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Sample records for making practical choices

  1. Make Better Food Choices

    10 tips Nutrition Education Series make better food choices 10 tips for women’s health Fruits Grains Dairy Vegetables Protein Make yourself a priority and take time to care for yourself. ChooseMyPlate. gov ...

  2. Making Smart Food Choices

    ... turn JavaScript on. Feature: Healthy Aging Making Smart Food Choices Past Issues / Winter 2015 Table of Contents Everyday ... NIH www.nia.nih.gov/Go4Life Making Smart Food Choices To maintain a healthy weight, balance the calories ...

  3. Making Healthy Choices Easier

    Guldborg Hansen, Pelle; Skov, Laurits Rohden; Lund Skov, Katrine

    2016-01-01

    . However, integration and testing of the nudge approach as part of more comprehensive public health strategies aimed at making healthy choices easier is being threatened by inadequate understandings of its scientific character, relationship with regulation and its ethical implications. This article reviews...... working with or incorporating the nudge approach into programs or policies aimed at making healthy choices easier...

  4. Private or salaried practice: how do young general practitioners make their career choice? A qualitative study.

    Kinouani, Shérazade; Boukhors, Gary; Luaces, Baptiste; Durieux, William; Cadwallader, Jean-Sébastien; Aubin-Auger, Isabelle; Gay, Bernard

    2016-09-01

    Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners. A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently. Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice. National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

  5. Academic or community practice? What is driving decision-making and career choices.

    Goudreau, Bernadette J; Hassinger, Taryn E; Hedrick, Traci L; Slingluff, Craig L; Schroen, Anneke T; Dengel, Lynn T

    2018-06-18

    Identifying factors that impact progression of surgery trainees into academic versus non-academic practices may permit tailoring residency experiences to promote academic careers in institutions charged with the training of future surgeon scientists. The aim of this study was to identify factors associated with progression of surgery trainees into academic versus non-academic practice. A survey was distributed to 135 surgeons graduating from the University of Virginia residency program from 1964-2016, a single academic institution. Questions addressed practice type, research productivity, work/life balance, mentorship, and overall sentiment toward research and academic surgery. A 5-point Likert scale measured career satisfaction and influence of factors in practice setting choice. Of the 135 surveys that were electronically distributed, 69 participants responded (response rate: 51%). Of the 54 with known current practice types, 34 (63%) were academic and 20 (37%) non-academic. Academic surgeons reported more publications by the conclusion of surgery training (56% vs 25% with >10 publications, P = .02). More academic surgeons reported >$100,000 in student debt at graduation (44% vs 25%, P productive research experiences, current surgical trainees may be more enthusiastic about a career in academic practice. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. Biofuels: making tough choices

    Vermeulen, Sonja; Dufey, Annie; Vorley, Bill

    2008-02-15

    The jury is still out on biofuels. But one thing at least is certain: serious trade-offs are involved in the production and use of these biomass-derived alternatives to fossil fuels. This has not been lost on the European Union. The year kicked off with an announcement from the EU environment commissioner that it may be better for the EU to miss its target of reaching 10 per cent biofuel content in road fuels by 2020 than to compromise the environment and human wellbeing. The 'decision tree' outlined here can guide the interdependent processes of deliberation and analysis needed for making tough choices in national biofuels development.

  7. Making Choices, Setting Goals

    Skinner, Timothy

    2013-01-01

    Diabetes management and education is very important. The way information is provided influences people's behaviours and thus outcomes. The way information is presented can increase or reduce the individual's ability to make informed decisions about their treatment and influences whether they acti...

  8. How to make moral choices.

    Chambers, David W

    2011-01-01

    Moral choice is committing to act for what one believes is right and good. It is less about what we know than about defining who we are. Three cases typical of those used in the principles or dilemmas approach to teaching ethics are presented. But they are analyzed using an alternative approach based on seven moral choice heuristics--approaches proven to increase the likelihood of locating the best course of action. The approaches suggested for analyzing moral choice situations include: (a) identify the outcomes of available alternative courses of action; (b) rule out strategies that involve deception, coercion, reneging on promises, collusion, and contempt for others; (c) be authentic (do not deceive yourself); (d) relate to others on a human basis; (e) downplay rational justifications; (f) match the solution to the problem, not the other way around; (g) execute on the best solution, do not hold out for the perfect one; and (h) take action to improve the choice after it has been made.

  9. Making healthy choices easy choices: the role of empowerment

    Koelen, M.A.; Lindström, B.

    2005-01-01

    An important goal of health promotion is to make it easier for people to make healthy choices. However, this may be difficult if people do not feel control over their environment and their personal circumstances. An important concept in relation to this is empowerment. Health professionals are

  10. Making Choices: Valletta, Development, Archaeology and Society

    Barney Sloane

    2018-03-01

    Full Text Available The European Archaeological Council's working group on 'Making Choices' conducted a survey of EAC member states about the ways in which they make decisions in archaeological heritage management with particular reference to development-led archaeological investigation. The driver for this is the belief that the approaches to development-led archaeology need to be more transparent and proportional to ensure continued state and developer/investor support. Based on a significant response (73% the survey gave a very useful insight into the way in which archaeological sites are defined and inventorised, the processes by which development-led investigations are designed, the means by which information is published and results (and collections archived, and the means by which the public are engaged in the process. The survey identified three key areas where choice-making is very much in the hands of the professional practice. These are: developing a clearer understanding of the significance of protected archaeological sites in the context of Valletta, assessing sensitivity to change for any sites proposed for development, and the design of the investigation itself. In addition, the survey revealed a clear interest in developing better ways of advocating the public value of development-led archaeology. This article summarises the issues raised in the survey and concludes that the most useful ways in which EAC could help its members would be through the preparation of guidance, case studies or toolkits — regardless of what legal or statutory structures are in operation in a given state — on the following subjects: understanding and articulating significance, developing national and regional research frameworks into which new excavations might be integrated, articulating the public value of archaeological investigation and developing better approaches to archaeological archives.

  11. How libraries make tough choices in difficult times purposeful abandonment

    Stern, David

    2013-01-01

    Contemporary library managers face the need to make difficult choices regarding resource allocation in the modern business environment. How Libraries Make Tough Choices in Difficult Times is a practical guide for library managers, offering techniques to analyze existing and potential services, implement best practices for maximizing existing resources, and utilize pressing financial scenarios in order to justify making difficult reallocation decisions. The book begins by asking the fundamental questions of why, what, and how, moving on to look at how to manage expectations and report to both a

  12. Making Healthy Choices Easier: Regulation versus Nudging.

    Hansen, Pelle Guldborg; Skov, Laurits Rohden; Skov, Katrine Lund

    2016-01-01

    In recent years, the nudge approach to behavior change has emerged from the behavioral sciences to challenge the traditional use of regulation in public health strategies to address modifiable individual-level behaviors related to the rise of noncommunicable diseases and their treatment. However, integration and testing of the nudge approach as part of more comprehensive public health strategies aimed at making healthy choices easier are being threatened by inadequate understandings of its scientific character, its relationship with regulation, and its ethical implications. This article reviews this character and its ethical implication with a special emphasis on the compatibility of nudging with traditional regulation, special domains of experience, and the need for a more nuanced approach to the ethical debate. The aim is to advance readers' understanding and give guidance to those who have considered working with or incorporating the nudge approach into programs or policies aimed at making healthful choices easier.

  13. Shared decision making, paternalism and patient choice.

    Sandman, Lars; Munthe, Christian

    2010-03-01

    In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship.

  14. Complex Strategic Choices Applying Systemic Planning for Strategic Decision Making

    Leleur, Steen

    2012-01-01

    Effective decision making requires a clear methodology, particularly in a complex world of globalisation. Institutions and companies in all disciplines and sectors are faced with increasingly multi-faceted areas of uncertainty which cannot always be effectively handled by traditional strategies. Complex Strategic Choices provides clear principles and methods which can guide and support strategic decision making to face the many current challenges. By considering ways in which planning practices can be renewed and exploring the possibilities for acquiring awareness and tools to add value to strategic decision making, Complex Strategic Choices presents a methodology which is further illustrated by a number of case studies and example applications. Dr. Techn. Steen Leleur has adapted previously established research based on feedback and input from various conferences, journals and students resulting in new material stemming from and focusing on practical application of a systemic approach. The outcome is a coher...

  15. Making Antibiotic Choices: Formula Derivation and Usage in the ...

    formulae was demonstrated in the rational selection of antibiotics most appropriate in the empirical ... antibiotics provides a suitable means of making antibiotic choices in the empirical treatment of ... decisions are made on their choices.

  16. Making the Most of Multiple Choice

    Brookhart, Susan M.

    2015-01-01

    Multiple-choice questions draw criticism because many people perceive they test only recall or atomistic, surface-level objectives and do not require students to think. Although this can be the case, it does not have to be that way. Susan M. Brookhart suggests that multiple-choice questions are a useful part of any teacher's questioning repertoire…

  17. Choice blindness in financial decision making

    Owen McLaughlin

    2013-09-01

    Full Text Available Choice Blindness is an experimental paradigm that examines the interplay between individuals' preferences, decisions, and expectations by manipulating the relationship between intention and choice. This paper expands upon the existing Choice Blindness framework by investigating the presence of the effect in an economically significant decision context, specifically that of pension choice. In addition, it investigates a number of secondary factors hypothesized to modulate Choice Blindness, including reaction time, risk preference, and decision complexity, as well as analysing the verbal reports of non-detecting participants. The experiment was administered to 100 participants of mixed age and educational attainment. The principal finding was that no more than 37.2% of manipulated trials were detected over all conditions, a result consistent with previous Choice Blindness research. Analysis of secondary factors found that reaction time, financial sophistication and decision complexity were significant predictors of Choice Blindness detection, while content analysis of non-detecting participant responses found that 20% implied significant preference changes and 62% adhered to initial preferences. Implications of the Choice Blindness effect in the context of behavioural economics are discussed, and an agenda for further investigation of the paradigm in this context is outlined.

  18. 'My kidneys, my choice, decision aid': supporting shared decision making.

    Fortnum, Debbie; Smolonogov, Tatiana; Walker, Rachael; Kairaitis, Luke; Pugh, Debbie

    2015-06-01

    For patients with chronic kidney disease (CKD) who are progressing to end-stage kidney disease (ESKD) a decision of whether to undertake dialysis or conservative care is a critical component of the patient journey. Shared decision making for complex decisions such as this could be enhanced by a decision aid, a practice which is well utilised in other disciplines but limited for nephrology. A multidisciplinary team in Australia and New Zealand (ANZ) utilised current decision-making theory and best practice to develop the 'My Kidneys, My Choice', a decision aid for the treatment of kidney disease. A patient-centred, five-sectioned tool is now complete and freely available to all ANZ units to support the ESKD education and shared decision-making process. Distribution and education have occurred across ANZ and evaluation of the decision aid in practice is in the first phase. Development of a new tool such as an ESKD decision aid requires vision, multidisciplinary input and ongoing implementation resources. This tool is being integrated into ANZ, ESKD education practice and is promoting the philosophy of shared decision making. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  19. [GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines].

    Alonso-Coello, Pablo; Oxman, Andrew D; Moberg, Jenny; Brignardello-Petersen, Romina; Akl, Elie A; Davoli, Marina; Treweek, Shaun; Mustafa, Reem A; Vandvik, Per O; Meerpohl, Joerg; Guyatt, Gordon H; Schünemann, Holger J

    Clinicians do not have the time or resources to consider the underlying evidence for the myriad decisions they must make each day and, as a consequence, rely on recommendations from clinical practice guidelines. Guideline panels should consider all the relevant factors (criteria) that influence a decision or recommendation in a structured, explicit, and transparent way and provide clinicians with clear and actionable recommendations. In this article, we will describe the Evidence to Decision (EtD) frameworks for clinical practice recommendations. The general structure of the EtD framework for clinical recommendations is similar to EtD frameworks for other types of recommendations and decisions, and includes formulation of the question, an assessment of the different criteria, and conclusions. Clinical recommendations require considering criteria differently, depending on whether an individual patient or a population perspective is taken. For example, from an individual patient's perspective, out-of-pocket costs are an important consideration, whereas, from a population perspective, resource use (not only out-of-pocket costs) and cost effectiveness are important. From a population perspective, equity, acceptability, and feasibility are also important considerations, whereas the importance of these criteria is often limited from an individual patient perspective. Specific subgroups for which different recommendations may be required should be clearly identified and considered in relation to each criterion because judgments might vary across subgroups. This article is a translation of the original article published in the British Medical Journal. The EtD frameworks are currently used in the Clinical Practice Guideline Programme of the Spanish National Health System, co-ordinated by GuíaSalud. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Making Healthy Choices at Fast Food Restaurants

    ... Conditions Prevention and Wellness Staying Healthy Healthy Living Travel Occupational Health First Aid and Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight Loss and ...

  1. Characterizing Mathematics Classroom Practice: Impact of Observation and Coding Choices

    Ing, Marsha; Webb, Noreen M.

    2012-01-01

    Large-scale observational measures of classroom practice increasingly focus on opportunities for student participation as an indicator of instructional quality. Each observational measure necessitates making design and coding choices on how to best measure student participation. This study investigated variations of coding approaches that may be…

  2. Desktop Publishing Choices: Making an Appropriate Decision.

    Crawford, Walt

    1991-01-01

    Discusses various choices available for desktop publishing systems. Four categories of software are described, including advanced word processing, graphics software, low-end desktop publishing, and mainstream desktop publishing; appropriate hardware is considered; and selection guidelines are offered, including current and future publishing needs,…

  3. Making personalised nutrition the easy choice

    Stewart-Knox, B.J.; Markovina, J.; Rankin, A.; Bunting, B.P.; Kuznesof, S.; Fischer, A.R.H.; Lans, van der I.A.; Poínhos, R.; Almeida, de M.D.V.; Panzone, L.; Gibney, M.; Frewer, L.J.

    2016-01-01

    Personalised diets based on people's existing food choices, and/or phenotypic, and/or genetic information hold potential to improve public dietary-related health. The aim of this analysis, therefore, has been to examine the degree to which factors which determine uptake of personalised nutrition

  4. Braving difficult choices alone: children's and adolescents' medical decision making.

    Azzurra Ruggeri

    Full Text Available OBJECTIVE: What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. METHODS: Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1 own informed choice; (2 informed parents' choice to amputate; (3 informed parents' choice to continue a treatment; and (4 uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. RESULTS: Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. CONCLUSIONS: Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process.

  5. Braving difficult choices alone: children's and adolescents' medical decision making.

    Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

    2014-01-01

    What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process.

  6. Braving Difficult Choices Alone: Children's and Adolescents' Medical Decision Making

    Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

    2014-01-01

    Objective What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Methods Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Results Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Conclusions Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process. PMID:25084274

  7. Assessing choice making among children with multiple disabilities.

    Sigafoos, J; Dempsey, R

    1992-01-01

    Some learners with multiple disabilities display idiosyncratic gestures that are interpreted as a means of making choices. In the present study, we assessed the validity of idiosyncratic choice-making behaviors of 3 children with multiple disabilities. Opportunities for each child to choose between food and drink were provided under two conditions. In one condition, the children were given the food or drink item corresponding to their prior choice. In the other condition, the teacher delivere...

  8. Making Type Inference Practical

    Schwartzbach, Michael Ignatieff; Oxhøj, Nicholas; Palsberg, Jens

    1992-01-01

    We present the implementation of a type inference algorithm for untyped object-oriented programs with inheritance, assignments, and late binding. The algorithm significantly improves our previous one, presented at OOPSLA'91, since it can handle collection classes, such as List, in a useful way. Abo......, the complexity has been dramatically improved, from exponential time to low polynomial time. The implementation uses the techniques of incremental graph construction and constraint template instantiation to avoid representing intermediate results, doing superfluous work, and recomputing type information....... Experiments indicate that the implementation type checks as much as 100 lines pr. second. This results in a mature product, on which a number of tools can be based, for example a safety tool, an image compression tool, a code optimization tool, and an annotation tool. This may make type inference for object...

  9. Affective biasing of choices in gambling task decision making.

    Hinson, John M; Whitney, Paul; Holben, Heather; Wirick, Aaron K

    2006-09-01

    The proponents of the somatic marker hypothesis presume that rational decision making is guided by emotional reactions that are developed from prior experience. Supporting evidence for the hypothesis comes almost exclusively from the short-term affective reactions that are learned during the course of a hypothetical decision-making task--the gambling task (GT). We examined GT performance and affective reactions to choices when those choices were biased by words that had preexisting affective value. In one experiment, affectively valued words directly signaled good and bad choices. A congruent relation between affective value of word and choice outcome improved GT performance, whereas an incongruent relation greatly interfered with performance. In another experiment, affectively valued words were maintained as a working memory (WM) load between GT choices. A WM load with affectively positive words somewhat improved GT performance, whereas affectively negative words interfered with performance. Somatic markers-indicated by differential anticipatory skin conductance response (SCR) amplitude for good and bad choices-appeared at a point in the GT session when choice performance was superior. However, differential SCR developed during the session after good choice performance was already established. These results indicate that preexisting affective biases can influence GT decision making. In addition, the somatic markers that are regular accompaniments of GT decision making appeared to be temporally lagging indicators of choice performance.

  10. Patients who make terrible therapeutic choices.

    Curzer, Howard J

    2014-01-01

    The traditional approaches to dental ethics include appeals to principles, duties (deontology), and consequences (utilitarianism). These approaches are often inadequate when faced with the case of a patient who refuses reasonable treatment and does not share the same ethical framework the dentist is using. An approach based on virtue ethics may be helpful in this and other cases. Virtue ethics is a tradition going back to Plato and Aristotle. It depends on forming a holistic character supporting general appropriate behavior. By correctly diagnosing the real issues at stake in a patient's inappropriate oral health choices and working to build effective habits, dentists can sometimes respond to ethical challenges that remain intractable given rule-based methods.

  11. Existential autonomy: why patients should make their own choices.

    Madder, H

    1997-08-01

    Savulescu has recently introduced the "rational non-interventional paternalist" model of the patient-doctor relationship. This paper addresses objections to such a model from the perspective of an anaesthetist. Patients need to make their own decisions if they are to be fully autonomous. Rational non-interventional paternalism undermines the importance of patient choice and so threatens autonomy. Doctors should provide an evaluative judgment of the best medical course of action, but ought to restrict themselves to helping patients to make their own choices rather than making such choices for them.

  12. Government Certification and Accreditation: Make a Choice

    Miles, Tracy L.

    2009-01-01

    One of the most significant challenges faced by government officials today is securing information systems to make them more resilient to attack from increasingly complex challenges from cyber-criminals, state-sponsored groups, and other threats. Over the years, the federal government has developed and implemented Certification and Accreditation…

  13. Rhetorical Design Studies: The Art of Making Design Choices Explicit

    Halstrøm, Per L.

    2017-01-01

    Design has the potential to affect the situations we are in, the choices we make and the beliefs we live by. Being such an affective field, one might expect that canonized design thinking models and methods would be much concerned with how designers can discover arguments for their design choices...

  14. Make Better Beverage Choices: 10 Tips to Get Started

    United States Department of Agriculture 10 tips Nutrition Education Series MyPlate MyWins Based on the Dietary Guidelines for Americans Make better beverage choices A healthy eating style includes all foods and beverages. Many beverages ...

  15. Choice-making treatment of young children's severe behavior problems.

    Peck, S M; Wacker, D P; Berg, W K; Cooper, L J; Brown, K A; Richman, D; McComas, J J; Frischmeyer, P; Millard, T

    1996-01-01

    The choice-making behavior of 5 young children with developmental disabilities who engaged in aberrant behavior was studied within a concurrent operants framework. Experimental analyses were conducted to identify reinforcers that maintained aberrant behavior, and functional communication training packages were implemented to teach the participants to gain reinforcement using mands. Next, a choice-making analysis, in which the participants chose one of two responses (either a mand or an altern...

  16. Understanding How Overweight and Obese Emerging Adults Make Lifestyle Choices.

    Cha, EunSeok; Crowe, James M; Braxter, Betty J; Jennings, Bonnie Mowinski

    To better understand health-related decision making among overweight and obese emerging adults. A cross-sectional design was used in the parent study involving overweight and obese emerging adults, ages 18-29 years. The goal of the parent study was to screen participants' diabetes risk and identify characteristics of emerging adults with prediabetes (N=107). A sub-sample of respondents (n=34) from the parent study were invited to participate in focus group interviews depending on whether they had prediabetes (three groups) or they did not have prediabetes (four groups). Each focus group interview lasted 90-120 minutes following a semi-structured interview guide. Conventional content analysis was used in the data analysis. Because of the similarities between participants with and without prediabetes, the findings were synthesized and reported in the aggregate. Moreover, during the analysis, the authors decided that rational choice theory provided a useful organizing structure for presenting the data. Emerging adults' behavioral decisions were rational reactions to their personal competence, perception of health, environment, and availability of resources to handle problems. Calculation of trade-offs and estimations of resource availability were often used when making decisions. Emerging adults choose unhealthy behaviors due to inaccurate information and insufficient competence to practice healthy lifestyles rather than because of laziness or being irrational. Behavioral interventions for emerging adults need to help them develop skills to enhance health literacy and problem solving, thereby enhancing their awareness of available resources and decreasing the perceived cost of making healthy choices. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Understanding and making practice explicit

    Gráinne Conole

    2006-12-01

    Full Text Available This issue contains four, on the face of it, quite different papers, but on looking a little closer there are a number of interesting themes running through them that illustrate some of the key methodological and theoretical issues that e-learning researchers are currently struggling with; central to these is the issue of how do we understand and make practice explicit?

  18. Food choice decision-making by women with gestational diabetes.

    Hui, Amy Leung; Sevenhuysen, Gustaaf; Harvey, Dexter; Salamon, Elizabeth

    2014-02-01

    To enhance the dietary education presented to women with gestational diabetes (GDM) by exploring the reasons and experiences that women with GDM reported in making their food-choice decisions after receipt of dietary education from a healthcare professional. Food Choice Map (FCM) semi-structured in-depth interviews were conducted with 30 women with GDM living in the Winnipeg area during their pregnancies. Verbatim transcripts were generated from the interviews. A constant comparative method was used to generate common themes to answer research inquiries. Personal food preferences, hunger and cravings were the main factors affecting food choice decision-making in women with GDM. Although the information from healthcare professionals was 1 factor that affected food choice decision-making for most of the participants, more than half of the women, including all the women who were on insulin, reported difficulties in quick adaptation to dietary management in a limited time period. Information from other sources such as family members, friends, and internet were used to cope with the adaptation. These difficulties led to a sense of decreased control of GDM and were accompanied by frustration, especially for women taking insulin. Food choice decision-making varied for this group of women with GDM. Knowledge and information aided in making healthy food choices and in portion control. However, balancing individual needs and blood glucose control in a short time period was felt to be difficult and created frustration. The findings suggested that dietary consultation needs to be personalized and to be time sensitive to promote confidence in self-control. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  19. Models of Affective Decision Making: How Do Feelings Predict Choice?

    Charpentier, Caroline J; De Neve, Jan-Emmanuel; Li, Xinyi; Roiser, Jonathan P; Sharot, Tali

    2016-06-01

    Intuitively, how you feel about potential outcomes will determine your decisions. Indeed, an implicit assumption in one of the most influential theories in psychology, prospect theory, is that feelings govern choice. Surprisingly, however, very little is known about the rules by which feelings are transformed into decisions. Here, we specified a computational model that used feelings to predict choices. We found that this model predicted choice better than existing value-based models, showing a unique contribution of feelings to decisions, over and above value. Similar to the value function in prospect theory, our feeling function showed diminished sensitivity to outcomes as value increased. However, loss aversion in choice was explained by an asymmetry in how feelings about losses and gains were weighted when making a decision, not by an asymmetry in the feelings themselves. The results provide new insights into how feelings are utilized to reach a decision. © The Author(s) 2016.

  20. Drug choice in medical practice : rationales, routines and remedies

    Denig, Petra

    1994-01-01

    The aim of the studies presented in this dissertation is to describe and analyse drug choice in medical practice, and provide a better understanding of the possible shortcomings and the role of biomedical knowledge in the drug choice process.

  1. Decision-making experiments and real-world choice behaviour

    Timmermans, H.J.P.; vd Heijden, R.E.C.M.; Westerveld, J.

    1984-01-01

    This article is concerned with the analysis of consumer spatial choice behaviour using conjoint measurements. The study's objectives are to assess the appropriateness of conjoint measurement to represent a consumer's spatial decision making process, to identify the nature of aggregate utility

  2. Making Choices about Hydrogen : Transport Issues for Developing ...

    30 sept. 2008 ... Couverture du livre Making Choices about Hydrogen : Transport Issues for Developing Countries ... International Water Resources Association, in close collaboration with IDRC, is holding a webinar titled “Climate change and adaptive water management: Innovative solutions from the Global South”.

  3. Melioration as rational choice: sequential decision making in uncertain environments.

    Sims, Chris R; Neth, Hansjörg; Jacobs, Robert A; Gray, Wayne D

    2013-01-01

    Melioration-defined as choosing a lesser, local gain over a greater longer term gain-is a behavioral tendency that people and pigeons share. As such, the empirical occurrence of meliorating behavior has frequently been interpreted as evidence that the mechanisms of human choice violate the norms of economic rationality. In some environments, the relationship between actions and outcomes is known. In this case, the rationality of choice behavior can be evaluated in terms of how successfully it maximizes utility given knowledge of the environmental contingencies. In most complex environments, however, the relationship between actions and future outcomes is uncertain and must be learned from experience. When the difficulty of this learning challenge is taken into account, it is not evident that melioration represents suboptimal choice behavior. In the present article, we examine human performance in a sequential decision-making experiment that is known to induce meliorating behavior. In keeping with previous results using this paradigm, we find that the majority of participants in the experiment fail to adopt the optimal decision strategy and instead demonstrate a significant bias toward melioration. To explore the origins of this behavior, we develop a rational analysis (Anderson, 1990) of the learning problem facing individuals in uncertain decision environments. Our analysis demonstrates that an unbiased learner would adopt melioration as the optimal response strategy for maximizing long-term gain. We suggest that many documented cases of melioration can be reinterpreted not as irrational choice but rather as globally optimal choice under uncertainty.

  4. Enhancing School Wellness Environments to Make to Make the Healthy Choice the Easy Choice

    Stevens, JA; Alie, K

    2016-01-01

    The Virginia Department of Health’s Division of Prevention & Health Promotion has partnered with Virginia Cooperative Extension’s Family Nutrition Program and Virginia Tech in order to enhance Extension’s efforts to promote and support student health in select K-12 schools by implementing a variety of evidence-based nutrition and physical activity platforms intended to enhance school wellness environments, policies, and practices. Additionally, the implementation of a consistent statewide hea...

  5. Existential autonomy: why patients should make their own choices.

    Madder, H

    1997-01-01

    Savulescu has recently introduced the "rational non-interventional paternalist" model of the patient-doctor relationship. This paper addresses objections to such a model from the perspective of an anaesthetist. Patients need to make their own decisions if they are to be fully autonomous. Rational non-interventional paternalism undermines the importance of patient choice and so threatens autonomy. Doctors should provide an evaluative judgment of the best medical course of action, but ought to ...

  6. Simple model for multiple-choice collective decision making.

    Lee, Ching Hua; Lucas, Andrew

    2014-11-01

    We describe a simple model of heterogeneous, interacting agents making decisions between n≥2 discrete choices. For a special class of interactions, our model is the mean field description of random field Potts-like models and is effectively solved by finding the extrema of the average energy E per agent. In these cases, by studying the propagation of decision changes via avalanches, we argue that macroscopic dynamics is well captured by a gradient flow along E. We focus on the permutation symmetric case, where all n choices are (on average) the same, and spontaneous symmetry breaking (SSB) arises purely from cooperative social interactions. As examples, we show that bimodal heterogeneity naturally provides a mechanism for the spontaneous formation of hierarchies between decisions and that SSB is a preferred instability to discontinuous phase transitions between two symmetric points. Beyond the mean field limit, exponentially many stable equilibria emerge when we place this model on a graph of finite mean degree. We conclude with speculation on decision making with persistent collective oscillations. Throughout the paper, we emphasize analogies between methods of solution to our model and common intuition from diverse areas of physics, including statistical physics and electromagnetism.

  7. Local Choices: Rationality and the Contextuality of Decision-Making

    Vlaev, Ivo

    2018-01-01

    Rational explanation is ubiquitous in psychology and social sciences, ranging from rational analysis, expectancy-value theories, ideal observer models, mental logic to probabilistic frameworks, rational choice theory, and informal “folk psychological” explanation. However, rational explanation appears to be challenged by apparently systematic irrationality observed in psychological experiments, especially in the field of judgement and decision-making (JDM). Here, it is proposed that the experimental results require not that rational explanation should be rejected, but that rational explanation is local, i.e., within a context. Thus, rational models need to be supplemented with a theory of contextual shifts. We review evidence in JDM that patterns of choices are often consistent within contexts, but unstable between contexts. We also demonstrate that for a limited, though reasonably broad, class of decision-making domains, recent theoretical models can be viewed as providing theories of contextual shifts. It is argued that one particular significant source of global inconsistency arises from a cognitive inability to represent absolute magnitudes, whether for perceptual variables, utilities, payoffs, or probabilities. This overall argument provides a fresh perspective on the scope and limits of human rationality. PMID:29301289

  8. Local Choices: Rationality and the Contextuality of Decision-Making.

    Vlaev, Ivo

    2018-01-02

    Rational explanation is ubiquitous in psychology and social sciences, ranging from rational analysis, expectancy-value theories, ideal observer models, mental logic to probabilistic frameworks, rational choice theory, and informal "folk psychological" explanation. However, rational explanation appears to be challenged by apparently systematic irrationality observed in psychological experiments, especially in the field of judgement and decision-making (JDM). Here, it is proposed that the experimental results require not that rational explanation should be rejected, but that rational explanation is local , i.e., within a context. Thus, rational models need to be supplemented with a theory of contextual shifts. We review evidence in JDM that patterns of choices are often consistent within contexts, but unstable between contexts. We also demonstrate that for a limited, though reasonably broad, class of decision-making domains, recent theoretical models can be viewed as providing theories of contextual shifts. It is argued that one particular significant source of global inconsistency arises from a cognitive inability to represent absolute magnitudes, whether for perceptual variables, utilities, payoffs, or probabilities. This overall argument provides a fresh perspective on the scope and limits of human rationality.

  9. Protect Your Heart: Check Food Labels to Make Heart-Healthy Choices

    ... Protein 15g Total Amounts To make heart-healthy food choices, look at the totals and cut back on • ... Toolkit No. 8: Protect Your Heart: Make Smart Food Choices • Toolkit No. 9: Protect Your Heart: Choose Fats ...

  10. How to make innovation practical

    Janssen, F.J.J.M.; Westbroek, H.B.; Doyle, W.; Van Driel, J.H.

    2013-01-01

    Many attempts to reform teaching fail to be enacted in most classrooms. The purpose of this paper is to present a bridging methodology for connecting pedagogical innovations to the practical demands of teaching.

  11. The priority heuristic: making choices without trade-offs.

    Brandstätter, Eduard; Gigerenzer, Gerd; Hertwig, Ralph

    2006-04-01

    Bernoulli's framework of expected utility serves as a model for various psychological processes, including motivation, moral sense, attitudes, and decision making. To account for evidence at variance with expected utility, the authors generalize the framework of fast and frugal heuristics from inferences to preferences. The priority heuristic predicts (a) the Allais paradox, (b) risk aversion for gains if probabilities are high, (c) risk seeking for gains if probabilities are low (e.g., lottery tickets), (d) risk aversion for losses if probabilities are low (e.g., buying insurance), (e) risk seeking for losses if probabilities are high, (f) the certainty effect, (g) the possibility effect, and (h) intransitivities. The authors test how accurately the heuristic predicts people's choices, compared with previously proposed heuristics and 3 modifications of expected utility theory: security-potential/aspiration theory, transfer-of-attention-exchange model, and cumulative prospect theory. ((c) 2006 APA, all rights reserved).

  12. The Priority Heuristic: Making Choices Without Trade-Offs

    Brandstätter, Eduard; Gigerenzer, Gerd; Hertwig, Ralph

    2010-01-01

    Bernoulli's framework of expected utility serves as a model for various psychological processes, including motivation, moral sense, attitudes, and decision making. To account for evidence at variance with expected utility, we generalize the framework of fast and frugal heuristics from inferences to preferences. The priority heuristic predicts (i) Allais' paradox, (ii) risk aversion for gains if probabilities are high, (iii) risk seeking for gains if probabilities are low (lottery tickets), (iv) risk aversion for losses if probabilities are low (buying insurance), (v) risk seeking for losses if probabilities are high, (vi) certainty effect, (vii) possibility effect, and (viii) intransitivities. We test how accurately the heuristic predicts people's choices, compared to previously proposed heuristics and three modifications of expected utility theory: security-potential/aspiration theory, transfer-of-attention-exchange model, and cumulative prospect theory. PMID:16637767

  13. Beyond labelling: what strategies do nut allergic individuals employ to make food choices? A qualitative study.

    Julie Barnett

    Full Text Available OBJECTIVE: Food labelling is an important tool that assists people with peanut and tree nut allergies to avoid allergens. Nonetheless, other strategies are also developed and used in food choice decision making. In this paper, we examined the strategies that nut allergic individuals deploy to make safe food choices in addition to a reliance on food labelling. METHODS: THREE QUALITATIVE METHODS: an accompanied shop, in-depth semi-structured interviews, and the product choice reasoning task - were used with 32 patients that had a clinical history of reactions to peanuts and/or tree nuts consistent with IgE-mediated food allergy. Thematic analysis was applied to the transcribed data. RESULTS: Three main strategies were identified that informed the risk assessments and food choice practices of nut allergic individuals. These pertained to: (1 qualities of product such as the product category or the country of origin, (2 past experience of consuming a food product, and (3 sensory appreciation of risk. Risk reasoning and risk management behaviours were often contingent on the context and other physiological and socio-psychological needs which often competed with risk considerations. CONCLUSIONS: Understanding and taking into account the complexity of strategies and the influences of contextual factors will allow healthcare practitioners, allergy nutritionists, and caregivers to advise and educate patients more effectively in choosing foods safely. Governmental bodies and policy makers could also benefit from an understanding of these food choice strategies when risk management policies are designed and developed.

  14. Nudge or Grudge? Choice Architecture and Parental Decision-Making.

    Blumenthal-Barby, Jennifer; Opel, Douglas J

    2018-03-01

    Richard Thaler and Cass Sunstein define a nudge as "any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives." Much has been written about the ethics of nudging competent adult patients. Less has been written about the ethics of nudging surrogates' decision-making and how the ethical considerations and arguments in that context might differ. Even less has been written about nudging surrogate decision-making in the context of pediatrics, despite fundamental differences that exist between the pediatric and adult contexts. Yet, as the field of behavioral economics matures and its insights become more established and well-known, nudges will become more crafted, sophisticated, intentional, and targeted. Thus, the time is now for reflection and ethical analysis regarding the appropriateness of nudges in pediatrics. We argue that there is an even stronger ethical justification for nudging in parental decision-making than with competent adult patients deciding for themselves. We give three main reasons in support of this: (1) child patients do not have autonomy that can be violated (a concern with some nudges), and nudging need not violate parental decision-making authority; (2) nudging can help fulfill pediatric clinicians' obligations to ensure parental decisions are in the child's interests, particularly in contexts where there is high certainty that a recommended intervention is low risk and of high benefit; and (3) nudging can relieve parents' decisional burden regarding what is best for their child, particularly with decisions that have implications for public health. © 2018 The Hastings Center.

  15. A practical test for the choice of mixing distribution in discrete choice models

    Fosgerau, Mogens; Bierlaire, Michel

    2007-01-01

    The choice of a specific distribution for random parameters of discrete choice models is a critical issue in transportation analysis. Indeed, various pieces of research have demonstrated that an inappropriate choice of the distribution may lead to serious bias in model forecast and in the estimated...... means of random parameters. In this paper, we propose a practical test, based on seminonparametric techniques. The test is analyzed both on synthetic and real data, and is shown to be simple and powerful. (c) 2007 Elsevier Ltd. All rights reserved....

  16. Decision-making: Theory and practice

    SM Turpin; MA Marais

    2004-01-01

    This paper compares a number of theoretical models of decision-making with the way in which senior managers make decisions in practice. Six prominent decision-makers were interviewed about their own decision-making style, as well as their use of decision support technology. Significant variation was found in personal decision-making styles. However, some central themes emerged, such as the importance of sensitivity to the decision-making context, attention to the presentation of information, ...

  17. The anatomy of choice: dopamine and decision-making.

    Friston, Karl; Schwartenbeck, Philipp; FitzGerald, Thomas; Moutoussis, Michael; Behrens, Timothy; Dolan, Raymond J

    2014-11-05

    This paper considers goal-directed decision-making in terms of embodied or active inference. We associate bounded rationality with approximate Bayesian inference that optimizes a free energy bound on model evidence. Several constructs such as expected utility, exploration or novelty bonuses, softmax choice rules and optimism bias emerge as natural consequences of free energy minimization. Previous accounts of active inference have focused on predictive coding. In this paper, we consider variational Bayes as a scheme that the brain might use for approximate Bayesian inference. This scheme provides formal constraints on the computational anatomy of inference and action, which appear to be remarkably consistent with neuroanatomy. Active inference contextualizes optimal decision theory within embodied inference, where goals become prior beliefs. For example, expected utility theory emerges as a special case of free energy minimization, where the sensitivity or inverse temperature (associated with softmax functions and quantal response equilibria) has a unique and Bayes-optimal solution. Crucially, this sensitivity corresponds to the precision of beliefs about behaviour. The changes in precision during variational updates are remarkably reminiscent of empirical dopaminergic responses-and they may provide a new perspective on the role of dopamine in assimilating reward prediction errors to optimize decision-making.

  18. How Politicians Make Decisions: A Political Choice Experiment

    Fatás, Enrique; Neugebauer, Tibor; Tamborero, Pilar

    2004-01-01

    The present paper reports on a political choice experiment with elected real-world politicians. A questionnaire on political and public issues is taken to examine whether prospect theory predicts the responses of experts from the field better than rational choice theory. The results indicate that framing effects exist but that expertise may weaken the deviation from rational choice.

  19. Make the healthy choice the easy choice: using behavioral economics to advance a culture of health.

    Volpp, K G; Asch, D A

    2017-05-01

    Despite great advances in the science and technology of health care, a large gap separates theoretically achievable advances in health from what individuals and populations actually achieve. Human behavior sits on the final common pathway to so many of our health and health care goals, including the prevention and management of illness and the fostering of wellness. Behavioral economics is a relatively new field offering approaches to supplement many of the conventional approaches to improving health behaviors that rely on education or standard economic theory. While those conventional approaches presume that an educated public will naturally make decisions that optimize personal welfare, approaches derived from behavioral economics harness existing and predictable patterns of behavior that often lead people to make choices against their best interests. By keeping these predictable patterns of behavior in mind when designing health insurance, health care programs or the health-related aspects of everyday life, behavioral economists aim to meet people half-way: no longer asking them to reshape their behavior to something more health promoting, but helping the behavioral patterns they already follow lead them to better health. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. How politicians make decisions under risk: a political choice experiment

    Enrique Fatás; Tibor Neugebauer; Pilar Tamborero

    2004-01-01

    We report on an experimental study with real-world politicians. These political experts face political choice problems under risk and probability. Thus, we test the frequently observed violations of rational choice theory -the reference point effect, loss aversion, framing effects, and the common ratio effect- with experts from the field. Their choices violate expected utility theory. Nevertheless, they appear to be more rational and less risk averse (loving) in the domain of gains (losses) t...

  1. Making choices about medical interventions: the experience of disabled young people with degenerative conditions.

    Mitchell, Wendy A

    2014-04-01

    Current western policy, including the UK, advocates choice for service users and their families, taking greater control and being more involved in decision making. However, children's role in health decision making, especially from their own perspective, has received less research attention compared to doctors and parents' perspectives. To explore the perspective and experiences of disabled young people with degenerative conditions as they face significant medical interventions and engage in decision-making processes. Findings from a longitudinal qualitative study of 10 young people (13-22 years) with degenerative conditions are reported. Individual semi-structured interviews were conducted with participants over 3 years (2007-2010); the paper reports data from all three interview rounds. Interviews focused on medical intervention choices the young people identified as significant. Although the young people in this study felt involved in the medical intervention choices discussed, findings demonstrate a complex and diverse picture of decision making. Results highlighted different decisional roles adopted by the young people, the importance of information heuristics and working with other people whilst engaging in complex processes weighing up different decisional factors. Young people's experiences demonstrate the importance of moving beyond viewing health choices as technical or rational decisions. How each young person framed their decision was important. Recognizing this diversity and the importance of emerging themes, such as living a normal life, independence, fear of decisions viewed as 'irreversible' and the role of parents and peers in decision making highlights that, there are clear practice implications including, active practitioner listening, sensitivity and continued holistic family working. © 2012 John Wiley & Sons Ltd.

  2. Beyond informed choice: Prenatal risk assessment, decision-making and trust

    Nete Schwennesen

    2008-05-01

    Full Text Available In 2004 prenatal risk assessment (PRA was implemented as a routine offer to all pregnant women in Denmark. It was argued that primarily the new programme would give all pregnant women an informed choice about whether to undergo prenatal testing. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, we call into question the assumption underlying the new guidelines that more choice and more objective information is a source of empowerment and control. We focus on one couple's experience of PRA. This case makes it evident how supposed choices in the context of PRA may not be experienced as such. Rather, they are experienced as complicated processes of meaning-making in the relational space between the clinical setting, professional authority and the social life of the couples. PRA users are reluctant to make choices and abandon health professionals as authoritative experts in the face of complex risk knowledge. When assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the foetus. It is argued that al-though the new programme of prenatal testing in Denmark presents itself in opposition to quasi-eugenic and paternalistic forms of governing couples' decisions it represents another form of government that works through the notion of choice. An ethics of a shared responsibility of PRA and its outcome would be more in agreement with how decisions are actually made.http://dx.doi.org/10.5324/eip.v2i1.1687

  3. The dynamics of user perception, decision making and route choice

    Vreeswijk, Jacob Dirk

    2015-01-01

    Travellers’ response to performance changes in the traffic system is a decisive factor in the effectiveness of traffic management measures. This thesis provides an empirical and quantitative assessment of choice behaviour and the effects of perception error on choice outcomes. It considers users’

  4. Decision-making: Theory and practice

    SM Turpin

    2004-12-01

    Full Text Available This paper compares a number of theoretical models of decision-making with the way in which senior managers make decisions in practice. Six prominent decision-makers were interviewed about their own decision-making style, as well as their use of decision support technology. Significant variation was found in personal decision-making styles. However, some central themes emerged, such as the importance of sensitivity to the decision-making context, attention to the presentation of information, and the use of intuition. In terms of the use of decision support technology, the use of self-help tools, such as office software, was clearly favoured.

  5. Selective attention increases choice certainty in human decision making.

    Zizlsperger, Leopold; Sauvigny, Thomas; Haarmeier, Thomas

    2012-01-01

    Choice certainty is a probabilistic estimate of past performance and expected outcome. In perceptual decisions the degree of confidence correlates closely with choice accuracy and reaction times, suggesting an intimate relationship to objective performance. Here we show that spatial and feature-based attention increase human subjects' certainty more than accuracy in visual motion discrimination tasks. Our findings demonstrate for the first time a dissociation of choice accuracy and certainty with a significantly stronger influence of voluntary top-down attention on subjective performance measures than on objective performance. These results reveal a so far unknown mechanism of the selection process implemented by attention and suggest a unique biological valence of choice certainty beyond a faithful reflection of the decision process.

  6. The Impact of Irish Policy and Legislation on How Adults with Learning Disabilities Make Choices

    Carey, Eileen; Griffiths, Colin

    2016-01-01

    This paper reflects the impact of policy and legislation in the context of how adults with learning disabilities make choices. Following an overview of policies which have improved choice for people with learning disability in the United Kingdom, this paper reviews "choice" in current Irish policy and legislation. This paper, while…

  7. Melioration as Rational Choice: Sequential Decision Making in Uncertain Environments

    Sims, Chris R.; Neth, Hansjorg; Jacobs, Robert A.; Gray, Wayne D.

    2013-01-01

    Melioration--defined as choosing a lesser, local gain over a greater longer term gain--is a behavioral tendency that people and pigeons share. As such, the empirical occurrence of meliorating behavior has frequently been interpreted as evidence that the mechanisms of human choice violate the norms of economic rationality. In some environments, the…

  8. Shape Your Family's Habits: Helping Kids Make Healthy Choices

    ... kids to be active. When it comes to food and physical activity, what you say and do around your children can have a lasting effect. Work ... Choices Help Kids Form Healthy Habits Be a role model. Eat healthy family meals together. Walk or ride ...

  9. Clinical decision making in veterinary practice

    Everitt, Sally

    2011-01-01

    Aim The aim of this study is to develop an understanding of the factors which influence veterinary surgeons’ clinical decision making during routine consultations. Methods The research takes a qualitative approach using video-cued interviews, in which one of the veterinary surgeon’s own consultations is used as the basis of a semi-structured interview exploring decision making in real cases. The research focuses primarily on small animal consultations in first opinion practice, how...

  10. Making Philosophy of Science Education Practical for Science Teachers

    Janssen, F. J. J. M.; van Berkel, B.

    2015-04-01

    Philosophy of science education can play a vital role in the preparation and professional development of science teachers. In order to fulfill this role a philosophy of science education should be made practical for teachers. First, multiple and inherently incomplete philosophies on the teacher and teaching on what, how and why should be integrated. In this paper we describe our philosophy of science education (ASSET approach) which is composed of bounded rationalism as a guideline for understanding teachers' practical reasoning, liberal education underlying the why of teaching, scientific perspectivism as guideline for the what and educational social constructivism as guiding choices about the how of science education. Integration of multiple philosophies into a coherent philosophy of science education is necessary but not sufficient to make it practical for teachers. Philosophies are still formulated at a too abstract level to guide teachers' practical reasoning. For this purpose, a heuristic model must be developed on an intermediate level of abstraction that will provide teachers with a bridge between these abstract ideas and their specific teaching situation. We have developed and validated such a heuristic model, the CLASS model in order to complement our ASSET approach. We illustrate how science teachers use the ASSET approach and the CLASS model to make choices about the what, the how and the why of science teaching.

  11. Behavioral Economics and the Supplemental Nutrition Assistance Program:: Making the Healthy Choice the Easy Choice.

    Ammerman, Alice S; Hartman, Terry; DeMarco, Molly M

    2017-02-01

    The Supplemental Nutrition Assistance Program (SNAP) serves as an important nutritional safety net program for many Americans. Given its aim to use traditional economic levers to provide access to food, the SNAP program includes minimal nutritional requirements and restrictions. As food choices are influenced by more than just economic constraints, behavioral economics may offer insights and tools for altering food purchases for SNAP users. This manuscript outlines behavioral economics strategies that have potential to encourage healthier food choices within the SNAP program. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  12. Making Choices about Hydrogen: Transport Issues for Developing ...

    30 sept. 2008 ... This timely book examines how developing countries can factor in competing arguments about the impending arrival of practical hydrogen fuel cell technology as they explore options for future policies.

  13. Making Choices: Self-Directed Teams or Total Quality Management?

    Holpp, Lawrence

    1992-01-01

    Describes differences between total quality management and self-directed teams in terms of job design, decision making, flexibility, supervision, labor relations, quality, customers, and training. Offers suggestions for which method to choose when. (SK)

  14. GM ethical decision making in practice

    Donald Bruce

    2002-09-01

    Full Text Available Celia Deane-Drummond's case for wisdom as an approach to ethical decision making and her doubts about case-oriented methodology are critiqued with reference to the SRT Project's Engineering Genesis study. Its approach is explored in practical decisions on various real life examples of genetic modification in crops and animals. It involved both intrinsic and consequential approaches, and identified key value positions behind different policies and stakeholders. The paper also clarifies the relationship between reactive (cost-benefit and precautionary risk assessment, explaining their strengths and limitations, and the role of underlying values in both forms of risk decision making.

  15. Why did Jacques Monod make the choice of mechanistic determinism?

    Loison, Laurent

    2015-06-01

    The development of molecular biology placed in the foreground a mechanistic and deterministic conception of the functioning of macromolecules. In this article, I show that this conception was neither obvious, nor necessary. Taking Jacques Monod as a case study, I detail the way he gradually came loose from a statistical understanding of determinism to finally support a mechanistic understanding. The reasons of the choice made by Monod at the beginning of the 1950s can be understood only in the light of the general theoretical schema supported by the concept of mechanistic determinism. This schema articulates three fundamental notions for Monod, namely that of the rigidity of the sequence of the genetic program, that of the intrinsic stability of macromolecules (DNA and proteins), and that of the specificity of molecular interactions. Copyright © 2015 Académie des sciences. Published by Elsevier SAS. All rights reserved.

