Knowing When to Pass: The Effect of AI Reliability in Risky Decision Contexts

OBJECTIVE

This study manipulates the presence and reliability of AI recommendations for risky decisions to measure the effect on task performance, behavioral consequences of trust, and deviation from a probability matching collaborative decision-making model.

BACKGROUND

Although AI decision support improves performance, people tend to underutilize AI recommendations, particularly when outcomes are uncertain. As AI reliability increases, task performance improves, largely due to higher rates of compliance (following action recommendations) and reliance (following no-action recommendations).

METHODS

In a between-subject design, participants were assigned to a high reliability AI, low reliability AI, or a control condition. Participants decided whether to bet that their team would win in a series of basketball games tying compensation to performance. We evaluated task performance (in accuracy and signal detection terms) and the behavioral consequences of trust (via compliance and reliance).

RESULTS

AI recommendations improved task performance, had limited impact on risk-taking behavior, and were under-valued by participants. Accuracy, sensitivity (d'), and reliance increased in the high reliability AI condition, but there was no effect on response bias (c) or compliance. Participant behavior was only consistent with a probability matching model for compliance in the low reliability condition.

CONCLUSION

In a pay-off structure that incentivized risk-taking, the primary value of the AI recommendations was in determining when to perform no action (i.e., pass on bets).

APPLICATION

In risky contexts, designers need to consider whether action or no-action recommendations will be more influential to design appropriate interventions.

Influence of exposure route and oral dosage regimen on 1, 1-dichloroethylene toxicokinetics and target organ toxicity

The objective of this investigation was to elucidate the effects of route of exposure and oral dosage regimen on the toxicokinetics (TK) of 1,1-dichloroethylene (DCE). Fasted male Sprague-Dawley rats that inhaled 100 or 300 ppm for 2 h absorbed total systemic doses of (10 or 30 mg/kg DCE, respectively. Other groups of rats received 10 or 30 mg/kg DCE by intravenous injection, bolus gavage (by mouth), or gastric infusion (g.i.) over a 2-h period. Serial microblood samples were taken from the cannulated, unanesthetized animals and analyzed for DCE content by gas chromatography to obtain concentration versus time profiles. Inhalation resulted in substantially higher peak blood concentrations and area under blood-concentration time curves (AUC(0)(2)) than did gastric infusion of the same dose over the same time frame at each dosage level, although inhalation (AUC(0)(infinity)) values were only modestly higher. Urinary N-acetyl-beta-D-glucosaminidase (NAG) and gamma-glutamyltranspeptidase (GGT) activities were monitored as indices of kidney injury in the high-dose groups. NAG and GGT excretion were much more pronounced after inhalation than gastric infusion. Administration of DCE by gavage also produced much higher Cmax and AUC(0)(2) values than did 2-h g.i., although AUC(0)(infinity) values were not very different. The 30 mg/kg bolus dose produced marked elevation in serum sorbitol dehydrogenase, an index of hepatocellular injury. Administration of this dose by inhalation and gastric infusion was only marginally hepatotoxic. These findings demonstrate the TK and target organ toxicity of DCE vary substantially between different exposure routes, as well as dosage regimens, making direct extrapolations untenable in health risk assessments.

Cancer pain management. Improving knowledge and patient care

OBJECTIVE

A pain management project was designed to assess the effectiveness of a multifaceted intervention for improving GPs' knowledge of cancer pain management. Two hypotheses were tested: that the intervention would influence GPs' knowledge in the area of cancer pain management; that information would be gathered to assist in the production of educational material.

METHOD

The project involved assessment of GP knowledge, feedback and discussion at project officer visits, mailings and participation in developing guidelines.

RESULTS

All participants who completed the second round of visits were glad they had participated in the program. A discussion of the information topics covered is included.

CONCLUSION

Increasing GPs' knowledge of the management of symptoms is only one of many factors that influence their prescribing patterns. In cancer pain management lack of knowledge is a significant contributor to unnecessary patient suffering. We have been able to demonstrate the success of a multifaceted intervention in improving the knowledge of cancer pain management by GPs. Although not measured directly, it is hoped that this will lead to improved quality of life for patients cared for by these practitioners.

Evaluation of a cancer pain education program for general practitioners

OBJECTIVE

To evaluate a cancer pain education program.

METHOD

Participants in the program completed an evaluation form covering various aspects of the program's design.

RESULTS

All participants who completed the program were glad that they had done so. The most and least useful aspects are included in the article. Participants were satisfied with the program and eager to participate in similar ones.

CONCLUSION

The education program was both successful at improving participants' knowledge of cancer pain management and provided in a manner acceptable to the participants. Ideas for future similar projects are included.

