of the payer and the investor for a drug in early clinical development phase. The concept is illustrated for a new hypothetical drug (Product X) in advanced breast cancer in 1-line, 2-line, and 3-line position.

METHODS

The Integrated Valuation Model includes the outcomes of the budget impact model, pricing matrix model, and cost-effectiveness model reflecting the payer's perspective. These models are interacted and linked with a discounted cash flow model in order to reflect also the economic value from the investor's perspective.

RESULTS

The maximum price in 1-line position is €269.7 for the payer and the minimum price is €14.7 for the investor, which are unit prices per administration corresponding with treatment regimens for the comparative treatments. In 2-line position, the maximum price is €274.1 for the payer and the minimum price for the investor increases to €184.5 for the investor because of the smaller market size in 2-line position, which leads to a smaller pricing corridor to satisfy both payer and investor. Consequently, Product X has market access attractiveness for both payer and investor in 1-line and 2-line position. However, the minimum price €942.7 in 3-line position for the investor is higher than the maximum price €283.3 for the payer, which means there is no market potential.

CONCLUSION

The practical strategic application of the Integrated Valuation Model is optimization of positioning and price of Product X. Hence, it can be a transparent tool in early-stage development of a compound based on upfront assessment of market access attractiveness for the payer and the investor.

The event study in international business research: Opportunities, challenges, and practical solutions

The event study or event study method (ESM) is an empirical technique for capturing investors' reaction to an event affecting one or more publicly traded firms. The ESM has been little employed in international business (IB) research despite its frequency in accounting, economics, and finance; for example, only two percent of the empirical articles in JIBS over 1970-2019 include an event study. While this scarcity could indicate a lack of demand, we argue that the field of IB studies offers many interesting and important research opportunities for an event study. We believe that the challenges arise primarily from the supply side, because conducting an event study involves overcoming a variety of data and analytical hurdles. We examine these methodological challenges and offer practical solutions designed to encourage adoption of the ESM. An online appendix with coding and examples provides additional resources.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1057/s41267-022-00509-7.

In Search for Comparability: The PECUNIA Reference Unit Costs for Health and Social Care Services in Europe

Improving the efficiency of mental healthcare service delivery by learning from international best-practice examples requires valid data, including robust unit costs, which currently often lack cross-country comparability. The European ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) aimed to harmonize the international unit cost development. This article presents the methodology and set of 36 externally validated, standardized reference unit costs (RUCs) for five health and social care services (general practitioner, dentist, help-line, day-care center, nursing home) in Austria, England, Germany, Hungary, The Netherlands, and Spain based on unambiguous service definitions using the extended DESDE PECUNIA coding framework. The resulting PECUNIA RUCs are largely comparable across countries, with any causes for deviations (e.g., country-specific scope of services) transparently documented. Even under standardized methods, notable limitations due to data-driven divergences in key costing parameters remain. Increased cross-country comparability by adopting a uniform methodology and definitions can advance the quality of evidence-based policy guidance derived from health economic evaluations. The PECUNIA RUCs are available free of charge and aim to significantly improve the quality and feasibility of future economic evaluations and their transferability across mental health systems.

Delay discounting in suicidal behavior: Myopic preference or inconsistent valuation?

Prior studies sought to explain the predisposition to suicidal behavior in terms of myopic preference for immediate versus delayed reward, generating mixed evidence. Data from gambling and bandit tasks, however, suggest that suboptimal decisions in suicidal individuals are explained by inconsistent valuation rather than myopic preferences. We tested these two alternative hypotheses using a delay discounting task in 622 adults (suicide attempters with depression, suicide ideators with depression, nonsuicidal participants with depression, and healthy controls) recruited across three sites through inpatient psychiatric units, mood disorders clinics, primary care, and advertisements. Multilevel models revealed group differences in valuation consistencies in all three samples, with high-lethality suicide attempters exhibiting less consistent valuation than all other groups in Samples 1 and 3 and less consistent valuation than the healthy controls or participants with depression in Sample 2. In contrast, group differences in preference for immediate versus delayed reward were observed only in Sample 1 and were due to the high-lethality suicide attempters displaying a weaker preference for immediate reward than low-lethality suicide attempters. The findings were robust to confounds such as cognitive functioning and comorbidities. Seemingly impulsive choices in suicidal behavior are explained by inconsistent reward valuation rather than a true preference for immediate reward. In a suicidal crisis, this inconsistency may result in a misestimation of the value of suicide relative to constructive alternatives and deterrents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Valuation of Informal Care Provided to People Living With Dementia: A Systematic Literature Review

OBJECTIVES

This study aimed to identify the methods used to determine the value of informal care provided to people living with dementia and to estimate the average hourly unit cost by valuation method.