  16. Bayesian probability estimates are not necessary to make choices satisfying Bayes’ rule in elementary situations

    Artur eDomurat

    2015-08-01

    Full Text Available This paper has two aims. First, we investigate how often people make choices conforming to Bayes’ rule when natural sampling is applied. Second, we show that using Bayes’ rule is not necessary to make choices satisfying Bayes’ rule. Simpler methods, even fallacious heuristics, might prescribe correct choices reasonably often under specific circumstances. We considered elementary situations with binary sets of hypotheses and data. We adopted an ecological approach and prepared two-stage computer tasks resembling natural sampling. Probabilistic relations were to be inferred from a set of pictures, followed by a choice between the data which was made to maximize a chance for a preferred outcome. Using Bayes’ rule was deduced indirectly from choices.Study 1 (N=60 followed a 2 (gender: female vs. male x 2 (education: humanities vs. pure sciences between-subjects factorial design with balanced cells, and a number of correct choices as a dependent variable. Choices satisfying Bayes’ rule were dominant. To investigate ways of making choices more directly, we replicated Study 1, adding a task with a verbal report. In Study 2 (N=76 choices conforming to Bayes’ rule dominated again. However, the verbal reports revealed use of a new, non-inverse rule, which always renders correct choices, but is easier than Bayes’ rule to apply. It does not require inversing conditions (transforming P(H and P(D|H into P(H|D when computing chances. Study 3 examined efficiency of the three fallacious heuristics (pre-Bayesian, representativeness, and evidence-only in producing choices concordant with Bayes’ rule. Computer-simulated scenarios revealed that the heuristics produce correct choices reasonably often under specific base rates and likelihood ratios. Summing up we conclude that natural sampling leads to most choices conforming to Bayes’ rule. However, people tend to replace Bayes’ rule with simpler methods, and even use of fallacious heuristics may

  17. Separate neural mechanisms underlie choices and strategic preferences in risky decision making.

    Venkatraman, Vinod; Payne, John W; Bettman, James R; Luce, Mary Frances; Huettel, Scott A

    2009-05-28

    Adaptive decision making in real-world contexts often relies on strategic simplifications of decision problems. Yet, the neural mechanisms that shape these strategies and their implementation remain largely unknown. Using an economic decision-making task, we dissociate brain regions that predict specific choices from those predicting an individual's preferred strategy. Choices that maximized gains or minimized losses were predicted by functional magnetic resonance imaging activation in ventromedial prefrontal cortex or anterior insula, respectively. However, choices that followed a simplifying strategy (i.e., attending to overall probability of winning) were associated with activation in parietal and lateral prefrontal cortices. Dorsomedial prefrontal cortex, through differential functional connectivity with parietal and insular cortex, predicted individual variability in strategic preferences. Finally, we demonstrate that robust decision strategies follow from neural sensitivity to rewards. We conclude that decision making reflects more than compensatory interaction of choice-related regions; in addition, specific brain systems potentiate choices depending on strategies, traits, and context.

  18. Making choices about hydrogen: Transport issues for developing ...

    12.6 Malaysian government hydrogen fuel-cell research, development and ...... Policies, promises and practices: The application of hydrogen fuel cells in the transport ... This contrasts with the internal combustion engine, whose principles were ..... through annual registration fees and taxes on motor vehicles and motor fuel.

  19. Making Good Choices: Districts Take the Lead. Comprehensive School Reform.

    North Central Regional Educational Lab., Oak Brook, IL.

    Public schools across the country are aiming to improve student performance by engaging in comprehensive school reform (CSR). This guide was created to help school districts make CSR an integral part of their strategies for improving student achievement. Five components for CSR are described: (1) Strategizing, whereby the district supports CSR by…

  20. Hungry pigeons make suboptimal choices, less hungry pigeons do not.

    Laude, Jennifer R; Pattison, Kristina F; Zentall, Thomas R

    2012-10-01

    Hungry animals will often choose suboptimally by being attracted to reliable signals for food that occur infrequently (they gamble) over less reliable signals for food that occur more often. That is, pigeons prefer an option that 50 % of the time provides them with a reliable signal for the appearance of food but 50 % of the time provides them with a reliable signal for the absence of food (overall 50 % reinforcement) over an alternative that always provides them with a signal for the appearance of food 75 % of the time (overall 75 % reinforcement). The pigeons appear to choose impulsively for the possibility of obtaining the reliable signal for reinforcement. There is evidence that greater hunger is associated with greater impulsivity. We tested the hypothesis that if the pigeons were less hungry, they would be less impulsive and, thus, would choose more optimally (i.e., on the basis of the overall probability of reinforcement). We found that hungry pigeons choose the 50 % reinforcement alternative suboptimally but less hungry pigeons prefer the more optimal 75 % reinforcement. Paradoxically, pigeons that needed the food more received less of it. These findings have implications for how level of motivation may also affect human suboptimal choice (e.g., purchase of lottery tickets and playing slot machines).

  1. Adapting Scott and Bruce's General Decision-Making Style Inventory to Patient Decision Making in Provider Choice.

    Fischer, Sophia; Soyez, Katja; Gurtner, Sebastian

    2015-05-01

    Research testing the concept of decision-making styles in specific contexts such as health care-related choices is missing. Therefore, we examine the contextuality of Scott and Bruce's (1995) General Decision-Making Style Inventory with respect to patient choice situations. Scott and Bruce's scale was adapted for use as a patient decision-making style inventory. In total, 388 German patients who underwent elective joint surgery responded to a questionnaire about their provider choice. Confirmatory factor analyses within 2 independent samples assessed factorial structure, reliability, and validity of the scale. The final 4-dimensional, 13-item patient decision-making style inventory showed satisfactory psychometric properties. Data analyses supported reliability and construct validity. Besides the intuitive, dependent, and avoidant style, a new subdimension, called "comparative" decision-making style, emerged that originated from the rational dimension of the general model. This research provides evidence for the contextuality of decision-making style to specific choice situations. Using a limited set of indicators, this report proposes the patient decision-making style inventory as valid and feasible tool to assess patients' decision propensities. © The Author(s) 2015.

  2. A Decision Making Analysis of Persuasive Argumentation and the Choice Shift Effect

    Vinokur, Amiram; And Others

    1975-01-01

    A subjective expected utility (SEU) decision-making analysis was performed on the content of arguments generated by subjects privately or during group discussion in response to choice-dilemmas shown to shift toward risk and caution. (Editor)

  3. Bayesian probability estimates are not necessary to make choices satisfying Bayes’ rule in elementary situations

    Domurat, Artur; Kowalczuk, Olga; Idzikowska, Katarzyna; Borzymowska, Zuzanna; Nowak-Przygodzka, Marta

    2015-01-01

    This paper has two aims. First, we investigate how often people make choices conforming to Bayes’ rule when natural sampling is applied. Second, we show that using Bayes’ rule is not necessary to make choices satisfying Bayes’ rule. Simpler methods, even fallacious heuristics, might prescribe correct choices reasonably often under specific circumstances. We considered elementary situations with binary sets of hypotheses and data. We adopted an ecological approach and prepared two-stage computer tasks resembling natural sampling. Probabilistic relations were inferred from a set of pictures, followed by a choice which was made to maximize the chance of a preferred outcome. Use of Bayes’ rule was deduced indirectly from choices. Study 1 used a stratified sample of N = 60 participants equally distributed with regard to gender and type of education (humanities vs. pure sciences). Choices satisfying Bayes’ rule were dominant. To investigate ways of making choices more directly, we replicated Study 1, adding a task with a verbal report. In Study 2 (N = 76) choices conforming to Bayes’ rule dominated again. However, the verbal reports revealed use of a new, non-inverse rule, which always renders correct choices, but is easier than Bayes’ rule to apply. It does not require inversion of conditions [transforming P(H) and P(D|H) into P(H|D)] when computing chances. Study 3 examined the efficiency of three fallacious heuristics (pre-Bayesian, representativeness, and evidence-only) in producing choices concordant with Bayes’ rule. Computer-simulated scenarios revealed that the heuristics produced correct choices reasonably often under specific base rates and likelihood ratios. Summing up we conclude that natural sampling results in most choices conforming to Bayes’ rule. However, people tend to replace Bayes’ rule with simpler methods, and even use of fallacious heuristics may be satisfactorily efficient. PMID:26347676

  4. >From individual choice to group decision-making

    Galam, Serge; Zucker, Jean-Daniel

    2000-12-01

    Some universal features are independent of both the social nature of the individuals making the decision and the nature of the decision itself. On this basis a simple magnet like model is built. Pair interactions are introduced to measure the degree of exchange among individuals while discussing. An external uniform field is included to account for a possible pressure from outside. Individual biases with respect to the issue at stake are also included using local random fields. A unique postulate of minimum conflict is assumed. The model is then solved with emphasis on its psycho-sociological implications. Counter-intuitive results are obtained. At this stage no new physical technicality is involved. Instead the full psycho-sociological implications of the model are drawn. Few cases are then detailed to enlight them. In addition, several numerical experiments based on our model are shown to give both an insight on the dynamics of the model and suggest further research directions.

  5. Putting informed and shared decision making into practice.

    Towle, Angela; Godolphin, William; Grams, Garry; Lamarre, Amanda

    2006-12-01

    To investigate the practice, experiences and views of motivated and trained family physicians as they attempt to implement informed and shared decision making (ISDM) in routine practice and to identify and understand the barriers they encounter. Patient involvement in decision making about their health care has been the focus of much academic activity. Although significant conceptual and experimental work has been done, ISDM rarely occurs. Physician attitudes and lack of training are identified barriers. Qualitative analysis of transcripts of consultations and key informant group interviews. Six family physicians received training in the ISDM competencies. Audiotapes of office consultations were made before and after training. Transcripts of consultations were examined to identify behavioural markers associated with each competency and the range of expression of the competencies. The physicians attended group interviews at the end of the study to explore experiences of ISDM. The physicians liked the ISDM model and thought that they should put it into practice. Evidence from transcripts indicated they were able to elicit concerns, ideas and expectations (although not about management) and agree an action plan. They did not elicit preferences for role or information. They sometimes offered choices. They had difficulty achieving full expression of any of the competencies and integrating ISDM into their script for the medical interview. The study also identified a variety of competency-specific barriers. A major barrier to the practice of ISDM by motivated physicians appears to be the need to change well-established patterns of communication with patients.

  6. Towards energy efficient distillation technologies – Making the right choice

    Kiss, Anton A.; Flores Landaeta, Servando J.; Infante Ferreira, Carlos A.

    2012-01-01

    In spite of claiming around half of the operational costs of chemical plants, distillation is still the most popular separation technology. Distillation has low thermodynamic efficiency, requiring the input of high quality energy in the reboiler – while rejecting a similar amount of heat at lower temperature, in the condenser. Several heat pump concepts have been proposed to upgrade that thermal energy and reduce the consumption of valuable utilities. Under certain conditions, the energy savings of heat pump assisted distillation is usually around 20–50%. This study proposes a novel selection scheme of energy efficient distillation technologies, with a special focus on heat pumps. The most promising technologies selected are vapor compression, mechanical or thermal vapor recompression, absorption, compression–resorption and thermo-acoustic heat pumps, multi-effect distillation, heat integrated distillation column, cyclic distillation, Kaibel and dividing-wall column. The scheme considers as the main selection criteria the type of separation tasks, product flow and specifications, operating pressure, difference in boiling points, reboiler duty and its temperature level. Moreover, this scheme is very practical, allowing major time and resources savings in the design of eco-efficient processes. -- Highlights: ► Heat pump assisted distillation with energy savings of 20–50%. ► Novel and practical selection scheme of energy efficient distillation technologies. ► Evaluation of promising technologies: VC, MVR, TVR, AHP, CHRP, TAHP, HIDiC, DWC, CyDist. ► Selection criteria include: ΔT b , ΔT lift , P, T reb , Q reb , volatility. ► Design of eco-efficient processes with high COP, and lower TIC and TAC.

  7. Pharmacy career deciding: making choice a "good fit".

    Willis, Sarah Caroline; Shann, Phillip; Hassell, Karen

    2009-01-01

    The purpose of this article is to explore factors influencing career deciding amongst pharmacy students and graduates in the U.K. Group interviews were used to devise a topic guide for five subsequent focus groups with pharmacy students and graduates. Focus groups were tape-recorded, recordings transcribed, and transcripts analysed. Key themes and interlinking factors relating to pharmacy career deciding were identified in the transcripts, following a constructivist approach. Participants' described making a "good fit" between themselves, their experiences, social networks etc. and pharmacy. Central to a coherent career deciding narrative were: having a job on graduation; and the instrumental advantage of studying a vocational course. Focusing on career deciding of UK pharmacy students and graduates may limit the study's generalisability to other countries. However, our findings are relevant to those interested in understanding students' motivations for healthcare careers, since our results suggest that making a "good fit" describes a general process of matching between a healthcare career and personal experience. As we have found that pharmacy career deciding was not, usually, a planned activity, career advisors and those involved in higher education recruitment should take into account the roles played by personal preferences and values in choosing a degree course. A qualitative study like this can illustrate how career deciding occurs and provide insight into the process from a student's perspective. This can help inform guidance processes, selection to healthcare professions courses within the higher education sector, and stimulate debate amongst those involved with recruitment of healthcare workers about desirable motivators for healthcare careers.

  8. Dental patient preferences and choice in clinical decision-making.

    Fukai, Kakuhiro; Yoshino, Koichi; Ohyama, Atsushi; Takaesu, Yoshinori

    2012-01-01

    In economics, the concept of utility refers to the strength of customer preference. In health care assessment, the visual analogue scale (VAS), the standard gamble, and the time trade-off are used to measure health state utilities. These utility measurements play a key role in promoting shared decision-making in dental care. Individual preference, however, is complex and dynamic. The purpose of this study was to investigate the relationship between patient preference and educational intervention in the field of dental health. The data were collected by distributing questionnaires to employees of two companies in Japan. Participants were aged 18-65 years and consisted of 111 males and 93 females (204 in total). One company (Group A) had a dental program of annual check-ups and health education in the workplace, while the other company (Group B) had no such program. Statistical analyses were performed with the t-test and Chi-square test. The questionnaire items were designed to determine: (1) oral health-related quality of life, (2) dental health state utilities (using VAS), and (3) time trade-off for regular dental check-ups. The percentage of respondents in both groups who were satisfied with chewing function, appearance of teeth, and social function ranged from 23.1 to 42.4%. There were no significant differences between groups A and B in the VAS of decayed, filled, and missing teeth. The VAS of gum bleeding was 42.8 in Group A and 51.3 in Group B (pdecision-making.

  9. Persistent optimizing: how mothers make food choices for their preschool children.

    Walsh, Audrey; Meagher-Stewart, Donna; Macdonald, Marilyn

    2015-04-01

    Mothers' ability to provide healthy food choices for their children has become more complex in our current obesogenic environment. We conducted a total of 35 interviews with 18 mothers of preschool children. Using constructivist grounded theory methods, we developed a substantive theory of how mothers make food choices for their preschoolers. Our substantive theory, persistent optimizing, consists of three main integrated conceptual categories: (a) acknowledging contextual constraints, (b) stretching boundaries, and (c) strategic positioning. Implications to improve mothers' ability to make healthy food choices that reduce their children's risk of becoming overweight or obese are discussed. © The Author(s) 2014.

  10. Ethical decision making in clinical practice.

    Fowler, M D

    1989-12-01

    Contemporary nursing ethics education focuses on the use of an analytical model of ethical decision making for both its process and its content. Perhaps this is the case because it bears some resemblance to the nursing process, which is taught in a similar fashion. Thus, a deductivist method of ethical decision making fits within the same general schema of the hypotheticodeductive method of decision making that is taught for nursing diagnosis. Ethics requires that nurses respect persons, inform patients and secure their consent, not inflict harm, preserve the patient's quality of life, prevent harm and remove harmful conditions, do good for patients, and minimize risk to themselves. These are among the norms of obligation that guide ethical analysis and judgment in nursing practice and are the substance of the analytical model of ethical decision making. Nursing's ethics has established high ideals and strong demands for nurses. These are demands which nurses have met and ideals which have often been realized. Whatever the strength of our science, nursing is an inherently moral endeavor and is only as strong as its commitment to its ethical obligations and values. Between the grinding edges of the forces that affect it, nursing must establish its priorities among the aspects of its environment that it attempts to control. Ethics must be chief among those priorities.

  11. One-reason decision making in risky choice? A closer look at the priority heuristic

    Benjamin E. Hilbig

    2008-08-01

    Full Text Available Although many models for risky choices between gambles assume that information is somehow integrated, the recently proposed priority heuristic (PH claims that choices are based on one piece of information only. That is, although the current reason for a choice according to the PH can vary, all other reasons are claimed to be ignored. However, the choices predicted by the PH and other pieces of information are often confounded, thus rendering critical tests of whether decisions are actually based on one reason only, impossible. The current study aims to remedy this problem by manipulating the number of reasons additionally in line with the choice implied by the PH. The results show that participants' choices and decision times depend heavily on the number of reasons in line with the PH --- thus contradicting the notion of non-compensatory, one-reason decision making.

  12. Parental Influence on Exploratory Students' College Choice, Major, and Career Decision Making

    Workman, Jamie L.

    2015-01-01

    This article explores parental influence on exploratory students' college choice, major, and career decision making. The research began with examination of a first year academic advising model and Living Learning Community. Parental influence emerged as a key theme in student decision making processes. The project was conducted using grounded…

  13. Tragic Choices in Humanitarian Aid : A Framework of Organizational Determinants of NGO Decision Making

    Heyse, Liesbet

    Humanitarian NGOs face difficult choices about whom to help and whom not on a daily basis. The research question in this article is how humanitarian NGOs make these difficult decisions and why in a particular way. March's study on consequential and appropriate decision-making processes is used to

  14. Free-Choice Learning Suited to Women's Participation Needs in Environmental Decision-Making Processes

    Skanavis, Constantina; Sakellari, Maria

    2012-01-01

    United Nations mandates recognize the need to promote the full participation of women in environmental decision-making processes on the basis of gender equality. But, there remains a profound lack of effective women's participation in some sectors of environmental decision-making. Free-choice environmental learning offers an effective educational…

  15. Preventing School Employee Sexual Misconduct: An Outcome Survey Analysis of Making Right Choices.

    Lipson, Glenn; Grant, Billie-Jo; Mueller, Jessica; Sonnich, Steve

    2018-05-30

    This treatment-only study examines the impact of Making Right Choices, an online course prevention program designed to promote the knowledge, awareness, and prevention of school employee sexual misconduct. The sample included 13,007 school employee participants who took the Making Right Choices course between May 6, 2011, and March 12, 2017, in California and New York. The 20-item measure, Preventing Misconduct Assessment, was administered to participants at the end of the online course; completion of the measure was voluntary. Descriptive statistics revealed that a large majority of participants reported increasing their knowledge and awareness of school employee sexual misconduct because of their participation in the Making Right Choices online course. This study yields important findings regarding the impact of a sexual misconduct prevention program and, specifically, the difference it may make for non-licensed school employees. These findings indicate that school employees are accepting of sexual misconduct training programs and rate them as having value.

  16. Balancing food values : Making sustainable choices within cooking practices

    De Jong, A.; Kuijer, S.C.; Rydell, T.

    2013-01-01

    Within user-centred design and topics such as persuasive design, pleasurable products, and design for sustainable behaviour, there is a danger of over-determining, pacifying or reducing people’s diversity. Taking the case of sustainable food, we have looked into the social aspects of cooking at

  17. Making ethical choices: a comprehensive decision-making model for Canadian psychologists.

    Hadjistavropoulos, T; Malloy, D C

    2000-05-01

    This paper proposes a theoretical augmentation of the seven-step decision-making model outlined in the Canadian Code of Ethics for Psychologists. We propose that teleological, deontological, and existential ethical perspectives should be taken into account in the decision-making process. We also consider the influence of individual, issue-specific, significant-other, situational, and external factors on ethical decision-making. This theoretical analysis demonstrates the richness and complexity of ethical decision-making.

  18. The Making of Informed Choice in Midwifery: A Feminist Experiment in Care.

    MacDonald, Margaret E

    2017-11-15

    This paper is about the clinical principle of informed choice-the hallmark feature of the midwifery model of care in Ontario, Canada. Drawing on ethnographic history interviews with midwives, I trace the origins of the idea of informed choice to its roots in the social movement of midwifery in North America in the late 1960s and 1970s. At that time informed choice was not the distinctive feature of midwifery but was deeply embedded what I call midwifery's feminist experiment in care. But as midwifery in Ontario transitioned from a social movement to a full profession within the formal health care system, informed choice was strategically foregrounded in order to make the midwifery model of care legible and acceptable to a skeptical medical profession, conservative law makers, and a mainstream clientele. As mainstream biomedicine now takes up the rhetoric of patient empowerment and informed choice, this paper is at once a nuanced history of the making of the concept and also a critique of the ascendant 'regime of choice' in contemporary health care, inspired by the reflections of the midwives in my study for whom choice is impossible without care.

  19. The spatial practices of school administrative clerks: making space ...

    The spatial practices of school administrative clerks: making space for ... their invisible, largely taken-for-granted roles in a school's everyday functioning. This main aim of this article is to make their everyday practices and contributions visible, ...

  20. RELATION BETWEEN QUALITY OF LIFE, CHOICE MAKING, AND FUTURE EXPECTATIONS IN ADULTS WITH INTELLECTUAL DISABILITY

    Vesna KOSTIKJ-IVANOVIKJ

    2016-09-01

    Full Text Available Introduction: Quality of life of individuals depends significantly on the ability to have control over everyday life, realized through the freedom to make choices from available options and self-determination. Objective: To determine the correlation between possibilities for making choices and expectations for the future with the quality of life in adults with intellectual disabilities according self-assessment and assessment by others. Methods: Descriptive, method of correlation and comparative analysis ware applied. From techniques, analysis of documents, surveys with the Quality of life questionnaire by Schalock and Keith and Questionnaire for expectations for the future by Speck, and scaling with the Scale for assessment of the opportunities for making choices by Kishi et al. Sample consisted of 130 intellectually disabled adults and 130 proxies. For establishing connection between the examined phenomena Pearson correlation coefficient (r was used, at p<0,01. Results: There is a strong correlation between the results obtained from the questionnaires about quality of life and opportunities for making choices, self-assessment r(130=0,497, p<0,01, assessment by others r(130=0,482, p<0,01. There is a correlation between the results obtained from the questionnaires about quality of life and expectations for the future, but not very strong, self-assessment r(130=0,233, p=0,008<0,01, assessment by others r(130=0,305, p<0,01. Conclusion: There is a correlation between opportunities for making choices and expectations for the future with the quality of life in adults with intellectual disabilities. To improve the quality of life in these individuals, it is necessary to design programs that will develop self-concept, abilities for self-determination and making personal choices.

  1. Choice of water in healthy baby nutrition – practical aspects

    Anna Rudnicka

    2018-03-01

    Full Text Available Water is the basic component of the human body at all development stages. The water requirement per body weight is four times higher in infants compared to adults. The only source of water in the first months of life is human milk and/or formula. The main factors determining the choice of water for infants and children are: the total amount, type and content of dissolved minerals (mainly sodium, sulphates, nitrates and nitrites, concentration of minerals and good manufacturing practice as well as implemented and evaluated safety systems for food quality. In the case of infants and children younger than 3 years of age, spring water or low-mineralised natural water is recommended, while moderately mineralised water is allowed in children older than 1 year of age. Water cannot have any, even potential, negative effects on the child’s organism. The main health-related threat associated with water consumption (also water used for formula preparation is microbiological, agricultural or industrial water contamination. This review presents the most important information about tap and bottled water used to feed infants and toddlers. Studies on well water have also been discussed, raising questions about the legitimacy and safety of its consumption by infants. The review presents a management scheme for water used for the preparation of infant formula as well as potential health-related risks of consuming overmineralised drinking water, water with chemical contamination or water distributed in plastic containers.

  2. Do Moral Choices Make Us Feel Good? The Development of Adolescents' Emotions Following Moral Decision Making

    Malti, Tina; Keller, Monika; Buchmann, Marlis

    2013-01-01

    Some people believe that making the morally right decision makes people feel good. However, until now, there has been no empirical evidence in support of this belief. In a representative two-wave longitudinal study of 995 15-year-old adolescents followed for 3 years (until the age of 18) in Switzerland, adolescents were asked about their decisions…

  3. Putting informed and shared decision making into practice

    Towle, Angela; Godolphin, William; Grams, Garry; LaMarre, Amanda

    2006-01-01

    Abstract Objective  To investigate the practice, experiences and views of motivated and trained family physicians as they attempt to implement informed and shared decision making (ISDM) in routine practice and to identify and understand the barriers they encounter. Background  Patient involvement in decision making about their health care has been the focus of much academic activity. Although significant conceptual and experimental work has been done, ISDM rarely occurs. Physician attitudes and lack of training are identified barriers. Design  Qualitative analysis of transcripts of consultations and key informant group interviews. Settings and participants  Six family physicians received training in the ISDM competencies. Audiotapes of office consultations were made before and after training. Transcripts of consultations were examined to identify behavioural markers associated with each competency and the range of expression of the competencies. The physicians attended group interviews at the end of the study to explore experiences of ISDM. Results  The physicians liked the ISDM model and thought that they should put it into practice. Evidence from transcripts indicated they were able to elicit concerns, ideas and expectations (although not about management) and agree an action plan. They did not elicit preferences for role or information. They sometimes offered choices. They had difficulty achieving full expression of any of the competencies and integrating ISDM into their script for the medical interview. The study also identified a variety of competency‐specific barriers. Conclusion  A major barrier to the practice of ISDM by motivated physicians appears to be the need to change well‐established patterns of communication with patients. PMID:17083559

  4. The decision-making capacity of elderly hospitalized patients: validation of a test on their choice of return home.

    Romdhani, Mouna; Abbas, Rachid; Peyneau, Cécile; Koskas, Pierre; Houenou Quenum, Nadège; Galleron, Sandrine; Drunat, Olivier

    2018-03-01

    Elderly hospitalized patients have uncertain or questionable capacity to make decisions about their care. Determining whether an elderly patient possesses decision-making capacity to return at home is a major concern for geriatricians in everyday practice. To construct and internally validate a new tool, the dream of home test (DROM-test), as support for decision making hospitalization discharge destination for the elderly in the acute or sub-acute care setting. The DROM-test consists of 10 questions and 4 vignettes based upon the 4 relevant criteria for decision-making: capacity to understand information, to appreciate and reason about medical risks and to communicate a choice. A prospective observational study was conducted during 6 months in 2 geriatric care units in Bretonneau Hospital (Assistance publique, Hôpitaux de Paris). We compared the patient decision of DROM-test regarding discharge recommendations with those of an Expert committee and of the team in charge of the patient. 102 were included: mean age 83.1 + 6.7 [70; 97], 66.67% females. Principal components analysis revealed four dimensions: choice, understanding, reasoning and understanding. The area under the ROC curve was 0.64 for the choice dimension, 0.59 for the understanding, 0.53 for the reasoning and 0.52 for the apprehension. Only the choice dimension was statistically associated with the decision of the committee of experts (p=0.017). Even though Drom-test has limitations, it provides an objective way to ascertain decision-making capacity for hospitalised elderly patients.

  5. The Effects of Frequency of Media Utilization on Decision Making of Media Choice

    Gotoh, Yasushi

    2014-01-01

    The purpose of this study is to use the Analytic Hierarchy Process in order to identify how frequency of media use in daily life affects decision-making in media choice. 276 university students took part in this research, They were asked to prioritize their ways of obtaining information about current affairs using sets of media such as TV, books,…

  6. Argumentation and Decision Making in Professional Practice

    Gainsburg, Julie; Fox, John; Solan, Lawrence M.

    2016-01-01

    How is argumentation used in professional practice? As schools aim to ensure that students are college-and-career ready, classroom practices might be informed by argumentation in the professions. An analysis of evidence-based reasoning in 3 professions--engineering, law, and medicine--offers out-of-school perspectives on the practices and purposes…

  7. Prefrontal spatial working memory network predicts animal's decision making in a free choice saccade task.

    Mochizuki, Kei; Funahashi, Shintaro

    2016-01-01

    While neurons in the lateral prefrontal cortex (PFC) encode spatial information during the performance of working memory tasks, they are also known to participate in subjective behavior such as spatial attention and action selection. In the present study, we analyzed the activity of primate PFC neurons during the performance of a free choice memory-guided saccade task in which the monkeys needed to choose a saccade direction by themselves. In trials when the receptive field location was subsequently chosen by the animal, PFC neurons with spatially selective visual response started to show greater activation before cue onset. This result suggests that the fluctuation of firing before cue presentation prematurely biased the representation of a certain spatial location and eventually encouraged the subsequent choice of that location. In addition, modulation of the activity by the animal's choice was observed only in neurons with high sustainability of activation and was also dependent on the spatial configuration of the visual cues. These findings were consistent with known characteristics of PFC neurons in information maintenance in spatial working memory function. These results suggest that precue fluctuation of spatial representation was shared and enhanced through the working memory network in the PFC and could finally influence the animal's free choice of saccade direction. The present study revealed that the PFC plays an important role in decision making in a free choice condition and that the dynamics of decision making are constrained by the network architecture embedded in this cortical area. Copyright © 2016 the American Physiological Society.

  8. Prefrontal spatial working memory network predicts animal's decision making in a free choice saccade task

    Mochizuki, Kei

    2015-01-01

    While neurons in the lateral prefrontal cortex (PFC) encode spatial information during the performance of working memory tasks, they are also known to participate in subjective behavior such as spatial attention and action selection. In the present study, we analyzed the activity of primate PFC neurons during the performance of a free choice memory-guided saccade task in which the monkeys needed to choose a saccade direction by themselves. In trials when the receptive field location was subsequently chosen by the animal, PFC neurons with spatially selective visual response started to show greater activation before cue onset. This result suggests that the fluctuation of firing before cue presentation prematurely biased the representation of a certain spatial location and eventually encouraged the subsequent choice of that location. In addition, modulation of the activity by the animal's choice was observed only in neurons with high sustainability of activation and was also dependent on the spatial configuration of the visual cues. These findings were consistent with known characteristics of PFC neurons in information maintenance in spatial working memory function. These results suggest that precue fluctuation of spatial representation was shared and enhanced through the working memory network in the PFC and could finally influence the animal's free choice of saccade direction. The present study revealed that the PFC plays an important role in decision making in a free choice condition and that the dynamics of decision making are constrained by the network architecture embedded in this cortical area. PMID:26490287

  9. Do pregnant women and their partners make an informed choice about first trimester risk assessment for Down syndrome, and are they satisfied with the choice?

    Bangsgaard, Louise; Tabor, Ann

    2012-01-01

    OBJECTIVE: All pregnant women in Denmark are offered risk assessment for Down syndrome. The aim of this study was to investigate whether women and partners make an informed choice about first trimester risk assessment, and their satisfaction with the choice. METHODS: A survey using multiple measure...... of knowledge (82% and 81%) and positive attitudes regarding risk assessment (97% and 98%), leading to 79% and 80% making an informed choice. Education predicted knowledge for women (odds ratio 3.42; 95% confidence interval 1.63-7.18) and partners (odds ratio 2.97; 95% confidence interval 1.37-6.45), country...... of origin predicted knowledge, attitude and informed choice among women. Three hundred thirty-two women (99%) and all partners were satisfied with having chosen risk assessment. CONCLUSIONS: Although 80% of pregnant women and partners make an informed choice about undergoing first trimester risk assessment...

  10. Perceived risks around choice and decision making at end-of-life: a literature review.

    Wilson, F; Gott, M; Ingleton, C

    2013-01-01

    the World Health Organization identifies meeting patient choice for care as central to effective palliative care delivery. Little is known about how choice, which implies an objective balancing of options and risks, is understood and enacted through decision making at end-of-life. to explore how perceptions of 'risk' may inform decision-making processes at end-of-life. an integrative literature review was conducted between January and February 2010. Papers were reviewed using Hawker et al.'s criteria and evaluated according to clarity of methods, analysis and evidence of ethical consideration. All literature was retained as background data, but given the significant international heterogeneity the final analysis specifically focused on the UK context. the databases Medline, PsycINFO, Assia, British Nursing Index, High Wire Press and CINAHL were explored using the search terms decision*, risk, anxiety, hospice and palliative care, end-of-life care and publication date of 1998-2010. thematic analysis of 25 papers suggests that decision making at end-of-life is multifactorial, involving a balancing of risks related to caregiver support; service provider resources; health inequalities and access; challenges to information giving; and perceptions of self-identity. Overall there is a dissonance in understandings of choice and decision making between service providers and service users. the concept of risk acknowledges the factors that shape and constrain end-of-life choices. Recognition of perceived risks as a central factor in decision making would be of value in acknowledging and supporting meaningful decision making processes for patients with palliative care needs and their families.

  11. Decision-making: Theory and Practice

    Turpin, SM

    2004-01-01

    Full Text Available of decision support technology. Much variation was found in people’s personal decision-making styles. However, some central themes emerged, such as the importance of sensitivity to the decision-making context, attention to the presentation of information...

  12. Making room in engineering design practices

    Petersen, Rikke Premer; Buch, Anders

    2016-01-01

    This article aims to explore the challenges that occur from a practice perspective when a new approach to engineering design enters an existing ecology of professional practices in a workplace. Using four empirical episodes, the article illustrates a concrete effort to challenge what counts...... as ‘real engineering’ or what is recognized as part of the engineering expertise. Using an ethnographic, case-studybased research design the article documentshowholistically minded professionals do engineering design ‘by other means’, in ways that strive to promote user experience approaches. The article...... aims to show how engineering practices do not exist in isolation within an organization and how ambitions to transform professional engineering work practices require a change in the very ecologies of practices that exist across an organization...

  13. Why women of lower educational attainment struggle to make healthier food choices

    Lawrence, Wendy; Skinner, Chas; Haslam, Cheryl

    2009-01-01

    Women of lower educational attainment are more likely to eat unhealthy diets than women of higher educational attainment. To identify influences on the food choices of women with lower educational attainment, 11 focus groups (eight with women of lower, and three with women of higher educational...... attainment) were held. Using a semi-structured discussion guide, environmental, social, historical and psychological factors known to be associated with food choice were explored. Audio recordings were transcribed verbatim and thematically analysed. Compared to women of higher educational attainment, women...... of lower educational attainment had less control over their families' food choices, less support for attempts to eat healthily, fewer opportunities to observe and learn good food-related practices, more negative affect, more perceived environmental constraints and more ambiguous beliefs about...

  14. Emotion regulation and risk taking: predicting risky choice in deliberative decision making.

    Panno, Angelo; Lauriola, Marco; Figner, Bernd

    2013-01-01

    Only very recently has research demonstrated that experimentally induced emotion regulation strategies (cognitive reappraisal and expressive suppression) affect risky choice (e.g., Heilman et al., 2010). However, it is unknown whether this effect also operates via habitual use of emotion regulation strategies in risky choice involving deliberative decision making. We investigated the role of habitual use of emotion regulation strategies in risky choice using the "cold" deliberative version of the Columbia Card Task (CCT; Figner et al., 2009). Fifty-three participants completed the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003) and--one month later--the CCT and the PANAS. Greater habitual cognitive reappraisal use was related to increased risk taking, accompanied by decreased sensitivity to changes in probability and loss amount. Greater habitual expressive suppression use was related to decreased risk taking. The results show that habitual use of reappraisal and suppression strategies predict risk taking when decisions involve predominantly cognitive-deliberative processes.

  15. Complex Decision Making Theory and Practice

    Qudrat-Ullah, Hassan; Spector, J Michael

    2007-01-01

    The increasingly complex environment of today's world, characterized by technological innovation and global communication, generates myriads of possible and actual interactions while limited physical and intellectual resources severely impinge on decision makers, be it in the public or private domains. At the core of the decision-making process is the need for quality information that allows the decision maker to better assess the impact of decisions in terms of outcomes, nonlinear feedback processes and time delays on the performance of the complex system invoked. This volume is a timely review on the principles underlying complex decision making, the handling of uncertainties in dynamic envrionments and of the various modeling approaches used. The book consists of five parts, each composed of several chapters: I: Complex Decision Making: Concepts, Theories and Empirical Evidence II: Tools and Techniques for Decision Making in Complex Environments and Systems III: System Dynamics and Agent-Based Modeling IV:...

  16. Understanding patients’ decision-making strategies in hospital choice: Literature review and a call for experimental research

    Sophia Fischer

    2015-12-01

    Full Text Available Insights from psychology and cognitive science have, as yet, barely entered hospital choice research. This conceptual article closes this gap by reviewing and conceptually framing the current literature on hospital choice and patient information behavior and by discussing which tools are needed to advance scientific methodology in the study of patient decision-making strategies in hospital choice. Specifically, we make a call for more experimental research in hospital choice in order to complement existing theories, methods, and tools. This article introduces computerized process-tracing tools in hospital choice research, and also outlines a hands-on example, to provide a basis for future research.

  17. Risky decision-making under risk in schizophrenia: A deliberate choice?

    Pedersen, Anya; Göder, Robert; Tomczyk, Samuel; Ohrmann, Patricia

    2017-09-01

    Patients with schizophrenia reveal impaired decision-making strategies causing social, financial and health care problems. The extent to which deficits in decision-making reflect intentional risky choices in schizophrenia is still under debate. Based on previous studies we expected patients with schizophrenia to reveal a riskier performance on the GDT and to make more disadvantageous decisions on the IGT. In the present study, we investigated 38 patients with schizophrenia and 38 matched healthy control subjects with two competing paradigms regarding feedback: (1) The Game of Dice Task (GDT), in which the probabilities of winning or losing are stable and explicitly disclosed to the subject, to assess decision-making under risk and (2) the Iowa Gambling Task (IGT), which requires subjects to infer the probabilities of winning or losing from feedback, to investigate decision-making under ambiguity. Patients with schizophrenia revealed an overall riskier performance on the GDT; although they adjusted their strategy over the course of the GDT, they still made significantly more disadvantageous choices than controls. More positive symptoms in patients with schizophrenia indicated by higher PANSS positive scores were associated with riskier choices and less use of negative feedback. Compared to healthy controls, they were not impaired in net score but chose more disadvantageous cards than controls on the first block of the IGT. Effects of medication at the time of testing cannot be ruled out. Our findings suggest that patients with schizophrenia make riskier decisions and are less able to regulate their decision-making to implement advantageous strategies, even when the probabilities of winning or losing are explicitly disclosed. The dissociation between performance on the GDT and IGT suggests a pronounced impairment of executive functions related to the dorsolateral prefrontal cortex. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Practice makes perfect in memory recall.

    Romani, Sandro; Katkov, Mikhail; Tsodyks, Misha

    2016-04-01

    A large variability in performance is observed when participants recall briefly presented lists of words. The sources of such variability are not known. Our analysis of a large data set of free recall revealed a small fraction of participants that reached an extremely high performance, including many trials with the recall of complete lists. Moreover, some of them developed a number of consistent input-position-dependent recall strategies, in particular recalling words consecutively ("chaining") or in groups of consecutively presented words ("chunking"). The time course of acquisition and particular choice of positional grouping were variable among participants. Our results show that acquiring positional strategies plays a crucial role in improvement of recall performance. © 2016 Romani et al.; Published by Cold Spring Harbor Laboratory Press.

  19. Making the Choices Necessary to Make a Difference: The Responsibility of National Bioethics Commissions.

    Grady, Christine

    2017-05-01

    In this essay, I offer some reflections on how the topics were identified and approached by the Presidential Commission for the Study of Bioethical Issues, on which I had the honor to serve, in the hope that the reflections may be useful to future national bioethics commissions. In the executive order that established the bioethics commission, President Obama explicitly recognized the ethical imperative to responsibly pursue science, innovation, and advances in biomedical research and health care, and the importance of national attention to these issues. The bioethics commission prioritized practicable, actionable, targeted recommendations. Like most earlier U.S. national bioethics commissions, President Obama's commission did not undertake projects on significant and troublesome issues related to health and health care that were not associated with new science or technology. Issues such as health care access, health care delivery, opioid addiction, end-of-life care, and physician-aid-in-dying are topical and ethically complex areas of significance to bioethics, and they are also being discussed and debated by the public, the media, and policy-makers. In my view, there are good reasons to select and prioritize projects as well as a justification for confining commission efforts to issues related to novel science and emerging technologies, when there is only one national-level bioethics commission that has been established by the Office of the President. © 2017 The Hastings Center.

  20. Evidence Accumulation and Choice Maintenance Are Dissociated in Human Perceptual Decision Making.

    Mads Lund Pedersen

    Full Text Available Perceptual decision making in monkeys relies on decision neurons, which accumulate evidence and maintain choices until a response is given. In humans, several brain regions have been proposed to accumulate evidence, but it is unknown if these regions also maintain choices. To test if accumulator regions in humans also maintain decisions we compared delayed and self-paced responses during a face/house discrimination decision making task. Computational modeling and fMRI results revealed dissociated processes of evidence accumulation and decision maintenance, with potential accumulator activations found in the dorsomedial prefrontal cortex, right inferior frontal gyrus and bilateral insula. Potential maintenance activation spanned the frontal pole, temporal gyri, precuneus and the lateral occipital and frontal orbital cortices. Results of a quantitative reverse inference meta-analysis performed to differentiate the functions associated with the identified regions did not narrow down potential accumulation regions, but suggested that response-maintenance might rely on a verbalization of the response.

  1. Seeking balance: the complexity of choice-making among academic surgeons.

    Brown, Judith Belle; Fluit, Meghan; Lent, Barbara; Herbert, Carol

    2011-10-01

    This study describes the experiences of academic surgeons in seeking a balance between their personal and professional lives. This phenomenological study, conducted in 2009-2010 at the University of Western Ontario, used in-depth individual semistructured interviews to explore the ideas, perceptions, and experiences of 17 recently recruited academic surgeons (nine women/eight men) about seeking balance between their personal and professional lives. All the interviews were audiotaped and transcribed verbatim. The data analysis was both iterative and interpretative. All the participants expressed a passion and commitment to academic surgery, but their stories revealed the complexity of making choices in seeking a balance between their personal and professional lives. This process of making choices was filtered through influential values in their lives, which in turn determined how they set boundaries to protect their personal and family time from the demands of their professional obligations. Intertwined in this process were the trade-offs they had to make in order to seek balance. Some choices, boundary-setting strategies, and trade-offs were dictated by gender. Finally, the process of making choices was not static; instead, the data revealed how it was both dynamic and cyclical, requiring reexamination over the life cycle, as well as their career trajectory. Thus, seeking a balance was an ever-changing process. Understanding how members of an academic department of surgery navigate the balance between their personal and professional worlds may provide new insights for other disciplines seeking to enhance the development of the next generation of academics.

  2. Developing and pilot testing a shared decision-making intervention for dialysis choice.

    Finderup, Jeanette; Jensen, Jens K D; Lomborg, Kirsten

    2018-04-17

    Evidence is inconclusive on how best to guide the patient in decision-making around haemodialysis and peritoneal dialysis choice. International guidelines recommend involvement of the patient in the decision to choose the dialysis modality most suitable for the individual patient. Nevertheless, studies have shown lack of involvement of the patient in decision-making. To develop and pilot test an intervention for shared decision-making targeting the choice of dialysis modality. This study reflects the first two phases of a complex intervention design: phase 1, the development process and phase 2, feasibility and piloting. Because decision aids were a part of the intervention, the International Patient Decision Aid Standards were considered. The pilot test included both the intervention and the feasibility of the validated shared decision-making questionnaire (SDM Q9) and the Decision Quality Measure (DQM) applied to evaluate the intervention. A total of 137 patients tested the intervention. After the intervention, 80% of the patients chose dialysis at home reflecting an increase of 23% in starting dialysis at home prior to the study. The SDM Q9 showed the majority of the patients experienced this intervention as shared decision-making. An intervention based on shared decision-making supported by decision aids seemed to increase the number of patients choosing home dialysis. The SDM Q9 and DQM were feasible evaluation tools. Further research is needed to gain insight into the patients' experiences of involvement and the implications for their choice of dialysis modality. © 2018 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  3. The Nature of Belief-Directed Exploratory Choice in Human Decision-Making

    W. Bradley Knox

    2012-01-01

    Full Text Available In non-stationary environments, there is a conflict between exploiting currently favored options and gaining information by exploring lesser-known options that in the past have proven less rewarding. Optimal decision making in such tasks requires considering future states of the environment (i.e., planning and properly updating beliefs about the state of environment after observing outcomes associated with choices. Optimal belief-updating is reflective in that beliefs can change without directly observing environmental change. For example, after ten seconds elapse, one might correctly believe that a traffic light last observed to be red is now more likely to be green. To understand human decision-making when rewards associated with choice options change over time, we develop a variant of the classic bandit task that is both rich enough to encompass relevant phenomena and sufficiently tractable to allow for ideal actor analysis of sequential choice behavior. We evaluate whether people update beliefs about the state of environment in a reflexive (i.e., only in response to observed changes in reward structure or reflective manner. In contrast to purely "random" accounts of exploratory behavior, model-based analyses of the subjects’ choices and latencies indicate that people are reflective belief-updaters. However, unlike the Ideal Actor model, our analyses indicate that people's choice behavior does not reflect consideration of future environmental states. Thus, although people update beliefs in a reflective manner consistent with the ideal actor, they do not engage in optimal long-term planning, but instead myopically choose the option on every trial that is believed to have the highest immediate payoff.

  4. The Nature of Belief-Directed Exploratory Choice in Human Decision-Making

    Knox, W. Bradley; Otto, A. Ross; Stone, Peter; Love, Bradley C.

    2011-01-01

    In non-stationary environments, there is a conflict between exploiting currently favored options and gaining information by exploring lesser-known options that in the past have proven less rewarding. Optimal decision-making in such tasks requires considering future states of the environment (i.e., planning) and properly updating beliefs about the state of the environment after observing outcomes associated with choices. Optimal belief-updating is reflective in that beliefs can change without directly observing environmental change. For example, after 10 s elapse, one might correctly believe that a traffic light last observed to be red is now more likely to be green. To understand human decision-making when rewards associated with choice options change over time, we develop a variant of the classic “bandit” task that is both rich enough to encompass relevant phenomena and sufficiently tractable to allow for ideal actor analysis of sequential choice behavior. We evaluate whether people update beliefs about the state of environment in a reflexive (i.e., only in response to observed changes in reward structure) or reflective manner. In contrast to purely “random” accounts of exploratory behavior, model-based analyses of the subjects’ choices and latencies indicate that people are reflective belief updaters. However, unlike the Ideal Actor model, our analyses indicate that people’s choice behavior does not reflect consideration of future environmental states. Thus, although people update beliefs in a reflective manner consistent with the Ideal Actor, they do not engage in optimal long-term planning, but instead myopically choose the option on every trial that is believed to have the highest immediate payoff. PMID:22319503

  5. Simplifying decision making: a practical framework

    Chaudhry, Muhammad Shirjeel Riaz; Sidek, Mohmad Safhree

    2014-01-01

    Approved for public release; distribution is unlimited This thesis proposes a decision-making model based on PESTEL (Political, Economic, Social, Technological, Environmental, and Legal) analysis, AHP (Analytical Hierarchical Process), and game theory. The case study used to demonstrate the concept is a 2013 Malaysian crisis wherein foreign intruders occupied a village in Sabah state. The Malaysian government, ultimately, launched a military operation to clear the area. The focus of our st...

  6. Evidence-based medicine, the research-practice gap, and biases in medical and surgical decision making in dermatology.

    Eaglstein, William H

    2010-10-01

    The objectives of this article are to promote a better understanding of a group of biases that influence therapeutic decision making by physicians/dermatologists and to raise the awareness that these biases contribute to a research-practice gap that has an impact on physicians and treatment solutions. The literature included a wide range of peer-reviewed articles dealing with biases in decision making, evidence-based medicine, randomized controlled clinical trials, and the research-practice gap. Bias against new therapies, bias in favor of indirect harm or omission, and bias against change when multiple new choices are offered may unconsciously affect therapeutic decision making. Although there is no comprehensive understanding or theory as to how choices are made by physicians, recognition of certain cognition patterns and their associated biases will help narrow the research-practice gap and optimize decision making regarding therapeutic choices.