Thyroid hormones and cytogenetic outcomes in backpack sprayers using ethylenebis(dithiocarbamate) (EBDC) fungicides in Mexico

Ethylenebis(dithiocarbamate) (EBDC) fungicides are used heavily in the United States. EBDCs (e.g., mancozeb, maneb) are metabolized to ethylene thiourea (ETU). The EPA classifies ETU as a carcinogen, based on thyroid and other cancers in rodents, and has restricted the use of EBDCs, while requiring workers to use protective equipment. There are no data on the potential carcinogenicity of EBDCs in humans, and there is only one study on human genotoxicity. ETU is known to cause decreases of thyroxine (T4) and increases in thyroid-stimulating hormone (TSH) in rodents. We have studied cytogenetic outcomes and serum thyroid hormone levels among 49 heavily exposed workers without protective equipment spraying EBDC on tomatoes in Mexico. We also studied 14 lightly exposed landowners and 31 nonexposed controls. Urinary ETU was used to compare exposure between groups. We found an increase in TSH (p = 0.05) among applicators compared to controls, but no decrease in thyroid hormone (T4). We found increases in sister chromatid exchange (p = 0.03) and in chromosome translocations (chromosome aberrations that persist through cell division) for applicators compared to controls (p = 0.05). However, the subset of reciprocal translocations showed a lesser increase (p = 0.24). Our data suggest that EBDCs affect the thyroid gland and the lymphocyte genome among heavily exposed workers. However, our data are limited to subclinical outcomes, are of borderline statistical significance, and should be interpreted with caution.

Cell cycle kinetic studies in 68 patients with myelodysplastic syndromes following intravenous iodo- and/or bromodeoxyuridine

Sixty-eight patients with myelodysplastic syndromes (MDS) received sequential infusions of iodo- and/or bromodeoxyuridine for cell kinetic analysis. Bone marrow biopsy sections were treated by appropriate antibodies and a labeling index (LI), duration of S-phase (Ts), and total cell cycle time (Tc) of myeloid cells were determined. The mean LI was 28.4%, Ts was 11.8 hours and Tc was 40.7 hours. The %LI decreased as the disease evolved from refractory anemia toward transformation to acute leukemia (p = 0.04). Double-labeling of biopsy sections for apoptosis and proliferation showed that 30-90% of S-phase cells in MDS patients were simultaneously apoptotic or "antonymous." We conclude that MDS are highly proliferative disorders in which the ineffective hematopoiesis is probably the result of excessive apoptosis rather than slow proliferation.

Use of intravenous albumin in the critically ill patient

The experimental data supporting and opposing the use of intravenous albumin in various groups of patients are provided, and conclusions are drawn from these data. The metabolism and kinetics of albumin are reviewed, and the importance of albumin levels in critically ill patients is discussed. The reviewed literature supports the conclusion that in most critically ill patients, intravenous albumin does not improve outcome.

Spontaneous perforation of the esophagus associated with a lower esophageal ring

We report a case of esophageal perforation that occurred in a man with a known symptomatic Schatzki ring. It is possible that the perforation may have been avoided with therapy of the lower esophageal ring. The evaluation and management of esophageal perforation are discussed.

Antacid maintenance therapy in the prevention of duodenal ulcer relapse

The effectiveness of antacid maintenance therapy in preventing duodenal ulcer (DU) relapse was investigated. Two hundred and fifty one asymptomatic patients with healed DU were stratified into smokers and non-smokers and randomised to receive for one year either placebo, or Maalox TC three tablets (81 mmol) at bedtime (hs), or Maalox TC three tablets in the morning plus three tablets at bedtime (bd) (162 mmol), or cimetidine 400 mg at bedtime. A double dummy technique was used to render the study double blind. In 176 patients evaluable for efficacy, the cumulative relapse at one year was: placebo 57%; Maalox TC hs 39%; Maalox TC bd 23%; cimetidine 25%. Maalox TC bd and cimetidine were equally effective and superior to placebo (p less than 0.01) and bedtime Maalox TC (p less than 0.04). The benefit of treatment was significant for the overall sample and for the subgroup of smokers. The results for the non-smokers also supported efficacy for these two treatments but, perhaps because of small sample sizes, these comparisons were not significant. All 251 patients were assessed for safety. Approximately half the patients in each treatment group had adverse events, leading to withdrawal in three, seven, 12, and four patients on placebo, Maalox hs, Maalox bd, and cimetidine respectively. Diarrhoea occurred in 12 patients in Maalox TC bd and eight in each other group. Serum magnesium concentrations were unchanged; aluminium concentrations were higher than baseline at six and 12 months in both antacid groups and at 12 months in the cimetidine group but the differences were not significant. Maalox TC three tablets bd are as effective as cimetidine 400 mg at bedtime in reducing DU relapse and both are superior to placebo.

Suppression behavior analyzed as a function of monovision addition power

Monovision, the use of a monocular addition for near viewing, is a clinical technique sometimes used to correct presbyopia. This technique attempts to maintain binocular function while requiring a degree of central suppression. We examined suppression behavior in spectacle monovision as a function of addition power. Suppression behavior was determined by measuring the length and frequency of periods of suppression for a range of monocular addition powers. Testing was conducted at viewing distances of 6 m and 40 cm. The most striking result is the existence of a near/distance differential: the monocular addition power required to stabilize suppression at near is greater than at distance. It was also found that suppression behavior may be stable even in the presence of a relatively high level of stereoscopic acuity. The relation between the contradictory needs for suppression and binocular functioning under monovision conditions is discussed.

Granular cell schwannoma of the extrahepatic biliary system

We report the case of a woman who presented with a typical picture of cholelithiasis and choledocholithiasis. A percutaneous transhepatic cholangiogram revealed instead a concentric narrowing of the common bile duct and at operation she was found to have a rare, benign tumor of the extrahepatic biliary tree, a granular cell schwannoma.