METHODS

A literature search in MEDLINE Complete, CINAHL, PsycINFO, EconLit, EMBASE and NHS Economic Evaluation Database was undertaken. Following the screening of title, abstract, and full text, characteristics of eligible studies were extracted systematically and analyzed descriptively. The corresponding hourly cost estimates were converted into 2018 US dollars based on purchasing power parities for gross domestic product.

RESULTS

A total number of 111 articles were included in this review from 3106 post-deduplication records. Three main valuation methodologies were identified: the replacement cost method (n = 50), the opportunity cost approach (n = 36), and the stated preference method based on willingness to pay (n = 3), with 16 studies using multiple methods and 6 studies not specifying the valuation method. The amount of informal care increased as the condition of dementia progressed, which was reflected in the cost of informal care. The average hourly unit cost used to value informal care was US $16.78 (SD = US $12.11). Although the unit cost was approximately US $15 per hour when using the opportunity cost method and US $14 when using the stated preference method, the highest unit cost was obtained when using the replacement cost method (US $18.37, SD = US $13.12).

CONCLUSIONS

Although costs of informal care should be considered when undertaking an economic evaluation or estimating the overall costs of dementia from a policy and priority-setting perspective, further research into applying consistent approaches to valuation is warranted.

Data Sharing of Imaging in an Evolving Health Care World: Report of the ACR Data Sharing Workgroup Part 2: Annotation, Curation, and Contracting

A core principle of ethical data sharing is maintaining the security and anonymity of the data, and care must be taken to ensure medical records and images cannot be reidentified to be traced back to patients or misconstrued as a breach in the trust between health care providers and patients. Once those principles have been observed, those seeking to share data must take the appropriate steps to curate the data in a way that organizes the clinically relevant information so as to be useful to the data sharing party, assesses the ensuing value of the data set and its annotations, and informs the data sharing contracts that will govern use of the data. Embarking on a data sharing partnership engenders a host of ethical, practical, technical, legal, and commercial challenges that require a thoughtful, considered approach. In 2019 the ACR convened a Data Sharing Workgroup to develop philosophies around best practices in the sharing of health information. This is Part 2 of a Report on the workgroup's efforts in exploring these issues.

Dynamic Representation of the Subjective Value of Information

To improve future decisions, people should seek information based on the value of information (VOI), which depends on the current evidence and the reward structure of the upcoming decision. When additional evidence is supplied, people should update the VOI to adjust subsequent information seeking, but the neurocognitive mechanisms of this updating process remain unknown. We used a modified beads task to examine how the VOI is represented and updated in the human brain of both sexes. We theoretically derived, and empirically verified, a normative prediction that the VOI depends on decision evidence and is biased by reward asymmetry. Using fMRI, we found that the subjective VOI is represented in the right dorsolateral prefrontal cortex (DLPFC). Critically, this VOI representation was updated when additional evidence was supplied, showing that the DLPFC dynamically tracks the up-to-date VOI over time. These results provide new insights into how humans adaptively seek information in the service of decision-making.SIGNIFICANCE STATEMENT For adaptive decision-making, people should seek information based on what they currently know and the extent to which additional information could improve the decision outcome, formalized as the VOI. Doing so requires dynamic updating of VOI according to outcome values and newly arriving evidence. We formalize these principles using a normative model and show that information seeking in people adheres to them. Using fMRI, we show that the underlying subjective VOI is represented in the dorsolateral prefrontal cortex and, critically, that it is updated in real time according to newly arriving evidence. Our results reveal the computational and neural dynamics through which evidence and values are combined to inform constantly evolving information-seeking decisions.