  7. Sensorimotor learning biases choice behavior: a learning neural field model for decision making.

    Christian Klaes

    Full Text Available According to a prominent view of sensorimotor processing in primates, selection and specification of possible actions are not sequential operations. Rather, a decision for an action emerges from competition between different movement plans, which are specified and selected in parallel. For action choices which are based on ambiguous sensory input, the frontoparietal sensorimotor areas are considered part of the common underlying neural substrate for selection and specification of action. These areas have been shown capable of encoding alternative spatial motor goals in parallel during movement planning, and show signatures of competitive value-based selection among these goals. Since the same network is also involved in learning sensorimotor associations, competitive action selection (decision making should not only be driven by the sensory evidence and expected reward in favor of either action, but also by the subject's learning history of different sensorimotor associations. Previous computational models of competitive neural decision making used predefined associations between sensory input and corresponding motor output. Such hard-wiring does not allow modeling of how decisions are influenced by sensorimotor learning or by changing reward contingencies. We present a dynamic neural field model which learns arbitrary sensorimotor associations with a reward-driven Hebbian learning algorithm. We show that the model accurately simulates the dynamics of action selection with different reward contingencies, as observed in monkey cortical recordings, and that it correctly predicted the pattern of choice errors in a control experiment. With our adaptive model we demonstrate how network plasticity, which is required for association learning and adaptation to new reward contingencies, can influence choice behavior. The field model provides an integrated and dynamic account for the operations of sensorimotor integration, working memory and action

  8. The dynamics of decision making in risky choice: An Eye-tracking Analysis

    Susann eFiedler

    2012-10-01

    Full Text Available In the last years, research on risky choice has moved beyond analyzing choices only. Models have been suggested that aim to describe the underlying cognitive processes and some studies have tested process predictions of these models. Prominent approaches are evidence accumulation models such as Decision Field Theory (DFT, simple serial heuristic models such as the Adaptive Toolbox, and connectionist approaches such as the Parallel Constraint Satisfaction Model (PCS. In two studies involving measures of attention and pupil dilation, we investigate hypotheses derived from these models in choices between two gambles with two outcomes each. We show that attention to an outcome of a gamble increases with its probability and its value and that attention shifts towards the subsequently favored gamble after about two thirds of the decision process, indicating a gaze-cascade effect. Information search occurs mostly within gambles, and the direction of search does not change over the course of decision making. Pupil dilation, which reflects both cognitive effort and arousal, increases during the decision process and increases with mean Expected Value. Overall, the results support aspects of automatic integration models for risky choice such as DFT and PCS, but in their current specification none of them can account for the full pattern of results.

  9. The dynamics of decision making in risky choice: an eye-tracking analysis.

    Fiedler, Susann; Glöckner, Andreas

    2012-01-01

    In the last years, research on risky choice has moved beyond analyzing choices only. Models have been suggested that aim to describe the underlying cognitive processes and some studies have tested process predictions of these models. Prominent approaches are evidence accumulation models such as decision field theory (DFT), simple serial heuristic models such as the adaptive toolbox, and connectionist approaches such as the parallel constraint satisfaction (PCS) model. In two studies involving measures of attention and pupil dilation, we investigate hypotheses derived from these models in choices between two gambles with two outcomes each. We show that attention to an outcome of a gamble increases with its probability and its value and that attention shifts toward the subsequently favored gamble after about two thirds of the decision process, indicating a gaze-cascade effect. Information search occurs mostly within-gambles, and the direction of search does not change over the course of decision making. Pupil dilation, which reflects both cognitive effort and arousal, increases during the decision process and increases with mean expected value. Overall, the results support aspects of automatic integration models for risky choice such as DFT and PCS, but in their current specification none of them can account for the full pattern of results.

  10. Making an informed choice in the catering environment: what do consumers want to know?

    Mackison, D; Wrieden, W L; Anderson, A S

    2009-12-01

    Eating outside the home is common in the UK, but it remains difficult for consumers to make informed choices based on menu information. The present study examines the reported preferences for the provision of nutrition (salt, fat and energy) and ingredient information in six types of UK catering outlets. Participants completed a short postal survey, assessing their frequency of dining at specific catering establishments as well as their desire to see nutrition and ingredient information. The responses from 786 adults aged >or=18 years (of whom 65% claimed to be 'motivated to eat a healthy diet') indicated that over 40% reported eating at a catering outlet at least once a week. Over half said that they would wish to see information on ingredients and the salt content of menu items at all venues. Preference for information on energy and fat content was less popular and varied in the range 42-56% for energy and 47-59% for fat. It is notable that 43% of respondents said they would welcome information on energy content of menu items in restaurants. A significant proportion of consumers wish to see information on the ingredients and nutrition composition on menu items for sale in UK catering outlets. Such information is likely to raise an awareness and understanding of healthy food choices and assist the population in making informed choices about healthy eating.

  11. Time Is Money: The Decision Making of Smartphone High Users in Gain and Loss Intertemporal Choice.

    Tang, Zixuan; Zhang, Huijun; Yan, An; Qu, Chen

    2017-01-01

    Nowadays the smartphone plays an important role in our lives. While it brings us convenience and efficiency, its overuse can cause problems. Although a great number of studies have demonstrated that people affected by substance abuse, pathological gambling, and internet addiction disorder have lower self-control than average, scarcely any study has investigated the decision making of smartphone high users by using a behavioral paradigm. The present study employed an intertemporal task, the Smartphone Addiction Inventory (SPAI) and the Barratt Impulsiveness Scale 11th version (BIS-11) to explore the decision control of smartphone high users in a sample of 125 college students. Participants were divided into three groups according to their SPAI scores. The upper third (69 or higher), middle third (from 61 to 68) and lower third (60 or lower) of scores were defined as high smartphone users, medium users and low users, respectively. We compared the percentage of small immediate reward/penalty choices in different conditions between the three groups. Relative to the low users group, high users and medium users were more inclined to request an immediate monetary reward. Moreover, for the two dimensions of time and money in intertemporal choice, high users and medium users showed a bias in intertemporal choice task among most of the time points and value magnitude compared to low users. These findings demonstrated that smartphone overuse was associated with problematic decision-making, a pattern similar to that seen in persons affected by a variety of addictions.

  12. A new model to understand the career choice and practice location decisions of medical graduates.

    Stagg, P; Greenhill, J; Worley, P S

    2009-01-01

    Australian medical education is increasingly influenced by rural workforce policy. Therefore, understanding the influences on medical graduates' practice location and specialty choice is crucial for medical educators and medical workforce planners. The South Australian Flinders University Parallel Rural Community Curriculum (PRCC) was funded by the Australian Government to help address the rural doctor workforce shortage. The PRCC was the first community based medical education program in Australia to teach a full academic year of medicine in South Australian rural general practices. The aim of this research was to identify what factors influence the career choices of PRCC graduates. A retrospective survey of all contactable graduates of the PRCC was undertaken. Quantitative data were analysed using SPSS 14.0 for Windows. Qualitative data were entered into NVIVO 7 software for coding, and analysed using content analysis. Usable data were collected from 46 of the 86 contactable graduates (53%). More than half of the respondents (54%) reported being on a rural career path. A significant relationship exists between being on a rural career pathway and making the decision prior to or during medical school (p = 0.027), and between graduates in vocational training who are on an urban career path and making a decision on career specialty after graduation from medical school (p = .004). Graduates in a general practice vocational training program are more likely to be on a rural career pathway than graduates in a specialty other than general practice (p = .003). A key influence on graduates' practice location is geographic location prior to entering medical school. Key influences on graduates choosing a rural career pathway are: having a spouse/partner with a rural background; clinical teachers and mentors; the extended rural based undergraduate learning experience; and a specialty preference for general practice. A lack of rural based internships and specialist training

  13. The making of expert clinicians: reflective practice.

    Maestre, J M; Szyld, D; Del Moral, I; Ortiz, G; Rudolph, J W

    2014-05-01

    Debriefing is a rigorous reflection process which helps trainees recognize and resolve clinical and behavioral dilemmas raised by a clinical case. This approach emphasizes eliciting trainees'assumptions about the situation and their reasons for performing as they did (mental models). It analyses their impact on actions, to understand if it is necessary to maintain them or construct new ones that may lead to better performance in the future. It blends evidence and theory from education research, the social and cognitive sciences, and experience drawn from conducting and teaching debriefing to clinicians worldwide, on how to improve professional effectiveness through "reflective practice". Copyright © 2013 Elsevier España, S.L. All rights reserved.

  14. Making practice transparent through e-portfolio.

    Stewart, Sarah M

    2013-12-01

    Midwives are required to maintain a professional portfolio as part of their statutory requirements. Some midwives are using open social networking tools and processes to develop an e-portfolio. However, confidentiality of patient and client data and professional reputation have to be taken into consideration when using online public spaces for reflection. There is little evidence about how midwives use social networking tools for ongoing learning. It is uncertain how reflecting in an e-portfolio with an audience impacts on learning outcomes. This paper investigates ways in which reflective midwifery practice be carried out using e-portfolio in open, social networking platforms using collaborative processes. Using an auto-ethnographic approach I explored my e-portfolio and selected posts that had attracted six or more comments. I used thematic analysis to identify themes within the textual conversations in the posts and responses posted by readers. The analysis identified that my collaborative e-portfolio had four themes: to provide commentary and discuss issues; to reflect and process learning; to seek advice, brainstorm and process ideas for practice, projects and research, and provide evidence of professional development. E-portfolio using open social networking tools and processes is a viable option for midwives because it facilitates collaborative reflection and shared learning. However, my experience shows that concerns about what people think, and client confidentiality does impact on the nature of open reflection and learning outcomes. I conclude this paper with a framework for managing midwifery statutory obligations using online public spaces and social networking tools. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  15. Testing Ecological Theories of Offender Spatial Decision Making Using a Discrete Choice Model

    Summers, Lucia

    2015-01-01

    Research demonstrates that crime is spatially concentrated. However, most research relies on information about where crimes occur, without reference to where offenders reside. This study examines how the characteristics of neighborhoods and their proximity to offender home locations affect offender spatial decision making. Using a discrete choice model and data for detected incidents of theft from vehicles (TFV), we test predictions from two theoretical perspectives—crime pattern and social disorganization theories. We demonstrate that offenders favor areas that are low in social cohesion and closer to their home, or other age-related activity nodes. For adult offenders, choices also appear to be influenced by how accessible a neighborhood is via the street network. The implications for criminological theory and crime prevention are discussed. PMID:25866412

  16. Testing Ecological Theories of Offender Spatial Decision Making Using a Discrete Choice Model.

    Johnson, Shane D; Summers, Lucia

    2015-04-01

    Research demonstrates that crime is spatially concentrated. However, most research relies on information about where crimes occur, without reference to where offenders reside. This study examines how the characteristics of neighborhoods and their proximity to offender home locations affect offender spatial decision making. Using a discrete choice model and data for detected incidents of theft from vehicles (TFV) , we test predictions from two theoretical perspectives-crime pattern and social disorganization theories. We demonstrate that offenders favor areas that are low in social cohesion and closer to their home, or other age-related activity nodes. For adult offenders, choices also appear to be influenced by how accessible a neighborhood is via the street network. The implications for criminological theory and crime prevention are discussed.

  17. Developing and pilot testing a shared decision-making intervention for dialysis choice

    Finderup, Jeanette; Jensen, Jens Dam; Lomborg, Kirsten

    2018-01-01

    . Nevertheless, studies have shown lack of involvement of the patient in decision-making. Objectives: To develop and pilot test an intervention for shared decision-making targeting the choice of dialysis modality. Methods: This study reflects the first two phases of a complex intervention design: phase 1......, the development process and phase 2, feasibility and piloting. Because decision aids were a part of the intervention, the International Patient Decision Aid Standards were considered. The pilot test included both the intervention and the feasibility of the validated shared decision-making questionnaire (SDM Q9......) and the Decision Quality Measure (DQM) applied to evaluate the intervention. Results: A total of 137 patients tested the intervention. After the intervention, 80% of the patients chose dialysis at home reflecting an increase of 23% in starting dialysis at home prior to the study. The SDM Q9 showed the majority...

  18. Risky decision-making is associated with residential choice in healthy older adults.

    Kendra L Seaman

    2015-08-01

    Full Text Available As our society becomes more mobile and people reside farther away from their immediate families, competent decision-making has become critical for the older adults wishing to maintain their independence. However, very little is known about the relationship between residential choice and decision making. Here we use the Balloon Analogue Risk Task (BART to examine risk-taking in two samples of older adults, one living in a retirement community and another living independently. We also used a cognitive model to gain insight into the cognitive factors underlying decision-making in these groups. We found that older adults living in a retirement community were more risk averse than their independent counterparts. Furthermore, this difference appeared to be motivated by group differences in initial perception of risk. This study suggests an intriguing difference between these two residential groups, and also points to the utility of using laboratory methods in research on real-world problems.

  19. Risky decision-making is associated with residential choice in healthy older adults.

    Seaman, Kendra L; Stillman, Chelsea M; Howard, Darlene V; Howard, James H

    2015-01-01

    As our society becomes more mobile and people reside farther away from their immediate families, competent decision-making has become critical for the older adults wishing to maintain their independence. However, very little is known about the relationship between residential choice and decision-making. Here we use the Balloon Analog Risk Task (BART) to examine risk-taking in two samples of older adults, one living in a retirement community and another living independently. We also used a cognitive model to gain insight into the cognitive factors underlying decision-making in these groups. We found that older adults living in a retirement community were more risk averse than their independent counterparts. Furthermore, this difference appeared to be motivated by group differences in initial perception of risk. This study suggests an intriguing difference between these two residential groups, and also points to the utility of using laboratory methods in research on real-world problems.

  20. Neural antecedents of social decision-making in a partner choice task.

    Cartmell, Samuel C D; Chun, Marvin M; Vickery, Timothy J

    2014-11-01

    Experiments in financial decision-making point to two complementary processes that encode prospective gain and loss preceding the choice to purchase consumer goods. These processes involve the nucleus accumbens (NAcc) and the right anterior insula, respectively. The current experiment used functional MRI to investigate whether these regions served a similar function during an analogous social decision-making task without the influence of monetary outcomes. In this task, subjects chose partners based on face stimuli of varying attractiveness (operationalizing value) and ratings of compatibility with the participant (operationalizing likelihood of rejection). The NAcc responded to anticipated gain; the right anterior insula responded to compatibility, but not in a manner that suggests an analogy to anticipated cost. Logistic regression modeling demonstrated that both regions predicted subsequent choice above and beyond the influence of group attractiveness ratings or compatibility alone. Although the function of the insula may differ between tasks, these results suggest that financial and social decision-making recruit a similar network of brain regions. © The Author (2013). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  1. Shared decision making and patient choice for growth hormone therapy: current perspectives

    George B

    2016-06-01

    Full Text Available Belinda George, Vageesh Ayyar Department of Endocrinology, St. John’s Medical College Hospital, Bangalore, Karnataka, India Abstract: Growth hormone has now been available in medical practice for close to 50 years. Its use has provided dramatic results in patients with growth hormone deficiency and it is associated with an overall favorable safety profile. Over the years, the utility of growth hormone has expanded to include treatment for short stature associated with conditions other than growth hormone deficiency, and this situation warrants greater involvement of the child and parents in the shared decision-making process. Shared decision making is in good conformance to the principle of informed consent, and it also improves the compliance and adherence to therapy as the patient fully understands the benefit and safety of the treatment. In the pediatric-care setting, the decision-making interactions usually occur between the health care provider, patient, and parents. The process may range from an autonomous decision-making pattern, where the patient or parents are fully responsible for the decision taken, to the paternalistic decision-making pattern, where the health care provider assumes full responsibility for the decision taken. However, the ideal situation is one where a truly shared decision-making process happens, in which the doctor and patient/parents work together to choose an evidence-based option, in line with the patient’s preferences and wishes. The limited data available on shared decision making with regard to growth hormone replacement, however, is not very encouraging and suggests that the actual involvement of the parents as perceived by them is less than optimal. Introduction of a simple structured model for a shared decision-making process that can be easily incorporated into clinical practice and familiarization of health care providers with the same is essential to improve our shared decision-making practices

  2. [Influenza A from the rational choice theory: proposals for decision making in prevention policies].

    Peña, Francisco Garrido; Fernández, Luís Andrés López; García, Eugenia Gil

    2009-01-01

    This article is a reflection on the social uncertainty caused by Influenza A and on the consequences that it can have on decision making in health promotion policies. We use concepts and metaphors of the Rational Choice Theory, among them, the "in gratitude effect" or the "distrust effect", as we analyse how these can become obstacles for the efficiency of prevention policies. Then, we focus on the information asymmetry of the principal-agent relationship, and we propose measures to diminish the "moral risk" that they cause. We finish by advancing some proposals for designing lines and strategies of action in health promotion policies.

  3. Usefulness of the discrete choice methodology for marketing decision-making in New Product Development

    Krystallis, Athanasios; Linadrakis, M.; Mamalis, S.

    2010-01-01

    functional children's snacks marketed in Greece. Using a very simple discrete choice experimental design, the authors aim (a) to provide an example of consumer research implementation in food-related NPD and to assess its marketing value, and (b) to evaluate the quality of the acquired consumer......-related information for marketing decision-making in food consumer-led NPD processes against a number of criteria set in the relevant literature. ''Functionality'' is found to be a statistically significant attribute for all three children's snacks of the research design compared to other attributes such as flavor...

  4. Decision making under internal uncertainty: the case of multiple-choice tests with different scoring rules.

    Bereby-Meyer, Yoella; Meyer, Joachim; Budescu, David V

    2003-02-01

    This paper assesses framing effects on decision making with internal uncertainty, i.e., partial knowledge, by focusing on examinees' behavior in multiple-choice (MC) tests with different scoring rules. In two experiments participants answered a general-knowledge MC test that consisted of 34 solvable and 6 unsolvable items. Experiment 1 studied two scoring rules involving Positive (only gains) and Negative (only losses) scores. Although answering all items was the dominating strategy for both rules, the results revealed a greater tendency to answer under the Negative scoring rule. These results are in line with the predictions derived from Prospect Theory (PT) [Econometrica 47 (1979) 263]. The second experiment studied two scoring rules, which allowed respondents to exhibit partial knowledge. Under the Inclusion-scoring rule the respondents mark all answers that could be correct, and under the Exclusion-scoring rule they exclude all answers that might be incorrect. As predicted by PT, respondents took more risks under the Inclusion rule than under the Exclusion rule. The results illustrate that the basic process that underlies choice behavior under internal uncertainty and especially the effect of framing is similar to the process of choice under external uncertainty and can be described quite accurately by PT. Copyright 2002 Elsevier Science B.V.

  5. Decision-making in nursing practice: An integrative literature review.

    Nibbelink, Christine W; Brewer, Barbara B

    2018-03-01

    To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient

  6. Is decision-making ability related to food choice and facets of eating behaviour in adolescents?

    Macchi, Rosemarie; MacKew, Laura; Davis, Caroline

    2017-09-01

    To test the prediction that poor decision-making would predict poor eating-related behaviours, which in turn would relate to elevated body mass index (BMI) percentile. Associations among decision-making ability, eating behaviours, and BMI percentile were examined in a sample of 311 healthy male and female adolescents, aged 14-18 years. Structural equation modelling was used to test the proposed relationships. The predicted model was a good fit to the data and all paths between latent and indicator variables were significant. Impulsive responding significantly predicted poor food choice and overeating. No significant relationships emerged between eating-related variables and BMI percentile. Findings from this study extend the existing research in adults and offer a more comprehensive understanding of factors that may contribute to eating behaviours and weight status in teenagers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. The effects of team expert choice on group decision-making in collaborative new product development; a pilot study

    Hummel, J. Marjan; van Rossum, Wouter; Verkerke, Gijsbertus Jacob; Rakhorst, G.

    2000-01-01

    This study analyses the effects of Team Expert Choice on group decision-making in collaborative new product development. We applied Team Expert Choice to support a product evaluation conducted by a new product development group composed of professionally diverse members. The evaluation resulted in

  8. Survival or Mortality : Does Risk Attribute Framing Influence Decision-Making Behavior in a Discrete Choice Experiment?

    Veldwijk, Jorien; Essers, Brigitte A B; Lambooij, Mattijs S; Dirksen, Carmen D; Smit, Henriette A; de Wit, G Ardine

    2016-01-01

    OBJECTIVE: To test how attribute framing in a discrete choice experiment (DCE) affects respondents' decision-making behavior and their preferences. METHODS: Two versions of a DCE questionnaire containing nine choice tasks were distributed among a representative sample of the Dutch population aged 55

  9. How to make guided discovery learning practical for student teachers

    Janssen, F.J.J.M.; Westbroek, H.B.; Van Driel, J.H.

    2013-01-01

    Many innovative teaching approaches lack classroom impact because teachers consider the proposals impractical. Making a teaching approach practical requires instrumentality (procedures), congruence (local fit), and affordable cost (limited time and resources).This paper concerns a study on the

  10. Drivers’ decision-making when attempting to cross an intersection results from choice between affordances

    Geoffrey eMARTI

    2015-01-01

    Full Text Available In theory, a safe approach to an intersection implies that the driver can simultaneously manage two scenarios: they either cross or they must give way to an oncoming vehicle. In this article we formalize the critical time for safe crossing (CTcross and the critical time for safe stopping (CTstop to represent crossing and stopping possibilities, respectively. We describe these critical times in terms of affordances and empirically test their respective contribution to the driver’s decision-making process. Using a driving simulator, three groups of participants drove cars with identical acceleration capabilities and different braking capabilities. They were asked to try to cross an intersection where there was an oncoming vehicle, if they deemed the maneuver to be safe. If not, they could decide to stop or, as a last resort, make an emergency exit. The intersections were identical among groups.Results showed that although the crossing possibilities (CTcross were the same for all groups, there were between-group differences in crossing frequency. This suggests that stopping possibilities (CTstop play a role in the driver’s decision-making process, in addition to the crossing possibilities. These results can be accounted for by a behavioral model of decision making, and provide support for the hypothesis of choice between affordances.

  11. Attention and choice: a review on eye movements in decision making.

    Orquin, Jacob L; Mueller Loose, Simone

    2013-09-01

    This paper reviews studies on eye movements in decision making, and compares their observations to theoretical predictions concerning the role of attention in decision making. Four decision theories are examined: rational models, bounded rationality, evidence accumulation, and parallel constraint satisfaction models. Although most theories were confirmed with regard to certain predictions, none of the theories adequately accounted for the role of attention during decision making. Several observations emerged concerning the drivers and down-stream effects of attention on choice, suggesting that attention processes plays an active role in constructing decisions. So far, decision theories have largely ignored the constructive role of attention by assuming that it is entirely determined by heuristics, or that it consists of stochastic information sampling. The empirical observations reveal that these assumptions are implausible, and that more accurate assumptions could have been made based on prior attention and eye movement research. Future decision making research would benefit from greater integration with attention research. Copyright © 2013 Elsevier B.V. All rights reserved.

  12. Health decision making: lynchpin of evidence-based practice.

    Spring, Bonnie

    2008-01-01

    Health decision making is both the lynchpin and the least developed aspect of evidence-based practice. The evidence-based practice process requires integrating the evidence with consideration of practical resources and patient preferences and doing so via a process that is genuinely collaborative. Yet, the literature is largely silent about how to accomplish integrative, shared decision making. for evidence-based practice are discussed for 2 theories of clinician decision making (expected utility and fuzzy trace) and 2 theories of patient health decision making (transtheoretical model and reasoned action). Three suggestions are offered. First, it would be advantageous to have theory-based algorithms that weight and integrate the 3 data strands (evidence, resources, preferences) in different decisional contexts. Second, patients, not providers, make the decisions of greatest impact on public health, and those decisions are behavioral. Consequently, theory explicating how provider-patient collaboration can influence patient lifestyle decisions made miles from the provider's office is greatly needed. Third, although the preponderance of data on complex decisions supports a computational approach, such an approach to evidence-based practice is too impractical to be widely applied at present. More troublesomely, until patients come to trust decisions made computationally more than they trust their providers' intuitions, patient adherence will remain problematic. A good theory of integrative, collaborative health decision making remains needed.

  13. Making pragmatic choices: women’s experiences of delivery care in Northern Ethiopia

    Gebrehiwot Tesfay

    2012-10-01

    Full Text Available Abstract Background In 2003, the Ethiopian Ministry of Health launched the Health Extension Programme (HEP, which was intended to increase access to reproductive health care. Despite enormous effort, utilization of maternal health services remains limited, and the reasons for the low utilization of the services offered through the HEP previously have not been explored in depth. This study explores women’s experiences and perceptions regarding delivery care in Tigray, a northern region of Ethiopia, and enables us to make suggestions for better implementation of maternal health care services in this setting. Methods We used six focus group discussions with 51 women to explore perceptions and experiences regarding delivery care. The data were analysed by means of grounded theory. Results One core category emerged, ‘making pragmatic choices’, which connected the categories ‘aiming for safer deliveries’, ‘embedded in tradition’, and ‘medical knowledge under constrained circumstances’. In this setting, women – aiming for safer deliveries – made choices pragmatically between the two available models of childbirth. On the one hand, choice of home delivery, represented by the category ‘embedded in tradition’, was related to their faith, the ascendancy of elderly women, the advantages of staying at home and the custom of traditional birth attendants (TBAs. On the other, institutional delivery, represented by the category ‘medical knowledge under constrained circumstances’, and linked to how women appreciated medical resources and the support of health extension workers (HEWs but were uncertain about the quality of care, emphasized the barriers to transportation. In Tigray women made choices pragmatically and seemed to not feel any conflict between the two available models, being supported by traditional birth attendants, HEWs and husbands in their decision-making. Representatives of the two models were not as open to

  14. Factors that affect general practice as a choice of medical speciality: implications for policy development.

    Vohra, Amit; Ladyshewsky, Richard; Trumble, Stephen

    2017-11-28

    Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work-life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking

  15. Use of food labels by adolescents to make healthier choices on snacks: a cross-sectional study from Sri Lanka.

    Talagala, Ishanka A; Arambepola, Carukshi

    2016-08-08

    Unhealthy snacking is commonly seen among adolescents. Therefore, use of food labels is promoted for making healthier choices on packaged snacks. This study was conducted to assess the use of food labels in making choices on packaged snack and its associated factors among adolescents. A cross-sectional study was conducted in 2012 among 542 Grade 12 students in Sri Lanka. Eight classes were selected as 'clusters' for the study (two classes each from two schools that were selected randomly from each list of 'Girls only' and 'Boys only' schools in Colombo district). A self-administered questionnaire assessed their socio-demography, snacking behaviour, attitudes and nutrition knowledge related to food labels. Adolescents' use of labels was assessed by three practices (label reading frequency, attention paid to label contents and correct interpretation of six hypothetical labels of snacks). Based on total scores obtained for the three practices, 'satisfactory' (score ≥75(th) percentile mark) and 'unsatisfactory' (score pocket money at least once/week on packaged snacks; predominantly on biscuits (85 %) and cola-drinks (77 %) and 88 % selected snacks on their own. The majority (74.5 %) was frequent ('always' or 'most often') label readers with female predominance (p < 0.05). Over 74 % paid attention frequently to the brand name (75 %), price (85 %) and nutrition panel (81 %). Over 64 % were able to select the better food label when given a choice between two snacks, although some did it for reasons such as attractive label (63 %). The majority (84 %) had good knowledge (obtaining more than the 75(th) percentile mark) on interpreting labels. Although not statistically significant, 'unsatisfactory' label use was higher among males (73 %), purchasing power (70.4 %) and unhealthy snacking behaviour (73 %). In contrast, among the marketing strategies, identifying known brands (73.2 %) and imported products (75.8 %) as 'good' products were significantly

  16. Use of food labels by adolescents to make healthier choices on snacks: a cross-sectional study from Sri Lanka

    Ishanka A. Talagala

    2016-08-01

    Full Text Available Abstract Background Unhealthy snacking is commonly seen among adolescents. Therefore, use of food labels is promoted for making healthier choices on packaged snacks. This study was conducted to assess the use of food labels in making choices on packaged snack and its associated factors among adolescents. Methods A cross–sectional study was conducted in 2012 among 542 Grade 12 students in Sri Lanka. Eight classes were selected as ‘clusters’ for the study (two classes each from two schools that were selected randomly from each list of ‘Girls only’ and ‘Boys only’ schools in Colombo district. A self-administered questionnaire assessed their socio-demography, snacking behaviour, attitudes and nutrition knowledge related to food labels. Adolescents’ use of labels was assessed by three practices (label reading frequency, attention paid to label contents and correct interpretation of six hypothetical labels of snacks. Based on total scores obtained for the three practices, ‘satisfactory’ (score ≥75th percentile mark and ‘unsatisfactory’ (score <75th percentile mark label users were identified. Using SPSS, associations were assessed at 0.05 significance level using Chi-square-test. Results Of the participants, 51 % were males; 61 % spent their pocket money at least once/week on packaged snacks; predominantly on biscuits (85 % and cola-drinks (77 % and 88 % selected snacks on their own. The majority (74.5 % was frequent (‘always’ or ‘most often’ label readers with female predominance (p < 0.05. Over 74 % paid attention frequently to the brand name (75 %, price (85 % and nutrition panel (81 %. Over 64 % were able to select the better food label when given a choice between two snacks, although some did it for reasons such as attractive label (63 %. The majority (84 % had good knowledge (obtaining more than the 75th percentile mark on interpreting labels. Although not statistically significant,

  17. Value for money or making the healthy choice: the impact of proportional pricing on consumers' portion size choices.

    Vermeer, Willemijn M; Alting, Esther; Steenhuis, Ingrid H M; Seidell, Jacob C

    2010-02-01

    Large food portion sizes are determinants of a high caloric intake, especially if they have been made attractive through value size pricing (i.e. lower unit prices for large than for small portion sizes). The purpose of the two questionnaire studies that are reported in this article was to assess the impact of proportional pricing (i.e. removing beneficial prices for large sizes) on people's portion size choices of high caloric food and drink items. Both studies employed an experimental design with a proportional pricing condition and a value size pricing condition. Study 1 was conducted in a fast food restaurant (N = 150) and study 2 in a worksite cafeteria (N = 141). Three different food products (i.e. soft drink, chicken nuggets in study 1 and a hot meal in study 2) with corresponding prices were displayed on pictures in the questionnaire. Outcome measures were consumers' intended portion size choices. No main effects of pricing were found. However, confronted with proportional pricing a trend was found for overweight fast food restaurant visitors being more likely to choose small portion sizes of chicken nuggets (OR = 4.31, P = 0.07) and less likely to choose large soft drink sizes (OR = 0.07, P = 0.04). Among a general public, proportional pricing did not reduce consumers' size choices. However, pricing strategies can help overweight and obese consumers selecting appropriate portion sizes of soft drink and high caloric snacks. More research in realistic settings with actual behaviour as outcome measure is required.

  18. What would Batman eat?: priming children to make healthier fast food choices.

    Wansink, B; Shimizu, M; Camps, G

    2012-04-01

    Fast food patronage is a frequent reality for many children and their parents. Although there are increasingly healthier alternatives for popular menu items (apple slices instead of French fries), they are infrequently selected. We investigated whether either of two priming tactics - the priming of a role model's food choices or the priming of healthy foods - could influence children to make healthier fast food choices. In the priming model condition, 22 children (ranging in age from 6 to 12 years) were presented with 12 photos of 6 admirable and 6 less admirable models and asked, 'Would this person order apple fries or French fries?' In the health prime condition, the same children were shown 12 photos of 6 healthy foods and 6 less healthy foods and asked to indicate if each food was healthy or unhealthy. When children were asked what various admirable people - such as Batman or Spiderman - would eat, 45% chose apple slices over French fries, which was higher than the health prime (P < 0.001) or the control condition (P < 0.001). Advising a parent to ask their child 'What would Batman (or another admired character or person) eat?' might be an easy step to take in what could be a healthier fast food world. © 2012 The Authors. Pediatric Obesity © 2012 International Association for the Study of Obesity.

  19. Insights from triangulation of two purchase choice elicitation methods to predict social decision making in healthcare.

    Whitty, Jennifer A; Rundle-Thiele, Sharyn R; Scuffham, Paul A

    2012-03-01

    Discrete choice experiments (DCEs) and the Juster scale are accepted methods for the prediction of individual purchase probabilities. Nevertheless, these methods have seldom been applied to a social decision-making context. To gain an overview of social decisions for a decision-making population through data triangulation, these two methods were used to understand purchase probability in a social decision-making context. We report an exploratory social decision-making study of pharmaceutical subsidy in Australia. A DCE and selected Juster scale profiles were presented to current and past members of the Australian Pharmaceutical Benefits Advisory Committee and its Economic Subcommittee. Across 66 observations derived from 11 respondents for 6 different pharmaceutical profiles, there was a small overall median difference of 0.024 in the predicted probability of public subsidy (p = 0.003), with the Juster scale predicting the higher likelihood. While consistency was observed at the extremes of the probability scale, the funding probability differed over the mid-range of profiles. There was larger variability in the DCE than Juster predictions within each individual respondent, suggesting the DCE is better able to discriminate between profiles. However, large variation was observed between individuals in the Juster scale but not DCE predictions. It is important to use multiple methods to obtain a complete picture of the probability of purchase or public subsidy in a social decision-making context until further research can elaborate on our findings. This exploratory analysis supports the suggestion that the mixed logit model, which was used for the DCE analysis, may fail to adequately account for preference heterogeneity in some contexts.

  20. Simon`s Puzzle: Heuristics in the Process of Making Political Choices

    Mateusz Wajzer

    2014-07-01

    Full Text Available In this article we analyse one of the most fascinating paradoxes of mass politics. Based on the data from the studies of neurobiologists, neurologists, social psychology, cognitive and evolution studies we answer the question specified in literature as the Simon’s puzzle: How is it possible that citizens have their opinions about politics, if they know so little about it? We began our analysis from the criticism of the economic rationality approach. To do this, we referred to the Allais paradox, cognitive dissonance theory, Ellsberg paradox, the concept of bounded rationality, conjunction fallacy and prospect theory. Next, we described the evolutionary processes shaping the minds of Homo sapiens and characterised cognitive mechanisms, thanks to which people can make political choices, especially in view of the shortage of time and information. The following heuristics are referred to herein: affect, recognition, judgment and imitation.

  1. Multi-disciplinary decision making in general practice.

    Kirby, Ann; Murphy, Aileen; Bradley, Colin

    2018-04-09

    Purpose Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners' (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making. Design/methodology/approach A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions. Findings Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants. Originality/value For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

  2. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices.

    Elwyn, G; Edwards, A; Kinnersley, P; Grol, R

    2000-11-01

    ) arrange follow-up. These clinicians viewed involvement as an implicit ethos that should permeate medical practice, provided that clinicians respect and remain alert to patients' individual preferred roles in decision making. The interpersonal skills and the information requirements needed to successfully share decisions are major challenges to the clinical consultation process in medical practice. The benefits of patient involvement and the skills required to achieve this approach need to be given much higher priority at all levels: at policy, education, and within further professional development strategies.

  3. Shared decision making in mental health: the importance for current clinical practice.

    Alguera-Lara, Victoria; Dowsey, Michelle M; Ride, Jemimah; Kinder, Skye; Castle, David

    2017-12-01

    We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. Narrative review of published English-language articles. After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers. There is a paucity of published studies specifically related to antipsychotic medications. Shared decision making is a central part of the recovery paradigm and is of increasing importance in mental health service delivery. The field needs to better understand the basis on which decisions are reached regarding psychiatric treatments. Discrete choice experiments might be useful to inform the development of tools to assist shared decision making in psychiatry.

  4. Searching Choices: Quantifying Decision-Making Processes Using Search Engine Data.

    Moat, Helen Susannah; Olivola, Christopher Y; Chater, Nick; Preis, Tobias

    2016-07-01

    When making a decision, humans consider two types of information: information they have acquired through their prior experience of the world, and further information they gather to support the decision in question. Here, we present evidence that data from search engines such as Google can help us model both sources of information. We show that statistics from search engines on the frequency of content on the Internet can help us estimate the statistical structure of prior experience; and, specifically, we outline how such statistics can inform psychological theories concerning the valuation of human lives, or choices involving delayed outcomes. Turning to information gathering, we show that search query data might help measure human information gathering, and it may predict subsequent decisions. Such data enable us to compare information gathered across nations, where analyses suggest, for example, a greater focus on the future in countries with a higher per capita GDP. We conclude that search engine data constitute a valuable new resource for cognitive scientists, offering a fascinating new tool for understanding the human decision-making process. Copyright © 2016 The Authors. Topics in Cognitive Science published by Wiley Periodicals, Inc. on behalf of Cognitive Science Society.

  5. Social value and individual choice: The value of a choice-based decision-making process in a collectively funded health system.

    Espinoza, Manuel Antonio; Manca, Andrea; Claxton, Karl; Sculpher, Mark

    2018-02-01

    Evidence about cost-effectiveness is increasingly being used to inform decisions about the funding of new technologies that are usually implemented as guidelines from centralized decision-making bodies. However, there is also an increasing recognition for the role of patients in determining their preferred treatment option. This paper presents a method to estimate the value of implementing a choice-based decision process using the cost-effectiveness analysis toolbox. This value is estimated for 3 alternative scenarios. First, it compares centralized decisions, based on population average cost-effectiveness, against a decision process based on patient choice. Second, it compares centralized decision based on patients' subgroups versus an individual choice-based decision process. Third, it compares a centralized process based on average cost-effectiveness against a choice-based process where patients choose according to a different measure of outcome to that used by the centralized decision maker. The methods are applied to a case study for the management of acute coronary syndrome. It is concluded that implementing a choice-based process of treatment allocation may be an option in collectively funded health systems. However, its value will depend on the specific health problem and the social values considered relevant to the health system. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Teachers' Choice of Using Practical Activities--A Hierarchical Classification Attempt

    Haara, Frode Olav

    2015-01-01

    From a system theoretically grounded point of view, a hierarchy of primary and secondary impact factors influencing the mathematics teacher's choice to use practical activities in mathematics teaching is suggested initially in the article. A study, based on qualitative responses from mathematics teachers, then gives grounds for suggesting that a…

  7. Making Practice Visible through Writing for Professional Publication

    Roberts, Sherron Killingsworth

    2016-01-01

    Why should educators and service professionals bother writing for professional publication? Experienced editor, Sherron Roberts says writing for professional publication allows educators to share their work and make their practice visible. Any educator is quite capable of writing for a professional publication. This article is intended to show…

  8. Investment Decision Making: A Guide to Good Practice.

    Higher Education Funding Council for England, Bristol.

    This "good practice" guide is aimed at anyone in higher education in England who is involved in making decisions on investments. It focuses on the principles to be followed, rather than the techniques of appraisal. The guide outlines the steps for developing an outline business case and then refining it into a full business case for the…

  9. Making Worlds: the commons and the practice of the encounter

    Susana Draper

    2013-03-01

    Full Text Available The texts explains the work dynamics of Making Worlds, a collective devoted to develop the practice of the commons in New York. Besides giving an idea of the context of emergence of the group within the first year of Occupy Wall Street, it analyzes its form of organization and the activities it carries out.

  10. Decision Making in Nursing Practice: A Concept Analysis.

    Johansen, Mary L; O'Brien, Janice L

    2016-01-01

    The study aims to gain an understanding of the concept of decision making as it relates to the nurse practice environment. Rodgers' evolutionary method on concept analysis was used as a framework for the study of the concept. Articles from 1952 to 2014 were reviewed from PsycINFO, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), JSTOR, PubMed, and Science Direct. Findings suggest that decision making in the nurse practice environment is a complex process, integral to the nursing profession. The definition of decision making, and the attributes, antecedents, and consequences, are discussed. Contextual factors that influence the process are also discussed. An exemplar is presented to illustrate the concept. Decision making in the nurse practice environment is a dynamic conceptual process that may affect patient outcomes. Nurses need to call upon ways of knowing to make sound decisions and should be self-reflective in order to develop the process further in the professional arena. The need for further research is discussed. © 2015 Wiley Periodicals, Inc.

  11. "You have to be careful who you talk to and what you say …" - on psychosis and making rational choices.

    Topor, Alain; Di Girolamo, Simonetta

    2010-12-01

    People who have been diagnosed with schizophrenia are regarded as being no longer capable of making rational choices. Fifteen users with psychosis diagnosis participated to 10 focus group sessions about different aspects of everyday life. The discussions were tape recorded and the transcript analyzed using a grounded theory inspired methodology. A core category that emerged was making choices in crises situations. Users have to choose whether or not they want help, to whom to turn for help, and how to describe their problems so as to get the kind of help they seek. The choices were based on past experiences in connection with the choices available. They were constantly making quality judgements of the care workers they came into contact with. Experiencing a sense of comradeship emerged as a vital criterion. The ability to make rational choices often existed parallel with hallucinations and delusions. This ability could form the basis for a true collaboration between users and professionals. The findings of this study indicate that such collaboration is possible, but that it requires a reassessment of our traditional knowledge base.

  12. Color Choice is Everything - Impacts Color makes to the Lighting Environment

    Clark, Toni A.

    2012-01-01

    When contracts are let out to design multiple systems in a vehicle, it is a challenge to maintain integration between system leads. Designers on niche systems, like lighting and control panel design, often get caught up in the challenge of designing the light source or visual interface and fail to include time in their schedule to work with system architects on how their lighting system will be integrated. Additionally, behavioral scientists, industrial designers, and materials engineers get caught up with the materials and look of the system, but often fail to consider how the selection of their materials could affect the certification or performance of electronic devices like lighting systems. Additionally, computer modeling of the system architecture often assumes a perfect environment without the clutter of actual human use (dirt, stowage, crowding). As a result, lighting systems, and backlit displays run the risk of being overdesigned or under designed. Engineers making the assumption that because they have no input or there is no requirement on work surface reflectance, make the assumption that they can t count on good material choices and thus may install more lighting than is necessary. While having more lights may seem better, for a vehicle that is trying to conserve power, more lights may not be a good option. On the other hand, designers who made the opposite assumption and designed a lighting system that only produced just enough light, often wind up with a system that did conserve power, but didn t produce enough light. These situations are exasperated when the system starts to be used and the models are not perfect anymore. The lack of coordination and iterative design not only can impact lighting levels within an environment, but also can affect color perception. This is because, if materials do not represent a gradation of white or black, the material unevenly absorbs and reflects light at different wavelengths of the visual spectrum. The lighting

  13. Design and protocol of a randomized multiple behavior change trial: Make Better Choices 2 (MBC2).

    Pellegrini, Christine A; Steglitz, Jeremy; Johnston, Winter; Warnick, Jennifer; Adams, Tiara; McFadden, H G; Siddique, Juned; Hedeker, Donald; Spring, Bonnie

    2015-03-01

    Suboptimal diet and inactive lifestyle are among the most prevalent preventable causes of premature death. Interventions that target multiple behaviors are potentially efficient; however the optimal way to initiate and maintain multiple health behavior changes is unknown. The Make Better Choices 2 (MBC2) trial aims to examine whether sustained healthful diet and activity change are best achieved by targeting diet and activity behaviors simultaneously or sequentially. Study design approximately 250 inactive adults with poor quality diet will be randomized to 3 conditions examining the best way to prescribe healthy diet and activity change. The 3 intervention conditions prescribe: 1) an increase in fruit and vegetable consumption (F/V+), decrease in sedentary leisure screen time (Sed-), and increase in physical activity (PA+) simultaneously (Simultaneous); 2) F/V+ and Sed- first, and then sequentially add PA+ (Sequential); or 3) Stress Management Control that addresses stress, relaxation, and sleep. All participants will receive a smartphone application to self-monitor behaviors and regular coaching calls to help facilitate behavior change during the 9 month intervention. Healthy lifestyle change in fruit/vegetable and saturated fat intakes, sedentary leisure screen time, and physical activity will be assessed at 3, 6, and 9 months. MBC2 is a randomized m-Health intervention examining methods to maximize initiation and maintenance of multiple healthful behavior changes. Results from this trial will provide insight about an optimal technology supported approach to promote improvement in diet and physical activity. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Shared Decision-Making for Nursing Practice: An Integrative Review.

    Truglio-Londrigan, Marie; Slyer, Jason T

    2018-01-01

    Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.

  15. Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care

    Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M.

    2017-01-01

    Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices. PMID:28752808

  16. Quantum Organizational World-Making through Material Emobided Storytelling Practices

    Svane, Marita

    2014-01-01

    -making phenomena. In this article, organizational development and change are viewed as world-making phenomena that emerge from material, embodied, storytelling practices and are dissipated in the organization through the living story web in fractal, rhizomatic organizing processes. Diffractively reading pri......-marily Boje, Barad, Ingold, Heidegger, Bakhtin, and Deleuze and Guattari through each other, a quantum storytelling framework is proposed for better understanding organizing processes towards the future. Special attention is paid to the prospective, sense-shaping role of agential rhizomatic antenarratives...

  17. Public policies, private choices: Consumer desire and the practice of energy efficiency

    Deumling, Reuben Alexander

    Refrigerator energy consumption has been the subject of regulatory attention in the US for some thirty years. Federal product standards, energy labels, and a variety of programs to get consumers to discard their existing refrigerators sooner and buy new, more energy efficient ones have transformed the refrigerator landscape and changed how many of us think about refrigerators. The results of these policies are celebrated as a successful model for how to combine regulatory objectives and consumer preferences in pursuit of environmental outcomes where everyone wins. Yet per capita refrigerator energy consumption today remains (much) higher in the US than anywhere else, in part because energy efficiency overlooks the ways behavior, habit, emulation, social norms, advertising, and energy efficiency policies themselves shape energy consumption patterns. To understand these dynamics I investigate how people replacing their refrigerators through a state-sponsored energy efficiency program make sense of the choices facing them, and how various types of information designed to aid in this process (Consumer Reports tests, Energy Guide labels, rebate programs) frame the issue of responsible refrigerator consumption. Using interviews and archival research I examine how this information is used to script the choice of a refrigerator, whose priorities shape the form and content of these cues, and what the social meanings generated by and through encounters with refrigerators and energy efficiency are. I also helped build a model for estimating historic refrigerator energy consumption in the US, to measure the repercussions of refrigerator energy inefficiency. My focus in this dissertation is on the ways the pursuit of energy efficiency improvements for domestic refrigerators intersects with and sometimes reinforces escalating demand for energy. My research suggests that the practice of pursuing energy efficiency improvements in refrigerators subordinates the issue of

  18. Who Makes the Choice? Rethinking the Role of Autonomy and Relatedness in Chinese Children's Motivation

    Bao, Xue-Hua; Lam, Shui-Fong

    2008-01-01

    The importance of autonomy for children's motivation in collectivistic cultures has been debated hotly. With the understanding that autonomy is not equivalent to freedom of choice, 4 studies addressed this debate by investigating how socioemotional relatedness, choice, and autonomy were related to Chinese children's motivation. Study 1 (N = 56,…

  19. Making Sustainable Energy Choices: Insights on the Energy/Water/Land Nexus

    2014-10-01

    This periodic publication summarizes insights from the body of NREL analysis work. In this issue of Analysis Insights, we examine the implications of our energy choices on water, land use, climate, developmental goals, and other factors. Collectively, NREL's work helps policymakers and investors understand and evaluate energy choices within the complex web of connections, or nexus, between energy, water, and land.

  20. Retrieval practice with short-answer, multiple-choice, and hybrid tests.

    Smith, Megan A; Karpicke, Jeffrey D

    2014-01-01

    Retrieval practice improves meaningful learning, and the most frequent way of implementing retrieval practice in classrooms is to have students answer questions. In four experiments (N=372) we investigated the effects of different question formats on learning. Students read educational texts and practised retrieval by answering short-answer, multiple-choice, or hybrid questions. In hybrid conditions students first attempted to recall answers in short-answer format, then identified answers in multiple-choice format. We measured learning 1 week later using a final assessment with two types of questions: those that could be answered by recalling information verbatim from the texts and those that required inferences. Practising retrieval in all format conditions enhanced retention, relative to a study-only control condition, on both verbatim and inference questions. However, there were little or no advantages of answering short-answer or hybrid format questions over multiple-choice questions in three experiments. In Experiment 4, when retrieval success was improved under initial short-answer conditions, there was an advantage of answering short-answer or hybrid questions over multiple-choice questions. The results challenge the simple conclusion that short-answer questions always produce the best learning, due to increased retrieval effort or difficulty, and demonstrate the importance of retrieval success for retrieval-based learning activities.

  1. Implementing and evaluating shared decision making in oncology practice.

    Kane, Heather L; Halpern, Michael T; Squiers, Linda B; Treiman, Katherine A; McCormack, Lauren A

    2014-01-01

    Engaging individuals with cancer in decision making about their treatments has received increased attention; shared decision making (SDM) has become a hallmark of patient-centered care. Although physicians indicate substantial interest in SDM, implementing SDM in cancer care is often complex; high levels of uncertainty may exist, and health care providers must help patients understand the potential risks versus benefits of different treatment options. However, patients who are more engaged in their health care decision making are more likely to experience confidence in and satisfaction with treatment decisions and increased trust in their providers. To implement SDM in oncology practice, physicians and other health care providers need to understand the components of SDM and the approaches to supporting and facilitating this process as part of cancer care. This review summarizes recent information regarding patient and physician factors that influence SDM for cancer care, outcomes resulting from successful SDM, and strategies for implementing SDM in oncology practice. We present a conceptual model illustrating the components of SDM in cancer care and provide recommendations for facilitating SDM in oncology practice. © 2014 American Cancer Society, Inc.

  2. Quantum paradox of choice: More freedom makes summoning a quantum state harder

    Adlam, Emily; Kent, Adrian

    2016-06-01

    The properties of quantum information in space-time can be investigated by studying operational tasks, such as "summoning," in which an unknown quantum state is supplied at one point and a call is made at another for it to be returned at a third. Hayden and May [arXiv:1210.0913] recently proved necessary and sufficient conditions for guaranteeing successful return of a summoned state for finite sets of call and return points when there is a guarantee of at most one summons. We prove necessary and sufficient conditions when there may be several possible summonses and complying with any one constitutes success, and we demonstrate the existence of an apparent paradox: The extra freedom makes it strictly harder to complete the summoning task. This result has practical applications for distributed quantum computing and cryptography and implications for our understanding of relativistic quantum information and its localization in space-time.

  3. The (non)making/becoming of inquiry practicing science teachers

    Sharma, Ajay; Muzaffar, Irfan

    2012-03-01

    Teacher education programs have adopted preparing science teachers that teach science through inquiry as an important pedagogic agenda. However, their efforts have not met with much success. While traditional explanations for this failure focus largely on preservice science teachers' knowledge, beliefs and conceptions regarding science and science teaching, this conceptual paper seeks to direct attention toward discursive practices surrounding inquiry science teaching in teacher education programs for understanding why most science teachers do not teach science through inquiry. The paper offers a theoretical framework centered on critical notions of subjection and performativity as a much needed perspective on making/becoming of science teachers through participation in discursive practices of science teacher education programs. It argues that research based on such perspectives have much potential to offer a deeper understanding of the difficult challenges teacher education programs face in preparing inquiry practicing science teachers.

  4. Supported Decision-Making from Theory to Practice: Implementing the Right to Enjoy Legal Capacity

    Rosie Harding

    2018-04-01

    Full Text Available The right to equal recognition before the law, protected by Article 12 of the United Nations (UN Convention on the Rights of Persons with Disabilities (CRPD, mandates the use of supported decision-making practices to enable disabled people, particularly those with intellectual and/or psychosocial disabilities, to enjoy their legal capacity. Finding ways to translate this theoretical mandate into practice poses a number of particularly challenging socio-legal issues, which this research seeks to address. The English Mental Capacity Act 2005 (MCA sets out a right to support with decision-making (s.1(3, underpinned by a presumption of capacity (s.1(2. Qualitative interviews with intellectually disabled people, their supporters, and care and support professionals were undertaken to explore how disabled people make decisions in their everyday lives, the kinds of support they need, and the strategies for supported decision-making used in practice. Analysis of these interviews suggests that a range of supported decision-making techniques have been developed in practice and are effective in supporting everyday preferences and some life choices. Paradoxically, it appears that as decisions become more complex, the support available to disabled people reduces. Specifically, much less support is available for more difficult decisions around finances, healthcare and legal matters. We argue that the reasons for this are due to a web of regulatory, social and policy issues. We conclude that implementing the right to enjoy legal capacity through supported decision-making will require a combination of regulatory reform, social change and policy amendment.

  5. The dynamics of decision making in risky choice: An Eye-tracking Analysis

    Susann eFiedler; Andreas eGlöckner

    2012-01-01

    In the last years, research on risky choice has moved beyond analyzing choices only. Models have been suggested that aim to describe the underlying cognitive processes and some studies have tested process predictions of these models. Prominent approaches are evidence accumulation models such as decision field theory (DFT), simple serial heuristic models such as the adaptive toolbox, and connectionist approaches such as the parallel constraint satisfaction (PCS) model. In two studies involving...

  6. Thermodynamic view on decision-making process: emotions as a potential power vector of realization of the choice.

    Pakhomov, Anton; Sudin, Natalya

    2013-12-01

    This research is devoted to possible mechanisms of decision-making in frames of thermodynamic principles. It is also shown that the decision-making system in reply to emotion includes vector component which seems to be often a necessary condition to transfer system from one state to another. The phases of decision-making system can be described as supposed to be nonequilibrium and irreversible to which thermodynamics laws are applied. The mathematical model of a decision choice, proceeding from principles of the nonlinear dynamics considering instability of movement and bifurcation is offered. The thermodynamic component of decision-making process on the basis of vector transfer of energy induced by emotion at the given time is surveyed. It is proposed a three-modular model of decision making based on principles of thermodynamics. Here it is suggested that at entropy impact due to effect of emotion, on the closed system-the human brain,-initially arises chaos, then after fluctuations of possible alternatives which were going on-reactions of brain zones in reply to external influence, an order is forming and there is choice of alternatives, according to primary entrance conditions and a state of the closed system. Entropy calculation of a choice expectation of negative and positive emotion shows judgment possibility of existence of "the law of emotion conservation" in accordance with several experimental data.

  7. What does the new breed of decision-making methodologies mean for choices and norms in hydrological science?

    Wikman-Svahn, Per

    2013-04-01

    Hydrological sciences are increasingly utilized in decision-making contexts that need to manage deep uncertainty, changing conditions and very long-lead times and lifetimes. Traditional optimizing approaches become problematic in such situations. For example, optimizing approaches may underestimate the importance of low probability outcomes, or very uncertain outcomes. Alternative decision-making strategies are therefore increasingly used in hydrological applications, including "bottom-up/top-down", "context-first", "decision-scaling", "assess risk of policy", "robust", "resilient" or "flexible" approaches. These kinds of strategies are typically designed to handle very uncertain and diverse outcomes, and often start from the particular decision-making context, in contrast to more traditional "predict-then-act" or "science first" approaches. Contemporary research in philosophy of science stress the influence of value judgments and norms in scientific assessments. In particular, this literature points out that implicit anticipated applications often influence choices made in scientific assessments. Furthermore, this literature also emphasize that choices made at within scientific assessments have consequences for decision-making later on. One reason is that it is often difficult for decision-makers to see what choices are made and the implications of these choices. Another reason is that information that could be of use for decision-makers are lost at an early stage. For example, the choice to focus on central estimates and not providing assessments on more unlikely outcomes is a choice that has consequences for what outcomes are taken into account in the decision-making process. This paper develops this argument and then analyzes the implications of these new developments for hydrological science. One implication of the increasing use of the new breed of planning strategies is that a broader range of uncertainty in scientific assessments becomes desirable in order

  8. Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study.

    Emmert, Martin; Meier, Florian; Pisch, Frank; Sander, Uwe

    2013-08-28

    Over the past decade, physician-rating websites have been gaining attention in scientific literature and in the media. However, little knowledge is available about the awareness and the impact of using such sites on health care professionals. It also remains unclear what key predictors are associated with the knowledge and the use of physician-rating websites. To estimate the current level of awareness and use of physician-rating websites in Germany and to determine their impact on physician choice making and the key predictors which are associated with the knowledge and the use of physician-rating websites. This study was designed as a cross-sectional survey. An online panel was consulted in January 2013. A questionnaire was developed containing 28 questions; a pretest was carried out to assess the comprehension of the questionnaire. Several sociodemographic (eg, age, gender, health insurance status, Internet use) and 2 health-related independent variables (ie, health status and health care utilization) were included. Data were analyzed using descriptive statistics, chi-square tests, and t tests. Binary multivariate logistic regression models were performed for elaborating the characteristics of physician-rating website users. Results from the logistic regression are presented for both the observed and weighted sample. In total, 1505 respondents (mean age 43.73 years, SD 14.39; 857/1505, 57.25% female) completed our survey. Of all respondents, 32.09% (483/1505) heard of physician-rating websites and 25.32% (381/1505) already had used a website when searching for a physician. Furthermore, 11.03% (166/1505) had already posted a rating on a physician-rating website. Approximately 65.35% (249/381) consulted a particular physician based on the ratings shown on the websites; in contrast, 52.23% (199/381) had not consulted a particular physician because of the publicly reported ratings. Significantly higher likelihoods for being aware of the websites could be

  9. Why women of lower educational attainment struggle to make healthier food choices: the importance of psychological and social factors.

    Lawrence, Wendy; Skinner, Chas; Haslam, Cheryl; Robinson, Sian; Inskip, Hazel; Barker, David; Cooper, Cyrus; Jackson, Alan; Barker, Mary

    2009-11-01

    Women of lower educational attainment are more likely to eat unhealthy diets than women of higher educational attainment. To identify influences on the food choices of women with lower educational attainment, 11 focus groups (eight with women of lower, and three with women of higher educational attainment) were held. Using a semi-structured discussion guide, environmental, social, historical and psychological factors known to be associated with food choice were explored. Audio recordings were transcribed verbatim and thematically analysed. Compared to women of higher educational attainment, women of lower educational attainment had less control over their families' food choices, less support for attempts to eat healthily, fewer opportunities to observe and learn good food-related practices, more negative affect, more perceived environmental constraints and more ambiguous beliefs about the consequences of eating a nutritious diet. These findings provide a starting point for taking forward the design of an intervention to improve the diets of young women.

  10. [Shared decision-making in medical practice--patient-centred communication skills].

    van Staveren, Remke

    2011-01-01

    Most patients (70%) want to participate actively in important healthcare decisions, the rest (30%) prefer the doctor to make the decision for them. Shared decision-making provides more patient satisfaction, a better quality of life and contributes to a better doctor-patient relationship. Patients making their own decision generally make a well considered and medically sensible choice. In shared decision-making the doctor asks many open questions, gives and requests much information, asks if the patient wishes to participate in the decision-making and explicitly takes into account patient circumstances and preferences. Shared decision-making should remain an individual choice and should not become a new dogma.

  11. Physician trainees' decision making and information processing: choice size and Medicare Part D.

    Barnes, Andrew J; Hanoch, Yaniv; Martynenko, Melissa; Wood, Stacey; Rice, Thomas; Federman, Alex D

    2013-01-01

    Many patients expect their doctor to help them choose a Medicare prescription drug plan. Whether the size of the choice set affects clinicians' decision processes and strategy selection, and the quality of their choice, as it does their older patients, is an important question with serious financial consequences. Seventy medical students and internal medicine residents completed a within-subject design using Mouselab, a computer program that allows the information-acquisition process to be examined. We examined highly numerate physician trainees' decision processes, strategy, and their ability to pick the cheapest drug plan-as price was deemed the most important factor in Medicare beneficiaries' plan choice-from either 3 or 9 drug plans. Before adjustment, participants were significantly more likely to identify the lowest cost plan when facing three versus nine choices (67.3% vs. 32.8%, pinformation on each attribute (pdecision strategies focusing on comparing alternate plans across a single attribute (search pattern, pdecision process and strategy, numeracy, and amount of medical training, the odds were 10.75 times higher that trainees would choose the lowest cost Medicare Part D drug plan when facing 3 versus 9 drug plans (pdecision environment are needed and suggest physicians' role in their patients' Part D choices may be most productive when assisting seniors with forecasting their expected medication needs and then referring them to the Medicare website or helpline.

  12. Does fertility status influence impulsivity and risk taking in human females? Adaptive influences on intertemporal choice and risky decision making.

    Kaighobadi, Farnaz; Stevens, Jeffrey R

    2013-07-18

    Informed by the research on adaptive decision making in other animal species, this study investigated human females' intertemporal and risky choices across the ovulatory cycle. We tested the hypothesis that at peak fertility, women who are exposed to environments that signal availability of higher quality mates (by viewing images of attractive males), become more impulsive and risk-seeking in economic decision tasks. To test this, we collected intertemporal and risky choice measures before and after exposure to images of either attractive males or neutral landscapes both at peak and low fertility conditions. The results showed an interaction between women's fertility status and image type, such that women at peak fertility viewing images of attractive men chose the smaller, sooner monetary reward option less than women at peak fertility viewing neutral images. Neither fertility status nor image type influenced risky choice. Thus, though exposure to images of men altered intertemporal choices at peak fertility, this occurred in the opposite direction than predicted--i.e., women at peak fertility became less impulsive. Nevertheless, the results of the current study provide evidence for shifts in preferences over the ovulatory cycle and opens future research on economic decision making.

  13. Does Fertility Status Influence Impulsivity and Risk Taking in Human Females? Adaptive Influences on Intertemporal Choice and Risky Decision Making

    Farnaz Kaighobadi

    2013-07-01

    Full Text Available Informed by the research on adaptive decision making in other animal species, this study investigated human females' intertemporal and risky choices across the ovulatory cycle. We tested the hypothesis that at peak fertility, women who are exposed to environments that signal availability of higher quality mates (by viewing images of attractive males, become more impulsive and risk-seeking in economic decision tasks. To test this, we collected intertemporal and risky choice measures before and after exposure to images of either attractive males or neutral landscapes both at peak and low fertility conditions. The results showed an interaction between women's fertility status and image type, such that women at peak fertility viewing images of attractive men chose the smaller, sooner monetary reward option less than women at peak fertility viewing neutral images. Neither fertility status nor image type influenced risky choice. Thus, though exposure to images of men altered intertemporal choices at peak fertility, this occurred in the opposite direction than predicted—i.e., women at peak fertility became less impulsive. Nevertheless, the results of the current study provide evidence for shifts in preferences over the ovulatory cycle and opens future research on economic decision making.

  14. Design Choices in a Compiler Course or How to Make Undergraduates Love Formal Notation

    Schwartzbach, Michael Ignatieff

    2008-01-01

    The undergraduate compiler course offers a unique opportunity to combine many aspects of the Computer Science curriculum. We discuss the many design choices that are available for the instructor and present the current compiler course at the University of Aarhus, the design of which displays at l...

  15. Emotion regulation and risk taking: predicting risky choice in deliberative decision making

    Panno, A.; Lauriola, M.; Figner, B.

    2013-01-01

    Only very recently has research demonstrated that experimentally induced emotion regulation strategies (cognitive reappraisal and expressive suppression) affect risky choice (e.g., Heilman et al., 2010). However, it is unknown whether this effect also operates via habitual use of emotion regulation

  16. An application of the rational choice approach to the offending process of sex offenders: a closer look at the decision-making.

    Beauregard, Eric; Leclerc, Benoît

    2007-06-01

    Although the study of both offense processes and implicit theories provides in-depth knowledge about the decision-making of sex offenders, these studies focus solely on the internal psychological processes of the offender leading to the commission of a sexual assault. These studies neglect to look specifically at the offender's decision-making during the offense in interaction with the immediate situations encountered at the offense scene, such as the choices of behavior while interacting with the victim in a specific context. Based on a rational choice approach, this study investigates the decision-making involved in the offending process of 69 serial sexual offenders who have committed their crimes against stranger victims. Semi-structured interviews were conducted with offenders in order to identify the rationale behind their actions during the pre-crime phase (premeditation of the crime, estimation of risk of apprehension by the offender, and forensic awareness of the offender), crime phase (use of a weapon, use of restraints, use of a vehicle, and level of force used), and the post-crime phase (event leading to the end of crime and victim release site location choice). Results show that sex offenders, even if traditionally described as "irrational" and impulsive individuals, are capable, up to a certain point, of an analysis of the costs/benefits related to their actions. Moreover, results emphasize the important role of situational factors, such as victim resistance, on the decision-making process of sex offenders. Implications of the results are briefly discussed in regard of clinical practice and crime prevention.

  17. Practical Usage of Multiple-Choice Questions as Part of Learning and Self-Evaluation

    Paula Kangasniemi

    2016-12-01

    Full Text Available The poster describes how the multiple-choice questions could be a part of learning, not only assessing. We often think of the role of questions only in order to test the student's skills. We have tested how questions could be a part of learning in our web-based course of information retrieval in Lapland University. In web-based learning there is a need for high-quality mediators. Mediators are learning promoters which trigger, support, and amplify learning. Mediators can be human mediators or tool mediators. The tool mediators are for example; tests, tutorials, guides and diaries. The multiple-choice questions can also be learning promoters which select, interpret and amplify objects for learning. What do you have to take into account when you are preparing multiple-choice questions as mediators? First you have to prioritize teaching objectives: what must be known and what should be known. According to our experience with contact learning, you can assess what the things are that students have problems with and need more guidance on. The most important addition to the questions is feedback during practice. The questions’ answers (wrong or right are not important. The feedback on the answers are important to guide students on how to search. The questions promote students’ self-regulation and self-evaluation. Feedback can be verbal, a screenshot or a video. We have added a verbal feedback for every question and also some screenshots and eight videos in our web-based course.

  18. Consumers' practical understanding of healthy food choices: a fake food experiment.

    Mötteli, Sonja; Keller, Carmen; Siegrist, Michael; Barbey, Jana; Bucher, Tamara

    2016-08-01

    Little is known about laypeople's practical understanding of a healthy diet, although this is important to successfully promote healthy eating. The present study is the first to experimentally examine how consumers define healthy and balanced food choices for an entire day compared with normal choices and compared with dietary guidelines. We used an extensive fake food buffet (FFB) with 179 foods commonly consumed in the Swiss diet. The FFB is a validated method to investigate food choice behaviour in a well-controlled laboratory setting. People from the general population in Switzerland (n 187; 51·9 % females), aged between 18 and 65 years, were randomly assigned to one of two conditions. In the control group, the participants were instructed to serve themselves foods they would eat on a normal day, whereas in the 'healthy' group they were instructed to choose foods representing a healthy diet. Participants chose significantly more healthy foods, with 4·5 g more dietary fibre, 2 % more protein and 2 % less SFA in the 'healthy' group compared with the control group. However, in both experimental conditions, participants served themselves foods containing twice as much sugar and salt than recommended by dietary guidelines. The results suggest that laypeople lack knowledge about the recommended portion sizes and the amounts of critical nutrients in processed food, which has important implications for communicating dietary guidelines. Furthermore, the energy of the food served was substantially correlated with the energy needs of the participants, demonstrating the potential of the fake food buffet method.

  19. Playful Mobility Choices: Motivating informed mobility decision making by applying game mechanics

    A. Millonig

    2014-10-01

    Full Text Available Motivating people to change their mobility behaviour patterns towards more sustainable forms of mobility is one of the major challenges regarding climate change and quality of life. Recently, an increasing amount of attempts to use gamification for triggering such behavioural changes can be observed. However, little is known about the actual impact of using game elements. This contribution describes a concept for systematically analysing the group-specific effects of different game mechanics on mobility decision processes (e.g. mode and route choice. Based on theoretical findings concerning player types and mobility styles we developed a framework for identifying effective game mechanics motivating users to explore mobility alternatives and take more informed and more sustainable mode or route choice decisions. The results will form the basis for implementing game mechanics in mobility information services motivating users to explore unfamiliar but more sustainable mobility options.

  20. Counselling and medical decision-making in the era of personalised medicine a practice-oriented guide

    Sanchini, Virginia

    2016-01-01

    This book offers an overview of the main questions arising when biomedical decision-making intersects ethical decision-making. It reports on two ethical decision-making methodologies, one addressing the patients, the other physicians. It shows how patients’ autonomous choices can be empowered by increasing awareness of ethical deliberation, and at the same time it supports healthcare professionals in developing an ethical sensitivity, which they can apply in their daily practice. The book highlights the importance and relevance of practicing bioethics in the age of personalized medicine. It presents concrete cases studies dealing with cancer and genetic diseases, where difficult decisions need to be made by all the parties involved: patients, physicians and families. Decisions concern not only diagnostic procedures and treatments, but also moral values, religious beliefs and ways of seeing life and death, thus adding further layers of complexity to biomedical decision-making. This book, which is strongly ro...

  1. When good pigeons make bad decisions: Choice with probabilistic delays and outcomes.

    Pisklak, Jeffrey M; McDevitt, Margaret A; Dunn, Roger M; Spetch, Marcia L

    2015-11-01

    Pigeons chose between an (optimal) alternative that sometimes provided food after a 10-s delay and other times after a 40-s delay and another (suboptimal) alternative that sometimes provided food after 10 s but other times no food after 40 s. When outcomes were not signaled during the delays, pigeons strongly preferred the optimal alternative. When outcomes were signaled, choices of the suboptimal alternative increased and most pigeons preferred the alternative that provided no food after the long delay despite the cost in terms of obtained food. The pattern of results was similar whether the short delays occurred on 25% or 50% of the trials. Shortening the 40-s delay to food sharply reduced suboptimal choices, but shortening the delay to no food had little effect. The results suggest that a signaled delay to no food does not punish responding in probabilistic choice procedures. The findings are discussed in terms of conditioned reinforcement by signals for good news. © Society for the Experimental Analysis of Behavior.

  2. General Practice as a career choice among undergraduate medical students in Greece

    Stefanadis Christodoulos

    2007-06-01

    Full Text Available Abstract Background Although General Practice (GP was recognized as a medical specialty in Greece in 1986, the number of GPs is insufficient to cover needs and only few medical graduates choose GP as a career option. In the present study we investigated the profile of medical students in terms of their decisions regarding specialization and the possible association of career choices different from GP with the status of undergraduate training regarding GP. Methods The sample consisted of final year students in the Medical School of the University of Athens, Greece. Students filled in a self-reported questionnaire focusing on medical specialization, and GP in particular. Results Response rate was 82.5% with 1021 questionnaires collected, out of 1237 eligible medical students. Only 44 out of the 1021 (4.3% respondents stated that GP is -or could be- among their choices for specialty. The most popular medical specialty was General Surgery (10.9%, followed by Cardiology (9.6%, Endocrinology (8.7% and Obstetrics-Gynaecology (8.3%. The most common criterion for choosing GP was the guaranteed employment on completion of the residency (54.6% while a 56.6% of total respondents were positive to the introduction of GP/FM as a curriculum course during University studies. Conclusion Despite the great needs, GP specialty is currently not a career option among undergraduate students of the greater Medical University in Greece and is still held in low esteem. A university department responsible for undergraduate teaching, promotion and research in GP (where not available is essential; the status of undergraduate training in general practice/family medicine seems to be one of the most important factors that influence physician career choices regarding primary care specialties.

  3. Practical Implications of Empirically Studying Moral Decision-Making

    Heinzelmann, Nora; Ugazio, Giuseppe; Tobler, Philippe N.

    2012-01-01

    This paper considers the practical question of why people do not behave in the way they ought to behave. This question is a practical one, reaching both into the normative and descriptive domains of morality. That is, it concerns moral norms as well as empirical facts. We argue that two main problems usually keep us form acting and judging in a morally decent way: firstly, we make mistakes in moral reasoning. Secondly, even when we know how to act and judge, we still fail to meet the requirements due to personal weaknesses. This discussion naturally leads us to another question: can we narrow the gap between what people are morally required to do and what they actually do? We discuss findings from neuroscience, economics, and psychology, considering how we might bring our moral behavior better in line with moral theory. Potentially fruitful means include nudging, training, pharmacological enhancement, and brain stimulation. We conclude by raising the question of whether such methods could and should be implemented. PMID:22783157

  4. Practical implications of empirically studying moral decision-making.

    Heinzelmann, Nora; Ugazio, Giuseppe; Tobler, Philippe N

    2012-01-01

    This paper considers the practical question of why people do not behave in the way they ought to behave. This question is a practical one, reaching both into the normative and descriptive domains of morality. That is, it concerns moral norms as well as empirical facts. We argue that two main problems usually keep us form acting and judging in a morally decent way: firstly, we make mistakes in moral reasoning. Secondly, even when we know how to act and judge, we still fail to meet the requirements due to personal weaknesses. This discussion naturally leads us to another question: can we narrow the gap between what people are morally required to do and what they actually do? We discuss findings from neuroscience, economics, and psychology, considering how we might bring our moral behavior better in line with moral theory. Potentially fruitful means include nudging, training, pharmacological enhancement, and brain stimulation. We conclude by raising the question of whether such methods could and should be implemented.

  5. Making health information meaningful: Children's health literacy practices

    Hannah Fairbrother

    2016-12-01

    Full Text Available Children's health and wellbeing is high on the research and policy agenda of many nations. There is a wealth of epidemiological research linking childhood circumstances and health practices with adult health. However, echoing a broader picture within child health research where children have typically been viewed as objects rather than subjects of enquiry, we know very little of how, in their everyday lives, children make sense of health-relevant information.This paper reports key findings from a qualitative study exploring how children understand food in everyday life and their ideas about the relationship between food and health. 53 children aged 9-10, attending two socio-economically contrasting schools in Northern England, participated during 2010 and 2011. Data were generated in schools through interviews and debates in small friendship groups and in the home through individual interviews. Data were analysed thematically using cross-sectional, categorical indexing.Moving beyond a focus on what children know the paper mobilises the concept of health literacy (Nutbeam, 2000, explored very little in relation to children, to conceptualise how children actively construct meaning from health information through their own embodied experiences. It draws on insights from the Social Studies of Childhood (James and Prout, 2015, which emphasise children's active participation in their everyday lives as well as New Literacy Studies (Pahl and Rowsell, 2012, which focus on literacy as a social practice. Recognising children as active health literacy practitioners has important implications for policy and practice geared towards improving child health. Keywords: Children, Health literacy, Qualitative, UK

  6. The Role of Hypertext in Consumer Decision Making. The Case of Travel Destination Choice

    Raúl Valdez Munoz

    2012-01-01

    Full Text Available Travel is one of the most popular items people tend to be comfortable with purchasing over the Internet. Hypertext is a form of electronic text composed of blocks of words (or images linked electronically by multiple paths, chains, or trails. This study explores the importance of hypertext in the travel destination choice from websites. Results show that hypertext links containing images of destinations, informative texts, and search tools are the three most important features utilized by tourist website browsers. This study aims to offer insights into new areas for further research on tourism websites design, application and evaluation.

  7. Making multiple 'online counsellings' through policy and practice: an evidence-making intervention approach.

    Savic, Michael; Dilkes-Frayne, Ella; Carter, Adrian; Kokanovic, Renata; Manning, Victoria; Rodda, Simone N; Lubman, Dan I

    2018-03-01

    Online counselling services for a range of health conditions have proliferated in recent years. However, there is ambiguity and tension around their role and function. It is often unclear whether online counselling services are intended to provide only a brief intervention, the provision of information or referral, or constitute an alternative to face-to-face treatment. In line with recent analyses of alcohol and other drug (AOD) policy and interventions that draw on a critical social science perspective, we take an evidence-making intervention approach to examine how online counselling in the AOD field is made in policy and through processes of local implementation. In this article, we analyse how online AOD counselling interventions and knowledges are enacted in Australia's AOD policy, and compare these enactments with an analysis of information about Australia's national online AOD counselling service, Counselling Online, and transcripts of counselling sessions with clients of Counselling Online. We suggest that while the policy enacts online counselling as a brief intervention targeting AOD use, and as an avenue to facilitate referral to face-to-face treatment services, in its implementation in practice online counselling is enacted in more varied ways. These include online counselling as attempting to attend to AOD use and interconnected psychosocial concerns, as a potential form of treatment in its own right, and as supplementing face-to-face AOD treatment services. Rather than viewing online counselling as a singular and stable intervention object, we suggest that multiple 'online counsellings' emerge in practice through local implementation practices and knowledges. We argue that the frictions that arise between policy and practice enactments need to be considered by policy makers, funders, clinicians and researchers as they affect how the concerns of those targeted by the intervention are attended to. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Food choices and practices during pregnancy of immigrant and Aboriginal women in Canada: a study protocol

    Higginbottom Gina MA

    2011-12-01

    Full Text Available Abstract Background Facilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the women's ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners. Methods/Design This four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2 with semi-structured photo-elicited interviews (in Phase 3. The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the city's most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge

  9. The rational choice model in family decision making at the end of life.

    Karasz, Alison; Sacajiu, Galit; Kogan, Misha; Watkins, Liza

    2010-01-01

    Most end-of-life decisions are made by family members. Current ethical guidelines for family decision making are based on a hierarchical model that emphasizes the patient's wishes over his or her best interests. Evidence suggests that the model poorly reflects the strategies and priorities of many families. Researchers observed and recorded 26 decision-making meetings between hospital staff and family members. Semi-structured follow-up interviews were conducted. Transcriptions were analyzed using qualitative techniques. For both staff and families, consideration of a patient's best interests generally took priority over the patient's wishes. Staff generally introduced discussion of the patient's wishes for rhetorical purposes, such as persuasion. Competing moral frameworks, which de-emphasized the salience of patients' autonomy and "right to choose," played a role in family decision making. The priority given to the patients' wishes in the hierarchical model does not reflect the priorities of staff and families in making decisions about end-of-life care.

  10. The Choice Project: Peer Workers Promoting Shared Decision Making at a Youth Mental Health Service.

    Simmons, Magenta Bender; Batchelor, Samantha; Dimopoulos-Bick, Tara; Howe, Deb

    2017-08-01

    In youth mental health services, consumer participation is essential, but few implementation strategies exist to engage young consumers. This project evaluated an intervention implemented in an Australian youth mental health service that utilized peer workers to promote shared decision making via an online tool. All new clients ages 16-25 were invited to participate in this nonrandomized comparative study, which used a historical comparison group (N=80). Intervention participants (N=149) engaged with a peer worker and used the online tool before and during their intake assessment. Pre- and postintake data were collected for both groups; measures included decisional conflict, perceived shared decision making, and satisfaction. A series of paired t tests, analyses of variance, and multiple regressions were conducted to assess differences in scores across intervention and comparison groups and pre- and postintake assessments. Ratings of perceived shared decision making with intake workers were higher in the intervention group than in the comparison group (p=.015). In both groups, decisional conflict scores were significantly lower after the intake assessment (pdecision making and lower decisional conflict were associated with satisfaction (pdecision making reported feeling more involved in their assessment. Feeling involved and having lower decisional conflict after seeing an intake worker were important for client satisfaction. These findings demonstrate the importance of both peer work and shared decision making for promoting optimal outcomes in youth mental health services.

  11. Survival or Mortality: Does Risk Attribute Framing Influence Decision-Making Behavior in a Discrete Choice Experiment?

    Veldwijk, Jorien; Essers, Brigitte A B; Lambooij, Mattijs S; Dirksen, Carmen D; Smit, Henriette A; de Wit, G Ardine

    2016-01-01

    To test how attribute framing in a discrete choice experiment (DCE) affects respondents' decision-making behavior and their preferences. Two versions of a DCE questionnaire containing nine choice tasks were distributed among a representative sample of the Dutch population aged 55 to 65 years. The DCE consisted of four attributes related to the decision regarding participation in genetic screening for colorectal cancer (CRC). The risk attribute included was framed positively as the probability of surviving CRC and negatively as the probability of dying from CRC. Panel mixed-logit models were used to estimate the relative importance of the attributes. The data of the positively and negatively framed DCE were compared on the basis of direct attribute ranking, dominant decision-making behavior, preferences, and importance scores. The majority (56%) of the respondents ranked survival as the most important attribute in the positively framed DCE, whereas only a minority (8%) of the respondents ranked mortality as the most important attribute in the negatively framed DCE. Respondents made dominant choices based on survival significantly more often than based on mortality. The framing of the risk attribute significantly influenced all attribute-level estimates and resulted in different preference structures among respondents in the positively and negatively framed data set. Risk framing affects how respondents value the presented risk. Positive risk framing led to increased dominant decision-making behavior, whereas negative risk framing led to risk-seeking behavior. Attribute framing should have a prominent part in the expert and focus group interviews, and different types of framing should be used in the pilot version of DCEs as well as in actual DCEs to estimate the magnitude of the effect of choosing different types of framing. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Using a Fine-Grained Multiple-Choice Response Format in Educational Drill-and-Practice Video Games

    Beserra, Vagner; Nussbaum, Miguel; Grass, Antonio

    2017-01-01

    When using educational video games, particularly drill-and-practice video games, there are several ways of providing an answer to a quiz. The majority of paper-based options can be classified as being either multiple-choice or constructed-response. Therefore, in the process of creating an educational drill-and-practice video game, one fundamental…

  13. The choice among non-callable bonds and make whole, claw back and otherwise ordinary callable bonds

    Booth, LD; Gounopoulos, D; Skinner, F

    2012-01-01

    This paper seeks to explain determinates of the choice and the pricing of various types of callable and non-callable bonds. We find that the popularity of different types of callable and non-callable bonds is significantly related to the economic environment. In addition, the popularity of claw back bonds appear to be driven by agency considerations, make whole bonds by the debt overhang problem, ordinary callable bonds by the need by banks to deal with interest rate changes and non-callable ...

  14. Evaluating the role of behavioral factors and practical constraints in the performance of an agent-based model of farmer decision making

    Malawska, Anna Katarzyna; Topping, Christopher John

    2016-01-01

    Farmer decision making models often focus on the behavioral assumptions in the representation of the decision making, applying bounded rationality theory to shift away from the generally criticized profit maximizer approach. Although complex on the behavioral side, such representations are usually...... simplistic with respect to the available choice options in farmer decision making and practical constraints related to farming decisions. To ascertain the relevance of modeling different facets of farmer decision making, we developed an agent based model of farmer decision making on crop choice, fertilizer...... and pesticide usage using an existing economic farm optimization model. We then gradually modified the model to include practical agronomic constraints and assumptions reflecting bounded rationality, and assessed the explanatory power of the added model components. The assessments were based on comparisons...

  15. The Home Identity Idea: How Good Homes Can Urge People to Make Environmentally Friendly Choices

    Paulsen, Karoline

    2017-01-01

    This thesis is a discussion on how we identify with the place we live and how we can make good places to live now and in the future. The idea is that if we feel at home in and identify with the place we live, we want to preserve it and make it better for the future. This can have effect on the environment and the climate. If we build places that are good to live in and the people who live there identify with their home place, they would want to live more sustainably. There is also a discussio...

  16. Balancing the educational choices in the decision-making of a dean ...

    The gap between theory and practice is, however, the nucleus of the position. Objectives. To describe insights into the educational forces that act on a dean of medicine and the implications for those who wish to bring about change – in this case, changes in the inclusion of public health in the medical curriculum. Methods.

  17. Uncovering Chemical Thinking in Students' Decision Making: A Fuel-Choice Scenario

    Banks, Gregory; Clinchot, Michael; Cullipher, Steven; Huie, Robert; Lambertz, Jennifer; Lewis, Rebecca; Ngai, Courtney; Sevian, Hannah; Szteinberg, Gabriela; Talanquer, Vicente; Weinrich, Melissa

    2015-01-01

    Making decisions about the production and use of chemical substances is of central importance in many fields. In this study, a research team comprising teachers and educational researchers collaborated in collecting and analyzing cognitive interviews with students from 8th grade through first-year university general chemistry in an effort to map…

  18. Socio-Semiotic Patterns in Digital Meaning-Making: Semiotic Choice as Indicator of Communicative Experience

    Sofkova Hashemi, Sylvana

    2017-01-01

    Access to digital technology in the classroom enables the composition and organization of ideas on screen with a variety of semiotic systems of different modes and media. This study explores patterns of communication and preference of design in digital meaning-making of twelve 7-8 years old students. Meanings were shaped in complex uses and…

  19. Pneumocystis PCR: It Is Time to Make PCR the Test of Choice.

    Doyle, Laura; Vogel, Sherilynn; Procop, Gary W

    2017-01-01

    The testing strategy for Pneumocystis at the Cleveland Clinic changed from toluidine blue staining to polymerase chain reaction (PCR). We studied the differences in positivity rates for these assays and compared each with the detection of Pneumocystis in companion specimens by cytology and surgical pathology. We reviewed the results of all Pneumocystis test orders 1 year before and 1 year after the implementation of a Pneumocystis -specific PCR. We also reviewed the corresponding cytology and surgical pathology results, if performed. Finally, we reviewed the medical records of patients with rare Pneumocystis detected by PCR in an effort to differentiate colonization vs true disease. Toluidine blue staining and surgical pathology had similar sensitivities and negative predictive values, both of which were superior to cytology. There was a >4-fold increase in the annual detection of Pneumocystis by PCR compared with toluidine blue staining (toluidine blue staining: 11/1583 [0.69%] vs PCR: 44/1457 [3.0%]; chi-square P < .001). PCR detected 1 more case than surgical pathology and was far more sensitive than cytology. Chart review demonstrated that the vast majority of patients with rare Pneumocystis detected were immunosuppressed, had radiologic findings supportive of this infection, had no other pathogens detected, and were treated for pneumocystosis by the clinical team. PCR was the most sensitive method for the detection of Pneumocystis and should be considered the diagnostic test of choice. Correlation with clinical and radiologic findings affords discrimination of early true disease from the far rarer instances of colonization.

  20. Bringing the patient back in: behavioral decision-making and choice in medical economics.

    Mendoza, Roger Lee

    2018-04-01

    We explore the behavioral methodology and "revolution" in economics through the lens of medical economics. We address two questions: (1) Are mainstream economic assumptions of utility-maximization realistic approximations of people's actual behavior? (2) Do people maximize subjective expected utility, particularly in choosing from among the available options? In doing so, we illustrate-in terms of a hypothetical experimental sample of patients with dry eye diagnosis-why and how utility in pharmacoeconomic assessments might be valued differently by patients when subjective psychological, social, cognitive, and emotional factors are considered. While experimentally-observed or surveyed behavior yields stated (rather than revealed) preferences, behaviorism offers a robust toolset in understanding drug, medical device, and treatment-related decisions compared to the optimizing calculus assumed by mainstream economists. It might also do so more perilously than economists have previously understood, in light of the intractable uncertainties, information asymmetries, insulated third-party agents, entry barriers, and externalities that characterize healthcare. Behavioral work has been carried out in many sub-fields of economics. Only recently has it been extended to healthcare. This offers medical economists both the challenge and opportunity of balancing efficiency presumptions with relatively autonomous patient choices, notwithstanding their predictable, yet seemingly consistent, irrationality. Despite its comparative youth and limitations, the scientific contributions of behaviorism are secure and its future in medical economics appears to be promising.

  1. Risk preferences in strategic wildfire decision making: a choice experiment with U.S. wildfire managers.

    Wibbenmeyer, Matthew J; Hand, Michael S; Calkin, David E; Venn, Tyron J; Thompson, Matthew P

    2013-06-01

    Federal policy has embraced risa management as an appropriate paradigm for wildfire management. Economic theory suggests that over repeated wildfire events, potential economic costs and risas of ecological damage are optimally balanced when management decisions are free from biases, risa aversion, and risa seeking. Of primary concern in this article is how managers respond to wildfire risa, including the potential effect of wildfires (on ecological values, structures, and safety) and the likelihood of different fire outcomes. We use responses to a choice experiment questionnaire of U.S. federal wildfire managers to measure attitudes toward several components of wildfire risa and to test whether observed risa attitudes are consistent with the efficient allocation of wildfire suppression resources. Our results indicate that fire managers' decisions are consistent with nonexpected utility theories of decisions under risa. Managers may overallocate firefighting resources when the likelihood or potential magnitude of damage from fires is low, and sensitivity to changes in the probability of fire outcomes depends on whether probabilities are close to one or zero and the magnitude of the potential harm. © 2012 Society for Risk Analysis.

  2. International Higher Education for Whom? Expatriate Students, Choice-Making and International (Im)mobility in the Northern United Arab Emirates

    Rensimer, Lee

    2016-01-01

    This article identifies a research gap on expatriate students attending international branch campuses in their country of residence, and presents evidence that they are insufficiently distinguished from international students in research on student mobility and choice-making. It finds that the priorities and enrollment choices of expatriates are…

  3. Perspectives of self-direction: a systematic review of key areas contributing to service users' engagement and choice-making in self-directed disability services and supports.

    Lakhani, Ali; McDonald, Donna; Zeeman, Heidi

    2018-05-01

    Self-directed disability support policies aim to encourage greater choice and control for service users in terms of the health and social care they receive. The proliferation of self-directed disability support policies throughout the developed world has resulted in a growing amount of research exploring the outcomes for service users, and their families and carers. Our understanding of the issues faced by people with disabilities, particularly how they make health and social care decisions and the key areas that determine their engagement with service providers within a self-directed environment is limited. A synthesis of research is timely and can provide knowledge for service users and health and social care support providers to ensure their successful participation. A systematic review guided by the PRISMA approach explored (i) the key areas determining service users' engagement with self-directed disability services and supports, and (ii) how service users make informed decisions about providers. In October 2014 and April 2016, three databases - MEDLINE, CINAHL and Web of Science - were searched for research and review articles. Eighteen sources met the search criteria. Findings were mapped into either: key areas determining service user engagement, or service users' informed decision-making. Findings concerning key areas determining engagement fell into three themes - personal responsibility for budgeting, personalised approaches, and a cultural shift in practice and delivery among service providers. Findings about decision-making yielded two themes - supporting informed decision-making and inhibiting informed decision-making. Literature suggests that self-directed models of care may provide service users with increased control over the services that they receive. Increased control for some service users and their families requires independent external decision-making support, particularly around the domains of budgeting, planning and hiring. Future research

  4. Positive Health and Financial Practices: Does Budgeting Make a Difference?

    O'Neill, Barbara; Xiao, Jing Jian; Ensle, Karen

    2017-01-01

    This study explored relationships between the practice of following a hand-written or computer-generated budget and the frequency of performance of positive personal health and financial practices. Data were collected from an online quiz completed by 942 adults, providing a simultaneous assessment of individuals' health and financial practices.…

  5. Evidence-Based Practice: A Framework for Making Effective Decisions

    Spencer, Trina D.; Detrich, Ronnie; Slocum, Timothy A.

    2012-01-01

    The research to practice gap in education has been a long-standing concern. The enactment of No Child Left Behind brought increased emphasis on the value of using scientifically based instructional practices to improve educational outcomes. It also brought education into the broader evidence-based practice movement that started in medicine and has…

  6. Nature and nurture in the family physician's choice of practice location.

    Orzanco, Maria Gabriela; Lovato, Chris; Bates, Joanna; Slade, Steve; Grand'Maison, Paul; Vanasse, Alain

    2011-01-01

    An understanding of the contextual, professional, and personal factors that affect choice of practice location for physicians is needed to support successful strategies in addressing geographic maldistribution of physicians. This study compared two categories of predictors of family practice location in non-metropolitan areas among undergraduate medical students: individual characteristics (nature), and the rural program component of their training program (nurture). The study aimed to identify factors that predict the location of practice 2 years post-residency training and determine the predictive value of combining nature and nurture variables using administrative data from two undergraduate medical education programs. Databases were developed from available administrative sources for a retrospective analysis of two undergraduate medical education programs in Canada: Université de Sherbrooke (UdeS) and University of British Columbia (UBC). Both schools have a strong mandate to evaluate the impact of their programs on physician distribution. The dependent variable was location of practice 2 years after completing postgraduate training in family medicine. Independent variables included individual and program characteristics. Separate analyses were conducted for each program using multiple logistic regression. The nature and nurture variables considered in the models explained only 21% to 27% of the variance in the eventual location of practice of family physician graduates. For UdeS, having an address in a rural/small-town environment at application to medical school (OR=2.61, 95% CI: 1.24-6.06) and for UBC, location of high school in a rural/small town (OR=4.03, 95% CI: 1.05-15.41), both increased the chances of practicing in a non-metropolitan area. For UdeS the nurture variable (ie length of clerkship in a non-metropolitan area) was the most significant predictor (OR=1.14, 95% CI: 1.067-1.22). For both medical schools, adding a single nurture variable to the

  7. Adolescents' perspectives and food choice behaviors in terms of the environmental impacts of food production practices: application of a psychosocial model.

    Bissonnette, M M; Contento, I R

    2001-01-01

    The objective of this study was to investigate adolescents' perspectives about the environmental impacts of food production practices and whether these perspectives are related to their food choice. Food choice was operationalized as consumption and purchase of organic foods and locally grown foods. A survey questionnaire was administered to a convenience sample of adolescents and analyzed for descriptive information and relationships among variables. Subjects were 651 ethnically diverse, urban and suburban high school senior students in a major metropolitan area. Variables of an Expanded Theory of Planned Behavior were measured including beliefs, attitudes, perceived social influences, motivation to comply, perceived behavioral control, self-identity, perceived responsibility, behavioral intention, and behavior. Descriptive statistics, Pearson correlation coefficients, and stepwise multiple regression analyses were used. Surveyed adolescents did not have strong or consistent beliefs or attitudes about the environmental impact of food production practices. Cognitive-motivational processes were at work, however, since their perspectives were significantly correlated with behavioral intentions and food choice behaviors. Behavioral intention was best accounted for by attitudes and perceived social influences (and perceived responsibility for organic food), and behavior was best accounted for by behavioral intentions, beliefs, and perceived social influences (and self-identity for local food). There is a need to make salient to adolescents the environmental impact of food production practices through both cognitive and experiential approaches.

  8. Information-sharing to promote informed choice in prenatal screening in the spirit of the SOGC clinical practice guideline: a proposal for an alternative model.

    Vanstone, Meredith; Kinsella, Elizabeth Anne; Nisker, Jeff

    2012-03-01

    The 2011 SOGC clinical practice guideline "Prenatal Screening for Fetal Aneuploidy in Singleton Pregnancies" recommends that clinicians offer prenatal screening to all pregnant women and provide counselling in a non-directive manner. Non-directive counselling is intended to facilitate autonomous decision-making and remove the clinician's views regarding a particular course of action. However, recent research in genetic counselling raises concerns that non-directive counselling is neither possible nor desirable, and that it may not be the best way to facilitate informed choice. We propose an alternative model of information-sharing specific to prenatal screening that combines attributes of the models of informative decision-making and shared decision-making. Our proposed model is intended to provide clinicians with a strategy to communicate information about prenatal screening in a way that facilitates a shared deliberative process and autonomous decision-making. Our proposed model may better prepare a pregnant woman to make an informed choice about participating in prenatal screening on the basis of her consideration of the medical information provided by her clinician and her particular circumstances and values.

  9. Context influences decision-making in boys with attention-deficit/hyperactivity disorder: A comparison of traditional and novel choice-impulsivity paradigms.

    Patros, Connor H G; Alderson, R Matt; Lea, Sarah E; Tarle, Stephanie J

    2017-02-01

    Attention-deficit/hyperactivity disorder (ADHD) is characterized by an impaired ability to maintain attention and/or hyperactivity/impulsivity. Impulsivity is frequently defined as the preference for small, immediate rewards over larger, delayed rewards, and has been associated with a variety of negative outcomes such as risky behavior and academic difficulty. Extant studies have uniformly utilized the traditional paradigm of presenting two response choices, which limits the generalization of findings to scenarios in which children/adolescents are faced with dichotomous decisions. The current study is the first to examine the effect of manipulating the number of available response options on impulsive decision-making in boys with and without ADHD. A total of 39 boys (ADHD = 16, typically developing [TD] = 23) aged 8-12 years completed a traditional two-choice impulsivity task and a novel five-choice impulsivity task to examine the effect of manipulating the number of choice responses (two vs five) on impulsive decision-making. A five-choice task was utilized as it presents a more continuous array of choice options when compared to the typical two-choice task, and is comparable given its methodological similarity to the two-choice task. Results suggested that boys with ADHD were significantly more impulsive than TD boys during the two-choice task, but not during the five-choice task. Collectively, these findings suggest that ADHD-related impulsivity is not ubiquitous, but rather dependent on variation in demands and/or context. Further, these findings highlight the importance of examining ADHD-related decision-making within the context of alternative paradigms, as the exclusive utilization of two-choice tasks may promote inaccurate conceptualizations of the disorder.

  10. Practice makes perfect: an Rx for healthy customer service.

    Manfredi, Jodi

    2006-01-01

    Evaluating the health of your practice is about much more than clinical skills or Occupational Safety and Health Administration regulations. It's about how your patients feel emotionally when they leave your office. When they've been treated with professionalism, kindness, and respect, they'll not only return--they'll refer. Happy patients are the key to a successful practice, especially for fee-for-service practices that rely heavily on referrals. In this article, the concept of the use of "mystery shoppers" in the medical practice, which has recently been featured on ABC News and in the Wall Street Journal, is discussed.

  11. What Sways People's Judgment of Sleep Quality? A Quantitative Choice-Making Study With Good and Poor Sleepers.

    Ramlee, Fatanah; Sanborn, Adam N; Tang, Nicole K Y

    2017-07-01

    We conceptualized sleep quality judgment as a decision-making process and examined the relative importance of 17 parameters of sleep quality using a choice-based conjoint analysis. One hundred participants (50 good sleepers; 50 poor sleepers) were asked to choose between 2 written scenarios to answer 1 of 2 questions: "Which describes a better (or worse) night of sleep?". Each scenario described a self-reported experience of sleep, stringing together 17 possible determinants of sleep quality that occur at different times of the day (day before, pre-sleep, during sleep, upon waking, day after). Each participant answered 48 questions. Logistic regression models were fit to their choice data. Eleven of the 17 sleep quality parameters had a significant impact on the participants' choices. The top 3 determinants of sleep quality were: Total sleep time, feeling refreshed (upon waking), and mood (day after). Sleep quality judgments were most influenced by factors that occur during sleep, followed by feelings and activities upon waking and the day after. There was a significant interaction between wake after sleep onset and feeling refreshed (upon waking) and between feeling refreshed (upon waking) and question type (better or worse night of sleep). Type of sleeper (good vs poor sleepers) did not significantly influence the judgments. Sleep quality judgments appear to be determined by not only what happened during sleep, but also what happened after the sleep period. Interventions that improve mood and functioning during the day may inadvertently also improve people's self-reported evaluation of sleep quality. © Sleep Research Society 2017. Published by Oxford University Press [on behalf of the Sleep Research Society].