Concordance among Swedish, German, Danish, and UK EQ-5D-3L Value Sets: Analyses of Patient-Reported Outcomes in the Swedish Hip Arthroplasty Register

Background: Application of different value sets to health-related quality of life (HRQoL) measured with the EQ-5D-3L may lead to different results due to differences in methods, perspectives, and countries used. Focusing on concordance, this study aimed at understanding the implications of applying EQ-5D-3L value sets from Sweden, Germany, Denmark, and the UK to evaluate HRQoL of patients undergoing total hip replacement (THR) in Sweden before and after surgery. Methods: We performed a longitudinal study of patients in the Swedish Hip Arthroplasty Register from preoperative stage to 1-year follow-up (n = 73,523) using data collected from 2008 to 2016. Eight EQ-5D-3L value sets from the four countries were compared based on a valuation method (visual analogue scale (VAS) or time trade-off (TTO)), perspective (experience-based or hypothetical), and country. Concordance among the value sets with patient-reported EQ VAS score was also assessed. Longitudinal changes in EQ-5D-3L index over the 1-year follow-up were compared across value sets by method, perspective, and country. Results: Value sets based on the same method and perspective showed higher concordance in EQ-5D-3L index at both measurement time points than other comparisons. In the comparisons by perspective, VAS value sets showed higher concordance than TTO value sets. The Swedish VAS and the Danish TTO value sets showed the highest levels of concordance with patient-reported EQ VAS scores. Generally, value sets based on the same method and perspective had the smallest mean differences between changes in EQ-5D-3L indices from preoperative to 1-year postoperative follow-up. Conclusion: Among THR patients value sets based on the same method and perspective, a direct transfer of results across countries could be meaningful. In cases of differences in methods and perspectives among value sets, transfer of value sets across settings would have to consider conversion through crosswalk.

Exploring Pharmacy Trainee Experiential Learning in a Full Scope Collaborative Rural Primary Care Practice: A Retrospective Chart Review

Despite reported benefits of pharmacy trainees (e.g., pharmacy students, pharmacy residents) in hospital settings, limited research on the impact of these trainees has been conducted in rural primary care. To explore the potential benefits and impact of pharmacy trainees practicing in a supervised collaborative rural primary care setting, a retrospective chart review was conducted. Drug therapy problems (DTPs) were classified using the Pharmaceutical Care Network Europe (PCNE V9) system. Valuation was measured using a validated tool developed by Overhage and Lukes (1999). Over 16 weeks on a part-time basis, pharmacy trainees (n = 3) identified 366 DTPs during 153 patient encounters. The most common causes for DTPs were related to patient transfers and the need for education. Drug level interventions carried out directly by trainees under supervision accounted for 13.1% of total interventions. Interventions that required prescriber authorization had an acceptance rate of 83.25%, 25% higher than previous acceptance rates found in urban primary care settings. About half (51%) of the interventions proposed and made by pharmacy trainees were classified as significant or very significant, suggesting these trainees added significant value to the pharmacy service provided to rural community residents. This study suggests that pharmacy trainees can be effective resources and contribute meaningfully to patient care in a collaborative rural primary care team setting.

To What Extent Do Patient Preferences Differ From General Population Preferences?

OBJECTIVES

In some countries including Germany, value sets based on general population preferences are not acceptable for decision-makers in healthcare because the impact of the reference group-general population versus patients-on utility decrements is questioned. The objective of this study was to explore potential differences in patient versus general population health preferences and a way of combining both preferences in economic evaluation.

METHODS

EQ-5D-5L general population preferences were available from national value sets in Germany and Spain. Patient preferences were obtained by conducting discrete choice experiments with patients with rheumatism and patients with diabetes mellitus in Germany and Spain using an online panel. The econometric approach was based on the conditional logit framework. Latent values were anchored using the national value sets.

RESULTS

A total of 1700 patients (Germany, n = 937; Spain, n = 763) were included in the analysis. In both countries, patients gave more importance to mobility, self-care, or usual activities and less importance to pain/discomfort and anxiety/depression than the general population. The size of these differences was larger in Germany than in Spain. In Germany, preferences reported by both patient groups were more similar than in Spain.

CONCLUSION

Patient preferences differ from preferences derived from the general population. In contrast to the general population, patients gave more importance to the functional dimensions than to symptoms in both countries. The extent of the differences depends on the disease and the country. For countries preferring patient preferences, a possible way of incorporating the patient perspective in health state valuation was suggested and needs to be further explored.

Does a health crisis change how we value health?