  12. Comparative effectiveness research for the clinician researcher: a framework for making a methodological design choice.

    Williams, Cylie M; Skinner, Elizabeth H; James, Alicia M; Cook, Jill L; McPhail, Steven M; Haines, Terry P

    2016-08-17

    Comparative effectiveness research compares two active forms of treatment or usual care in comparison with usual care with an additional intervention element. These types of study are commonly conducted following a placebo or no active treatment trial. Research designs with a placebo or non-active treatment arm can be challenging for the clinician researcher when conducted within the healthcare environment with patients attending for treatment.A framework for conducting comparative effectiveness research is needed, particularly for interventions for which there are no strong regulatory requirements that must be met prior to their introduction into usual care. We argue for a broader use of comparative effectiveness research to achieve translatable real-world clinical research. These types of research design also affect the rapid uptake of evidence-based clinical practice within the healthcare setting.This framework includes questions to guide the clinician researcher into the most appropriate trial design to measure treatment effect. These questions include consideration given to current treatment provision during usual care, known treatment effectiveness, side effects of treatments, economic impact, and the setting in which the research is being undertaken.

  13. Masturbation and premarital sexual intercourse among college women: making choices for sexual fulfillment.

    Davidson, J K; Moore, N B

    1994-01-01

    Given the potential value of masturbation as an alternative to high-risk sexual practices, there is a need to investigate factors surrounding this method of physiological sexual fulfillment. Therefore, this study examined the differences, if any, between women who have engaged in masturbation only (MO), both masturbation and sexual intercourse (MSI), and sexual intercourse only (SIO). An anonymous questionnaire was administered to volunteer respondents enrolled at a Midwestern university, yielding a subsample of 777 never-married, heterosexual women. Group comparisons indicated that MO Group women were most likely to feel guilty about engaging in masturbation and petting, but least likely to report either comfort with their sexuality or sexual satisfaction. MSI Group women indicated that, while growing up, they were less attached to their mother and father figures, whom they rated as uncommunicative. They also were more likely to have engaged in risk-related sexual behaviors. SIO Group women were more likely to have used contraceptives at first sexual intercourse and to report fewer lifetime sex partners than MSI Group women. Since a substantial number of college women refrain from engaging in masturbation, yet choose to have unprotected sexual intercourse and multiple sex partners, and others engage in masturbation but report experiencing guilt feelings regarding self-stimulation, it is of crucial importance that the negative connotations of masturbation and its attendant impact on sexual satisfaction be addressed by sexuality educators, clinicians, and researchers.

  14. Do dogs (Canis lupus familiaris) make counterproductive choices because they are sensitive to human ostensive cues?

    Marshall-Pescini, Sarah; Passalacqua, Chiara; Miletto Petrazzini, Maria Elena; Valsecchi, Paola; Prato-Previde, Emanuela

    2012-01-01

    Dogs appear to be sensitive to human ostensive communicative cues in a variety of situations, however there is still a measure of controversy as to the way in which these cues influence human-dog interactions. There is evidence for instance that dogs can be led into making evaluation errors in a quantity discrimination task, for example losing their preference for a larger food quantity if a human shows a preference for a smaller one, yet there is, so far, no explanation for this phenomenon. Using a modified version of this task, in the current study we investigated whether non-social, social or communicative cues (alone or in combination) cause dogs to go against their preference for the larger food quantity. Results show that dogs' evaluation errors are indeed caused by a social bias, but, somewhat contrary to previous studies, they highlight the potent effect of stimulus enhancement (handling the target) in influencing the dogs' response. A mild influence on the dog's behaviour was found only when different ostensive cues (and no handling of the target) were used in combination, suggesting their cumulative effect. The discussion addresses possible motives for discrepancies with previous studies suggesting that both the intentionality and the directionality of the action may be important in causing dogs' social biases.

  15. 2012 Dewey Lecture: Making Meaning Together beyond Theory and Practice

    Garrison, Jim

    2013-01-01

    Educators frequently fret over how to bridge the gap between theory and practice. In an important sense, it is a false problem. Theory is simply the thoughtful, reflective phase of good practice. We will approach Dewey's philosophy as one of continuous creation and re-creation or even more precisely, social co-creation, that requires making…

  16. Practical implications of empirically studying moral decision making

    Heinzelmann, N.; Ugazio, G.; Tobler, P.N.

    2012-01-01

    This paper considers the practical question of why people do not behave in the way they ought to behave. This question is a practical one, reaching both into the normative and descriptive domains of morality. That is, it concerns moral norms as well as empirical facts. We argue that two main

  17. Education(al) Research, Educational Policy-Making and Practice

    Clark, Charles

    2011-01-01

    Professor Whitty has endorsed the consensus that research into education is empirical social science, distinguishing "educational research" which seeks directly to influence practice, and "education research" that has substantive value but no necessary practical application. The status of the science here is problematic. The positivist approach is…

  18. An Analysis of Design Decision-Making in Industrial Practice

    Ahmed, Saeema; Hansen, Claus Thorp

    2002-01-01

    This paper describes research that confronts a generic decision-making model with design strategies employed by experienced designers. The relationship between the decision-making activities proposed by the model and the eight design strategies identified by an empirical study of design work is e...

  19. A Shared Decision-Making System for Diabetes Medication Choice Utilizing Electronic Health Record Data.

    Wang, Yu; Li, Peng-Fei; Tian, Yu; Ren, Jing-Jing; Li, Jing-Song

    2017-09-01

    The use of a shared decision-making (SDM) process in antihyperglycemic medication strategy decisions is necessary due to the complexity of the conditions of diabetes patients. Knowledge of guidelines is used as decision aids in clinical situations, and during this process, no patient health conditions are considered. In this paper, we propose an SDM system framework for type-2 diabetes mellitus (T2DM) patients that not only contains knowledge abstracted from guidelines but also employs a multilabel classification model that uses class-imbalanced electronic health record (EHR) data and that aims to provide a recommended list of available antihyperglycemic medications to help physicians and patients have an SDM conversation. The use of EHR data to serve as a decision-support component in decision aids helps physicians and patients to reach a more intuitive understanding of current health conditions and allows the tailoring of the available knowledge to each patient, leading to a more effective SDM. Real-world data from 2542 T2DM inpatient EHRs were substituted by 77 features and eight output labels, i.e., eight antihyperglycemic medications, and these data were utilized to build and validate the recommendation model. The multilabel recommendation model exhibited stable performance in every single-label classification and showed the ability to predict minority positive cases in which the average recall value of the eight classes was 0.9898. As a whole multilabel classifier, the recommendation model demonstrated outstanding performance, with scores of 0.0941 for Hamming Loss, 0.7611 for Accuracy exam , 0.9664 for Recall exam , and 0.8269 for F exam .

  20. Reversible inactivation of the lateral hypothalamus reversed high reward choices in cost-benefit decision-making in rats.

    Karimi, Sara; Mesdaghinia, Azam; Farzinpour, Zahra; Hamidi, Gholamali; Haghparast, Abbas

    2017-11-01

    The Lateral hypothalamus (LH) is an important component of the networks underlying the control of feeding and other motivated behaviors. Cost-benefit decision-making is mediated largely by the prefrontal cortex (PFC) which strongly innervates the LH. Therefore, in the current study, we conducted a series of experiments to elucidate the role of the perifornical area of the lateral hypothalamus (PeF-LH) in effort and/or delay-based decision-making. We trained different groups of rats in a delay-based and/or an effort-based form of cost-benefit T-maze decision- making task in which they could either choose to pay the cost to obtain a high reward in one arm or could obtain a low reward in the other arm with no cost. During test days, the rats received local injections of either vehicle or lidocaine4% (0.5 μl/side), in the PeF-LH. In an effort-based decision task, PeF-LH inactivation led to decrease in high reward choice. Similarly, in a delay-based decision task animals' preference changed to a low but immediately available reward. This was not caused by a spatial memory or motor deficit. PeF-LH inactivation modified decision behavior. The results imply that PeF-LH is important for allowing the animal to pay a cost to acquire greater rewards. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Everyday and medical life choices: decision-making among 8- to 15-year-old school students.

    Alderson, P

    1992-01-01

    How much do young patients expect to be involved in medical decisions affecting them? We are investigating this question during interviews with 8- to 15-year-olds having orthopaedic surgery. Many youngsters taking part in our research project on consent to surgery are more than usually dependent on their parents. We wondered how their views would compare with those of their peers at school. This paper reports a schools survey carried out as a background to the research with young people in hospital. Students in seven schools answered questionnaires on choices about late-night television viewing, new friends, timing homework, seeing their family doctor and consenting to surgery. They were asked about agreement with their parents, how they negotiate disagreement, and when they think they were/will be old enough to make everyday and medical decisions without their parents' help.

  2. Risky decision making across three arenas of choice: are younger and older adults differently susceptible to framing effects?

    Rönnlund, Michael; Karlsson, Erik; Laggnäs, Erica; Larsson, Lisa; Lindström, Therese

    2005-01-01

    In the present study, the authors investigated the effects of framing of options on risky decision making in groups of younger adults (M = 23.8 years, n = 192) and older adults (M = 69.1 years, n = 192). The participants were assigned to one of three scenarios varying in the goods at stake (human lives, paintings, money). The authors observed a majority preference in favor of the risky options after negative, but not positive framing. They also found, as they had predicted, that the type of framing effect varied across scenarios, with a bidirectional framing effect for the life-death scenario and unidirectional (risk averse) framing effects when public property (paintings) or personal property (money) were at stake. It is important to note that these choice preference patterns were highly similar across the age groups, which reinforced the conclusion that younger and older adults are equally susceptible to framing effects.

  3. Making choice between competing rewards in uncertain versus safe social environment:role of neuronal nicotinic receptors of acetylcholine

    Jonathan eChabout

    2013-08-01

    Full Text Available In social environments, choosing between multiple rewards is modulated by the uncertainty of the situation. Here, we compared how mice interact with a conspecific and how they use acoustic communication during this interaction in a 3 chambers task (no social threat was possible and a Social Interaction Task, SIT (uncertain situation as two mice interact freely. We further manipulated the motivational state of the mice to see how they rank natural rewards such as social contact, food, and novelty seeking. We previously showed that beta2-subunit containing nicotinic receptors -2*nAChRs- are required for establishing reward ranking between social interaction, novelty exploration, and food consumption in social situations with high uncertainty. Knockout mice for 2*nAChRs -2-/-mice- exhibit profound impairment in making social flexible choices, as compared to control -WT- mice.Our current data shows that being confronted with a conspecific in a socially safe environment as compared to a more uncertain environment, drastically reduced communication between the two mice, and changed their way to deal with a social conspecific. Furthermore, we demonstrated for the first time, that 2-/- mice had the same motivational ranking than WT mice when placed in a socially safe environment. Therefore,2*nAChRs are not necessary for integrating social information or social rewards per se, but are important for making choices, only in a socially uncertain environment.This seems particularly important in the context of Social Neuroscience, as numerous animal models are used to provide novel insights and to test promising novel treatments of human pathologies affecting social and communication processes, among which Autistic spectrum disorders and schizophrenia.

  4. Single-larger-portion-size and dual-column nutrition labeling may help consumers make more healthful food choices.

    Lando, Amy M; Lo, Serena C

    2013-02-01

    The Food and Drug Administration is considering changes to the Nutrition Facts label to help consumers make more healthful choices. To examine the effects of modifications to the Nutrition Facts label on foods that can be listed as having 1 or 2 servings per container, but are reasonably consumed at a single eating occasion. Participants were randomly assigned to study conditions that varied on label format, product, and nutrition profile. Data were collected via an online consumer panel. Adults aged 18 years and older were recruited from Synovate's online household panel. Data were collected during August 2011. A total of 32,897 invitations were sent for a final sample of 9,493 interviews. Participants were randomly assigned to one of 10 label formats classified into three groups: listing 2 servings per container with a single column, listing 2 servings per container with a dual column, and listing a single serving per container. Within these groups there were versions that enlarged the font size for "calories," removed "calories from fat," and changed the wording for serving size declaration. The single product task measured product healthfulness, the amount of calories and various nutrients per serving and per container, and label perceptions. The product comparison task measured ability to identify the healthier product and the product with fewer calories per container and per serving. Analysis of covariance models with Tukey-Kramer tests were used. Covariates included general label use, age, sex, level of education, and race/ethnicity. Single-serving and dual-column formats performed better and scored higher on most outcome measures. For products that contain 2 servings but are customarily consumed at a single eating occasion, using a single-serving or dual-column labeling approach may help consumers make healthier food choices. Published by Elsevier Inc.

  5. Towards a life cycle sustainability assessment: making informed choices on products

    Ciroth, Andreas [GreenDeltaTC, Berlin (Germany); Finkbeiner, Matthias; Traverso, Marzia [TU Berlin (Germany); Hildenbrand, Jutta [Chalmers University (United States); Kloepffer, Walter [Editor-in-Chief of the International Journal of Life Cycle Assessment (Germany); Mazijn, Bernard [Ghent University (Belgium); Prakash, Siddharth [Oeko-Institut (Germany); Sonnemann, Guido; Valdivia, Sonia [UNEP (France); Ugaya, Cassia Maria Lie [Technological Federal University of Parana, ACV (Brazil); Vickery-Niederman, Gina [University of Arkansas (United States)

    2011-07-01

    In this introduction to the concept of life cycle sustainability assessment (LCSA), we acknowledge the foundations laid by previous works and initiatives. One such initiative has been the ISO 14040 series (Environmental management -- Life cycle assessment -- Principles and framework), which in addition to the ISO 26000: Social Responsibility Guidance Standard, and the contribution of a number of international initiatives (Appendix A) have been essential for the development of this publication. The life cycle of a product involves flows of material, energy and money. Nonetheless, the picture is not complete unless we look also at the production and consumption impacts on all actors along the 'value chain' -- workers, local communities, consumers and society itself. Different life cycle assessment techniques allow individuals and enterprises to assess the impact of their purchasing decisions and production methods along different aspects of this value chain. An (Environmental) life cycle assessment (LCA) looks at potential impacts to the environment as a result of the extraction of resources, transportation, production, use, recycling and discarding of products; life cycle costing (LCC) is used to assess the cost implications of this life cycle; and social life cycle assessment (S-LCA) examines the social consequences. However, in order to get the 'whole picture', it is vital to extend current life cycle thinking to encompass all three pillars of sustainability: (i) environmental, (ii) economic and (iii) social. This means carrying out an assessment based on environmental, economic and social issues -- by conducting an overarching life cycle sustainability assessment (LCSA). This publication shows how all three techniques -- which all share similar methodological frameworks and aims -- can be combined to make the move towards an overarching LCSA possible. Because it is holistic, systemic and rigorous, (environmental) LCA is the preferred technique

  6. Towards a life cycle sustainability assessment: making informed choices on products

    Ciroth, Andreas [GreenDeltaTC, Berlin (Germany); Finkbeiner, Matthias; Traverso, Marzia [TU Berlin (Germany); Hildenbrand, Jutta [Chalmers University (United States); Kloepffer, Walter [Editor-in-Chief of the International Journal of Life Cycle Assessment (Germany); Mazijn, Bernard [Ghent University (Belgium); Prakash, Siddharth [Oeko-Institut (Germany); Sonnemann, Guido; Valdivia, Sonia [UNEP (France); Ugaya, Cassia Maria Lie [Technological Federal University of Parana, ACV (Brazil); Vickery-Niederman, Gina [University of Arkansas (United States)

    2011-07-01

    In this introduction to the concept of life cycle sustainability assessment (LCSA), we acknowledge the foundations laid by previous works and initiatives. One such initiative has been the ISO 14040 series (Environmental management -- Life cycle assessment -- Principles and framework), which in addition to the ISO 26000: Social Responsibility Guidance Standard, and the contribution of a number of international initiatives (Appendix A) have been essential for the development of this publication. The life cycle of a product involves flows of material, energy and money. Nonetheless, the picture is not complete unless we look also at the production and consumption impacts on all actors along the 'value chain' -- workers, local communities, consumers and society itself. Different life cycle assessment techniques allow individuals and enterprises to assess the impact of their purchasing decisions and production methods along different aspects of this value chain. An (Environmental) life cycle assessment (LCA) looks at potential impacts to the environment as a result of the extraction of resources, transportation, production, use, recycling and discarding of products; life cycle costing (LCC) is used to assess the cost implications of this life cycle; and social life cycle assessment (S-LCA) examines the social consequences. However, in order to get the 'whole picture', it is vital to extend current life cycle thinking to encompass all three pillars of sustainability: (i) environmental, (ii) economic and (iii) social. This means carrying out an assessment based on environmental, economic and social issues -- by conducting an overarching life cycle sustainability assessment (LCSA). This publication shows how all three techniques -- which all share similar methodological frameworks and aims -- can be combined to make the move towards an overarching LCSA possible. Because it is holistic, systemic and rigorous, (environmental) LCA is the preferred technique when it comes to

  7. In private practice, informed consent is interpreted as providing explanations rather than offering choices: a qualitative study.

    Delany, Clare M

    2007-01-01

    How do physiotherapists working in private practice understand and interpret the meaning and significance of informed consent in everyday clinical practice? Qualitative study using semi-structured interviews. Seventeen physiotherapists purposefully recruited from metropolitan private practices where treatment was on a one-on-one basis. Therapists defined informed consent as an implicit component of their routine clinical explanations, rather than a process of providing explicit patient choices. Therapists' primary concern was to provide information that led to a (therapist-determined) beneficial therapeutic outcome, rather than to enhance autonomous patient choice. Explicit patient choice and explicit informed consent were defined as important only if patients requested information or therapists recognised risks associated with the treatment. Physiotherapists defined informed consent within a context of achieving therapeutic outcomes rather than a context of respect for patient autonomy and autonomous choice. Physiotherapy practice guidelines developed to ensure compliance with ethical and legal obligations may therefore be followed only if they fit with therapists' understanding and interpretation of a desired therapeutic outcome.

  8. Understanding the Interconnectedness between Language Choices, Cultural Identity Construction and School Practices in the Life of a Latina Educator

    Mercuri, Sandra Patricia

    2012-01-01

    This qualitative research looks at the effects that language choices and cultural practices have on identity development in the education of minority students in the United States. It examines the educational journey of Irma, a Latina educator. Through the analysis of interviews with the participant, this paper intends to show the effects of…

  9. [An investigation of career choice, plans and expectations and practice preferences of male and female dental students

    Daalmans, M.T.; Vissia, M.S.; Kuijpers-Jagtman, A.M.; Lagro-Janssen, A.L.M.

    2004-01-01

    Aim of this study was to get more insight into the career choice, plans and expectations, and practice pattern preferences of male and female dental students in The Netherlands. A structured questionnaire was sent out to all 5th year dental students in The Netherlands in the academic year 2001/2002

  10. Ideological Tensions in the Educational Choice Practices of Modern Greek Cypriot Parents: The Role of Social Capital

    Green, Anthony; Vryonides, Marios

    2005-01-01

    The rapid modernisation process of Greek Cypriot society has created a cultural environment with an amalgam of traditionalist and modernist ethical attitudes, and antagonisms between them concerning, among other things, social advancement. These have implications for the way individuals and families develop various strategies of choice-making for…

  11. Practice Options and Decision Making for Dental Students.

    Manski, Richard J.

    1987-01-01

    One dental school implemented in its fourth-year curriculum an intensive simulation exercise to teach students the application of fundamental economic concepts such as capital costs, leasehold improvements, operating expenses, working capital, and financial risk in dental practice. (MSE)

  12. Making Theory Come Alive through Practice-based Design Research

    Markussen, Thomas; Knutz, Eva; Rind Christensen, Poul

    The aim of this paper is to demonstrate how practice-based design research is able not only to challenge, but also to push toward further development of some of the basic assumpstions in emotion theories as used within design research. In so doing, we wish to increase knolwedge on a central...... epistemological question for design research, namely how practice-based design research can be a vehicle for the construction of new theory for design research....

  13. Decision Making in Action: Applying Research to Practice

    Orasanu, Judith; Statler, Irving C. (Technical Monitor)

    1994-01-01

    The importance of decision-making to safety in complex, dynamic environments like mission control centers and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. A similar observation has been made in nuclear power plants. Yet laboratory research on decision making has not proven especially helpful in improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multidimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication

  14. Governance mode vs. governance fit? : Performance implications of make-or-ally choices for product innovation in the worldwide aircraft industry, 1942-2000

    Castaner, X.; Mulotte, L.; Garrette, B.; Dussauge, P.

    We examine the impact of governance mode and governance fit on performance in make-or-ally decisions. We argue that while horizontal collaboration and autonomous governance have direct and countervailing performance implications, the alignment of make-or-ally choices with the focal firm's resource

  15. Analysis of Farmer’s Choices for Climate Change Adaptation Practices in South-Western Uganda, 1980–2009

    Alex Zizinga

    2017-12-01

    Full Text Available Climate change is a serious threat to the livelihoods of rural communities, particularly in mountainous areas because they are very sensitive to such changes. In this study, we assessed the household determinants to climate change adaptation drawing from a case study of agricultural adaptation in the Mount Rwenzori area of South Western Uganda. The study identified the major adaptation practices that are adopted by farmers to cope with the impacts of climate change and using available on-farm technologies. A total of 143 smallholder farmers were sampled and interviewed using field based questionnaires, field observations, and key informant interviews. Data was cleaned, entered and analysed using SPSS and Stata software for descriptive statistics. Thereafter, a Multinomial logistic regression model was used to assess the drivers of farmers’ choice for adaptation practices, factors influencing the choice of adaptation, and barriers. The major adaptation practices that were identified included; use of different crop varieties, tree planting, soil and water conservation, early and late planting, and furrow irrigation. Discrete choice model results indicated the age of the household head, experience in farming, household size, climate change shocks, land size, use of agricultural inputs, landscape position (location, and crop yield varied significantly (p > 0.05, which influenced farmers’ choice of climate change adaptation practices. The main barriers to adaptation included inadequate information on adaptation methods and financial constraints, leading us to conclude that contextual adaptation practices are more desirable for adoption to farmers. Adapting to climate change needs support from government and other stakeholders, however the implementation is more successful when appropriate and suitable choices are employed.

  16. The Environment Makes a Difference: The Impact of Explicit and Implicit Attitudes as Precursors in Different Food Choice Tasks.

    König, Laura M; Giese, Helge; Schupp, Harald T; Renner, Britta

    2016-01-01

    Studies show that implicit and explicit attitudes influence food choice. However, precursors of food choice often are investigated using tasks offering a very limited number of options despite the comparably complex environment surrounding real life food choice. In the present study, we investigated how the assortment impacts the relationship between implicit and explicit attitudes and food choice (confectionery and fruit), assuming that a more complex choice architecture is more taxing on cognitive resources. Specifically, a binary and a multiple option choice task based on the same stimulus set (fake food items) were presented to ninety-seven participants. Path modeling revealed that both explicit and implicit attitudes were associated with relative food choice (confectionery vs. fruit) in both tasks. In the binary option choice task, both explicit and implicit attitudes were significant precursors of food choice, with explicit attitudes having a greater impact. Conversely, in the multiple option choice task, the additive impact of explicit and implicit attitudes was qualified by an interaction indicating that, even if explicit and implicit attitudes toward confectionery were inconsistent, more confectionery was chosen than fruit if either was positive. This compensatory 'one is sufficient'-effect indicates that the structure of the choice environment modulates the relationship between attitudes and choice. The study highlights that environmental constraints, such as the number of choice options, are an important boundary condition that need to be included when investigating the relationship between psychological precursors and behavior.

  17. Making Judgements about Students Making Work: Lecturers’ Assessment Practices in Art and Design

    Orr, Susan; Bloxham, Sue

    2013-01-01

    This research study explores the assessment practices in two higher education art and design departments. The key aim of this research was to explore art and design studio assessment practices as lived and experienced by art and design lecturers. This work draws on two bodies of pre-existing research. Firstly this study adopted methodological…

  18. Advances in fuzzy decision making theory and practice

    Skalna, Iwona; Gaweł, Bartłomiej; Basiura, Beata; Duda, Jerzy; Opiła, Janusz; Pełech-Pilichowski, Tomasz

    2015-01-01

    This book shows how common operation management methods and algorithms can be extended to deal with vague or imprecise information in decision-making problems. It describes how to combine decision trees, clustering, multi-attribute decision-making algorithms and Monte Carlo Simulation with the mathematical description of imprecise or vague information, and how to visualize such information. Moreover, it discusses a broad spectrum of real-life management problems including forecasting the apparent consumption of steel products, planning and scheduling of production processes, project portfolio selection and economic-risk estimation. It is a concise, yet comprehensive, reference source for researchers in decision-making and decision-makers in business organizations alike.

  19. Citizens and/or Consumers: Mutations in the Construction of Concepts and Practices of School Choice

    Wilkins, Andrew

    2010-01-01

    Recent research on school choice highlights the tendency among some White, middle-class parents to engage with discourses of community responsibility and ethnic diversity as part of their responsibility and duty as choosers and who therefore exercise choice in ways that undercut the individualistic and self-interested character framing…

  20. Making Philosophy of Science Education Practical for Science Teachers

    Janssen, F. J. J. M.; van Berkel, B.

    2015-01-01

    Philosophy of science education can play a vital role in the preparation and professional development of science teachers. In order to fulfill this role a philosophy of science education should be made practical for teachers. First, multiple and inherently incomplete philosophies on the teacher and teaching on what, how and why should be…

  1. The Nature of Decision Making in the Practice of Dwelling

    Fyhn, Håkon; Baron, Nina

    2017-01-01

    as the result of existing material conditions, meanings and competences. Rather than focusing on decisions and acts pertaining to refurbishment alone, we take one step back and observe the whole process of keeping a home habitable. Inspired by theories of Tim Ingold and Elizabeth Shove we call it the “practice...

  2. Professional Learning in Higher Education: Making Good Practice Relevant

    Daniels, Jeannie

    2017-01-01

    Professionals working in a range of contexts are increasingly expected to engage in ongoing professional learning to maintain their skills and develop their practices. In this paper, I focus on professional learning in Higher Education and challenge the standardisation of professional learning that is becoming prevalent in a number of countries. I…

  3. Ventriloquism as Early Literacy Practice: Making Meaning in Pretend Play

    Bateman, Amanda

    2018-01-01

    This article discusses how children in New Zealand make meaning in their spontaneous pretend play from kindergarten (four years old) through to their first year of primary school (five years old). The findings discussed here are taken from a wider project investigating children's storytelling where 12 child participants were video recorded during…

  4. Barriers and opportunities for shared decision making in clinical practice

    Schuitmaker-Warnaar, T.J.; Scheele, Fedde

    2017-01-01

    Shared decision-making (SDM) is promoted as tool for improving quality and responsiveness of care, while lowering overall costs. The underlying idea of SDM is well-conceptualised and a wide range of experiments in the Netherlands and abroad have been executed over the last couple of years. However,

  5. Making the EZ Choice

    2001-01-01

    Analytical Mechanics Associates, Inc. (AMA), of Hampton, Virginia, created the EZopt software application through Small Business Innovation Research (SBIR) funding from NASA's Langley Research Center. The new software is a user-friendly tool kit that provides quick and logical solutions to complex optimal control problems. In its most basic form, EZopt converts process data into math equations and then proceeds to utilize those equations to solve problems within control systems. EZopt successfully proved its advantage when applied to short-term mission planning and onboard flight computer implementation. The technology has also solved multiple real-life engineering problems faced in numerous commercial operations. For instance, mechanical engineers use EZopt to solve control problems with robots, while chemical plants implement the application to overcome situations with batch reactors and temperature control. In the emerging field of commercial aerospace, EZopt is able to optimize trajectories for launch vehicles and perform potential space station- keeping tasks. Furthermore, the software also helps control electromagnetic devices in the automotive industry.

  6. Making Choices about Change.

    Steinburg, Craig; And Others

    1992-01-01

    This special report includes four articles arising from the American Society for Training and Development's symposium, "Approaches to Change in Organizations": "Taking Charge of of Change" (Steinburg); "Five Views of Change" (Conner et al.); "Breakpoint Change" (Land, Jarman); and "Approaches to Change" (Kotler). (JOW)

  7. Parents' accounts : factors considered when deciding how far to involve their son/daughter with learning disabilities in choice-making

    Mitchell, Wendy Ann

    2012-01-01

    There is limited literature on the processes of choice-making in families of young people with learning disabilities. This paper examines the factors considered by parents of young people with learning disabilities when deciding their own and their child's role in a range of significant choices (health, social care and education) about their child's life. The paper reports data collected from a sub-sample of 14 parents recruited from 11 families participating in a longitudinal (2007-2010) qua...

  8. Association Between Student Loan Debt on Graduation, Demographic Characteristics and Initial Choice of Practice Setting of Pharmacists

    Akeem A. Yusuf

    2011-01-01

    Full Text Available Objectives: (1 To examine trends in level of student loan indebtedness for groups of pharmacists that were first licensed between 1980 and 2006; (2 To examine if demographic variables are associated with level of student loan indebtedness; (3 To examine the association between student loan debt and choice of practice setting while controlling for demographic variables. Methods: Data for this study were collected from a national random sample of 3,000 pharmacists using a self administered survey. Descriptive statistics were used to examine trends in level of indebtedness. The relationships between level of indebtedness, demographic variables and practice setting choice were examined using Chi-square statistics. Multinomial logistic regression was used to determine the independent association of student loan debt and choice of practice setting while controlling for demographic variables. Results: The proportion of licensed pharmacists reporting student loan debt after graduation, and the mean amount of debt incurred increased between 1980 and 2006. Non-white pharmacists incurred debt at a higher proportion compared to white, and they also incurred significantly higher levels of debt. A lower level of indebtedness was associated with choosing independent practice over chain practice. Conclusions: Student loan indebtedness has been increasing over time, especially for non-white pharmacy students. Future research should be done to examine other factors that might influence student debt load, work contributions and choice of practice settings. The affordability of pharmacy education for students of color and how salaries may or may not help off-set these costs also should be examined closely.   Type: Original Research

  9. A practical workflow for making anatomical atlases for biological research.

    Wan, Yong; Lewis, A Kelsey; Colasanto, Mary; van Langeveld, Mark; Kardon, Gabrielle; Hansen, Charles

    2012-01-01

    The anatomical atlas has been at the intersection of science and art for centuries. These atlases are essential to biological research, but high-quality atlases are often scarce. Recent advances in imaging technology have made high-quality 3D atlases possible. However, until now there has been a lack of practical workflows using standard tools to generate atlases from images of biological samples. With certain adaptations, CG artists' workflow and tools, traditionally used in the film industry, are practical for building high-quality biological atlases. Researchers have developed a workflow for generating a 3D anatomical atlas using accessible artists' tools. They used this workflow to build a mouse limb atlas for studying the musculoskeletal system's development. This research aims to raise the awareness of using artists' tools in scientific research and promote interdisciplinary collaborations between artists and scientists. This video (http://youtu.be/g61C-nia9ms) demonstrates a workflow for creating an anatomical atlas.

  10. Making embeddedness work: social practice institutions in foreign consulting markets

    Johannes Glückler

    2005-01-01

    This paper develops conceptual and empirical evidence for the importance of social practice institutions in the internationalisation process of management-consulting firms. Personal trust and reputation rather than price are examined as key mechanisms of foreign market entry and penetration. Empirical case studies in London, Frankfurt, and Madrid produce three findings. First, enduring client relations and client referrals facilitated most foreign firm entries and the majority of local client...

  11. Making perceptual learning practical to improve visual functions.

    Polat, Uri

    2009-10-01

    Task-specific improvement in performance after training is well established. The finding that learning is stimulus-specific and does not transfer well between different stimuli, between stimulus locations in the visual field, or between the two eyes has been used to support the notion that neurons or assemblies of neurons are modified at the earliest stage of cortical processing. However, a debate regarding the proposed mechanism underlying perceptual learning is an ongoing issue. Nevertheless, generalization of a trained task to other functions is an important key, for both understanding the neural mechanisms and the practical value of the training. This manuscript describes a structured perceptual learning method that previously used (amblyopia, myopia) and a novel technique and results that were applied for presbyopia. In general, subjects were trained for contrast detection of Gabor targets under lateral masking conditions. Training improved contrast sensitivity and diminished the lateral suppression when it existed (amblyopia). The improvement was transferred to unrelated functions such as visual acuity. The new results of presbyopia show substantial improvement of the spatial and temporal contrast sensitivity, leading to improved processing speed of target detection as well as reaction time. Consequently, the subjects, who were able to eliminate the need for reading glasses, benefited. Thus, here we show that the transfer of functions indicates that the specificity of improvement in the trained task can be generalized by repetitive practice of target detection, covering a sufficient range of spatial frequencies and orientations, leading to an improvement in unrelated visual functions. Thus, perceptual learning can be a practical method to improve visual functions in people with impaired or blurred vision.

  12. Association of preresidency peer-reviewed publications with radiation oncology resident choice of academic versus private practice career.

    McClelland, Shearwood; Thomas, Charles R; Wilson, Lynn D; Holliday, Emma B; Jaboin, Jerry J

    The decision of radiation oncology residents to pursue academic versus private practice careers plays a central role in shaping the present and future of the field, but factors that are potentially predictive of this decision are lacking. This study was performed to examine the role of several factors publicly available before residency on postresidency career choice, including preresidency peer-reviewed publications (PRPs), which have been associated with resident career choice in comparably competitive subspecialties such as neurosurgery. Using a combination of Internet searches, telephone interviews, and the 2015 Association of Residents in Radiation Oncology directory, a list of 2016 radiation oncology resident graduates was compiled, along with their postresidency career choice. PRP was defined as the number of PubMed publications encompassing the end of the calendar year (2010) in which residency applications were due; this number was then correlated with career choice. A total of 163 residents from 76 Accreditation Council for Graduate Medical Education-certified programs were examined: 78% were male, 22% were MDs/PhDs, and 79 graduates (48%) chose academic careers. Fifty-two percent of graduates had at least 1 PRP at the time of application to radiation oncology residency; 35% had more than 1 PRP. Regarding career choice, the difference between 0 and 1+ PRP was statistically significant (odds ratio, 3.3; P 1 PRP. Sex, PhD, or non-PhD dual degree status were not associated with career choice. Radiation oncology residency graduates with 1 or more PRPs at the time of residency application were roughly 2 times more likely to choose an academic career as their initial career choice than graduates with no preresidency PRPs. This information may prove useful to medical students, medical school advisors, and residency program directors and deserves further prospective investigation. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier

  13. Can Food Stamps Do More to Improve Food Choices? An Economic Perspective--Making Healthy Food Choices Easier: Ideas From Behavioral Economics

    Mancino, Lisa; Andrews, Margaret S.

    2007-01-01

    With obesity the most prevalent nutrition problem facing Americans at all economic levels, promoting diets that provide adequate nutrition without too many calories has become an important objective for the Food Stamp Program. Findings from behavioral economics suggest innovative, low-cost ways to improve the diet quality of food stamp participants without restricting their freedom of choice. Unlike more traditional economic interventions, such as changing prices or banning specific foods, th...

  14. Effect of center practices on the choice of the first dialysis modality for children and young adults.

    Hogan, Julien; Ranchin, Bruno; Fila, Marc; Harambat, Jérome; Krid, Saoussen; Vrillon, Isabelle; Roussey, Gwenaelle; Fischbach, Michel; Couchoud, Cécile

    2017-04-01

    Peritoneal dialysis (PD) remains the modality of choice in children, but there is no clear evidence to support a better outcome in children treated with PD. We aimed to assess factors that have an impact on the choice of dialysis modality in children and young adults in France and sought to determine the roles of medical factors and center practices. We included all patients aged dialysis modality. We included 806 patients starting RRT in 177 centers, 23 of which were specialized pediatric centers. Six hundred and one patients (74.6 %) started with hemodialysis (HD), whereas 205 (25.4 %) started with PD. A greater probability of PD was found in younger children, whereas starting the treatment in an emergency setting was associated with a low use of PD. We found a significant variability among centers that accounted for 43 % of the total variability. The probability of PD was higher in adult centers and was proportional to the rate of PD in the center. Center practices are a major factor in the choice of dialysis modality. This raises concerns about patient and family choices and to what extent doctors may influence the final decision. Further pediatric studies focusing on children's and parents' wishes are needed to provide care as close as possible to patients' and families' expectations.

  15. Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study

    Kiiskinen U

    2013-07-01

    Full Text Available Urpo Kiiskinen,1 Stephan Matthaei,2 Matthew Reaney,3 Chantal Mathieu,4 Claes-Göran Östenson,5 Thure Krarup,6 Michael Theodorakis,7,* Jacek Kiljanski,8 Carole Salaun-Martin,9 Hélène Sapin,9 Bruno Guerci10 1Eli Lilly, Helsinki, Finland; 2Quakenbrück Diabetes Center, Quakenbrück, Germany; 3Eli Lilly, Windlesham, Surrey, UK; 4Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium; 5Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 6Department of Endocrinology, Bispebjerg Hospital, Copenhagen, Denmark; 7Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; 8Eli Lilly, Warsaw, Poland; 9Eli Lilly, Neuilly Cedex, France; 10Department of Diabetes, Metabolic Diseases, and Nutrition, Hôpital Brabois, Vandoeuvre-Lès-Nancy, France *Michael Theodorakis was affiliated with the institution shown above at the time of the study, but has since left this institution Purpose: CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study. Methods: CHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices. Results: A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P < 0.001 for both, but mean weight was reduced in the exenatide bid cohort (P < 0

  16. How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania.

    Kolstad, Julie Riise

    2011-02-01

    The geographical imbalance of the health workforce in Tanzania represents a serious problem when it comes to delivering crucial health services to a large share of the population. This study provides new quantitative information about how to make jobs in rural areas more attractive to newly educated clinical officers (COs). A unique data set stemming from a discrete choice experiment with CO finalists in Tanzania is applied. The results show that offering continuing education after a certain period of service is one of the most powerful recruitment instruments the authorities have available. Increased salaries and hardship allowances will also substantially increase recruitment in rural areas. Offers of decent housing and good infrastructure, including the provision of equipment, will increase recruitment to rural remote areas but not as much as higher wages and offers of education. Women are less responsive to pecuniary incentives and are more concerned with factors that directly allow them to do a good job, while those with parents living in a remote rural area are generally less responsive to the proposed policies. When the willingness to help other people is a strong motivating force, policies that improve the conditions for helping people appear particularly effective.

  17. Making mathematics and science integration happen: key aspects of practice

    Ríordáin, Máire Ní; Johnston, Jennifer; Walshe, Gráinne

    2016-02-01

    The integration of mathematics and science teaching and learning facilitates student learning, engagement, motivation, problem-solving, criticality and real-life application. However, the actual implementation of an integrative approach to the teaching and learning of both subjects at classroom level, with in-service teachers working collaboratively, at second-level education, is under-researched due to the complexities of school-based research. This study reports on a year-long case study on the implementation of an integrated unit of learning on distance, speed and time, within three second-level schools in Ireland. This study employed a qualitative approach and examined the key aspects of practice that impact on the integration of mathematics and science teaching and learning. We argue that teacher perspective, teacher knowledge of the 'other subject' and of technological pedagogical content knowledge (TPACK), and teacher collaboration and support all impact on the implementation of an integrative approach to mathematics and science education.

  18. Theoretical concepts aiding in decision making and practical aspects

    Schenker-Wicki, Andrea; Rauber, Dominique

    1997-01-01

    Emergency-simulating drillings are current preoccupations of the national organizations in charge with emergency interventions. Generally, the attention is focused on the initial phases of the operations to the detriment of the later stages that concern the agricultural and agro-alimentary problems. In order to test its theoretical concepts and its coordinating role, the National Centre for Emergency Operations launched the drilling BACCHUS, addressed to the personnel of different authorities. For the first time in Switzerland executive bodies in the agricultural and agro-alimentary fields were integrated in the decision-making process involved in final phases. These final phases aim at simulating the means of reducing the ingestion doses after an accidental release of radioactivity. The principal conclusion was that the contamination criteria used by radiation protection and agro-alimentary industry experts could be very different if healthy foodstuffs are available

  19. Ethics support in community care makes a difference for practice.

    Magelssen, Morten; Gjerberg, Elisabeth; Lillemoen, Lillian; Førde, Reidun; Pedersen, Reidar

    2018-03-01

    Through the Norwegian ethics project, ethics activities have been implemented in the health and care sector in more than 200 municipalities. To study outcomes of the ethics activities and examine which factors promote and inhibit significance and sustainability of the activities. Two online questionnaires about the municipal ethics activities. Participants and research context: A total of 137 municipal contact persons for the ethics project answered the first survey (55% response rate), whereas 217 ethics facilitators responded to the second survey (33% response rate). Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services. Around half of the respondents found the ethics project to have been highly significant for daily professional practice. Outcomes include better handling of ethical challenges, better employee cooperation, better service quality, and better relations to patients and next of kin. Factors associated with sustainability and/or significance of the activities were sufficient support from stakeholders, sufficient available time, and ethics facilitators having sufficient knowledge and skills in ethics and access to supervision. This study shows that ethics initiatives can be both sustainable and significant for practice. There is a need to create regional or national structures for follow-up and develop more comprehensive ethics training for ethics facilitators. It is both possible and potentially important to implement clinical ethics support activities in community health and care services systematically on a large scale. Future ethics initiatives in the community sector should be designed in light of documented promoting and inhibiting factors.

  20. Simple heuristics in over-the-counter drug choices: a new hint for medical education and practice.

    Riva, Silvia; Monti, Marco; Antonietti, Alessandro

    2011-01-01

    Over-the-counter (OTC) drugs are widely available and often purchased by consumers without advice from a health care provider. Many people rely on self-management of medications to treat common medical conditions. Although OTC medications are regulated by the National and the International Health and Drug Administration, many people are unaware of proper dosing, side effects, adverse drug reactions, and possible medication interactions. This study examined how subjects make their decisions to select an OTC drug, evaluating the role of cognitive heuristics which are simple and adaptive rules that help the decision-making process of people in everyday contexts. By analyzing 70 subjects' information-search and decision-making behavior when selecting OTC drugs, we examined the heuristics they applied in order to assess whether simple decision-making processes were also accurate and relevant. Subjects were tested with a sequence of two experimental tests based on a computerized Java system devised to analyze participants' choices in a virtual environment. We found that subjects' information-search behavior reflected the use of fast and frugal heuristics. In addition, although the heuristics which correctly predicted subjects' decisions implied significantly fewer cues on average than the subjects did in the information-search task, they were accurate in describing order of information search. A simple combination of a fast and frugal tree and a tallying rule predicted more than 78% of subjects' decisions. The current emphasis in health care is to shift some responsibility onto the consumer through expansion of self medication. To know which cognitive mechanisms are behind the choice of OTC drugs is becoming a relevant purpose of current medical education. These findings have implications both for the validity of simple heuristics describing information searches in the field of OTC drug choices and for current medical education, which has to prepare competent health

  1. Simple heuristics in over-the-counter drug choices: a new hint for medical education and practice

    Riva, Silvia; Monti, Marco; Antonietti, Alessandro

    2011-01-01

    Introduction Over-the-counter (OTC) drugs are widely available and often purchased by consumers without advice from a health care provider. Many people rely on self-management of medications to treat common medical conditions. Although OTC medications are regulated by the National and the International Health and Drug Administration, many people are unaware of proper dosing, side effects, adverse drug reactions, and possible medication interactions. Purpose This study examined how subjects make their decisions to select an OTC drug, evaluating the role of cognitive heuristics which are simple and adaptive rules that help the decision-making process of people in everyday contexts. Subjects and methods By analyzing 70 subjects’ information-search and decision-making behavior when selecting OTC drugs, we examined the heuristics they applied in order to assess whether simple decision-making processes were also accurate and relevant. Subjects were tested with a sequence of two experimental tests based on a computerized Java system devised to analyze participants’ choices in a virtual environment. Results We found that subjects’ information-search behavior reflected the use of fast and frugal heuristics. In addition, although the heuristics which correctly predicted subjects’ decisions implied significantly fewer cues on average than the subjects did in the information-search task, they were accurate in describing order of information search. A simple combination of a fast and frugal tree and a tallying rule predicted more than 78% of subjects’ decisions. Conclusion The current emphasis in health care is to shift some responsibility onto the consumer through expansion of self medication. To know which cognitive mechanisms are behind the choice of OTC drugs is becoming a relevant purpose of current medical education. These findings have implications both for the validity of simple heuristics describing information searches in the field of OTC drug choices and

  2. Encouragers and discouragers affecting medical graduates' choice of regional and rural practice locations.

    McKillop, Ann; Webster, Craig; Bennett, Win; O'Connor, Barbara; Bagg, Warwick

    2017-12-01

    Access to health care as near to where people live as possible is desirable. However, not enough medical graduates choose to work in rural and regional areas, especially in general practice. The career decisions of recent medical graduates are known to be affected by a variety of professional, societal and personal factors. Internationally, medical programmes have exposed students to regional and rural experiences partly to encourage them to seek employment in these areas after graduation. As such, the Pūkawakawa Programme is a year-long regional and rural experience for selected Year 5 students from the University of Auckland‘s Medical Programme in New Zealand in partnership with the Northland District Health Board and two Primary Health Organisations. A lack of clarity about the drivers of rural and regional career decisions underpinned this study, which aimed to explore the barriers and encouragers for students of the programme to return as resident medical officers to the regional hospital where they had gained clinical experience. A mixed-method, descriptive design was used, including a short survey, followed by participation in a focus-group discussion or a one-on-one interview. Survey data were summarised in tabular form and inductive, thematic analysis was applied to transcripts of focus groups and interviews. Nineteen doctors in their first or second year following graduation participated: 15 who had returned to the hospital where they had clinical experience in the programme and four who were employed elsewhere. 'A match of personal goals and intended career intentions' was the reason most frequently selected for junior doctors’ choice of early career employment. Other frequently selected reasons were lifestyle, friends and family close by, and the reputation and experience of the Pūkawakawa Programme. Qualitative data revealed that the learning experience, the unique design of the curriculum and associated support from clinicians were identified as

  3. 'We eat together; today she buys, tomorrow I will buy the food': adolescent best friends' food choices and dietary practices in Soweto, South Africa.

    Voorend, Carlijn G N; Norris, Shane A; Griffiths, Paula L; Sedibe, Modiehi H; Westerman, Marjan J; Doak, Colleen M

    2013-03-01

    To explore if and how female adolescents engage in shared eating and joint food choices with best friends within the context of living in urban Soweto, South Africa. A qualitative, exploratory, multiple case study was conducted using semi-structured duo interviews of best friend pairs to ascertain their eating patterns, friendship and social interactions around dietary habits. Participants were recruited from three high schools in the urban township of Soweto, South Africa. Fifty-eight female adolescents (twenty-nine friend pairs) still in high school (mean age of 18 years) were enrolled. Although overweight rates were high, no association between friends was found; neither did friends share dieting behaviours. Both at school and during visits to the shopping mall, foods were commonly shared and money pooled together by friends to make joint purchases. Some friends carefully planned expenditures together. Foods often bought at school were mostly unhealthy. Availability, price and quality were reported to affect choice of foods purchased at school. Preference shaped joint choices within the shopping mall environment. Food sharing practices should be investigated in other settings so as to identify specific behaviours and contexts for targeted and tailored obesity prevention interventions. School-based interventions focusing on price and portion size should be considered. In the Sowetan context, larger portions of healthy food may improve dietary intake of fruit and vegetables where friends are likely to share portions.

  4. Complex Strategic Choices

    Leleur, Steen

    to strategic decision making, Complex Strategic Choices presents a methodology which is further illustrated by a number of case studies and example applications. Dr. Techn. Steen Leleur has adapted previously established research based on feedback and input from various conferences, journals and students...... resulting in new material stemming from and focusing on practical application of a systemic approach. The outcome is a coherent and flexible approach named systemic planning. The inclusion of both the theoretical and practical aspects of systemic planning makes this book a key resource for researchers...

  5. Integration of professional judgement and decision-making in high-level adventure sports coaching practice.

    Collins, Loel; Collins, Dave

    2015-01-01

    This study examined the integration of professional judgement and decision-making processes in adventure sports coaching. The study utilised a thematic analysis approach to investigate the decision-making practices of a sample of high-level adventure sports coaches over a series of sessions. Results revealed that, in order to make judgements and decisions in practice, expert coaches employ a range of practical and pedagogic management strategies to create and opportunistically use time for decision-making. These approaches include span of control and time management strategies to facilitate the decision-making process regarding risk management, venue selection, aims, objectives, session content, and differentiation of the coaching process. The implication for coaches, coach education, and accreditation is the recognition and training of the approaches that "create time" for the judgements in practice, namely "creating space to think". The paper concludes by offering a template for a more expertise-focused progression in adventure sports coaching.

  6. The Making of Practical Optics : Mathematical Practitioners’ Appropriation of Optical Knowledge between Theory and Practice

    Dupré, S.; Cormack, L.B.; Walton, S.A.; Schuster, J.A.

    2017-01-01

    The discussion of the differing practices of mathematical practitioners’ appropriation of the optical tradition in this essay brings out a variety among mathematical practitioners and within the tradition of practical mathematics. This diversity is difficult to grasp in accounts of practical

  7. What is a family? Kinship, reproductive practices and single mothers by choice

    Ravn, Tine

    of single mothers by choice, the paper explores how the women conceive and enact the notions of family and kinship in terms of creating significant relations and networks. Furthermore, the paper shows and discusses how a complex interplay of biogenetic and social ties impacts on these family conceptions...... to one emerging ‘new’ family form represented by single mothers by choice (SMC’s) who by means of donor insemination and/or IVF treatment, intentionally choose to conceive a child and act as the sole parent. Based on very initial findings from a larger Danish biographical narrative interview study...

  8. Governance mode vs. governance fit? : Performance implications of make-or-ally choices for product innovation in the worldwide aircraft industry, 1942-2000

    Castaner, X.; Mulotte, L.; Garrette, B.; Dussauge, P.

    2014-01-01

    We examine the impact of governance mode and governance fit on performance in make-or-ally decisions. We argue that while horizontal collaboration and autonomous governance have direct and countervailing performance implications, the alignment of make-or-ally choices with the focal firm's resource endowment and the activity's resource requirements leads to better performance. Data on the aircraft industry show that relative to aircraft developed autonomously, collaborative aircraft exhibit gr...

  9. Managing patient demand: a qualitative study of appointment making in general practice.

    Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

    2001-04-01

    Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. A qualitative study using participant observation. Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

  10. Experiences and Motives of Australian Single Mothers by Choice Who Make Early Contact with their Child's Donor Relatives.

    Kelly, Fiona J; Dempsey, Deborah J

    2017-01-30

    An increasing number of Australian parents of donor-conceived children are making contact with their child's donor relatives prior to their child reaching the age of majority. This process, often referred to as 'donor linking', can be achieved in Australia through either formal or informal mechanisms. Formal mechanisms exist in three states, each of which has legislation enabling donor linking in certain circumstances. Donor linking may also be achieved through informal mechanisms, such as online donor registries, social media searches, direct-to-consumer genetic testing, and fertility clinics which act as intermediaries between donors and recipients. Drawing on qualitative interview data, this article explores the donor linking practices of twenty-five single women who conceived using donated gametes. The findings suggest that early contact with donors is extremely popular among single women and that, even when formal legislative mechanisms are available, informal linking remains common. © The Author 2017. Published by Oxford University Press.

  11. Experiences and Motives of Australian Single Mothers by Choice who make Early Contact with their Child’s Donor Relatives

    Dempsey, Deborah J

    2016-01-01

    Abstract An increasing number of Australian parents of donor-conceived children are making contact with their child’s donor relatives prior to their child reaching the age of majority. This process, often referred to as ‘donor linking’, can be achieved in Australia through either formal or informal mechanisms. Formal mechanisms exist in three states, each of which has legislation enabling donor linking in certain circumstances. Donor linking may also be achieved through informal mechanisms, such as online donor registries, social media searches, direct-to-consumer genetic testing, and fertility clinics which act as intermediaries between donors and recipients. Drawing on qualitative interview data, this article explores the donor linking practices of twenty-five single women who conceived using donated gametes. The findings suggest that early contact with donors is extremely popular among single women and that, even when formal legislative mechanisms are available, informal linking remains common. PMID:28137771

  12. Menopause as a long-term risk to health: implications of general practitioner accounts of prevention for women's choice and decision-making.

    Murtagh, Madeleine J; Hepworth, Julie

    2003-03-01

    Over the past two decades medical researchers and modernist feminist researchers have contested the meaning of menopause. In this article we examine various meanings of menopause in major medical and feminist literature and the construction of menopause in a semi-structured interview study of general practitioners in rural South Australia. Three discursive themes are identified in these interviews; (i) .the hormonal menopause - symptoms, risk, prevention; (ii). the informed menopausal woman; and (iii). decision-making and hormone replacement therapy. By using the discourse of prevention, general practitioners construct menopause in relation to women's health care choices, empowerment and autonomy. We argue that the ways in which these concepts are deployed by general practitioners in this study produces and constrains the options available to women. The implications of these general practitioner accounts are discussed in relation to the proposition that medical and feminist descriptions of menopause posit alternative but equally-fixed truths about menopause and their relationship with the range of responses available to women at menopause. Social and cultural explanations of disease causality (c.f. Germov 1998, Hardey 1998) are absent from the new menopause despite their being an integral part of the framework of the women's health movement and health promotion drawn on by these general practitioners. Further, the shift of responsibility for health to the individual woman reinforces practice claims to empower women, but oversimplifies power relations and constructs menopause as a site of self-surveillance. The use of concepts from the women's health movement and health promotion have nevertheless created change in both the positioning of women as having 'choices' and the positioning of some general practitioners in terms of greater information provision to women and an attention to the woman's autonomy. In conclusion, we propose that a new menopause has evolved

  13. Normalizing ideological food choice and eating practices: identity work in online discussions on veganism

    Sneijder, P.W.J.; Molder, te H.F.M.

    2009-01-01

    In this paper we use discursive psychology to explore the relation between ideologically based food choice and identity in an online forum on veganism. The discursive psychological perspective underlines the notion of identities being part of social actions performed in talk, and thus designed and

  14. Nurse/physician conflict management mode choices: implications for improved collaborative practice.

    Hendel, Tova; Fish, Miri; Berger, Ornit

    2007-01-01

    In today's complex healthcare organizations, conflicts between physicians and nurses occur daily. Consequently, organizational conflict has grown into a major subfield of organizational behavior. Researchers have claimed that conflict has a beneficial effect on work group function and identified collaboration as one of the intervening variables that may explain the relationship between magnet hospitals and positive patient outcomes. The purpose of this study was to identify and compare conflict mode choices of physicians and head nurses in acute care hospitals and examine the relationship of conflict mode choices with their background characteristics. In a cross-sectional correlational study, 75 physicians and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann Conflict Mode Instrument. No difference was found between physicians and nurses in choice of the most frequently used mode in conflict management. The compromising mode was found to be the significantly most commonly chosen mode (P = .00) by both. Collaborating was chosen significantly more frequently among head nurses (P = .001) and least frequently among physicians (P = .00). Most of the respondents' characteristics were not found to be correlated with mode choices. The findings indicate a need to enhance partnerships in the clinical environment to ensure quality patient care and staff satisfaction.

  15. Valence of emotions and moral decision-making: increased pleasantness to pleasant images and decreased unpleasantness to unpleasant images are associated with utilitarian choices in healthy adults.

    Carmona-Perera, Martina; Martí-García, Celia; Pérez-García, Miguel; Verdejo-García, Antonio

    2013-01-01

    Moral decision-making is a key asset for humans' integration in social contexts, and the way we decide about moral issues seems to be strongly influenced by emotions. For example, individuals with deficits in emotional processing tend to deliver more utilitarian choices (accepting an emotionally aversive action in favor of communitarian well-being). However, little is known about the association between emotional experience and moral-related patterns of choice. We investigated whether subjective reactivity to emotional stimuli, in terms of valence, arousal, and dominance, is associated with moral decision-making in 95 healthy adults. They answered to a set of moral and non-moral dilemmas and assessed emotional experience in valence, arousal and dominance dimensions in response to neutral, pleasant, unpleasant non-moral, and unpleasant moral pictures. Results showed significant correlations between less unpleasantness to negative stimuli, more pleasantness to positive stimuli and higher proportion of utilitarian choices. We also found a positive association between higher arousal ratings to negative moral laden pictures and more utilitarian choices. Low dominance was associated with greater perceived difficulty over moral judgment. These behavioral results are in fitting with the proposed role of emotional experience in moral choice.

  16. Valence of emotions and moral decision-making: increased pleasantness to pleasant images and decreased unpleasantness to unpleasant images are associated with utilitarian choices in healthy adults

    Carmona-Perera, Martina; Martí-García, Celia; Pérez-García, Miguel; Verdejo-García, Antonio

    2013-01-01

    Moral decision-making is a key asset for humans’ integration in social contexts, and the way we decide about moral issues seems to be strongly influenced by emotions. For example, individuals with deficits in emotional processing tend to deliver more utilitarian choices (accepting an emotionally aversive action in favor of communitarian well-being). However, little is known about the association between emotional experience and moral-related patterns of choice. We investigated whether subjective reactivity to emotional stimuli, in terms of valence, arousal, and dominance, is associated with moral decision-making in 95 healthy adults. They answered to a set of moral and non-moral dilemmas and assessed emotional experience in valence, arousal and dominance dimensions in response to neutral, pleasant, unpleasant non-moral, and unpleasant moral pictures. Results showed significant correlations between less unpleasantness to negative stimuli, more pleasantness to positive stimuli and higher proportion of utilitarian choices. We also found a positive association between higher arousal ratings to negative moral laden pictures and more utilitarian choices. Low dominance was associated with greater perceived difficulty over moral judgment. These behavioral results are in fitting with the proposed role of emotional experience in moral choice. PMID:24133433

  17. Opportunities for Improving Army Modeling and Simulation Development: Making Fundamental Adjustments and Borrowing Commercial Business Practices

    Lee, John

    2000-01-01

    ...; requirements which span the conflict spectrum. The Army's current staff training simulation development process could better support all possible scenarios by making some fundamental adjustments and borrowing commercial business practices...

  18. Patients' perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice.

    Légaré, France; Turcotte, Stéphane; Stacey, Dawn; Ratté, Stéphane; Kryworuchko, Jennifer; Graham, Ian D

    2012-01-01

    Shared decision making is the process in which a healthcare choice is made jointly by the health professional and the patient. Little is known about what patients view as effective or ineffective strategies to implement shared decision making in routine clinical practice. This systematic review evaluates the effectiveness of interventions to improve health professionals' adoption of shared decision making in routine clinical practice, as seen by patients. We searched electronic databases (PubMed, the Cochrane Library, EMBASE, CINAHL, and PsycINFO) from their inception to mid-March 2009. We found additional material by reviewing the reference lists of the studies found in the databases; systematic reviews of studies on shared decision making; the proceedings of various editions of the International Shared Decision Making Conference; and the transcripts of the Society for Medical Decision Making's meetings. In our study selection, we included randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series analyses in which patients evaluated interventions to improve health professionals' adoption of shared decision making. The interventions in question consisted of the distribution of printed educational material; educational meetings; audit and feedback; reminders; and patient-mediated initiatives (e.g. patient decision aids). Two reviewers independently screened the studies and extracted data. Statistical analyses considered categorical and continuous process measures. We computed the standardized effect size for each outcome at the 95% confidence interval. The primary outcome of interest was health professionals' adoption of shared decision making as reported by patients in a self-administered questionnaire. Of the 6764 search results, 21 studies reported 35 relevant comparisons. Overall, the quality of the studies ranged from 0% to 83%. Only three of the 21 studies reported a clinically significant effect

  19. Are Sexual and Emotional Infidelity Equally Upsetting to Men and Women? Making Sense of Forced-Choice Responses

    David A. Lishner

    2008-10-01

    Full Text Available Forced-choice measures that assess reactions to imagined sexual and emotional infidelity are ubiquitous in studies testing the Jealousy as a Specific Innate Module (JSIM model. One potential problem with such measures is that they fail to identify respondents who find both forms of infidelity equally upsetting. To examine this issue, an experiment was conducted in which two groups of participants imagined a romantic infidelity after which participants in the first group used a traditional forced-choice measure to indicate whether they found sexual or emotional infidelity more upsetting. Participants in the second group instead used a modified forced-choice measure that allowed them also to indicate whether they found both forms of infidelity equally upsetting. Consistent with previous research, those given the traditional forced-choice measure tended to respond in a manner that supported the JSIM model. However, the majority of participants given the modified measure indicated that both forms of infidelity were equally upsetting.

  20. Comparative analysis of nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks: a discussion paper.

    Kennedy, Catriona; O'Reilly, Pauline; Fealy, Gerard; Casey, Mary; Brady, Anne-Marie; McNamara, Martin; Prizeman, Geraldine; Rohde, Daniela; Hegarty, Josephine

    2015-08-01

    To review, discuss and compare nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks. Scope of practice in professional nursing and midwifery is an evolving process which needs to be responsive to clinical, service, societal, demographic and fiscal changes. Codes and frameworks offer a system of rules and principles by which the nursing and midwifery professions are expected to regulate members and demonstrate responsibility to society. Discussion paper. Twelve scope of practice and associated decision-making frameworks (January 2000-March 2014). Two main approaches to the regulation of the scope of practice and associated decision-making frameworks exist internationally. The first approach is policy and regulation driven and behaviour oriented. The second approach is based on notions of autonomous decision-making, professionalism and accountability. The two approaches are not mutually exclusive, but have similar elements with a different emphasis. Both approaches lack explicit recognition of the aesthetic aspects of care and patient choice, which is a fundamental principle of evidence-based practice. Nursing organizations, regulatory authorities and nurses should recognize that scope of practice and the associated responsibility for decision-making provides a very public statement about the status of nursing in a given jurisdiction. © 2015 John Wiley & Sons Ltd.

  1. The neuronal substrate of risky choice: an insight into the contributions of neuroimaging to the understanding of theories on decision making under risk.

    Vorhold, Verena

    2008-04-01

    This chapter provides an overview of studies in the field of neuroscience that investigate some of the processes and concepts of risk perception, risky choice, and decision making under risk. First, early studies in the field of neuroscience addressing the diminished decision-making abilities in lesion patients are presented. A classical task in this research field is described along with its neural implications. After this, the underlying model, its hypotheses, and neuronal implications are discussed. Different aspects within risky decision making, such as the influence of memory, inhibition, motivation, and personality, on risky choice and the respective underlying neuronal substrate are described. After this, studies of risky decision making in healthy subjects are reviewed. A selection of studies shows that theories focusing on cognitive aspects only have to be enriched in order to allow for additional aspects within risky decision making (e.g., emotion). Next, the classical economic approaches and the development of theories incorporating further aspects within economical decision making and the underlying neuronal substrate will be presented. Finally, research in the field of neuroeconomics, focusing on the role of social decision making and evaluative judgment within risky decision making, is reviewed.

  2. Healthy Choices for Every Body Adult Curriculum Improves Participants' Food Resource Management Skills and Food Safety Practices.

    Adedokun, Omolola A; Plonski, Paula; Jenkins-Howard, Brooke; Cotterill, Debra B; Vail, Ann

    2018-04-03

    To evaluate the impact of the University of Kentucky's Healthy Choices for Every Body (HCEB) adult nutrition education curriculum on participants' food resource management (FRM) skills and food safety practices. A quasi-experimental design was employed using propensity score matching to pair 8 intervention counties with 8 comparison counties. Independent-samples t tests and ANCOVA models compared gains in FRM skills and food safety practices between the intervention and comparison groups (n = 413 and 113, respectively). Propensity score matching analysis showed a statistical balance and similarities between the comparison and intervention groups. Food resource management and food safety gain scores were statistically significantly higher for the intervention group (P food safety practices of participants. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  3. The social context of career choice among millennial nurses: implications for interprofessional practice.

    Price, Sheri; McGillis Hall, Linda; Angus, Jan; Peter, Elizabeth

    2013-11-01

    Health human resource and workforce planning is a global priority. Given the critical nursing shortage, and the fact that nurses are the largest group of healthcare providers, health workforce planning must focus on strategies to enhance both recruitment and retention of nurses. Understanding early socialization to career choice can provide insight into professional perceptions and expectations that have implications for recruitment, retention and interprofessional collaboration. This interpretive narrative inquiry utilized Polkinghorne's theory of narrative emplotment to understand the career choice experiences of 12 millennial nurses (born between 1980 and 2000) in Eastern Canada. Participants were interviewed twice, face-to-face, 4 to 6 weeks apart prior to commencing their nursing program. The narratives present career choice as a complex consideration of social positioning. The findings provide insight into how nursing is perceived to be positioned in relation to medicine and how the participants struggled to locate themselves within this social hierarchy. Implications of this research highlight the need to ensure that recruitment messaging and organizational policies promote interprofessional collaboration from the onset of choosing a career in the health professions. Early professional socialization strategies during recruitment and education can enhance future collaboration between the health professions.

  4. Nursing Faculty Decision Making about Best Practices in Test Construction, Item Analysis, and Revision

    Killingsworth, Erin Elizabeth

    2013-01-01

    With the widespread use of classroom exams in nursing education there is a great need for research on current practices in nursing education regarding this form of assessment. The purpose of this study was to explore how nursing faculty members make decisions about using best practices in classroom test construction, item analysis, and revision in…

  5. Making Use of Theories about Literacy and Justice: Teachers Re-Searching Practice.

    Comber, Barbara

    This paper explores the way teachers make use of and work on theory to disrupt and ultimately improve everyday educational practice. The paper argues that teachers working on and with theory can and do generate new forms of educative practices in the field of literacy education, which are based on explicit standpoints towards social justice in…

  6. Leadership and Decision-Making Practices in Public versus Private Universities in Pakistan

    Zulfqar, A.; Valcke, M.; Devos, G.; Tuytens, M.; Shahzad, A.

    2016-01-01

    The goal of this study is to examine differences in leadership and decision-making practices in public and private universities in Pakistan, with a focus on transformational leadership (TL) and participative decision-making (PDM). We conducted semi-structured interviews with 46 deans and heads of department from two public and two private…

  7. Nonsensical choices? Fall armyworm moths choose seemingly best or worst hosts for their larvae, but neonate larvae make their own choices.

    Julio C Rojas

    Full Text Available Selecting optimal host plants is critical for herbivorous insects, such as fall armyworm (Spodoptera frugiperda, an important maize pest in the Americas and Africa. Fall armyworm larvae are presumed to have limited mobility, hence female moths are presumed to be largely responsible for selecting hosts. We addressed host selection by fall armyworm moths and neonate and older (3rd-instar larvae, as mediated by resistance and herbivory in maize plants. Thus, we compared discrimination among three maize cultivars with varying degrees of resistance to fall armyworm, and between plants subjected or not to two types of herbivory. The cultivars were: (i susceptible, and deficient in jasmonic acid (JA production and green leaf volatiles (GLV emissions (inbred line B73-lox10; (ii modestly resistant (B73, and; (iii highly resistant (Mp708. The herbivory types were: (i ongoing (= fall armyworm larvae present, and; (ii future (= fall armyworm eggs present. In choice tests, moths laid more eggs on the highly resistant cultivar, and least on the susceptible cultivar, though on those cultivars larvae performed poorest and best, respectively. In the context of herbivory, moths laid more eggs: (i on plants subject to versus free of future herbivory, regardless of whether plants were deficient or not in JA and GLV production; (ii on plants subject versus free of ongoing herbivory, and; (iii on plants not deficient in compared to deficient in JA and GLV production. Neonate larvae dispersed aerially from host plants (i.e. ballooned, and most larvae colonized the modestly resistant cultivar, and fewest the highly resistant cultivar, suggesting quasi-directional, directed aerial descent. Finally, dispersing older larvae did not discriminate among the three maize cultivars, nor between maize plants and (plastic model maize plants, suggesting random, visually-oriented dispersal. Our results were used to assemble a model of host selection by fall armyworm moths and

  8. On the choice of farm management practices after the reform of the Common Agricultural Policy in 2003.

    Schmid, Erwin; Sinabell, Franz

    2007-02-01

    The Common Agricultural Policy (CAP) was fundamentally reformed in 2003. From 2005, farmers will receive decoupled income support payments instead of production premiums if basic standards for environment, food safety, animal health and welfare are met. Farmers are likely to adjust production and management practices to the new policy framework. We describe how this reform fits into the EU strategy of making agricultural production more environmentally friendly by concentrating on the financial aspects of the reforms. Using an agricultural sector model for Austria, we show that the reform will further decrease agricultural outputs, reduce farm inputs, lessen nitrogen surpluses and make environmentally friendly management practices more attractive for farmers.

  9. Equity, empowerment and choice: from theory to practice in public health.

    Ratna, Jalpa; Rifkin, Susanb

    2007-05-01

    The purpose of this article is to illustrate how a framework that links equity and empowerment to improved health outcomes for those who live in poverty can be a useful tool for planning and managing health programmes. Using the work of Amartya Sen, Susan Rifkin has developed a framework described in the acronym CHOICE. The article applies the framework to two case studies from Kenya seeking to reduce the disease burdens of malaria and HIV/AIDS. The article examines how the process of pursuing equity and empowerment either supports the positive health outcomes identified as objectives and/or strengthens these outcomes.

  10. Evaluating a Teaching Module on Ethically Responsible Evidence-Based Practice Decision Making in an Advanced Micro Practice Course

    Wong, Rose

    2017-01-01

    This article adds to the growing body of literature on the use of evidence-based practice (EBP) in social work. Specifically, it examines a 9-hour EBP educational model designed to prepare MSW students for appropriate decision-making strategies in working with multicultural client populations. The model places emphasis on identification and…

  11. The Effect of Trait Self-Awareness, Self-Reflection, and Perceptions of Choice Meaningfulness on Indicators of Social Identity within a Decision-Making Context.

    Dishon, Noam; Oldmeadow, Julian A; Critchley, Christine; Kaufman, Jordy

    2017-01-01

    Theorists operating from within a narrative identity framework have suggested that self-reflective reasoning plays a central role in the development of the self. Typically, however, narrative identity researchers have investigated this relationship using correlational rather than experimental methods. In the present study, leveraging on a classic research paradigm from within the social identity literature we developed an experiment to test the extent to which self-reflection might have a causal impact on the self-concept within a decision-making context. In a minimal group paradigm participants were prompted to reflect on their painting choices either before or after allocating points to in-group∖ out-group members. As anticipated, self-reflection augmented social identification, but only when participants felt their choices were personally meaningful. Participants who reasoned about their choices and felt they were subjectively meaningful showed stronger similarity and liking for in-group members compared to those who did not reflect on their choices or found them to be subjectively meaningless. Hence, reflecting on and finding meaning in one's choices may be an important step in linking behavior with in-group identification and thus the self-concept in turn. The absence of any effects on in-group favoritism (a third indicator of social identification measured) as well as implications of the study's findings for self-perception, cognitive dissonance and social identity processes are also discussed.

  12. Are medical students influenced by preceptors in making career choices, and if so how? A systematic review.

    Stagg, P; Prideaux, D; Greenhill, J; Sweet, L

    2012-01-01

    Increasingly medical students undertake clinical training in distributed learning environments. The driving factor for this is predominantly to address medical workforce shortages. In these environments students are often taught by private practitioners, residents, house staff and registrars, as well as faculty. Through a mix of short- and long-term preceptorships, clerkships and rotations, medical students are exposed to a wider range of preceptors, mentors and role models than has traditionally been the case. The aim of this systematic review was to understand if and how medical students' career choices are influenced by their interactions with preceptors. A search of Ovid Medline, Scopus, ISI Web of Science, PubMed, Eric and CIHNAL was undertaken. The search was structured around the key terms: Medical Student, Career Choice and Preceptor, and variants of these terms. Search limits were set to English-language publications between 1995 and 2010. A total of 36 articles met the selection criteria from the 533 citations sourced from the search. Required preceptorships as short as 3 weeks' duration influence the career choice of students when they rate the preceptor as a high quality teacher. Preceptors who are judged (by students) as high quality teachers have the greatest influence on student career choice by up to four-fold. When students judged a preceptor as being a negative role model, a poor teacher or lacking discipline specific knowledge they will turn away from that field. The positive influence of relationships between preceptors and students on career choice is strongest where there is continuity of preceptors, continuity of care, and continuity of patient interactions. The longer the duration of the preceptorship the greater the influence on student career choice, particularly in primary cares environments. This review adds to the literature by identifying how differing components and combinations of components of a preceptorship influence medical

  13. What factors influence choice of waste management practice? Evidence from rice straw management in the Philippines.

    Launio, Cheryll C; Asis, Constancio A; Manalili, Rowena G; Javier, Evelyn F; Belizario, Annabelle F

    2014-02-01

    This study applied a multinomial logit model to understand why farmers choose to burn, incorporate or remove rice straw in the field. Four hundred randomly selected farmers were interviewed in four major rice-producing provinces covering the 2009 wet and 2010 dry seasons. Results of the model with burning as the baseline category indicate farm type, location dummies, number of household members with older than 13 years, cow ownership and distance from farm to house as significant variables influencing farmers' choice of straw incorporation or removal over burning. Significant perception variables are the negative impacts of open-field burning, awareness of environmental regulations and attitude towards incentives. Other factors significantly influencing the decision to incorporate over-burn are training attendance and perceptions of effects of straw incorporation. Income from non-rice farming, total area cultivated, tenure status, presence of burning and solid waste management provincial ordinances are significant factors affecting choice to remove over burn. Continually providing farmers' training in rice production, increasing demand for rice straw for other uses, and increasing awareness of environmental laws and regulations are policy directions recommended.

  14. The Psychological Benefits from Reconceptualizing Music-Making as Mindfulness Practice.

    Steinfeld, Matthew; Brewer, Judson

    2015-06-01

    While the music psychology and education literatures have devoted considerable attention to how musical instrumentalists practice their instruments, less formal scholarly attention has been given in consideration of what it means to maintain a musical "practice" over time and across context. In this paper, the practice of mindfulness meditation is used as heuristic, arguing for a view of mindfulness meditation as a formalized de-specialization of the infinite number of other activities with which people can achieve mindfulness. Sitting meditation, requiring of one to observe the contents of their mind unmediated, can serve as a useful model for the musician in understanding the phenomenology of the music-making process and the "flow" states that can result from an embodied musical practice. Finally, reconceptualizing music-making as a mindfulness practice is considered with psychological and pedagogical implications relevant for developing musicians.

  15. PMP practice makes perfect over 1000 PMP practice questions and answers

    Estrella, John A; Zahran, Sami

    2011-01-01

    A unique learning resource to prepare for the PMP certification exam Without sufficient practice and preparation for taking the Project Management Institute's (PMI's) PMP certification exam, you won't be able to actually put your skills into practice in the real world! To help you achieve your goal of passing the exam, this two-part prep book covers all elements of the brand-new Project Management Professional exam. A team of experts presents you with a solid overview of the exam as well as hundreds of questions, detailed answers, and explanations. In addition, each question is accompa

  16. Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer.

    Burton, Maria; Kilner, Karen; Wyld, Lynda; Lifford, Kate Joanna; Gordon, Frances; Allison, Annabel; Reed, Malcolm; Collins, Karen Anna

    2017-12-01

    To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision-making (DM) style. This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences. Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology-based sources of information. There was equal preference for a patient- or doctor-centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0-100). Women strongly preferred face to face information. Written formats were also helpful but not computer-based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret. Copyright © 2017 John Wiley & Sons, Ltd.

  17. Faculty of Radiation Oncology 2012 trainee survey: perspectives on choice of specialty training and future work practice preferences.

    Leung, John; Le, Hien; Turner, Sandra; Munro, Philip; Vukolova, Natalia

    2014-02-01

    This paper reports the key findings of the first Faculty of Radiation Oncology survey of trainees dealing with experiences and perceptions on work practices and choice of specialty. The survey was conducted in mid 2012 using a 37-question instrument. This was distributed by email to 159 current trainees and advertised through the Radiation Oncology Trainees Committee and other channels. There were six email reminders. Respondents were reassured that their responses were anonymous. The overall response rate was 82.8%. Gender was balanced among respondents with 67 (51.5%) being male and 63 (48.5%) being female. The most common age bracket was the 31 to 35 years range. There were similar proportions of trainee responders in each of the five years of training. A substantial number of trainees held other degrees besides medical degrees. The large majority were satisfied with radiation oncology as a career choice and with the Training Network within which they were training. Interest in oncology patients, lifestyle after training and work hours were given as the major reasons for choosing radiation oncology as a career. Nearly half of trainees were interested in undertaking some of their training in a part-time capacity and working part time as a radiation oncologist in the future. Over 70% of trainees stated they were working 36-55 clinical hours per week with additional non-clinical tasks, after-hours work and on-call duties. Nearly half of all trainees reported having one or less hours of protected time per week. Nonetheless, 40% of respondents indicated they had enough time to pursue outside interests. Radiation treatment planning and maintaining currency in general medicine were considered the most difficult aspects of training in radiation oncology. Most respondents were keen on the concept of fostering a research mentor. In terms of views on practice after completion of training, the majority were interested in pursuing a fellowship, and nearly all expressed an

  18. Faculty of Radiation Oncology 2012 trainee survey: perspectives on choice of speciality training and future work practice preference

    Leung, John; Le, Hien; Turner, Sandra; Munro, Philip; Vukolova, Natalia

    2014-01-01

    This paper reports the key findings of the first Faculty of Radiation Oncology survey of trainees dealing with experiences and perceptions on work practices and choice of specialty. The survey was conducted in mid 2012 using a 37-question instrument. This was distributed by email to 159 current trainees and advertised through the Radiation Oncology Trainees Committee and other channels. There were six email reminders. Respondents were reassured that their responses were anonymous. The overall response rate was 82.8%. Gender was balanced among respondents with 67 (51.5%) being male and 63 (48.5%) being female. The most common age bracket was the 31 to 35 years range. There were similar proportions of trainee responders in each of the five years of training. A substantial number of trainees held other degrees besides medical degrees. The large majority were satisfied with radiation oncology as a career choice and with the Training Network within which they were training. Interest in oncology patients, lifestyle after training and work hours were given as the major reasons for choosing radiation oncology as a career. Nearly half of trainees were interested in undertaking some of their training in a part-time capacity and working part time as a radiation oncologist in the future. Over 70% of trainees stated they were working 36–55 clinical hours per week with additional non-clinical tasks, after-hours work and on-call duties. Nearly half of all trainees reported having one or less hours of protected time per week. Nonetheless, 40% of respondents indicated they had enough time to pursue outside interests. Radiation treatment planning and maintaining currency in general medicine were considered the most difficult aspects of training in radiation oncology. Most respondents were keen on the concept of fostering a research mentor. In terms of views on practice after completion of training, the majority were interested in pursuing a fellowship, and nearly all expressed an

  19. Choosing academia versus private practice: factors affecting oral maxillofacial surgery residents' career choices.

    Lanzon, Jesse; Edwards, Sean P; Inglehart, Marita R

    2012-07-01

    This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. Residents who considered academia were more likely to be women (29% vs 8%; P career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Making Good Choices: How Autonomy Support Influences the Behavior Change and Motivation of Troubled and Troubling Youth

    Harper, Elaine

    2007-01-01

    Autonomy is a basic human need having influence on motivation. Facilitating student autonomy is an essential ingredient of effective programs for maximizing internalized change and increasing motivation in troubled and troubling youth. This article examines the theoretical concepts of autonomy and control related to choices and considers their…

  1. "Putting Music On": Everyday Leisure Activities, Choice-Making and Person-Centred Planning in a Supported Living Scheme

    Hassan, Nedim

    2017-01-01

    Background: Person-centred planning, which commonly becomes formalised within services for people with learning disabilities through an Essential Lifestyle Plan (ELP), was intended to help place the choices of individuals at the forefront of service provision. However, beyond UK government policy rhetoric, scholars have raised issues regarding the…

  2. Gender influences on career opportunities, practice choices, and job satisfaction in a cohort of physicians with certification in sports medicine.

    Pana, A L; McShane, J

    2001-04-01

    To examine the gender differences in practice patterns, experiences, and career opportunities for family physicians who practice sports medicine. Descriptive, self-administered questionnaire. Family physicians with Certificate of Added Qualification (CAQ) in sports medicine were surveyed. The survey was sent to all women with a CAQ in Sports Medicine and a random sample of 20% of the men with CAQs in sports medicine. Survey consisted of multiple choice, Likert scale, and opened-ended questions. The data was analyzed with contingency tables, with gender as the dependent variable. Response rate to the survey was 75%, which included 42 females and 102 males. Demographics of our population demonstrated some gender differences. Males were of higher average age (41.1 vs. 38.1), and more likely to be married and have children. Practice types, location, and time spent in sports medicine did not differ with the exception of training room and event coverage. Males were more likely to cover all levels of training room except at the Division I level, where the percent of males and females covering training rooms were equal. Males were also more likely to cover all types of sporting events. Job satisfaction and reasons for choosing current jobs did not show significant gender differences. However, factors affecting career opportunities did vary. Professional relationships with athletic trainers and coaches were perceived to be different by males and females surveyed. Our survey of sports medicine physicians showed some gender differences in practice patterns relative to training room and sporting event coverage. Surprisingly, there were not many differences in the factors that affected job choice and factors affecting job opportunities with the exception of gender itself. However, our study does not conclude how or when gender begins to affect the female sports medicine physician's career opportunities.

  3. Implementing shared decision-making in routine practice: barriers and opportunities.

    Holmes-Rovner, Margaret; Valade, Diane; Orlowski, Catherine; Draus, Catherine; Nabozny-Valerio, Barbara; Keiser, Susan

    2000-09-01

    OBJECTIVE: Determine feasibility of shared decision-making programmes in fee-for-service hospital systems including physicians' offices and in-patient facilities. DESIGN: Survey and participant observation. Data obtained during Phase 1 of a patient outcome study. SETTINGS AND PARTICIPANTS: Three hospitals in Michigan: one 299-bed rural regional hospital, one 650-bed urban community hospital, one 459-bed urban and suburban teaching hospital. All nurses and physicians who agreed to use the programmes participated in the evaluation (n = 34). INTERVENTION: Two shared decision-making(R) (SDP) multimedia programmes: surgical treatment choice for breast cancer and ischaemic heart disease treatment choice. MAIN OUTCOME MEASURES: (1) clinicians' evaluations of programme quality; (2) challenges in hospital settings; and (3) patient referral rates. RESULTS: SDP programmes were judged to be clear, accurate and about the right length and amount of information. Programmes were judged to be informative and appropriate for patients to see before making a decision. Clinicians were neutral about patients' desire to participate in treatment decision-making. Referral volume to SDPs was lower than expected: 24 patients in 7 months across three hospitals. Implementation challenges centred on time pressures in patient care. CONCLUSIONS: Productivity and time pressure in US health care severely constrain shared decision-making programme implementation. Physician referral may not be a reliable mechanism for patient access. Possible innovations include: (1) incorporation into the informed consent process; (2) provider or payer negotiated requirement in the routine hospital procedure to use the SDP as a quality indicator; and (3) payer reimbursement to professional providers who make SDP programmes available to patients.

  4. Physical restrictions on the choice of electromagnetic gauge and their practical consequences

    Reiss, H R

    2017-01-01

    It is shown that electromagnetic potentials convey physical information beyond that supplied by electric and magnetic fields alone, and are thus more fundamental. Observable physical properties can impose conditions on the selection of electromagnetic gauge (i.e. sets of potentials) that are explicit and restrictive. This is true both classically and quantum mechanically. The implication that the choice of gauge carries physical information is confirmed by exhibiting a set of potentials that describes fields correctly, but that violates physical constraints. The basic conclusions are that physical requirements place limits on acceptable gauges; and that potentials are more fundamental than fields in both classical and quantum physics, representing a major generalization of the quantum-only Aharonov–Bohm effect. These important properties are obscured if the dipole approximation is employed. The properties demonstrated here relate directly to conditions that exist in strong-field laser applications. (paper)

  5. Joint influence of individual choices, parenting practices, and physician advice on adolescent obesity, Nebraska, 2008.

    Wang, Hongmei; Kim, Jungyoon; Su, Dejun; Xu, Liyan; Chen, Li-Wu; Huang, Terry T-K

    2014-10-09

    Reducing childhood obesity remains a public health priority given its high prevalence and its association with increased risk of adult obesity and chronic diseases. The objective of this study was to examine the joint influence of multiple risk factors on adolescent overweight status. We conducted a random-digit-dialed telephone survey of adolescents aged 12 to 19 years in fall 2008 in a Midwestern city in Nebraska. On the basis of survey data for 791 youths aged 12 to 18 years, we conducted latent class analysis to group youths by the joint occurrence of dietary behavior, physical activity, parenting practices, and physician advice. We then examined the association between the groups and overweight status by using logistic regression, controlling for age, sex, race/ethnicity, and parent and family information. Youths were clustered into 3 groups. Group I (52%) were youths with healthy dietary behavior and physical activity, less permissive parenting practices, and physician advice; Group II (30%) were youths with moderately healthy dietary behavior and physical activity, less permissive parenting practices, and no physician advice; and Group III (18%) were youths with unhealthy dietary behavior and physical activity, permissive parenting practices, and physician advice. Youths in Groups I and II were less likely to be overweight than youths in Group III. Youths with healthier behavior and less permissive parenting practices were less likely to be overweight. Study findings highlight the need to address obesity risk factors among youths with unhealthy dietary behavior, inadequate exercise, permissive parenting practices, and some physician advice. Tailored interventions should be used to target youths with different obesity risk factors.

  6. Risk and Rationality in Adolescent Decision Making: Implications for Theory, Practice, and Public Policy.

    Reyna, Valerie F; Farley, Frank

    2006-09-01

    Crime, smoking, drug use, alcoholism, reckless driving, and many other unhealthy patterns of behavior that play out over a lifetime often debut during adolescence. Avoiding risks or buying time can set a different lifetime pattern. Changing unhealthy behaviors in adolescence would have a broad impact on society, reducing the burdens of disease, injury, human suffering, and associated economic costs. Any program designed to prevent or change such risky behaviors should be founded on a clear idea of what is normative (what behaviors, ideally, should the program foster?), descriptive (how are adolescents making decisions in the absence of the program?), and prescriptive (which practices can realistically move adolescent decisions closer to the normative ideal?). Normatively, decision processes should be evaluated for coherence (is the thinking process nonsensical, illogical, or self-contradictory?) and correspondence (are the outcomes of the decisions positive?). Behaviors that promote positive physical and mental health outcomes in modern society can be at odds with those selected for by evolution (e.g., early procreation). Healthy behaviors may also conflict with a decision maker's goals. Adolescents' goals are more likely to maximize immediate pleasure, and strict decision analysis implies that many kinds of unhealthy behavior, such as drinking and drug use, could be deemed rational. However, based on data showing developmental changes in goals, it is important for policy to promote positive long-term outcomes rather than adolescents' short-term goals. Developmental data also suggest that greater risk aversion is generally adaptive, and that decision processes that support this aversion are more advanced than those that support risk taking. A key question is whether adolescents are developmentally competent to make decisions about risks. In principle, barring temptations with high rewards and individual differences that reduce self-control (i.e., under ideal

  7. Literacy Practices and Linguistic Choices: A Sociocultural Study of a Multilingual Adult Literacy Student Group.

    Black, Stephen R.; Thorp, Kay

    The report describes a study of a multilingual group of six adult literacy students, five women and one man, enrolled in an English literacy class at an Australian college. Subjects' countries of origin include Afghanistan, Indonesia/China, Lebanon, Iran, and China. The study examined factors affecting subjects' daily literacy practices and…

  8. 'Just a GP': a mixed method study of undermining of general practice as a career choice in the UK.

    Alberti, Hugh; Banner, Kimberley; Collingwood, Helen; Merritt, Kymberlee

    2017-11-03

    Failure to recruit sufficient applicants to general practice (GP) training has been a problem both nationally and internationally for many years and undermining of GP is one possible contributing factor. The aim of our study was to ascertain what comments, both negative and positive, are being made in UK clinical settings to GP trainees about GP and to further explore these comments and their influence on career choice. We conducted a mixed methods study. We surveyed all foundation doctors and GP trainees within one region of Health Education England regarding any comments they experienced relating to a career in GP. We also conducted six focus groups with early GP trainees to discuss any comments that they experienced and whether these comments had any influence on their or others career choice. Positive comments reported by trainees centred around the concept that choosing GP is a positive, family-focused choice which facilities a good work-life balance. Workload was the most common negative comment, alongside the notion of being 'just a GP'; the belief that GP is boring, a waste of training and a second-class career choice. The reasons for and origin of the comments are multifactorial in nature. Thematic analysis of the focus groups identified key factors such as previous exposure to and experience of GP, family members who were GPs, GP role models, demographics of the clinician and referral behaviour. Trainees perceived that negative comments may be discouraging others from choosing GP as a career. Our study demonstrates that negative comments towards GP as a career do exist within clinical settings and are having a potential impact on poor recruitment rates to GP training. We have identified areas in which further negative comments could be prevented by changing perceptions of GP as a career. Additional time spent in GP as undergraduates and postgraduates, and positive GP role models, could particularly benefit recruitment. We recommend that undermining of GP

  9. Which Infidelity Type Makes You More Jealous? Decision Strategies in a Forced-Choice between Sexual and Emotional Infidelity

    Achim Schützwohl

    2004-01-01

    This study tested the prediction derived from the evolutionary psychological analysis of jealousy that men and women selecting the adaptively primary infidelity type (i.e., female sexual and male emotional infidelity, respectively) in a forced-choice response format need to engage in less elaborate decision strategies than men and women selecting the adaptively secondary infidelity type (i.e., male sexual and female emotional infidelity, respectively). Unknown to the participants, decision ti...

  10. CHOICE OF THE INITIAL TREATMENT FOR MILD TO MODERATE ARTERIAL HYPERTENSION IN MOSCOW PRIMARY PRACTICE

    S. V. Gatsura

    2015-09-01

    Full Text Available Aim. To assess the choice of initial pharmacotherapy of uncomplicated mild to moderate arterial hypertension (HT in Moscow primary care as well as to clear up the influence of regulatory measures on this choice.Material and methods. Results of two similar surveys conducted in 2011-2012 (452 respondents and 2013-2014 (273 respondents were compared to estimate preferences of Moscow primary care physicians regarding initial antihypertensive agents for therapy of uncomplicated mild to moderate HT taking into consideration an influence of regulatory requirement to prescribe medicinal products by international nonproprietary name (INN since July 2012. All participants were proposed to write down their preferred antihypertensive agents for initial mono- or combined therapy of mild to moderate HT with moderate cardiovascular risk and absence of compelling indications.Results. Angiotensin converting enzyme inhibitors (ACEI remained the leading class of antihypertensive agents, though their popularity slightly but significantly declined from 44.4% in 2011-12 to 37.2% in 2013-14 (р<0.05. Angiotensin receptor blockers partially displaced the leaders and increased their popularity from 11.3% in 2011-12 to 18.0% in 2013-14 (р<0.01. ACEI/diuretic combination remained on the 3rd position (16.4% and 15.3% respectively. Beta-blockers and diuretics as monotherapy shared 4th and 5th places in this rating. Calcium channel blockers popularity among Moscow prescribers remained unchanged and poor – 2.1%. The most popular medicine by trade name was Noliprel, perindopril/indapamide fixed combination, – 14.0% and 13.7% of respondents in 2011-12 and 2013-14, respectively. The share of medicine products recommended by INN went up from 11.9% to 22.8% among top-10 popular medications (р<0.01.Conclusion. Blockers of renin-angiotensin-aldosterone system remain the leading drugs for the initial treatment of uncomplicated mild to moderate HT without compelling indications

  11. Α4β2 and α7 nicotinic acetylcholine receptor binding predicts choice preference in two cost benefit decision-making tasks.

    Mendez, I A; Damborsky, J C; Winzer-Serhan, U H; Bizon, J L; Setlow, B

    2013-01-29

    Nicotinic receptors have been linked to a wide range of cognitive and behavioral functions, but surprisingly little is known about their involvement in cost benefit decision making. The goal of these experiments was to determine how nicotinic acetylcholine receptor (nAChR) expression is related to two forms of cost benefit decision making. Male Long Evans rats were tested in probability- and delay-discounting tasks, which required discrete trial choices between a small reward and a large reward associated with varying probabilities of omission and varying delays to reward delivery, respectively. Following testing, radioligand binding to α4β2 and α7 nAChR subtypes in brain regions implicated in cost benefit decision making was examined. Significant linear relationships were observed between choice of the large delayed reward in the delay discounting task and α4β2 receptor binding in both the dorsal and ventral hippocampus. Additionally, trends were found suggesting that choice of the large costly reward in both discounting tasks was inversely related to α4β2 receptor binding in the medial prefrontal cortex and nucleus accumbens shell. Similar trends suggested that choice of the large delayed reward in the delay discounting task was inversely related to α4β2 receptor binding in the orbitofrontal cortex, nucleus accumbens core, and basolateral amygdala, as well as to α7 receptor binding in the basolateral amygdala. These data suggest that nAChRs (particularly α4β2) play both unique and common roles in decisions that require consideration of different types of reward costs. Copyright © 2012 IBRO. Published by Elsevier Ltd. All rights reserved.

  12. Motives of former interns in general practice for speciality-choice − Results of a cross-sectional study among graduates 2007 to 2012

    Abendroth, Jens; Schnell, Ute; Lichte, Thomas; Oemler, Matthias; Klement, Andreas

    2014-01-01

    Background: The influence of a final-year elective internship in general practice (IGP) on motives affecting graduates’ choice of specialty is the object of great public interest, yet still insufficiently evaluated. Longitudinal studies show the influence of numerous motives (e.g. work-life balance), but not following the IGP experience itself. Thus, we performed a cross-sectional questionnaire study of all graduates who completed the IGP in Saxony-Anhalt during 2007-2012 regarding their motives for choosing a speciality. Method: A standardized questionnaire was sent to 109 former interns in general practice. The questionnaire contained 29 items addressing three topics (personal attitudes, concept of personal and professional life, motives for speciality choice) and used single-choice and multiple-choice answers, as well as Likert scales. Correlation analysis was carried out by means of Kendall's tau. Results: The questionnaire reached 97 former interns, of which 45 (46%) responded. In the overall ranking of motives for speciality choice, family (71%), leisure time (66%) and job opportunities (48%) rated as more important than income (36%), mentoring (20%), status or scientific work (20%). Only 29% of the respondents stated that their speciality choice was changed by the IGP. If the speciality choice was already established before the IGP, the influence of the IGP on speciality choice was significantly low (r=-.5; pteacher during the IGP. Conclusion: The final-year IGP is an opportunity to change the perception of general practice in students who are still undecided. This can lead to different speciality choices in a subgroup. Personal attitudes and concepts of personal life and career were also important factors affecting speciality choice. The aspects of the positive influence exerted by medical teachers on those students who are still undecided during the IGP should be carefully evaluated. PMID:24575153

  13. Normalizing ideological food choice and eating practices. Identity work in online discussions on veganism.

    Sneijder, Petra; Te Molder, Hedwig

    2009-06-01

    In this paper we use discursive psychology to explore the relation between ideologically based food choice and identity in an online forum on veganism. The discursive psychological perspective underlines the notion of identities being part of social actions performed in talk, and thus designed and deployed for different interactional purposes. It is demonstrated that participants draw on specific discursive devices to (1) define vegan meals as ordinary and easy to prepare and (2) construct methods of preventing vitamin deficiency, such as taking supplements, as routine procedures. In 'doing being ordinary', participants systematically resist the notion that being a vegan is complicated--in other words, that it is both difficult to compose a meal and to protect your health. In this way, 'ordinariness' helps to construct and protect veganism as an ideology. We point out similarities and differences with other studies on eating or healthy lifestyles and argue, more broadly, that identities and their category-bound features are part and parcel of participants' highly flexible negotiation package.

  14. Elbow Room for Best Practice? Montgomery, Patients' values, and Balanced Decision-Making in Person-Centred Clinical Care.

    Herring, Jonathan; Fulford, Kmw; Dunn, Michael; Handa, Ashoki

    2017-11-01

    The UK Supreme Court Montgomery judgment marks a decisive shift in the legal test of duty of care in the context of consent to treatment, from the perspective of the clinician (as represented by Bolam rules) to that of the patient. A majority of commentators on Montgomery have focused on the implications of the judgment for disclosure of risk. In this article, we set risk disclosure in context with three further elements of the judgment: benefits, options, and dialogue. These elements, we argue, taken together with risk disclosure, reflect the origins of the Montgomery ruling in a model of consent based on autonomy of patient choice through shared decision-making with their doctor. This model reflects recent developments in both law and medicine and is widely regarded (by the General Medical Council and others) as representing best practice in contemporary person-centred medicine. So understood, we suggest, the shift marked by Montgomery in the basis of duty of care is a shift in underpinning values: it is a shift from the clinician's interpretation about what would be best for patients to the values of (to what is significant or matters from the perspective of) the particular patient concerned in the decision in question. But the values of the particular patient do not thereby become paramount. The Montgomery test of duty of care requires the values of the particular patient to be balanced alongside the values of a reasonable person in the patient's position. We illustrate some of the practical challenges arising from the balance of considerations required by Montgomery with examples from surgical care. These examples show the extent to which Montgomery, in mirroring the realities of clinical decision-making, provides elbowroom for best practice in person-centred clinical care. © The Author 2017. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. A two-layered diffusion model traces the dynamics of information processing in the valuation-and-choice circuit of decision making.