General population health state values are used in healthcare resource allocation, including health technology assessment. We examine whether UK general population health valuations changed during the COVID-19 pandemic. Ratings of EQ-5D-5L health states 11111 (no problems), 55555 (extreme problems), and dead were collected in a UK general population survey during the pandemic (April-May 2020) using the 0 = worst imaginable health, 100 = best imaginable health visual analog scale (EQ-VAS). Ratings for 55555 were transformed to a full health = 1, dead = 0 scale. Responses were compared to similar data collected pre-pandemic (2018). After propensity score matching to minimize sample differences, EQ-VAS responses were analyzed using Tobit regressions. On the 0-100 scale, 11111 was rated on average 8.67 points lower, 55555 rated 9.56 points higher, and dead rated 7.45 points lower post-pandemic onset compared to pre-pandemic. On the full health = 1, dead = 0 scale, 55555 values were 0.09 higher post-pandemic onset. There was evidence of differential impacts of COVID-19 by gender, age, and ethnicity, although only age impacted values on the 1-0 scale. COVID-19 may have affected how people value health. It is unknown whether the effect is large enough to have policy relevance, but caution should be taken in assuming pre-COVID-19 values are unchanged.

Comparison of Adult and Adolescent Preferences Toward EQ-5D-Y-3L Health States

OBJECTIVES

The international EQ-5D-Y-3L valuation protocol suggests obtaining preferences for EQ-5D-Y-3L health states from a sample of the general adult population. There is discussion around involving children and adolescents in the processes of preference elicitation and decision making. The objective of this study was to compare the preferences for EQ-5D-Y-3L obtained from adolescents for themselves to those of adults considering a hypothetical 10-year-old child in Germany, Slovenia, and Spain.

METHODS

A sample of a minimum of 700 adolescents and 1000 adults in each country was recruited through online panels. An online discrete choice experiment was used to obtain health-state preferences. For the purposes of comparison, all coefficients were rescaled to a 1 (best) to 0 (worst) scale. The differences between preferences in both samples were analyzed via the relative attribute importance of health dimensions from the mixed logit models.

RESULTS

Statistically significant differences between the preferences for EQ-5D-Y-3L states given by the 2 samples were observed in all 3 countries. The overall relative attribute importance was similar between adolescents and adults; adolescents usually gave more importance to mobility and self-care, and less to anxiety/depression. The rank-order of the dimension levels between adults and adolescents differs in all 3 countries.

CONCLUSIONS

Preferences toward EQ-5D-Y-3L states differ if estimated by adults taking the perspective of a child or by the adolescents themselves. Although it seems possible to obtain adolescents' preferences for inclusion in EQ-5D-Y-3L value sets, the desirability and acceptance of their preferences by researchers and decision makers need to be explored further.

On the value(s) of time: Workers' value of their time depends on mode of valuation

In this paper, we investigate how individuals make time-money tradeoffs in labor contexts in which they are either asked to work to earn money or to pay money to avoid work. Theory predicts that exchange rates between time and money are invariant to the elicitation method. Results from our experiments, however, show otherwise, highlighting inconsistencies in how individuals consider their time. In the first two experiments, participants work to earn money, and we compare two incentivized elicitation methods. In the first, "Fixed-Time mode," we fix the amount of time participants need to work and elicit the minimum dollar amount they require to do the job. In the second, "Fixed-Money mode," we fix the amount of money we pay participants and ask for the maximum amount of time they are willing to work for that pay. We similarly vary elicitation procedures in Experiment 3 for paying money to avoid work. Translating the results into pay per hour, we find that in Fixed-Time mode, valuation of time is stable across durations, based on an analytical approach. By contrast, in Fixed-Money mode, participants increase their pay-per-hour demand when the amount of money increases, indicating a less calculated and more emotional view of time. Our results demonstrate that individuals' value of their time of labor can be fluid and dependent on the compensation structure. Our findings have implications for theories of time valuation in the labor market.

Strategies of stratification: Regulating market access in the era of personalized medicine

Personalized medicine raises the stakes of pharmaceutical market regulation. Drawing on pragmatist valuation studies and science and technology studies literature on personalized medicine and pharmaceutical markets, this article demonstrates how complex negotiations about the value of a pharmaceutical can constitute a market in various ways, while also shaping the concerned patient populations. Tracing the path of a pharmacogenetic treatment, Spinraza, from its approval by the European Medicines Agency to its adoption in the publicly funded Danish healthcare system, we show how the market was formatted through particular stratifications of the patient population. We conceptualize these seemingly technical moves as strategies of stratification, that is, the application of techniques to assemble and divide data - and what data are meant to represent - into groups delineated by certain characteristics. We argue that stakeholders' use of strategies of stratification has important implications not only for market access, but also for the delineation of diseases and patient populations. Hence, it is crucial to make intelligible the mutual constitution of pharmaceutical markets and patient populations and the political efforts of delineating and connecting the two.