    Piu, Pietro; Fargnoli, Francesco; Innocenti, Alessandro; Rufa, Alessandra

    2014-01-01

    A circuit of evaluation and selection of the alternatives is considered a reliable model in neurobiology. The prominent contributions of the literature to this topic are reported. In this study, valuation and choice of a decisional process during Two-Alternative Forced-Choice (TAFC) task are represented as a two-layered network of computational cells, where information accrual and processing progress in nonlinear diffusion dynamics. The evolution of the response-to-stimulus map is thus modeled by two linked diffusive modules (2LDM) representing the neuronal populations involved in the valuation-and-decision circuit of decision making. Diffusion models are naturally appropriate for describing accumulation of evidence over the time. This allows the computation of the response times (RTs) in valuation and choice, under the hypothesis of ex-Wald distribution. A nonlinear transfer function integrates the activities of the two layers. The input-output map based on the infomax principle makes the 2LDM consistent with the reinforcement learning approach. Results from simulated likelihood time series indicate that 2LDM may account for the activity-dependent modulatory component of effective connectivity between the neuronal populations. Rhythmic fluctuations of the estimate gain functions in the delta-beta bands also support the compatibility of 2LDM with the neurobiology of DM.

  16. Protocol for the Osteoporosis Choice trial. A pilot randomized trial of a decision aid in primary care practice

    Tulledge-Scheitel Sidna M

    2009-12-01

    Full Text Available Abstract Background Bisphosphonates can reduce fracture risk in patients with osteoporosis, but many at-risk patients do not start or adhere to these medications. The aims of this study are to: (1 preliminarily evaluate the effect of an individualized 10-year osteoporotic fracture risk calculator and decision aid (OSTEOPOROSIS CHOICE for postmenopausal women at risk for osteoporotic fractures; and (2 assess the feasibility and validity (i.e., absence of contamination of patient-level randomization (vs. cluster randomization in pilot trials of decision aid efficacy. Methods/Design This is a protocol for a parallel, 2-arm, randomized trial to compare an intervention group receiving OSTEOPOROSIS CHOICE to a control group receiving usual primary care. Postmenopausal women with bone mineral density T-scores of STEOPOROSIS CHOICE on five outcomes: (a patient knowledge regarding osteoporosis risk factors and treatment; (b quality of the decision-making process for both the patient and clinician; (c patient and clinician acceptability and satisfaction with the decision aid; (d rate of bisphosphonate use and adherence, and (e trial processes (e.g., ability to recruit participants, collect patient outcomes. To capture these outcomes, we will use patient and clinician surveys following each visit and video recordings of the clinical encounters. These video recordings will also allow us to determine the extent to which clinicians previously exposed to the decision aid were able to recreate elements of the decision aid with control patients (i.e., contamination. Pharmacy prescription profiles and follow-up phone interviews will assess medication start and adherence at 6 months. Discussion This pilot trial will provide evidence of feasibility, validity of patient randomization, and preliminary efficacy of a novel approach -- decision aids -- to improving medication adherence for postmenopausal women at risk of osteoporotic fractures. The results will inform

  17. Factors influencing the choice of going to a dental quack practice for orthodontic treatment among the citizen of Bandung

    Akhyar Dyni Zakyah

    2016-11-01

    Full Text Available Introduction: Braces is the treatment of choice for malocclusion. However, in recent years malocclusion no longer serves as the reason behind the orthodontic treatment. Many people use it for the fashion purposes and some of them got it from a dental quack. The purpose of this study was to understand factors that influenced citizen of Bandung to go to dental quack practice for orthodontics treatment. Methods: Cross-sectional study with purposive sampling technique consisting of 30 samples. Inclusion criteria were subject wearing metal braces from dental quack, live within area of Bandung, and willing to participate in the study. Exclusion criteria was subjects that refused to participate in the study. Results: The study showed that 73% of the subjects use the treatment for aligning teeth over getting along with the trend or the perception of beauty from using colorful bracket rubber. 63% chose a dental quack because of the suggestions from friends who had done it before them. Low income combined with the need for orthodontics treatment and inadequate information about dental braces influencing subjects choice to go to a dental quack. The study showed that socioeconomic environment highly influenced the decision to wear braces from a dental quack. Conclusion: The low price factor was the main reason for dental quack braces highly demanded. Common people need to be educated to get proper treatment for malocclusion and to go for improper provider of dental treatment.

  18. Which Infidelity Type Makes You More Jealous? Decision Strategies in a Forced-Choice between Sexual and Emotional Infidelity

    Achim Schützwohl

    2004-01-01

    Full Text Available This study tested the prediction derived from the evolutionary psychological analysis of jealousy that men and women selecting the adaptively primary infidelity type (i.e., female sexual and male emotional infidelity, respectively in a forced-choice response format need to engage in less elaborate decision strategies than men and women selecting the adaptively secondary infidelity type (i.e., male sexual and female emotional infidelity, respectively. Unknown to the participants, decision times were registered as an index of the elaborateness of their decision strategies. The results clearly support the prediction. Implications and limitations of the present findings are discussed.

  19. Linking science and decision making to promote an ecology for the city: practices and opportunities

    Morgan Grove; Daniel L. Childers; Michael Galvin; Sarah J. Hines; Tischa Munoz-Erickson; Erika S. Svendsen

    2016-01-01

    To promote urban sustainability and resilience, there is an increasing demand for actionable science that links science and decision making based on social–ecological knowledge. Approaches, frameworks, and practices for such actionable science are needed and have only begun to emerge. We propose that approaches based on the co- design and co- production of knowledge...

  20. Practical Strategies for Integrating Final Ecosystem Goods and Services into Community Decision-Making.

    The concept of Final Ecosystem Goods and Services (FEGS) explicitly connects ecosystem services to the people that benefit from them. This report presents a number of practical strategies for incorporating FEGS, and more broadly ecosystem services, into the decision-making proces...

  1. Using Cognitive Referents in Making Sense of Teaching: A Chemistry Teacher's Struggle to Change Assessment Practices.

    Briscoe, Carol

    1993-01-01

    Study suggests that cognitive referents are important influences in how a teacher thinks about assessment and may constrain a teacher's implementation of innovative practices. Identification of referents such as myths, their associated beliefs, and metonymic conceptual models that teachers use to make sense of their actions is an important step in…

  2. Making Sense of Learning at Secondary School: Involving Students to Improve Teaching Practice

    Kane, Ruth G.; Maw, Nicola

    2005-01-01

    Consulting students on their experiences of learning and teaching in schools, while signalled as a potentially valuable research practice fifteen years ago by Michael Fullan, is now gaining prominence in educational research within New Zealand. The "Making Sense of Learning at Secondary Schools" research began with the premise that to…

  3. Changing policy and practice: making sense of national guidelines for osteoarthritis.

    Ong, Bie Nio; Morden, Andrew; Brooks, Lauren; Porcheret, Mark; Edwards, John J; Sanders, Tom; Jinks, Clare; Dziedzic, Krysia

    2014-04-01

    Understanding uptake of complex interventions is an increasingly prominent area of research. The interplay of macro (such as changing health policy), meso (re-organisation of professional work) and micro (rationalisation of clinical care) factors upon uptake of complex interventions has rarely been explored. This study focuses on how English General Practitioners and practice nurses make sense of a complex intervention for the management of osteoarthritis, using the macro-meso-micro contextual approach and Normalisation Process Theory (NPT), specifically the construct of coherence. It is embedded in a cluster RCT comprising four control practices and four intervention practices. In order to study sense-making by professionals introduction and planning meetings (N = 14) between researchers and the practices were observed. Three group interviews were carried out with 10 GPs and 5 practice nurses after they had received training in the intervention. Transcripts were thematically analysed before comparison with NPT constructs. We found that: first, most GPs and all nurses distinguished the intervention from current ways of working. Second, from the introduction meeting to the completion of the training the purpose of the intervention increased in clarity. Third, GPs varied in their understanding of their remit, while the practice nurses felt that the intervention builds on their holistic care approach. Fourth, the intervention was valued by practice nurses as it strengthened their expert status. GPs saw its value as work substitution, but felt that a positive conceptualisation of OA enhanced the consultation. When introducing new interventions in healthcare settings the interaction between macro, meso and micro factors, as well as the means of engaging new clinical practices and their sense-making by clinicians needs to be considered. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. On the Choice of Farm Management Practices after the Reform of the Common Agricultural Policy in 2003

    Schmid, Erwin; Sinabell, Franz

    2004-01-01

    The Common Agricultural Policy (CAP) was fundamentally reformed in 2003. From 2005 on, farmers will receive decoupled income support payments instead of production premiums if basic standards for environment, food safety, animal health and welfare are met. Farmers will likely adjust production and management practices to the new policy framework. We describe how this reform fits into the EU strategy of making agricultural production more environmentally friendly by concentrating on financial ...

  5. Cognitive schema and naturalistic decision making in evidence-based practices.

    Falzer, Paul R

    2004-04-01

    A recent article in this journal proposed a naturalistic approach to decision making that overcomes problems intrinsic to classical decision theory. The approach emphasizes cognitive and multi-level processes, the development of expert reasoning, and the role of decision support in individual and organizational decision making. The current paper builds on this effort by suggesting a naturalistic, multi-level, theory that can facilitate the dissemination of evidence-based practices (EBPs). The paper presents "Image Theory," a theory that has been extensively investigated in other disciplines, but has yet to be utilized in medical decision research. It is suggested that its rich, empirically tested, distinctions among kinds of cognitive and organizational processes and types of decisions and tasks make Image Theory especially valuable in describing impediments to implementing EBPs. The paper discusses how naturalistic theory can assist clinicians, administrators, researchers, and policy makers in achieving a balance between evidence-based medicine and patient-centered practice.

  6. Restructuring locality: practice, identity and place-making on the German-Polish border

    Sandberg, Marie

    2016-01-01

    Taking cities as analytical entry points for investigating practice, identity and place-making, this article explores the differential restructurings of locality in the twin cities of Görlitz and Zgorzelec on the German-Polish border. Drawing on ethnographic fieldwork, it shows how the local cities......′ leaderships are attempting to wrestle the cities out of their downmarket positioning in the global economy. Deploying a performative research strategy of methodological relationalism, the article examines intersections between these cities′ strategies of situating local youth within urban regeneration...... and cross-border projects and local youth′s preferences for engaging in other kinds of place-making. By ‘seeing’ the cities in border regions through practices of place-making within the multiscalar processes of urban regeneration, new insights about ‘place’ are generated in which city branding...

  7. African Americans in Oral and Maxillofacial Surgery: Factors Affecting Career Choice, Satisfaction, and Practice Patterns.

    Criddle, Thalia-Rae; Gordon, Newton C; Blakey, George; Bell, R Bryan

    2017-12-01

    There are few data available on the experience of minority surgeons in the field of oral and maxillofacial surgery (OMS). Therefore, the purpose of this study was to 1) explore factors that contribute to African Americans choosing OMS as a career, 2) examine satisfaction among minority oral and maxillofacial surgeons with the residency application and training process, 3) report on practice patterns among minority oral and maxillofacial surgeons, and 4) identify perceived bias for or against minority oral and maxillofacial surgeons in an attempt to aid the efforts of OMS residency organizations to foster diversity. A 19-item survey was sent to 80 OMS practitioners by use of information from the mailing list of the National Society of Oral and Maxillofacial Surgeons, an American Association of Oral and Maxillofacial Surgeons-affiliated organization. All surveys were sent by mail and were followed by a reminder mailing after 8 weeks. Responses returned within 16 weeks were accepted for analysis. Of the 80 mailed surveys, 41 were returned within the 16-week parameter, representing a return rate of 51%. Most of the minority surgeon respondents were married men with a mean age of 60 years who worked as private practitioners. Most respondents practiced on the eastern and western coasts of the United States. Exposure in dental school was the most important factor in selecting OMS as a specialty. Location and prestige were the most important factors in selecting a residency program. Most respondents reported that race did not affect the success of their application to a residency program and did not currently affect the success of their practice. However, 25 to 46% of participants experienced race-related harassment, and 48 to 55% of participants believed there was a bias against African Americans in OMS. Our data suggest that a substantial number of minority oral and maxillofacial surgeons subjectively perceive race-based bias in their career, although it does not

  8. Kid-Friendly Veggies and Fruits: 10 Tips for Making Healthy Food Choices More Fun for Children

    ... Set up a pizza-making station in the kitchen. Use whole-wheat English muffins, bagels, or pita ... veggies or fruits into a fun shape or design. 5 fruity peanut butterfly Start with carrot sticks ...

  9. Model complexity and choice of model approaches for practical simulations of CO2 injection, migration, leakage and long-term fate

    Celia, Michael A. [Princeton Univ., NJ (United States)

    2016-12-30

    This report documents the accomplishments achieved during the project titled “Model complexity and choice of model approaches for practical simulations of CO2 injection,migration, leakage and long-term fate” funded by the US Department of Energy, Office of Fossil Energy. The objective of the project was to investigate modeling approaches of various levels of complexity relevant to geologic carbon storage (GCS) modeling with the goal to establish guidelines on choice of modeling approach.

  10. Creative choices and fan practices in the transformation of theme park space

    Carissa Ann Baker

    2016-09-01

    Full Text Available This article describes and interprets fan activities within the theme park space related to a particular fan object. It examines an evolving paradigm wherein the role of theme park visitors is changed. Rather than being perceived as observers of spectacles, they can participate and interact with the environment in new ways. An example of this is Sorcerers of the Magic Kingdom (2012, an interactive role-playing quest and collector card game at Disney's Magic Kingdom Park in Florida. Fans participate in a variety of practices that have dynamically redefined theme park activities. Together, management, designers, and fans have cocreated and reconstructed the theme park experience as one of exploration and participation. Despite multiple levels of control, fans will likewise persist in engagement with activities (in park and online that help shape and interrogate the theme park space.

  11. Affective and rational consumer choice modes: The role of intuition, analytical decision-making, and attitudes to money

    Andersson, Patric; Engelberg, Elisabeth

    2006-01-01

    This paper was motivated by a paucity of research addressing how consumer decision-making is related to beliefs about money and different modes of reasoning. To investigate this issue, data were collected from 142 participants, who filled out questionnaires involving scales aimed to measure affective and rational purchase approaches, intuitive and analytical decision-making styles, as well as money attitudes. One finding was that consumers interchangeably rely on affective and rational approa...

  12. Unpacking Docent Practice in Free Choice Science Learning Settings: A Qualitative Study Documenting the What and Whys of Docent Interpretive Practice

    Good, Laura H.

    whole, and have to be flexible when working with different types of learners. They believe that being a docent means balancing potentially conflicting roles; and 4) docents use interpretation as a pedagogy to engage visitors with science and create personally meaningful experiences. Analysis of significant interactions between docents and visitors shows that such practices are mediated through a variety of discursive and physical tools and implemented by docents as a means of engaging visitors with science and conservation. Moreover, most of these skills appear to be learned on-the-job within their communities of practice, and while specific docent actions and skills may be different across contexts, member checks with docents working in other museum settings demonstrate the resonance of the findings across contexts. The findings of the study are placed in the context of interpretation theories of communication as well as research on docents as lifelong, free-choice learners both facilitating and participating in societal STEM learning activity. Findings and methods of research from this study are valuable to the greater understanding of how docents learn and enact interpretive practice and the development of more effective professional development for docents in museum settings.

  13. Bayesian deterministic decision making: A normative account of the operant matching law and heavy-tailed reward history dependency of choices

    Hiroshi eSaito

    2014-03-01

    Full Text Available The decision making behaviors of humans and animals adapt and then satisfy an ``operant matching law'' in certain type of tasks. This was first pointed out by Herrnstein in his foraging experiments on pigeons. The matching law has been one landmark for elucidating the underlying processes of decision making and its learning in the brain. An interesting question is whether decisions are made deterministically or probabilistically. Conventional learning models of the matching law are based on the latter idea; they assume that subjects learn choice probabilities of respective alternatives and decide stochastically with the probabilities. However, it is unknown whether the matching law can be accounted for by a deterministic strategy or not. To answer this question, we propose several deterministic Bayesian decision making models that have certain incorrect beliefs about an environment. We claim that a simple model produces behavior satisfying the matching law in static settings of a foraging task but not in dynamic settings. We found that the model that has a belief that the environment is volatile works well in the dynamic foraging task and exhibits undermatching, which is a slight deviation from the matching law observed in many experiments. This model also demonstrates the double-exponential reward history dependency of a choice and a heavier-tailed run-length distribution, as has recently been reported in experiments on monkeys.

  14. End-of-life decision making in respiratory failure. The therapeutic choices in chronic respiratory failure in a 7-item questionnaire

    Dagmar Elfriede Rinnenburger

    2012-01-01

    Full Text Available INTRODUCTION: The transition from paternalistic medicine to a healthcare culture centred on the patient's decision making autonomy presents problems of communication and understanding. Chronic respiratory failure challenges patients, their families and caregivers with important choices, such as invasive and non-invasive mechanical ventilation and tracheostomy, which, especially in the case of neuromuscular diseases, can significantly postpone the end of life. MATERIAL AND METHODS: A 7-item questionnaire was administered to 100 patients with advanced COPD, neuromuscular diseases and pulmonary fibrosis, all of them on oxygen therapy and receiving day-hospital treatment for respiratory failure. The objective was to find out whether or not patients, if faced with a deterioration of their health condition, would want to take part in the decision making process and, if so, how and with whom. RESULTS. Results showed that: 90% of patients wanted to be interviewed, 10% preferred not to be interviewed, 82% wanted to be regularly updated on their clinical situation, 75% wanted to be intubated, if necessary, and 56% would also agree to have a tracheostomy. These choices have been confirmed one year later, with 93% of respondents accepting the questionnaire and considering it useful. CONCLUSIONS: It is possible to conclude that a simple questionnaire can be a useful tool contributing to therapeutic decision making in respiratory failure.

  15. Market Exchange Rates Or Purchasing Power Parity. Does The Choice Make A Difference To The Climate Debate?

    Manne, A.S.; Richels, R.G.; Edmonds, J.A.

    2005-01-01

    Critics of the Intergovernmental Panel on Climate Change's Special Report on Emission Scenarios claim that the use of market exchange rates (MER) rather than purchasing power parity (PPP) to measure gross domestic product (GDP) has led to a significant upward bias in projections of greenhouse gas emissions, and hence unrealistically high future temperature. Rather than revisit the debate on the choice of exchange rates, we address a much simpler question: when it comes to temperature change, how much does it matter if potential GDP is expressed in MER rather than PPP? Employing a computable general equilibrium model designed to examine a variety of issues in the climate debate, we find that there is a difference, but that it is only minor

  16. Independence and interdependence in collective decision making: an agent-based model of nest-site choice by honeybee swarms

    List, Christian; Elsholtz, Christian; Seeley, Thomas D.

    2008-01-01

    Condorcet's jury theorem shows that when the members of a group have noisy but independent information about what is best for the group as a whole, majority decisions tend to outperform dictatorial ones. When voting is supplemented by communication, however, the resulting interdependencies between decision makers can strengthen or undermine this effect: they can facilitate information pooling, but also amplify errors. We consider an intriguing non-human case of independent information pooling combined with communication: the case of nest-site choice by honeybee (Apis mellifera) swarms. It is empirically well documented that when there are different nest sites that vary in quality, the bees usually choose the best one. We develop a new agent-based model of the bees' decision process and show that its remarkable reliability stems from a particular interplay of independence and interdependence between the bees. PMID:19073474

  17. Diluent choice for subcutaneous infusion: a survey of the literature and Australian practice.

    Flowers, Charne; McLeod, Fiona

    2005-02-01

    Continuous subcutaneous infusion is a method frequently used in palliative care to manage patient symptoms. To deliver the dose required and prevent subcutaneous sites from becoming inflamed and painful, the drug is often diluted in a solution, most commonly sterile water for injection or sodium chloride. The use of sterile water for injection has been recommended for cyclizine yet beyond this example there appears to be limited clinical direction regarding diluent selection. Inconsistency or lack of guidelines can be problematic if a diluent that may enhance the effectiveness of a drug compared with an alternate is not used because of lack of knowledge or guidance. This investigation considered existing literature, drug databases and directories, and involved a survey of palliative care services to examine evidence and experience relating to diluent selection. A number of inconsistencies emerged in both the literature and practice. With the exception of five drugs for which only saline was recommended, there appeared to be an inclination to use water unless contraindicated. Given an increasing reliance on this method of symptom management, the absence of formal clinical evidence or recommendations and ambiguity in relation to the use of diluents highlights the need for these deficits to be addressed as quickly as possible.

  18. Use of classical criterions of a decision making for choice of measures on decrease of economic damage from nuclear and radiation accidents

    Rylov, M.I.; Kamynov, Sh.V.; Mozhaev, A.S.; Anisimov, N.A.; Nikitin, V.S.

    2004-01-01

    Application of classical criteria of decision making for choice of measures on the decrease of economic damage from possible nuclear and radiation accidents during spent fuel unloading from nuclear submarines and storage in the process of their utilization was demonstrated. Economic damage was chosen as optimization index, three versions of possible accidents and limited number of measures on the decrease of their effect were treated for illustration of the suggested approach. On the base of analysis of classical criteria the optimal strategy for decrease of economic damage was chosen [ru

  19. Choice Shifts in Groups

    Kfir Eliaz; Debraj Ray

    2004-01-01

    The phenomenon of "choice shifts" in group decision-making is fairly ubiquitous in the social psychology literature. Faced with a choice between a ``safe" and ``risky" decision, group members appear to move to one extreme or the other, relative to the choices each member might have made on her own. Both risky and cautious shifts have been identified in different situations. This paper demonstrates that from an individual decision-making perspective, choice shifts may be viewed as a systematic...

  20. Emotions in Risk Assessment and Decision Making Processes During Craft Practice

    Camilla Groth

    2015-12-01

    Full Text Available Traditionally subjective experiences and emotions have been overlooked in the practice of scientific research. In the field of design and craft research too, feelings and emotions have been considered as interfering with the rigour of research. However, as a result of findings in neuroscience, a new understanding has emerged, providing emotions a central role in risk assessment and decision making processes. This has implications also for how we understand craft practice. In this practice-led research, a craft practitioner analysed five video-recordings of herself while throwing clay blindfolded. The researcher-practitioner specifically studied critical incidents in the throwing process and made a detailed analysis of how sensory experiences and emotions guided her in risk assessment, decision making, and problem solving during the clay-throwing sessions. She found that her tactile experience gave her important clues on the condition of the material and its consequent possibilities at different stages. These experiences in turn affected her emotions in either positive or negative ways, affecting her risk assessment, decision making, and problem solving activities. This research has shown that sensory experiences and emotions influence the craft making process and are thus important elements in the expertise of the craftsperson. The role of such emotions remains to be studied further in the expertise of researchers in general.

  1. People adopt optimal policies in simple decision-making, after practice and guidance.

    Evans, Nathan J; Brown, Scott D

    2017-04-01

    Organisms making repeated simple decisions are faced with a tradeoff between urgent and cautious strategies. While animals can adopt a statistically optimal policy for this tradeoff, findings about human decision-makers have been mixed. Some studies have shown that people can optimize this "speed-accuracy tradeoff", while others have identified a systematic bias towards excessive caution. These issues have driven theoretical development and spurred debate about the nature of human decision-making. We investigated a potential resolution to the debate, based on two factors that routinely differ between human and animal studies of decision-making: the effects of practice, and of longer-term feedback. Our study replicated the finding that most people, by default, are overly cautious. When given both practice and detailed feedback, people moved rapidly towards the optimal policy, with many participants reaching optimality with less than 1 h of practice. Our findings have theoretical implications for cognitive and neural models of simple decision-making, as well as methodological implications.

  2. Motives of former interns in general practice for speciality-choice--results of a cross-sectional study among graduates 2007 to 2012.

    Abendroth, Jens; Schnell, Ute; Lichte, Thomas; Oemler, Matthias; Klement, Andreas

    2014-01-01

    The influence of a final-year elective internship in general practice (IGP) on motives affecting graduates' choice of specialty is the object of great public interest, yet still insufficiently evaluated. Longitudinal studies show the influence of numerous motives (e.g., work-life balance), but not following the IGP experience itself. Thus, we performed a cross-sectional questionnaire study of all graduates who completed the IGP in Saxony-Anhalt during 2007-2012 regarding their motives for choosing a speciality. A standardized questionnaire was sent to 109 former interns in general practice. The questionnaire contained 29 items addressing three topics (personal attitudes, concept of personal and professional life, motives for speciality choice) and used single-choice and multiple-choice answers, as well as Likert scales. Correlation analysis was carried out by means of Kendall's tau. The questionnaire reached 97 former interns, of which 45 (46%) responded. In the overall ranking of motives for speciality choice, family (71%), leisure time (66%) and job opportunities (48%) rated as more important than income (36%), mentoring (20%), status or scientific work (20%). Only 29% of the respondents stated that their speciality choice was changed by the IGP. If the speciality choice was already established before the IGP, the influence of the IGP on speciality choice was significantly low (r = -.5; p life and career were also important factors affecting speciality choice. The aspects of the positive influence exerted by medical teachers on those students who are still undecided during the IGP should be carefully evaluated.

  3. What choices should we be able to make about designer babies? A Citizens' Jury of young people in South Wales.

    Iredale, Rachel; Longley, Marcus; Thomas, Christian; Shaw, Anita

    2006-09-01

    Young people will increasingly have the option of using new technologies for reproductive decision making but their voices are rarely heard in debates about acceptable public policy in this area. Capturing the views of young people about potentially esoteric topics, such as genetics, is difficult and methodologically challenging. A Citizens' Jury is a deliberative process that presents a question to a group of ordinary people, allows them to examine evidence given by expert witnesses and personal testimonies and arrive at a verdict. This Citizens' Jury explored designer babies in relation to inherited conditions, saviour siblings and sex selection with young people. Fourteen young people aged 16-19 in Wales. Acceptance of designer baby technology was purpose-specific; it was perceived by participants to be acceptable for preventing inherited conditions and to create a child to save a sibling, but was not recommended for sex selection. Jurors stated that permission should not depend on parents' age, although some measure of suitability should be assessed. Preventing potential parents from going abroad was considered impractical. These young people felt the Human Fertilisation and Embryology Authority should have members under 20 and that the term 'designer baby' was not useful. Perspectives on the acceptability of this technology were nuanced, and based on implicit value judgements about the extent of individual benefit derived. Young people have valuable and interesting contributions to make to the debate about genetics and reproductive decision making and a variety of innovative methods must be used to secure their involvement in decision-making processes.

  4. Epistemic objects in collective decision-making: a practice perspective on the use of causal maps as situated material artifacts

    Arevuo, Mikko

    2015-01-01

    Recent practice-based approaches to strategic decision-making research have emphasized the importance of gaining a deeper understanding how managers think, act, and interpret strategic decisions in practice. This focus on the micro aspects of strategic decision-making has emerged from the critique that much of the ‘traditional’ decision- making theory may not be actionable in practice. Research should therefore concentrate on what managers do when they engage in strategic activ...

  5. PRACTICE AND BUSINESS STRATEGIES FOR DECISION -MAKING IN THE AUTOMOTIVE SPARE PARTS SECTOR

    Neyda Ibañez

    2017-09-01

    Full Text Available This paper aims to describe the practices and prospective strategies used by the Venezuelan automotive spare parts sector. The study was located in the post positivist paradigm using the descriptive method of scientist mode. The results showed that the industry uses more than 54.83 percent in qualitative prospective methods for constructing scenarios that enable their decision making, and 19,35 percent in quantitative forward-looking strategies, and the rest corresponding to a 25,82 percent in practices and prospective strategies that combine both. We conclude that made a new type of design with nine steps to build their scenarios.

  6. Making it lean applying lean practices to the work of it

    Williams, Howard

    2013-01-01

    Making IT Lean: Applying Lean Practices to the Work of IT presents Lean concepts and techniques for improving processes and eliminating waste in IT operations and IT Service Management, in a manner that is easy to understand. The authors provide a context for discussing several areas of application within this domain, allowing you to quickly gain insight into IT processes and Lean principles.The text reviews IT Service Management, with reference to the IT Infrastructure Library (ITIL®) as a framework for best practices-explaining how to use it to accommod

  7. Pediatricians' practice location choice-Evaluating the effect of Japan's 2004 postgraduate training program on the spatial distribution of pediatricians.

    Sakai, Rie; Fink, Günther; Kawachi, Ichiro

    2014-01-01

    To explore determinants of change in pediatrician supply in Japan, and examine impacts of a 2004 reform of postgraduate medical education on pediatricians' practice location choice. Data were compiled from secondary data sources. The dependent variable was the change in the number of pediatricians at the municipality ("secondary tier of medical care" [STM]) level. To analyze the determinants of pediatrician location choices, we considered the following predictors: initial ratio of pediatricians per 1000 children under five years of age (pediatrician density) and under-5 mortality as measures of local area need, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Basic comparisons of pediatrician coverage in the top and bottom 10% of STMs were conducted to assess inequality in pediatrician supply. Increased supply was inversely associated with baseline pediatrician density both in the pre-period and post-period. Estimated impact of pediatrician density declined over time (P = 0.026), while opposite trends were observed for measures of residential quality. More specifically, urban centers and the SES composite index were positively associated with pediatrician supply for the post-period, but no such associations were found for the pre-period. Inequality in pediatrician distribution increased substantially after the reform, with the best-served 10% of communities benefitting from five times the pediatrician coverage compared to the least-served 10%. Residential quality increasingly became a function of location preference rather than public health needs after the reform. New placement schemes should be developed to achieve more equity in access to pediatric care.

  8. The application of a selection of decision-making techniques by employees in a transport work environment in conjunction with their perceived decision-making success and practice

    Theuns F.J. Oosthuizen

    2014-03-01

    Full Text Available A lack of optimum selection and application of decision-making techniques, in conjunction with suitable decision-making practice and perception of employees in a transport work environment demands attention to improve overall performance. Although multiple decision-making techniques exist, five prevalent techniques were considered in this article, namely the Kepner-Tregoe, Delphi, stepladder, nominal group and brainstorming techniques. A descriptive research design was followed, using an empirical survey which was conducted among 210 workers employed in a transport work environment and studying in the field of transport management. The purpose was to establish to what extent the five decision-making techniques are used in their work environment and furthermore how the decision-making practice of using gut-feel and/or a step-by-step decision-making process and their perception of their decision-making success relate. The research confirmed that the use of decision-making techniques is correlated to perceived decision-making success. Furthermore, the Kepner-Tregoe, stepladder, Delphi and brainstorming techniques are associated with a step-by-step decision-making process. No significant association was confirmed between the use of gut-feel and decision-making techniques. Brainstorming was found to be the technique most frequently used by transport employees; however, it has limitations as a comprehensive decision-making technique. Employees working in a transport work environment need training in order to select and use the four comprehensive decision-making techniques.

  9. Factors influencing the choice of antidepressants: A study of antidepressant prescribing practice at University psychiatric clinic in Belgrade

    Marić Nađa P.

    2012-01-01

    Full Text Available Background/Aim. Antidepressants are a widely used class of drugs. The aim of this study was to investigate different aspects of antidepressant prescribing practice at University Psychiatric Clinic in Belgrade. Methods. This cross-sectional study was carried out by retrospective analysis of the patient's medical charts. The study included all patients with antidepressant prescribed at discharge during 2009 (n = 296. The evaluation was focused on patient- related factors (socio-demographic and illness related, psychiatrist-related factors (sex and duration of working experience and drug related factors (type of antidepressant, dose, polypharmacy and reimbursement by national health insurance. Results. Antidepressants were prescribed for unipolar depression (F32-34, ICD X either without comorbidity (46.2% or with comorbidity (24.7%, mostly as a monotherapy (91% had one antidepressant, to the patients who were 65% female, aged 50.1 ± 8.9, most of them with 12 years of education (52.6%, married (69.3% and employed (55.9%. The majority of patients had a history of two hospitalizations (Med 2; 25th-75th perc. 1-4 during nine years (Med 9; 25th-75th perc. 2-15 after the first episode of depression. Among them, 19% were found to be suicidal in a lifetime. The single most prescribed antidepressant was sertraline (20.4%, followed by fluoxetine (13.3% and maprotiline (11.7%. Utilization of antidepressants was positively correlated with the rate of reimbursement (p < 0.01. The most prescribed antidepressant group was selective serotonin reuptake inhibitors (SSRI (47.8%, followed by tricyclic antidepresants (TCA (25.3% and new antidepressants - venlafaxine, tianeptine, mirtazapine, bupropion, trazodone (15.1%. Most of the drugs were prescribed in doses which are at the lower end of the recommended dose-range. Regarding severity of the actual depressive episode, TCA were prescribed for severe depression with psychotic features, while SSRI were choice for

  10. Making healthy food choices using nutrition facts panels. The roles of knowledge, motivation, dietary modifications goals, and age.

    Miller, Lisa M Soederberg; Cassady, Diana L

    2012-08-01

    Nutrition facts panels (NFPs) contain a rich assortment of nutrition information and are available on most food packages. The importance of this information is potentially even greater among older adults due to their increased risk for diet-related diseases, as well as those with goals for dietary modifications that may impact food choice. Despite past work suggesting that knowledge and motivation impact attitudes surrounding and self-reported use of NFPs, we know little about how (i.e., strategies used) and how well (i.e., level of accuracy) younger and older individuals process NFP information when evaluating healthful qualities of foods. We manipulated the content of NFPs and, using eye tracking methodology, examined strategies associated with deciding which of two NFPs, presented side-by-side, was healthier. We examined associations among strategy use and accuracy as well as age, dietary modification status, knowledge, and motivation. Results showed that, across age groups, those with dietary modification goals made relatively more comparisons between NFPs with increasing knowledge and motivation; but that strategy effectiveness (relationship to accuracy) depended on age and motivation. Results also showed that knowledge and motivation may protect against declines in accuracy in later life and that, across age and dietary modification status, knowledge mediates the relationship between motivation and decision accuracy. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices.

    Grech, A; Allman-Farinelli, M

    2015-12-01

    Internationally, vending machines are scrutinized for selling energy-dense nutrient-poor foods and beverages, and the contribution to overconsumption and subsequent risk of obesity. The aim of this review is to determine the efficacy of nutrition interventions in vending machine in eliciting behaviour change to improve diet quality or weight status of consumers. Electronic databases Cochrane, EMBASE, CINAHL, Science Direct and PubMed were searched from inception. (i) populations that have access to vending machines; (ii) nutrition interventions; (iii) measured outcomes of behaviour change (e.g. sales data, dietary intake or weight change); and (iv) experimental trials where controls were not exposed to the intervention. Risk of bias was assessed independently by two researchers, and higher quality research formed the basis of this qualitative review. Twelve articles from 136 searched were included for synthesis. Intervention settings included schools, universities and workplaces. Reducing price or increasing the availability increased sales of healthier choices. The results of point-of-purchase nutrition information interventions were heterogeneous and when measured changes to purchases were small. This review offers evidence that pricing and availability strategies are effective at improving the nutritional quality foods and beverages purchased from vending machines. Evidence on how these interventions alter consumer's overall diet or body mass index is needed. © 2015 World Obesity.

  12. Making Healthy Food Choices Using Nutrition Facts Panels: The Roles of Knowledge, Motivation, Dietary Modifications Goals, and Age

    Cassady, Diana L.

    2012-01-01

    Nutrition facts panels (NFPs) contain a rich assortment of nutrition information and are available on most food packages. The importance of this information is potentially even greater among older adults due to their increased risk for diet-related diseases, as well as those with goals for dietary modifications that may impact food choice. Despite past work suggesting that knowledge and motivation impact attitudes surrounding and self-reported use of NFPs, we know little about how (i.e., strategies used) and how well (i.e., level of accuracy) younger and older individuals process NFP information when evaluating healthful qualities of foods. We manipulated the content of NFPs and, using eye tracking methodology, examined strategies associated with deciding which of two NFPs, presented side-by-side, was healthier. We examined associations among strategy use and accuracy as well as age, dietary modification status, knowledge, and motivation. Results showed that, across age groups, those with dietary modification goals made relatively more comparisons between NFPs with increasing knowledge and motivation; but that strategy effectiveness (relationship to accuracy) depended on age and motivation. Results also showed that knowledge and motivation may protect against declines in accuracy in later life and that, across age and dietary modification status, knowledge mediates the relationship between motivation and decision accuracy. PMID:22524999

  13. On framing effects in decision making: linking lateral versus medial orbitofrontal cortex activation to choice outcome processing.

    Windmann, Sabine; Kirsch, Peter; Mier, Daniela; Stark, Rudolf; Walter, Bertram; Güntürkün, Onur; Vaitl, Dieter

    2006-07-01

    Two correlates of outcome processing in the orbitofrontal cortex (OFC) have been proposed in the literature: One hypothesis suggests that the lateral/medial division relates to representation of outcome valence (negative vs. positive), and the other suggests that the medial OFC maintains steady stimulus-outcome associations, whereas the lateral OFC represents changing (unsteady) outcomes to prepare for response shifts. These two hypotheses were contrasted by comparing the original with the inverted version of the Iowa Gambling Task in an event-related functional magnetic resonance imaging experiment. Results showed (1) that (caudo) lateral OFC was indeed sensitive to the steadiness of the outcomes and not merely to outcome valence and (2) that the original and the inverted tasks, although both designed to measure sensitivity for future outcomes, were not equivalent as they enacted different behaviors and brain activation patterns. Results are interpreted in terms of Kahneman and Tversky's prospect theory suggesting that cognitions and decisions are biased differentially when probabilistic future rewards are weighed against consistent punishments relative to the opposite scenario [Kahneman, D., & Tversky, A. Choices, values, and frames. American Psychologist, 39, 341-350, 1984]. Specialized processing of unsteady rewards (involving caudolateral OFC) may have developed during evolution in support of goal-related thinking, prospective planning, and problem solving.

  14. Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice?

    Kabaalioglu, Adnan; Ceken, Kagan; Alimoglu, Emel; Apaydin, Ali

    2006-01-01

    Aim: To evaluate the long-term results of percutaneous imaging-guided treatment of hydatid liver cysts. Materials and methods: Sixty patients with 77 hydatid liver cysts underwent percutaneous treatment with ultrasonography (US) or computed tomography (CT) guidance. Absolute alcohol and hypertonic saline were used for sclerosing the cysts after aspiration. Prophylactic albendazole treatment was given before and after the procedures. Follow-up US and CT were obtained periodically, and changes in cyst morphology were recorded. Minimum follow-up period for the patients included in this study was 12 months. Serological correlation was also available for a group of patients. The outcome of the procedures were categorized into five groups based on morphological changes observed by imaging. Results: Procedures were regarded as successful in 80% and unsuccessful in 20% of patients. Failures most often occurred with type III cysts; less than half (39%) of the total type III cysts had a successful outcome. On the other hand, all type I cysts ended up with cure. Anaphylaxis, pneumotorax and severe pain interrupting the procedures were also among the reasons of failure. Conclusion: Percutaneous aspiration, injection and reaspiration (PAIR) of types I and II hydatid liver cysts is effective and safe in the long-term. Surgery should no longer be regarded as the first choice treatment in all hydatid liver cysts but should be reserved for type III and certain active type IV cysts

  15. Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice?

    Kabaalioglu, Adnan [Department of Radiology, Akdeniz University Hospital, Antalya (Turkey)]. E-mail: adnank@akdeniz.edu.tr; Ceken, Kagan [Department of Radiology, Akdeniz University Hospital, Antalya (Turkey); Alimoglu, Emel [Department of Radiology, Akdeniz University Hospital, Antalya (Turkey); Apaydin, Ali [Department of Radiology, Akdeniz University Hospital, Antalya (Turkey)

    2006-07-15

    Aim: To evaluate the long-term results of percutaneous imaging-guided treatment of hydatid liver cysts. Materials and methods: Sixty patients with 77 hydatid liver cysts underwent percutaneous treatment with ultrasonography (US) or computed tomography (CT) guidance. Absolute alcohol and hypertonic saline were used for sclerosing the cysts after aspiration. Prophylactic albendazole treatment was given before and after the procedures. Follow-up US and CT were obtained periodically, and changes in cyst morphology were recorded. Minimum follow-up period for the patients included in this study was 12 months. Serological correlation was also available for a group of patients. The outcome of the procedures were categorized into five groups based on morphological changes observed by imaging. Results: Procedures were regarded as successful in 80% and unsuccessful in 20% of patients. Failures most often occurred with type III cysts; less than half (39%) of the total type III cysts had a successful outcome. On the other hand, all type I cysts ended up with cure. Anaphylaxis, pneumotorax and severe pain interrupting the procedures were also among the reasons of failure. Conclusion: Percutaneous aspiration, injection and reaspiration (PAIR) of types I and II hydatid liver cysts is effective and safe in the long-term. Surgery should no longer be regarded as the first choice treatment in all hydatid liver cysts but should be reserved for type III and certain active type IV cysts.

  16. Involvement as inclusion? Shared decision-making in social work practice in Israel: a qualitative account.

    Levin, Lia

    2015-03-01

    Shared decision-making (SDM), a representation of shared knowledge and power between social workers and their clients, is gaining popularity and prevalence in social services around the world. In many senses, SDM reflects values traditionally associated with social work and service provision, such as equality and anti-discrimination. In the complex context of social problem-solving, however, the relationship between SDM, social workers and their clients is multi-faceted and deserves particular attention. The current study examined SDM and the dilemmas it entails through interviews conducted in 2012 with 77 Israeli social workers and policy makers whose responses were analysed according to the guiding principles of descriptive phenomenological content analysis and dialogical commonality. Participants' responses represent notions of hope, change, identity and choice. Findings are discussed in correspondence with current and recent trends in Israeli social services, and the social work profession in Israel. © 2014 John Wiley & Sons Ltd.

  17. Buying in and Checking out: Identity Development and Meaning Making in the Practice of Mathematics Homework

    Mara Landers

    2013-06-01

    Full Text Available This paper presents findings from an ethnographic study of the role and meaning of mathematics homework in the lives of middle school students. The study conceptualizes and examines homework as a social practice, with a focus on how students make meaning out of their experiences and the role of identity development in meaning making. Specifically, the study examines how middle school students come to value or reject mathematics homework. Case study analyses revealed two ways of characterizing students’ experiences with homework. Students who buy into homework develop aspects of their identities related to school, math and homework that support them in valuing homework. Students who check out develop aspects of their identities that support them in rejecting homework. The concepts of buying in and checking out have implications for theory development around motivation and identity and for school practices around homework.

  18. Making things explicit using instructional materials: a case study of a Singapore teacher's practice

    Leong, Yew Hoong; Cheng, Lu Pien; Toh, Wei Yeng Karen; Kaur, Berinderjeet; Toh, Tin Lam

    2018-04-01

    The phrase `make it explicit' is a common advice given to teachers. It is, however, not clear to us what this actually means when translated into classroom practice. Our review found that we are not alone: "explicit" is used in different ways in the education literature. This paper explores, through a case study of a teacher who stated "making things explicit" as an ostensible goal of his instructional practice, how the explicitation is realised in teaching mathematics. In particular, we examine how he used the instructional materials that he crafted to fulfil his goal of explicitation. We were able to uncover three strategies he used: explicit-from, explicit-within, and explicit-to.

  19. What choices should we be able to make about designer babies? A Citizens’ Jury of young people in South Wales

    Iredale, Rachel; Longley, Marcus; Thomas, Christian; Shaw, Anita

    2006-01-01

    Abstract Background  Young people will increasingly have the option of using new technologies for reproductive decision making but their voices are rarely heard in debates about acceptable public policy in this area. Capturing the views of young people about potentially esoteric topics, such as genetics, is difficult and methodologically challenging. Design  A Citizens’ Jury is a deliberative process that presents a question to a group of ordinary people, allows them to examine evidence given by expert witnesses and personal testimonies and arrive at a verdict. This Citizens’ Jury explored designer babies in relation to inherited conditions, saviour siblings and sex selection with young people. Participants  Fourteen young people aged 16–19 in Wales. Results  Acceptance of designer baby technology was purpose‐specific; it was perceived by participants to be acceptable for preventing inherited conditions and to create a child to save a sibling, but was not recommended for sex selection. Jurors stated that permission should not depend on parents’ age, although some measure of suitability should be assessed. Preventing potential parents from going abroad was considered impractical. These young people felt the Human Fertilisation and Embryology Authority should have members under 20 and that the term ‘designer baby’ was not useful. Conclusions  Perspectives on the acceptability of this technology were nuanced, and based on implicit value judgements about the extent of individual benefit derived. Young people have valuable and interesting contributions to make to the debate about genetics and reproductive decision making and a variety of innovative methods must be used to secure their involvement in decision‐making processes. PMID:16911135

  20. Experiences and Motives of Australian Single Mothers by Choice who make Early Contact with their Child?s Donor Relatives

    Kelly, Fiona J; Dempsey, Deborah J

    2017-01-01

    Abstract An increasing number of Australian parents of donor-conceived children are making contact with their child?s donor relatives prior to their child reaching the age of majority. This process, often referred to as ?donor linking?, can be achieved in Australia through either formal or informal mechanisms. Formal mechanisms exist in three states, each of which has legislation enabling donor linking in certain circumstances. Donor linking may also be achieved through informal mechanisms, s...

  1. The art of grocery shopping on a food stamp budget: factors influencing the food choices of low-income women as they try to make ends meet.

    Wiig, Kristen; Smith, Chery

    2009-10-01

    Amidst a hunger-obesity paradox, the purpose of the present study was to examine the grocery shopping behaviour and food stamp usage of low-income women with children to identify factors influencing their food choices on a limited budget. Focus groups, which included questions based on Social Cognitive Theory constructs, examined food choice in the context of personal, behavioural and environmental factors. A quantitative grocery shopping activity required participants to prioritize food purchases from a 177-item list on a budget of $US 50 for a one-week period, an amount chosen based on the average household food stamp allotment in 2005. Ninety-two low-income women, with at least one child aged 9-13 years in their household, residing in the Twin Cities, Minnesota, USA. Participants' mean age was 37 years, and 76% were overweight or obese (BMI> or =25.0 kg/m2). Key findings suggest that their food choices and grocery shopping behaviour were shaped by not only individual and family preferences, but also their economic and environmental situation. Transportation and store accessibility were major determinants of shopping frequency, and they used various strategies to make their food dollars stretch (e.g. shopping based on prices, in-store specials). Generally, meat was the most important food group for purchase and consumption, according to both the qualitative and quantitative data. Efforts to improve food budgeting skills, increase nutrition knowledge, and develop meal preparation strategies involving less meat and more fruits and vegetables, could be valuable in helping low-income families nutritionally make the best use of their food dollars.

  2. Preparing Parents to Make An Informed Choice About Antibiotic Use for Common Acute Respiratory Infections in Children: A Randomised Trial of Brief Decision Aids in a Hypothetical Scenario.

    Coxeter, Peter D; Del Mar, Chris B; Hoffmann, Tammy C

    2017-08-01

    Childhood acute respiratory infections (ARIs) are one of the most common reasons for primary care consultations and for receiving an antibiotic. Public awareness of antibiotic benefit and harms for these conditions is low. To facilitate informed decision making, ideally in collaboration with their doctor, parents need clear communication about benefits and harms. Decision aids may be able to facilitate this process. The aim of this study was to evaluate the effectiveness of three decision aids about antibiotic use for common ARIs in children. Adult parents of children aged 1-16 years (n = 120) were recruited from community settings and then randomised using a computer-generated randomisation sequence to receive a decision aid (n = 60) or fact sheet (n = 60). Allocation was concealed and used sealed and opaque sequentially numbered envelopes. Participants self-completed questionnaires at baseline and immediately post-intervention. The primary outcome was informed choice (conceptual and numerical knowledge; attitudes towards, and intention to use, antibiotics for a future ARI). Secondary outcomes were decisional conflict, decisional self-efficacy, and material acceptability. After reading the information, significantly more intervention group participants made an informed choice [57%] compared with control group participants [29%] [difference 28, 95% confidence interval (CI) 11-45%, p decision aids prepared parents to make an informed choice about antibiotic use more than fact sheets, in a hypothetical situation. Their effect within a consultation needs to be evaluated. Clinical Trials Registration Number: ACTRN12615000843550.

  3. Making LibrariesAccessible for Visually Impaired Users: Practical Advice For Librarians

    Devney Hamilton

    2011-12-01

    Full Text Available This article provides an introduction to making university libraries accessible to visually impaired users. It includes a summary of how visually impaired students access information and how libraries can provide access to materials, devices and software, and staff support to ensure visually impaired students ’ equal opportunity to use the library. The practical advice for librarians are based on interviews with 18 visually impaired university students and professionals who specialize in media, library services and information retrieval.