Value signals guide abstraction during learning

The human brain excels at constructing and using abstractions, such as rules, or concepts. Here, in two fMRI experiments, we demonstrate a mechanism of abstraction built upon the valuation of sensory features. Human volunteers learned novel association rules based on simple visual features. Reinforcement-learning algorithms revealed that, with learning, high-value abstract representations increasingly guided participant behaviour, resulting in better choices and higher subjective confidence. We also found that the brain area computing value signals – the ventromedial prefrontal cortex – prioritised and selected latent task elements during abstraction, both locally and through its connection to the visual cortex. Such a coding scheme predicts a causal role for valuation. Hence, in a second experiment, we used multivoxel neural reinforcement to test for the causality of feature valuation in the sensory cortex, as a mechanism of abstraction. Tagging the neural representation of a task feature with rewards evoked abstraction-based decisions. Together, these findings provide a novel interpretation of value as a goal-dependent, key factor in forging abstract representations.

Modifying food items valuation and weight with gamified executive control training

Recent lines of research suggest that repeated executive control of motor responses to food items modifies their perceived value and in turn their consumption. Cognitive interventions involving the practice of motor control and attentional tasks have thus been advanced as potential approach to improve eating habits. Yet, their efficacy remains debated, notably due to a lack of proper control for the effects of expectations. We examined whether a one-month intervention combining the practice of Go/NoGo and Cue approach training modified the perceived palatability of food items (i.e. decrease in unhealthy and increase in healthy food items' palatability ratings), and in turn participants' weights. We assessed our hypotheses with a parallel, double-blind, randomized controlled trial. Motivation and adherence to the intervention were maximized by a professional-level gamification of the training tasks. The control intervention differed from the experimental intervention only in the biasing of the stimulus-response mapping rules, enabling to balance expectations between the two groups and thus to conclude on the causal influence of motoric control on items valuation. We found a larger decrease of the unhealthy items' palatability ratings in the experimental (20.6%) than control group (13.1%). However, we did not find any increase of the healthy items' ratings or weight loss. Overall, the present registered report confirms that the repeated inhibition of motor responses to food cues, together with the development of attentional biases away from these cues, reduces their perceived value.

Retrieval-constrained valuation: Toward prediction of open-ended decisions

Real-world decisions are often open ended, with goals, choice options, or evaluation criteria conceived by decision-makers themselves. Critically, the quality of decisions may heavily rely on the generation of options, as failure to generate promising options limits, or even eliminates, the opportunity for choosing them. This core aspect of problem structuring, however, is largely absent from classical models of decision-making, thereby restricting their predictive scope. Here, we take a step toward addressing this issue by developing a neurally inspired cognitive model of a class of ill-structured decisions in which choice options must be self-generated. Specifically, using a model in which semantic memory retrieval is assumed to constrain the set of options available during valuation, we generate highly accurate out-of-sample predictions of choices across multiple categories of goods. Our model significantly and substantially outperforms models that only account for valuation or retrieval in isolation or those that make alternative mechanistic assumptions regarding their interaction. Furthermore, using neuroimaging, we confirm our core assumption regarding the engagement of, and interaction between, semantic memory retrieval and valuation processes. Together, these results provide a neurally grounded and mechanistic account of decisions with self-generated options, representing a step toward unraveling cognitive mechanisms underlying adaptive decision-making in the real world.

Are Emotions Natural Kinds After All? Rethinking the Issue of Response Coherence

The synchronized co-activation of multiple responses-motivational, behavioral, and physiological-has been taken as a defining feature of emotion. Such response coherence has been observed inconsistently however, and this has led some to view emotion programs as lacking biological reality. Yet, response coherence is not always expected or desirable if an emotion program is to carry out its adaptive function. Rather, the hallmark of emotion is the capacity to orchestrate multiple mechanisms adaptively-responses will co-activate in stereotypical fashion or not depending on how the emotion orchestrator interacts with the situation. Nevertheless, might responses cohere in the general case where input variables are specified minimally? Here we focus on shame as a case study. We measure participants' responses regarding each of 27 socially devalued actions and personal characteristics. We observe internal and external coherence: The intensities of felt shame and of various motivations of shame (hiding, lying, destroying evidence, and threatening witnesses) vary in proportion (i) to one another, and (ii) to the degree to which audiences devalue the disgraced individual-the threat shame defends against. These responses cohere both within and between the United States and India. Further, alternative explanations involving the low-level variable of arousal do not seem to account for these results, suggesting that coherence is imparted by a shame system. These findings indicate that coherence can be observed at multiple levels and raise the possibility that emotion programs orchestrate responses, even in those situations where coherence is low.

Systematic review of soil ecosystem services in tropical regions

Soil ecosystem service (SES) approaches evidence the importance of soil for human well-being, contribute to improving dialogue between science and decision-making and encourage the translation of scientific results into public policies. Herein, through systematic review, we assess the state of the art of SES approaches in tropical regions. Through this review, 41 publications were identified; while most of these studies considered SES, a lack of a consistent framework to define SES was apparent. Most studies measured soil natural capital and processes, while only three studies undertook monetary valuation. Although the number of publications increased (from 1 to 41), between 2001 and 2019, the total number of publications for tropical regions is still small. Countries with the largest number of publications were Brazil (n = 8), Colombia (n = 6) and Mexico (n = 4). This observation emphasizes an important knowledge gap pertaining to SES approaches and their link to tropical regions. With global momentum behind SES approaches, there is an opportunity to integrate SES approaches into policy and practice in tropical regions. The use of SES evaluation tools in tropical regions could transform how land use decisions are informed, mitigating soil degradation and protecting the ecosystems that soil underpins.

Conditional valuation for combinations of goods in primates

Valuing goods and selecting the one with the highest value forms the basis of adaptive behaviour across species. While it is obvious that the valuation of a given type of goods depends on ownership and availability of that type of goods, the effects of other goods on valuation of the original good are sometimes underappreciated. Yet, goods interact with each other, indicating that the valuation of a given good is conditional on the other goods it is combined with, both in the wild and the laboratory. Here, we introduce conditional valuation in the context of valuing multiple goods and briefly review how human and animal experimentalists can leverage economic tools for the study of interactions among goods. We then review evidence for conditional valuation for combined foods in both human and non-human primates. In the laboratory, non-human primates show increased valuation of certain combinations of foods but decreased valuation of other types of combinations. Thus, similarly to humans, monkeys appear to value combinations of goods in a conditional fashion. Additionally, both humans and monkeys appear to employ similar neural substrates for the valuation of single goods, such as the orbitofrontal cortex. Together, investigations of our evolutionary precursors may provide insights on how we value interacting goods. This article is part of the theme issue 'Existence and prevalence of economic behaviours among non-human primates'.

How pride works

The emotion of pride appears to be a neurocognitive guidance system to capitalize on opportunities to become more highly valued and respected by others. Whereas the inputs and the outputs of pride are relatively well understood, little is known about how the pride system matches inputs to outputs. How does pride work? Here we evaluate the hypothesis that pride magnitude matches the various outputs it controls to the present activating conditions - the precise degree to which others would value the focal individual if the individual achieved a particular achievement. Operating in this manner would allow the pride system to balance the competing demands of effectiveness and economy, to avoid the dual costs of under-deploying and over-deploying its outputs. To test this hypothesis, we measured people's responses regarding each of 25 socially valued traits. We observed the predicted magnitude matchings. The intensities of the pride feeling and of various motivations of pride (communicating the achievement, demanding better treatment, investing in the valued trait and pursuing new challenges) vary in proportion: (a) to one another; and (b) to the degree to which audiences value each achievement. These patterns of magnitude matching were observed both within and between the USA and India. These findings suggest that pride works cost-effectively, promoting the pursuit of achievements and facilitating the gains from others' valuations that make those achievements worth pursuing.

Social tariffs and democratic choice-Do population-based health state values reflect the will of the people?

In economic evaluations of health technologies, health outcomes are commonly measured in terms of quality-adjusted life years (QALYs). QALYs are the product of time and health-related quality of life. Health-related quality of life, in turn, is determined by a social tariff, which is supposed to reflect the public's preference over health states. This study argues that, because of the tariff's role in the societal decision-making process, it should not be understood as merely an operational (statistical) definition of health, but as a major instrument of democratic participation. I outline what implications this might have for both the method used to aggregate individual preferences, and the set of individuals whose preferences should count. Alternative tariff specifications and decision rules are explored, and future research directions are proposed.