  4. A new R-SWAT Decision Making Framework for the Efficient Allocation of Best Management Practices

    UDIAS MOINELO ANGEL; MALAGO ANNA; REYNAUD ARNAUD; PASTORI MARCO; VIGIAK OLGA; BOURAOUI Faycal

    2015-01-01

    The work presents and illustrates the application of R-SWAT-DM, a new R framework designed for Decision Making (DM), related to the implementation of Best Management Practices (BMPs), for restoring and protecting the good ecological status of freshwater bodies. R-SWAT-DM combines the use of the SWAT watershed model, the spatial representation of BMPs and an economic component. The SWAT model served as the nonpoint source pollution estimator for current conditions (base line) as well as for sc...

  5. What counts as a choice? U.S. Americans are more likely than Indians to construe actions as choices.

    Savani, Krishna; Markus, Hazel Rose; Naidu, N V R; Kumar, Satishchandra; Berlia, Neha

    2010-03-01

    People everywhere select among multiple alternatives, but are they always making choices? In five studies, we found that people in U.S. American contexts, where the disjoint model of agency is prevalent, are more likely than those in Indian contexts to construe their own and other individuals' behaviors as choices, to construe ongoing behaviors and behaviors recalled from memory as choices, to construe naturally occurring and experimentally controlled behaviors as choices, to construe mundane and important actions as choices, and to construe personal and interpersonal actions as choices. Indians showed a greater tendency to construe actions as choices when these actions involved responding to other people than when they did not. These findings show that whether people construe actions as choices is significantly shaped by sociocultural systems of meanings and practices. Together, they suggest that the positive consequences associated with maximizing the availability of personal choice may not be universal and instead may be limited to North American contexts.

  6. Some singularities of application of the principle of justification for decision making about new practices

    Holubiev, V.; Makarovska, O.

    1999-01-01

    For the purpose of establishing a unified approach for the regulation of activities that are connected with exposure of people, ICRP, INSAG and the IAEA have developed the series of regulations in which a variety of practical kinds of activities are brought together in terms of PRACTICES and INTERVENTIONS. For the overwhelming majority of real situations, the exposure of people from radiation sources occur due to the side effect of the utilization of atomic energy. Recommendations that are developed in detail about regulation of such activities by authorities could be applicable for a majority of situations. However, for some cases, where planned exposure of people isn't directly connected with atomic energy utilization or with radiation accident consequences, mitigation and liquidation, the estimation of the situation in terms of the definitions of PRACTICE and INTERVENTION is acceptable with some restrictions. It is necessary to work out new approaches for making decisions by regulatory authorities for these situations. (author)

  7. Reproductive autonomy as self-making: procreative liberty and the practice of ethical subjectivity.

    Mills, Catherine

    2013-12-01

    In this article, I consider recent debates on the notion of procreative liberty, to argue that reproductive freedom can be understood as a form of positive freedom-that is, the freedom to make oneself according to various ethical and aesthetic principles or values. To make this argument, I draw on Michel Foucault's later work on ethics. Both adopting and adapting Foucault's notion of ethics as a practice of the self and of liberty, I argue that reproductive autonomy requires enactment to gain meaning within the life contexts of prospective parents. Thus, I propose a shift away from the standard negative model of freedom that sees it solely as a matter of noninterference or nonimpedance, a view advocated by major commentators such as John Harris and John Robertson. Instead, reproduction should be understood as a deeply personal project of self-making that integrates both negative and positive freedom.

  8. Using cognitive referents in making sense of teaching: A chemistry teacher's struggle to change assessment practices

    Briscoe, Carol

    This qualitative case study focused on the role of cognitive referents in the sense-making process of one teacher as he attempted to change his classroom science assessment. The interpretations identify cultural myths, conceptual metonymys, as well as personally constructed beliefs as referents that constrained change. The teacher's cognitive struggle to make sense of assessment and his role as assessor are linked to conflicting referents he used in varying contexts including day-to-day assessment and summative assessment settings. The results of the study suggest that cognitive referents are important influences in driving how a teacher thinks about assessment and may constrain an individual teacher's implementation of innovative practices. Accordingly, identification of referents such as myths, their associated beliefs, and metonymic conceptual models that teachers use to make sense of their actions is an important first step in developing an understanding of constraints to educational change.

  9. Making the Case for Practice-Based Research and the Imperative Role of Design Practitioners.

    Freihoefer, Kara; Zborowsky, Terri

    2017-04-01

    The purpose of this article is to justify the need for evidence-based design (EBD) in a research-based architecture and design practice. This article examines the current state of practice-based research (PBR), supports the need for EBD, illustrates PBR methods that can be applied to design work, and explores how findings can be used as a decision-making tool during design and as a validation tool during postoccupancy. As a result, design professions' body of knowledge will advance and practitioners will be better informed to protect the health, safety, and welfare of the society. Furthermore, characteristics of Friedman's progressive research program are used as a framework to examine the current state of PBR in design practice. A modified EBD approach is proposed and showcased with a case study of a renovated inpatient unit. The modified approach demonstrates how a highly integrated project team, especially the role of design practitioners, contributed to the success of utilizing baseline findings and evidence in decision-making throughout the design process. Lastly, recommendations and resources for learning research concepts are provided for practitioners. It is the role of practitioners to pave the way for the next generation of design professionals, as the request and expectation for research become more prevalent in design practice.

  10. Make

    Frauenfelder, Mark

    2012-01-01

    The first magazine devoted entirely to do-it-yourself technology projects presents its 29th quarterly edition for people who like to tweak, disassemble, recreate, and invent cool new uses for technology. MAKE Volume 29 takes bio-hacking to a new level. Get introduced to DIY tracking devices before they hit the consumer electronics marketplace. Learn how to build an EKG machine to study your heartbeat, and put together a DIY bio lab to study athletic motion using consumer grade hardware.

  11. Can Walking or Biking to Work Really Make a Difference? Compact Development, Observed Commuter Choice and Body Mass Index.

    Wojan, Timothy R; Hamrick, Karen S

    2015-01-01

    Promoting active commuting is viewed as one strategy to increase physical activity and improve the energy balance of more sedentary individuals thereby improving health outcomes. However, the potential effectiveness of promotion policies may be seriously undermined by the endogenous choice of commute mode. Policy to promote active commuting will be most effective if it can be demonstrated that 1) those in compact cities do not necessarily have a preference for more physical activity, and 2) that current active commuting is not explained by unobserved characteristics that may be the true source of a lower body mass index (BMI). Daily time-use diaries are used in combination with geographical characteristics of where respondents live and work to test 1) whether residents of more compact settlements are characterized by higher activity levels; and 2) whether residents of more compact settlements are more likely to bike or walk to work. An endogenous treatment model of active commuting allows testing whether reductions in BMI associated with walking or biking to work are in fact attributable to that activity or are more strongly associated with unobserved characteristics of these active commuters. The analysis of general activity levels confirms that residents of more compact cities do not expend more energy than residents of more sprawling cities, indicating that those in compact cities do not necessarily have a preference for more physical activity. The endogenous treatment model is consistent with walking or biking to work having an independent effect on BMI, as unobserved factors that contribute to a higher likelihood of active commuting are not associated with lower BMI. Despite evidence that more compact settlement patterns enable active commuting, only a small share of workers in these areas choose to walk or bike to work. In general, the activity level of residents in more compact cities and residents in more sprawling areas is very similar. But, there is a

  12. Can Walking or Biking to Work Really Make a Difference? Compact Development, Observed Commuter Choice and Body Mass Index.

    Timothy R Wojan

    Full Text Available Promoting active commuting is viewed as one strategy to increase physical activity and improve the energy balance of more sedentary individuals thereby improving health outcomes. However, the potential effectiveness of promotion policies may be seriously undermined by the endogenous choice of commute mode. Policy to promote active commuting will be most effective if it can be demonstrated that 1 those in compact cities do not necessarily have a preference for more physical activity, and 2 that current active commuting is not explained by unobserved characteristics that may be the true source of a lower body mass index (BMI.Daily time-use diaries are used in combination with geographical characteristics of where respondents live and work to test 1 whether residents of more compact settlements are characterized by higher activity levels; and 2 whether residents of more compact settlements are more likely to bike or walk to work. An endogenous treatment model of active commuting allows testing whether reductions in BMI associated with walking or biking to work are in fact attributable to that activity or are more strongly associated with unobserved characteristics of these active commuters.The analysis of general activity levels confirms that residents of more compact cities do not expend more energy than residents of more sprawling cities, indicating that those in compact cities do not necessarily have a preference for more physical activity. The endogenous treatment model is consistent with walking or biking to work having an independent effect on BMI, as unobserved factors that contribute to a higher likelihood of active commuting are not associated with lower BMI.Despite evidence that more compact settlement patterns enable active commuting, only a small share of workers in these areas choose to walk or bike to work. In general, the activity level of residents in more compact cities and residents in more sprawling areas is very similar. But

  13. Making sense of the "clean label" trends: A review of consumer food choice behavior and discussion of industry implications.

    Asioli, Daniele; Aschemann-Witzel, Jessica; Caputo, Vincenzina; Vecchio, Riccardo; Annunziata, Azzurra; Næs, Tormod; Varela, Paula

    2017-09-01

    Consumers in industrialized countries are nowadays much more interested in information about the production methods and components of the food products that they eat, than they had been 50years ago. Some production methods are perceived as less "natural" (i.e. conventional agriculture) while some food components are seen as "unhealthy" and "unfamiliar" (i.e. artificial additives). This phenomenon, often referred to as the "clean label" trend, has driven the food industry to communicate whether a certain ingredient or additive is not present or if the food has been produced using a more "natural" production method (i.e. organic agriculture). However, so far there is no common and objective definition of clean label. This review paper aims to fill the gap via three main objectives, which are to a) develop and suggest a definition that integrates various understandings of clean label into one single definition, b) identify the factors that drive consumers' choices through a review of recent studies on consumer perception of various food categories understood as clean label with the focus on organic, natural and 'free from' artificial additives/ingredients food products and c) discuss implications of the consumer demand for clean label food products for food manufacturers as well as policy makers. We suggest to define clean label, both in a broad sense, where consumers evaluate the cleanliness of product by assumption and through inference looking at the front-of-pack label and in a strict sense, where consumers evaluate the cleanliness of product by inspection and through inference looking at the back-of-pack label. Results show that while 'health' is a major consumer motive, a broad diversity of drivers influence the clean label trend with particular relevance of intrinsic or extrinsic product characteristics and socio-cultural factors. However, 'free from' artificial additives/ingredients food products tend to differ from organic and natural products. Food

  14. Making Communication Strategy Choices in a Fast Evolving Crisis Situation—Results from a Table-Top Discussion on an Anthrax Scenario

    Aino Ruggiero

    2016-05-01

    Full Text Available This paper aims at clarifying a timely topic of how communication strategy choices are made in evolving, complex crises, such as those caused by terrorism involving chemical, biological, radiological, or nuclear (CBRN agents. This is done by examining data gathered from a table-top discussion among crisis communication experts, focusing on a scenario of an anthrax attack and analysed qualitatively. The communication experts followed the evolving crisis situation by gathering inputs from various actors in the crisis management network, thereby creating situational understanding, and interpreted these inputs for decision-making on communication strategies. The underlying process of coping with complexity in evolving CBRN terrorism crises can be described as a continuous, dynamic process that can best be explained with a combination of traditional and more modern crisis communication approaches. Strategy-making in crisis situations by communication experts is still largely a black box. In this study, a novel approach of decomposing strategy-making by observing a table-top discussion is chosen to clarify the process. By identifying the core elements involved, a more detailed picture of communication strategy-making is created, thus promoting preparedness and professional resilience in the field.

  15. The application of a selection of decision-making techniques by employees in a transport work environment in conjunction with their perceived decision-making success and practice

    Theuns F.J. Oosthuizen

    2014-01-01

    A lack of optimum selection and application of decision-making techniques, in conjunction with suitable decision-making practice and perception of employees in a transport work environment demands attention to improve overall performance. Although multiple decision-making techniques exist, five prevalent techniques were considered in this article, namely the Kepner-Tregoe, Delphi, stepladder, nominal group and brainstorming techniques. A descriptive research design was followed, using an empi...

  16. Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice.

    Sedgwick, M G; Grigg, L; Dersch, S

    2014-01-01

    Rural acute care nursing requires an extensive breadth and depth of knowledge as well as the ability to quickly reason through problems in order to make sound clinical decisions. This reasoning often occurs within an environment that has minimal medical or ancillary support. Registered nurses (RN) new to rural nursing, and employers, have raised concerns about patient safety while new nurses make the transition into rural practice. In addition, feeling unprepared for the rigors of rural hospital nursing practice is a central issue influencing RN recruitment and retention. Understanding how rural RNs reason is a key element for identifying professional development needs and may support recruitment and retention of skilled rural nurses. The purpose of this study was to explore how rural RNs reason through clinical problems as well as to assess the quality of such reasoning. This study used a non-traditional approach for data collection. Fifteen rural acute care nurses with varying years of experience working in southern Alberta, Canada, were observed while they provided care to patients of varying acuity within a simulated rural setting. Following the simulation, semi-structured interviews were conducted using a substantive approach to critical thinking. Findings revealed that the ability to engage in deep clinical reasoning varied considerably among participants despite being given the same information under the same circumstances. Furthermore, the number of years of experience did not seem to be directly linked to the ability to engage in sound clinical reasoning. Novice nurses, however, did rely heavily on others in their decision making in order to ensure they were making the right decision. Hence, their relationships with other staff members influenced their ability to engage in clinical reasoning and decision making. In situations where the patient's condition was deteriorating quickly, regardless of years of experience, all of the participants depended on

  17. The Influence of Religiosity and Spirituality on Rural Parents' Health Decision Making and Human Papillomavirus Vaccine Choices.

    Thomas, Tami; Blumling, Amy; Delaney, Augustina

    2015-01-01

    General health implications of religiosity and spirituality on health have been associated with health promotion, so the purpose of this study was to examine the influence of religiosity and spirituality on rural parents' decision making to vaccinate their children against human papillomavirus (HPV). The associations of religiosity and spirituality with parental HPV vaccine decisions were examined in a sample of parents residing in small rural communities (N = 37). Parents of children aged 9 to 13 years participated in focus groups held in rural community contexts. Religiosity (i.e., participation in religious social structures) was a recurring and important theme when discussing HPV vaccination. Spirituality (i.e., subjective commitment to spiritual or religious beliefs) was found to influence the ways in which parents perceived their control over and coping with health issues potentially related to HPV vaccination. Together, religiosity and spirituality were found to play integral roles in these parents' lives and influenced their attitudes toward HPV vaccination uptake for their children.

  18. Influencing Eating Choices: Biological Food Cues in Advertising and Packaging Alter Trajectories of Decision Making and Behavior.

    Bailey, Rachel L

    2017-10-01

    From an ecological perception perspective (Gibson, 1977), the availability of perceptual information alters what behaviors are more and less likely at different times. This study examines how perceptual information delivered in food advertisements and packaging alters the time course of information processing and decision making. Participants categorized images of food that varied in information delivered in terms of color, glossiness, and texture (e.g., food cues) before and after being exposed to a set of advertisements that also varied in this way. In general, items with more direct cues enhanced appetitive motivational processes, especially if they were also advertised with direct food cues. Individuals also chose to eat products that were packaged with more available direct food cues compared to opaque packaging.

  19. Making the invisible visible--operating theatre nurses' perceptions of caring in perioperative practice.

    Blomberg, Ann-Catrin; Bisholt, Birgitta; Nilsson, Jan; Lindwall, Lillemor

    2015-06-01

    The aim of this study was to describe operating theatre nurses' (OTNs') perceptions of caring in perioperative practice. A qualitative descriptive design was performed. Data were collected with interviews were carried out with fifteen strategically selected operating theatre nurses from different operating theatres in the middle of Sweden. A phenomenographic analysis was used to analyse the interviews. The findings show that operating theatre nurses' perceptions of caring in perioperative practice can be summarised in one main category: To follow the patient all the way. Two descriptive categories emerged: To ensure continuity of patient care and keeping a watchful eye. The operating theatre nurses got to know the patient and as a result became responsible for the patient. They protected the patient's body and preserved patient dignity in perioperative practice. The findings show different aspects of caring in perioperative practice. OTNs wanted to be more involved in patient care and follow the patient throughout the perioperative nursing process. Although OTNs have the ambition to make the care in perioperative practice visible, there is today a medical technical approach which promotes OTNs continuing to offer care in secret. © 2014 Nordic College of Caring Science.

  20. Helping patients make better decisions: how to apply behavioral economics in clinical practice

    Courtney MR

    2014-10-01

    Full Text Available Maureen Reni Courtney,1 Christy Spivey,2 Kathy M Daniel1 1College of Nursing, 2College of Business, University of Texas at Arlington, Arlington, TX, USA  Abstract: Clinicians are committed to effectively educating patients and helping them to make sound decisions concerning their own health care. However, how do clinicians determine what is effective education? How do they present information clearly and in a manner that patients understand and can use to make informed decisions? Behavioral economics (BE is a subfield of economics that can assist clinicians to better understand how individuals actually make decisions. BE research can help guide interactions with patients so that information is presented and discussed in a more deliberate and impactful way. We can be more effective providers of care when we understand the factors that influence how our patients make decisions, factors of which we may have been largely unaware. BE research that focuses on health care and medical decision making is becoming more widely known, and what has been reported suggests that BE interventions can be effective in the medical realm. The purpose of this article is to provide clinicians with an overview of BE decision science and derived practice strategies to promote more effective behavior change in patients.Keywords: nursing, message framing, defaults, incentives, social norms, commitment devices, health care

  1. Choice & Consequence

    Khan, Azam

    to support hypothesis generation, hypothesis testing, and decision making. In addition to sensors in buildings, infrastructure, or the environment, we also propose the instrumentation of user interfaces to help measure performance in decision making applications. We show the benefits of applying principles...... between cause and effect in complex systems complicates decision making. To address this issue, we examine the central role that data-driven decision making could play in critical domains such as sustainability or medical treatment. We developed systems for exploratory data analysis and data visualization...... of data analysis and instructional interface design, to both simulation systems and decision support interfaces. We hope that projects such as these will help people to understand the link between their choices and the consequences of their decisions....

  2. Nudging and social marketing techniques encourage employees to make healthier food choices: a randomized controlled trial in 30 worksite cafeterias in The Netherlands.

    Velema, Elizabeth; Vyth, Ellis L; Hoekstra, Trynke; Steenhuis, Ingrid H M

    2018-02-01

    Currently, many studies focus on how the environment can be changed to encourage healthier eating behavior, referred to as choice architecture or "nudging." However, to date, these strategies are not often investigated in real-life settings, such as worksite cafeterias, or are only done so on a short-term basis. The objective of this study is to examine the effects of a healthy worksite cafeteria ["worksite cafeteria 2.0" (WC 2.0)] intervention on Dutch employees' purchase behavior over a 12-wk period. We conducted a randomized controlled trial in 30 worksite cafeterias. Worksite cafeterias were randomized to either the intervention or control group. The intervention aimed to encourage employees to make healthier food choices during their daily worksite cafeteria visits. The intervention consisted of 14 simultaneously executed strategies based on nudging and social marketing theories, involving product, price, placement, and promotion. Adjusted multilevel models showed significant positive effects of the intervention on purchases for 3 of the 7 studied product groups: healthier sandwiches, healthier cheese as a sandwich filling, and the inclusion of fruit. The increased sales of these healthier meal options were constant throughout the 12-wk intervention period. This study shows that the way worksite cafeterias offer products affects purchase behavior. Situated nudging and social marketing-based strategies are effective in promoting healthier choices and aim to remain effective over time. Some product groups only indicated an upward trend in purchases. Such an intervention could ultimately help prevent and reduce obesity in the Dutch working population. This trial was registered at the Dutch Trial Register (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5372) as NTR5372.

  3. Socioemotional selectivity theory, aging, and health: the increasingly delicate balance between regulating emotions and making tough choices.

    Löckenhoff, Corinna E; Carstensen, Laura L

    2004-12-01

    After providing an introductory overview of socioemotional selectivity theory, we review empirical evidence for its basic postulates and consider the implications of the predicted cognitive and behavioral changes for physical health. The main assertion of socioemotional selectivity theory is that when boundaries on time are perceived, present-oriented goals related to emotional meaning are prioritized over future-oriented goals aimed at acquiring information and expanding horizons. Such motivational changes, which are strongly correlated with chronological age, systematically influence social preferences, social network composition, emotion regulation, and cognitive processing. On the one hand, there is considerable reason to believe that such changes are good for well-being and social adjustment. On the other hand, the very same motivational changes may limit health-related information-seeking and influence attention, memory, and decision-making such that positive material is favored over negative information. Grounding our arguments in socioemotional selectivity theory, we consider possible ways to tailor contexts such that disadvantages are avoided.

  4. HEALTH TECHNOLOGY ASSESSMENT FOR DECISION MAKING IN LATIN AMERICA: GOOD PRACTICE PRINCIPLES.

    Pichon-Riviere, Andrés; Soto, Natalie C; Augustovski, Federico Ariel; García Martí, Sebastián; Sampietro-Colom, Laura

    2018-06-11

    The aim of this study was to identify good practice principles for health technology assessment (HTA) that are the most relevant and of highest priority for application in Latin America and to identify potential barriers to their implementation in the region. HTA good practice principles proposed at the international level were identified and then explored during a deliberative process in a forum of assessors, funders, and product manufacturers. Forty-two representatives from ten Latin American countries participated. Good practice principles proposed at the international level were considered valid and potentially relevant to Latin America. Five principles were identified as priority and with the greatest potential to be strengthened at this time: transparency in the production of HTA, involvement of relevant stakeholders in the HTA process, mechanisms to appeal decisions, clear priority-setting processes in HTA, and a clear link between HTA and decision making. The main challenge identified was to find a balance between the application of these principles and the available resources in a way that would not detract from the production of reports and adaptation to the needs of decision makers. The main recommendation was to progress gradually in strengthening HTA and its link to decision making by developing appropriate processes for each country, without trying to impose, in the short-term, standards taken from examples at the international level without adequate adaptation of these to local contexts.

  5. [Health technology assessment for decision-making in Latin America: good practice principles].

    Pichon-Riviere, Andrés; Soto, Natalie C; Augustovski, Federico Ariel; García Martí, Sebastián; Sampietro-Colom, Laura

    2018-02-19

    Identify the most relevant, applicable, and priority good practice principles in health technology assessment (HTA) in Latin America, and potential barriers to implementing them in the region. HTA good practice principles postulated worldwide were identified and then explored through a deliberative process in a forum of evaluators, funders, and technology producers. Forty-two representatives from ten Latin American countries participated in the forum. The good practice principles postulated at the international level were considered valid and potentially applicable in Latin America. Five principles were identified as priorities and as having greater potential to be expanded at this time: transparency in carrying out HTA; involvement of stakeholders in the HTA process; existence of mechanisms to appeal decisions; existence of clear mechanisms for HTA priority-setting; and existence of a clear link between assessment and decision-making. The main challenge identified was to find a balance between application of these principles and available resources, to prevent the planned improvements from jeopardizing report production times and failing to meet decision-makers' needs. The main recommendation was to gradually advance in improving HTA and its link to decision-making by developing appropriate processes for each country, without attempting to impose, in the short term, standards taken from examples at the international level without adequate adaptation to the local context.

  6. Building to Make a Difference: Advanced Practice Nurses' Experience of Power.

    Schoales, Catherine A; Bourbonnais, Frances Fothergill; Rashotte, Judy

    2018-02-01

    Power is necessary for nurses to affect change in patient care and to move the nursing profession forward. Despite the evolving body of nursing research on power, there have been no studies that have investigated the nature of advanced practice nurses' (APNs') power. The purpose of this study was to explore the APNs' lived experience of power. Interpretive phenomenology guided the method and analysis. Eight APNs employed in a single Canadian tertiary care teaching health-care organization engaged in in-depth interviews. The overarching theme, building to make a difference, reflected the APNs' perception of power in their practice, which involved a passion to facilitate change in practice to improve patient care. Building to make a difference involved three themes: building on, building with, and building for. The APNs experienced more power-a process they described as power creep-when they used soft power that was shared with others to affect positive change in health care. These findings contribute to our understanding of how power is perceived and manifested in the APN role, thus further enabling organizations to create working conditions to support the APNs' endeavors to empower others.

  7. Make It Intuitive: An Evaluation Practice Emergent From The Plans And Scripted Behavior Of The Computer-community Of Practice

    Pat Lehane

    2012-01-01

    Full Text Available The catch phrase today for system designers is to “make it intuitive,” which begs the question, what is intuitive? The action research discussed in this article was the final stage of the application of grounded theory to user data that provided survey categories (criteria for system acceptance. A theoretical rationale from the discipline of human–computer interaction was proposed to provide a consistent and repeatable interpretation of the users’ responses to the survey and directly align the responses to software design considerations. To put this work into context, I discuss in this article a case study on the use of the survey to monitor the user experience during the upgrade of an enterprise system and the subsequent implications and outcomes of applying the theoretical paradigm in practice. As such it may provide food for thought on survey design for elicitation of user requirements for information and communication technology systems.

  8. Does front-of-pack nutrition information improve consumer ability to make healthful choices? Performance of warnings and the traffic light system in a simulated shopping experiment.

    Machín, Leandro; Aschemann-Witzel, Jessica; Curutchet, María Rosa; Giménez, Ana; Ares, Gastón

    2018-02-01

    The inclusion of more attention-grabbing and easily interpretable front-of-pack (FOP) nutrition information is one of the public policies that can be implemented to empower consumers to identify unhealthful food products and to make more informed food choices. The aim of the present work was to evaluate the influence of two FOP nutrition labelling schemes - the traffic light labelling and the warning scheme - on consumer food purchases when facing a health goal. The study was conducted with 1182 people from Montevideo (Uruguay), recruited using a Facebook advertisement. Participants were randomly allocated to one of three between-subjects experimental conditions: (i) a control condition with no FOP nutrition information, (ii) FOP nutrition information using a modified version of the traffic light system including information about calorie, saturated fat, sugars and sodium content per portion, and (iii) FOP nutrition information using the Chilean warning system including separate signs for high calorie, saturated fat, sugars and sodium content. Respondents were asked to imagine that they had to purchase food in order to prepare a healthy dinner for themselves and their family, using the website of an online grocery store. Results showed that FOP nutrition information effectively improved the average healthfulness of participants' choices compared to the control condition, both in terms of the average nutritional composition of the purchased products and expenditure in specific product categories. No relevant differences between the effect of the traffic light and the warning system were found. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. New Min-Max Approach to Optimal Choice of the Weights in Multi-Criteria Group Decision-Making Problems

    Ming Chen

    2015-11-01

    Full Text Available In multi-criteria group decision-making (MCGDM, one of the most important problems is to determine the weights of criteria and experts. This paper intends to present two Min-Max models to optimize the point estimates of the weights. Since each expert generally possesses a uniform viewpoint on the importance (weighted value of each criterion when he/she needs to rank the alternatives, the objective function in the first model is to minimize the maximum variation between the actual score vector and the ideal one for all the alternatives such that the optimal weights of criteria are consistent in ranking all the alternatives for the same expert. The second model is designed to optimize the weights of experts such that the obtained overall evaluation for each alternative can collect the perspectives of the experts as many as possible. Thus, the objective function in the second model is to minimize the maximum variation between the actual vector of evaluations and the ideal one for all the experts, such that the optimal weights can reduce the difference among the experts in evaluating the same alternative. For the constructed Min-Max models, another focus in this paper is on the development of an efficient algorithm for the optimal weights. Some applications are employed to show the significance of the models and algorithm. From the numerical results, it is clear that the developed Min-Max models more effectively solve the MCGDM problems including the ones with incomplete score matrices, compared with the methods available in the literature. Specifically, by the proposed method, (1 the evaluation uniformity of each expert on the same criteria is guaranteed; (2 The overall evaluation for each alternative can collect the judgements of the experts as many as possible; (3 The highest discrimination degree of the alternatives is obtained.

  10. Fusion Power: A Strategic Choice for the Future Energy Provision. Why is So Much Time Wasted for Decision Making?

    D'haeseleer, William D.

    2005-01-01

    From a general analysis of the world energy issue, it is argued that an affordable, clean and reliable energy supply will have to consist of a portfolio of primary energy sources, a large fraction of which will be converted to a secondary carrier in large baseload plants. Because of all future uncertainties, it would be irresponsible not to include thermonuclear fusion as one of the future possibilities for electricity generation.The author tries to understand why nuclear-fusion research is not considered of strategic importance by the major world powers. The fusion programs of the USA and Europe are taken as prime examples to illustrate the 'hesitation'. Europe is now advocating a socalled 'fast-track' approach, thereby seemingly abandoning the 'classic' time frame towards fusion that it has projected for many years. The US 'oscillatory' attitude towards ITER in relation to its domestic program is a second case study that is looked at.From the real history of the ITER design and the 'siting' issue, one can try to understand how important fusion is considered by these world powers. Not words are important, but deeds. Fast tracks are nice to talk about, but timely decisions need to be taken and sufficient money is to be provided. More fundamental understanding of fusion plasma physics is important, but in the end, real hardware devices must be constructed to move along the path of power plant implementation.The author tries to make a balance of where fusion power research is at this moment, and where, according to his views, it should be going

  11. "We make choices we think are going to save us": Debate and stance identification for online breast cancer CAM discussions.

    Zhang, Shaodian; Qiu, Lin; Chen, Frank; Zhang, Weinan; Yu, Yong; Elhadad, Noémie

    2017-04-01

    Patients discuss complementary and alternative medicine (CAM) in online health communities. Sometimes, patients' conflicting opinions toward CAM-related issues trigger debates in the community. The objectives of this paper are to identify such debates, identify controversial CAM therapies in a popular online breast cancer community, as well as patients' stances towards them. To scale our analysis, we trained a set of classifiers. We first constructed a supervised classifier based on a long short-term memory neural network (LSTM) stacked over a convolutional neural network (CNN) to detect automatically CAM-related debates from a popular breast cancer forum. Members' stances in these debates were also identified by a CNN-based classifier. Finally, posts automatically flagged as debates by the classifier were analyzed to explore which specific CAM therapies trigger debates more often than others. Our methods are able to detect CAM debates with F score of 77%, and identify stances with F score of 70%. The debate classifier identified about 1/6 of all CAM-related posts as debate. About 60% of CAM-related debate posts represent the supportive stance toward CAM usage. Qualitative analysis shows that some specific therapies, such as Gerson therapy and usage of laetrile, trigger debates frequently among members of the breast cancer community. This study demonstrates that neural networks can effectively locate debates on usage and effectiveness of controversial CAM therapies, and can help make sense of patients' opinions on such issues under dispute. As to CAM for breast cancer, perceptions of their effectiveness vary among patients. Many of the specific therapies trigger debates frequently and are worth more exploration in future work.

  12. Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices.

    Wilson, Leslie; Loucks, Aimee; Bui, Christine; Gipson, Greg; Zhong, Lixian; Schwartzburg, Amy; Crabtree, Elizabeth; Goodin, Douglas; Waubant, Emmanuelle; McCulloch, Charles

    2014-09-15

    Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs. Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits. Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR=0.22, pbenefit (OR=3.68, pbenefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Translating shared decision-making into health care clinical practices: Proof of concepts

    St-Jacques Sylvie

    2008-01-01

    Full Text Available Abstract Background There is considerable interest today in shared decision-making (SDM, defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective. Methods Participants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1 establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2 hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis, and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3 conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4 build capacity with involvement of graduate students in the workshop and online forum; and 5 elaborate a position paper and an international multi-site study protocol. Discussion This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective.

  14. Shared decision making observed in clinical practice: visual displays of communication sequence and patterns.

    Elwyn, G; Edwards, A; Wensing, M; Hibbs, R; Wilkinson, C; Grol, R

    2001-05-01

    The aim of the study was to examine the communication strategies of general practitioners attempting to involve patients in treatment or management decisions. This empirical data was then compared with theoretical 'competences' derived for 'shared decision making'. The subjects were four general practitioners, who taped conducted consultations with the specific intent of involving patients in the decision-making process. The consultations were transcribed, coded into skill categorizations and presented as visual display using a specifically devised sequential banding The empirical data from these purposively selected consultation from clinicians who are experienced in shared decision making did not match suggested theoretical frameworks. The views of patients about treatment possibilities and their preferred role in decision making were not explored. The interactions were initiated by a problem-defining phase, statements of 'equipoise' consistently appeared and the portrayal of option information was often intermingled with opportunities to allow patients to question and reflect. A decision-making stage occurred consistently after approximately 80% of the total consultation duration and arrangements were consistently made for follow-up and review. Eight of the 10 consultations took more than 11 min - these specific consultations were characterized by significant proportions of time provided for information exchange and patient interaction. The results demonstrate that some theoretical competences are not distinguishable in practice and other stages, not previously described, such as the 'portrayal of equipoise', are observed. The suggested ideal of a shared decision-making interaction will either require more time than currently allocated, or alternative strategies to enable information exchange outside the consultation.

  15. Preaching What We Practice: Teaching Ethical Decision-Making to Computer Security Professionals

    Fleischmann, Kenneth R.

    The biggest challenge facing computer security researchers and professionals is not learning how to make ethical decisions; rather it is learning how to recognize ethical decisions. All too often, technology development suffers from what Langdon Winner terms technological somnambulism - we sleepwalk through our technology design, following past precedents without a second thought, and fail to consider the perspectives of other stakeholders [1]. Computer security research and practice involves a number of opportunities for ethical decisions. For example, decisions about whether or not to automatically provide security updates involve tradeoffs related to caring versus user autonomy. Decisions about online voting include tradeoffs between convenience and security. Finally, decisions about routinely screening e-mails for spam involve tradeoffs of efficiency and privacy. It is critical that these and other decisions facing computer security researchers and professionals are confronted head on as value-laden design decisions, and that computer security researchers and professionals consider the perspectives of various stakeholders in making these decisions.

  16. The paradox of un/making science people: practicing ethico-political hesitations in science education

    Wallace, Maria F. G.

    2018-03-01

    Over the years neoliberal ideology and discourse have become intricately connected to making science people. Science educators work within a complicated paradox where they are obligated to meet neoliberal demands that reinscribe dominant, hegemonic assumptions for producing a scientific workforce. Whether it is the discourse of school science, processes of being a scientist, or definitions of science particular subjects are made intelligible as others are made unintelligible. This paper resides within the messy entanglements of feminist poststructural and new materialist perspectives to provoke spaces where science educators might enact ethicopolitical hesitations. By turning to and living in theory, the un/making of certain kinds of science people reveals material effects and affects. Practicing ethicopolitical hesitations prompt science educators to consider beginning their work from ontological assumptions that begin with abundance rather than lack.

  17. Resonant Cholinergic Dynamics in Cognitive and Motor Decision-Making: Attention, Category Learning, and Choice in Neocortex, Superior Colliculus, and Optic Tectum.

    Grossberg, Stephen; Palma, Jesse; Versace, Massimiliano

    2015-01-01

    Freely behaving organisms need to rapidly calibrate their perceptual, cognitive, and motor decisions based on continuously changing environmental conditions. These plastic changes include sharpening or broadening of cognitive and motor attention and learning to match the behavioral demands that are imposed by changing environmental statistics. This article proposes that a shared circuit design for such flexible decision-making is used in specific cognitive and motor circuits, and that both types of circuits use acetylcholine to modulate choice selectivity. Such task-sensitive control is proposed to control thalamocortical choice of the critical features that are cognitively attended and that are incorporated through learning into prototypes of visual recognition categories. A cholinergically-modulated process of vigilance control determines if a recognition category and its attended features are abstract (low vigilance) or concrete (high vigilance). Homologous neural mechanisms of cholinergic modulation are proposed to focus attention and learn a multimodal map within the deeper layers of superior colliculus. This map enables visual, auditory, and planned movement commands to compete for attention, leading to selection of a winning position that controls where the next saccadic eye movement will go. Such map learning may be viewed as a kind of attentive motor category learning. The article hereby explicates a link between attention, learning, and cholinergic modulation during decision making within both cognitive and motor systems. Homologs between the mammalian superior colliculus and the avian optic tectum lead to predictions about how multimodal map learning may occur in the mammalian and avian brain and how such learning may be modulated by acetycholine.

  18. Resonant cholinergic dynamics in cognitive and motor decision-making:Attention, category learning, and choice in neocortex, superior colliculus, and optic tectum

    Stephen eGrossberg

    2016-01-01

    Full Text Available Freely behaving organisms need to rapidly calibrate their perceptual, cognitive, and motor decisions based on continuously changing environmental conditions. These plastic changes include sharpening or broadening of cognitive and motor attention and learning to match the behavioral demands that are imposed by changing environmental statistics. This article proposes that a shared circuit design for such flexible decision-making is used in specific cognitive and motor circuits, and that both types of circuits use acetylcholine to modulate choice selectivity. Such task-sensitive control is proposed to control thalamocortical choice of the critical features that are cognitively attended and that are incorporated through learning into prototypes of visual recognition categories. A cholinergically-modulated process of vigilance control determines if a recognition category and its attended features are abstract (low vigilance or concrete (high vigilance. Homologous neural mechanisms of cholinergic modulation are proposed to focus attention and learn a multimodal map within the deeper layers of superior colliculus. This map enables visual, auditory, and planned movement commands to compete for attention, leading to selection of a winning position that controls where the next saccadic eye movement will go. Such map learning may be viewed as a kind of attentive motor category learning. The article hereby explicates a link between attention, learning, and cholinergic modulation during decision making within both cognitive and motor systems. Homologs between the mammalian superior colliculus and the avian optic tectum lead to predictions about how multimodal map learning may occur in the avian brain and how such learning may be modulated by acetycholine.

  19. Assessing Option Grid® practicability and feasibility for facilitating shared decision making: An exploratory study.

    Tsulukidze, Maka; Grande, Stuart W; Gionfriddo, Michael R

    2015-07-01

    To assess the feasibility of Option Grids(®)for facilitating shared decision making (SDM) in simulated clinical consultations and explore clinicians' views on their practicability. We used mixed methods approach to analyze clinical consultations using the Observer OPTION instrument and thematic analysis for follow-up interviews with clinicians. Clinicians achieved high scores on information sharing and low scores on preference elicitation and integration. Four themes were identified: (1) Barriers affect practicability of Option Grids(®); (2) Option Grids(®) facilitate the SDM process; (3) Clinicians are aware of the gaps in their practice of SDM; (4) Training and ongoing feedback on the optimal use of Option Grids(®) are necessary. Use of Option Grids(®) by clinicians with background knowledge in SDM did not facilitate optimal levels of competency on the SDM core concepts of preference elicitation and integration. Future research must evaluate the impact of training on the use of Option Grids(®), and explore how best to help clinicians bridge the gap between knowledge and action. Clinicians proficiently imparting information in simulations struggled to elicit and integrate patient preferences - understanding this gap and developing strategies to close it are the next steps for implementing SDM into clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Make Change Happen at the Program or Institutional Scale: Converting Community Expertise into Practical Guidance

    McDaris, J. R.; Manduca, C. A.; Orr, C. H.

    2016-12-01

    As geoscience and STEM programs address common challenges like increasing the diversity of graduates or implementing active learning pedagogies, it is important to learn from the experiences of others in the community. Individual faculty members embody a wealth of experience on these topics but distilling that experience into practical guidance that has value for a broad audience is not as simple as knowing exactly what one person did. Context is important, not only because activities used in similar contexts are easier to adapt, but also because activities that work across multiple contexts are more robust. The development of any best practices guidance benefits from the engagement of a community. Synthesizing across multiple viewpoints leads to a consensus that builds on the diversity of individual experiences. The Science Education Resource Center (SERC) at Carleton College has had success generating such resources in geoscience and STEM education. Working with different groups of educators, we have helped develop content around making change happen at the program or institutional levels, increasing the diversity of students graduating in geoscience and STEM, fostering interdisciplinary learning, translating the results of education research into practice, and several others. These resources draw out common practices, situate them in the education research base, and highlight examples of their use in the real world but also communicate the different ways individuals or institutions have adapted these practices for their particular situation. These resources were developed through a group synthesis process involving the contribution of individual or group expertise, a face-to-face meeting of teams working on themes drawn from the contributed work, and asynchronous group revision and review following the meeting. The materials developed via this process provide reliable and adaptable guidance firmly rooted in the community's experience. This presentation will

  1. A decision-making tool to prescribe knee orthoses in daily practice for patients with osteoarthritis.

    Coudeyre, Emmanuel; Nguyen, Christelle; Chabaud, Aurore; Pereira, Bruno; Beaudreuil, Johann; Coudreuse, Jean-Marie; Deat, Philippe; Sailhan, Frédéric; Lorenzo, Alain; Rannou, François

    2018-03-01

    To develop a decision-making tool (DMT) to facilitate the prescription of knee orthoses for patients with osteoarthritis (OA) in daily practice. A steering committee gathered a multidisciplinary task force experienced in OA management/clinical research. Two members performed a literature review with qualitative analysis of the highest-quality randomized controlled trials and practice guidelines to confirm evidence concerning knee orthosis for OA. A first DMT draft was presented to the task force in a 1-day meeting in January 2016. The first version of the DMT was criticized and discussed regarding everyday practice issues. Every step was discussed and amended until consensus agreement was achieved within the task force. Then 4 successive consultation rounds occurred by electronic communication, first with primary- and secondary-care physicians, then with international experts. All corrections and suggestions by each member were shared with the rest of the task force and included to reach final consensus. The final version was validated by the steering committee. The definition and indication of several types of knee orthoses (sleeve, patello-femoral, hinged or unicompartmental offloading braces) were detailed. Orthoses may be proposed in addition to first-line non-pharmacological treatment if patient acceptance is considered good. At every step, a specific clinical assessment is needed. Based on the latest high-level evidence, practice guidelines, and an expert panel, a DMT to facilitate daily practice prescription of knee orthoses for OA patients was designed. An evaluation of DMT implementation in a wide range of health professionals is still needed. Copyright © 2018 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.

  2. Using cost-effectiveness analysis for formulary decision making: from theory into practice.

    Detsky, A S

    1994-10-01

    The growth of expenditures on healthcare and pharmaceutical products is a concern to third-party payers because of the absence of market discipline (price signals that consumers face). Cost-effectiveness analysis is a method that allows third-party payers to systematically make judgements about the 'value for money' of these products. It moves beyond simple unit price comparisons of alternate interventions/products to consider the full stream of relevant cost and benefits. As formulary committees begin to adopt the systematic use of cost-effectiveness analyses to inform the debate, the exercise will move from an academic to a more practical application. This transition will require several important changes including defining the purpose of cost-effectiveness analysis, measurement of outcomes and data, format of reports, and contractual arrangements between the pharmaceutical industry and analysts. As more 'real world' experience is gained in the practical application of cost-effectiveness analysis, the quality of data will improve as will its value as an aid to decision making.

  3. Shared decision making and patient decision aids: knowledge, attitudes, and practices among Hawai'i physicians.

    Alden, Dana L; Friend, John; Chun, Maria B J

    2013-11-01

    As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai'i's physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai'i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs. One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai'i physicians are promising.

  4. Voice and choice by delegation.

    van de Bovenkamp, Hester; Vollaard, Hans; Trappenburg, Margo; Grit, Kor

    2013-02-01

    In many Western countries, options for citizens to influence public services are increased to improve the quality of services and democratize decision making. Possibilities to influence are often cast into Albert Hirschman's taxonomy of exit (choice), voice, and loyalty. In this article we identify delegation as an important addition to this framework. Delegation gives individuals the chance to practice exit/choice or voice without all the hard work that is usually involved in these options. Empirical research shows that not many people use their individual options of exit and voice, which could lead to inequality between users and nonusers. We identify delegation as a possible solution to this problem, using Dutch health care as a case study to explore this option. Notwithstanding various advantages, we show that voice and choice by delegation also entail problems of inequality and representativeness.

  5. Making learning whole: an instructional approach for mediating the practices of authentic science inquiries

    Liljeström, Anu; Enkenberg, Jorma; Pöllänen, Sinikka

    2013-03-01

    This design experiment aimed to answer the question of how to mediate the practices of authentic science inquiries in primary education. An instructional approach based on activity theory was designed and carried out with multi-age students in a small village school. An open-ended learning task was offered to the older students. Their task was to design and implement instruction about the Ice Age to their younger fellows. The objective was collaborative learning among students, the teacher, and outside domain experts. Mobile phones and GPS technologies were applied as the main technological mediators in the learning process. Technology provided an opportunity to expand the learning environment outside the classroom, including the natural environment. Empirically, the goal was to answer the following questions: What kind of learning project emerged? How did the students' knowledge develop? What kinds of science learning processes, activities, and practices were represented? Multiple and parallel data were collected to achieve this aim. The data analysis revealed that the learning project both challenged the students to develop explanations for the phenomena and generated high quality conceptual and physical models in question. During the learning project, the roles of the community members were shaped, mixed, and integrated. The teacher also repeatedly evaluated and adjusted her behavior. The confidence of the learners in their abilities raised the quality of their learning outcomes. The findings showed that this instructional approach can not only mediate the kind of authentic practices that scientists apply but also make learning more holistic than it has been. Thus, it can be concluded that nature of the task, the tool-integrated collaborative inquiries in the natural environment, and the multiage setting can make learning whole.

  6. Exploring Best Practice Skills to Predict Uncertainties in Venture Capital Investment Decision-Making

    Blum, David Arthur

    Algae biodiesel is the sole sustainable and abundant transportation fuel source that can replace petrol diesel use; however, high competition and economic uncertainties exist, influencing independent venture capital decision making. Technology, market, management, and government action uncertainties influence competition and economic uncertainties in the venture capital industry. The purpose of this qualitative case study was to identify the best practice skills at IVC firms to predict uncertainty between early and late funding stages. The basis of the study was real options theory, a framework used to evaluate and understand the economic and competition uncertainties inherent in natural resource investment and energy derived from plant-based oils. Data were collected from interviews of 24 venture capital partners based in the United States who invest in algae and other renewable energy solutions. Data were analyzed by coding and theme development interwoven with the conceptual framework. Eight themes emerged: (a) expected returns model, (b) due diligence, (c) invest in specific sectors, (d) reduced uncertainty-late stage, (e) coopetition, (f) portfolio firm relationships, (g) differentiation strategy, and (h) modeling uncertainty and best practice. The most noteworthy finding was that predicting uncertainty at the early stage was impractical; at the expansion and late funding stages, however, predicting uncertainty was possible. The implications of these findings will affect social change by providing independent venture capitalists with best practice skills to increase successful exits, lessen uncertainty, and encourage increased funding of renewable energy firms, contributing to cleaner and healthier communities throughout the United States..

  7. Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making.

    Prahl, Andrew; Dexter, Franklin; Braun, Michael T; Van Swol, Lyn

    2013-11-01

    Because operating room (OR) management decisions with optimal choices are made with ubiquitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans' limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual influence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions considered unjust. In conclusion, leaders will find the most success if they do not bring OR management operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science.

  8. Shared Decision-Making in Oncology - A Qualitative Analysis of Healthcare Providers' Views on Current Practice.

    Frerichs, Wiebke; Hahlweg, Pola; Müller, Evamaria; Adis, Christine; Scholl, Isabelle

    2016-01-01

    Despite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. In order to overcome this challenge, it is important to understand healthcare providers' views regarding SDM and to take their perspectives and opinions into account in the development of an implementation program. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice. A qualitative study was conducted using focus groups and individual interviews with different healthcare providers at the University Cancer Center Hamburg, Germany. Focus groups and interviews were audio-recorded, transcribed and analyzed using conventional content analysis and descriptive statistics. N = 4 focus groups with a total of N = 25 participants and N = 17 individual interviews were conducted. Attitudes regarding SDM varied greatly between the different participants, especially concerning the definition of SDM, the attitude towards the degree of patient involvement in decision-making and assumptions about when SDM should take place. Experiences on how treatment decisions are currently made varied. Negative experiences included time and structural constraints, and a lack of (multidisciplinary) communication. Positive experiences comprised informed patients, involvement of relatives and a good physician-patient relationship. The results show that German healthcare providers in oncology have a range of attitudes that currently function as barriers towards the implementation of SDM. Also, their experiences on how decision-making is currently done reveal difficulties in actively involving patients in decision-making processes. It will be crucial to take these attitudes and experiences seriously and to subsequently disentangle existing misconceptions in future implementation programs.

  9. The Influences of Middle School Mathematics Teachers' Practical Rationality on Instructional Decision Making Regarding the Common Core State Standards for Mathematical Practices

    Sobolewski-McMahon, Lauren M.

    2017-01-01

    The purpose of this study was to examine the influences of various facets of middle school mathematics teachers' practical rationality on their instructional decision making as they plan to enact the Common Core State Standards for Mathematical Practice, CCSS-MP1 (perseverance in problem solving) and CCSS-MP3 (communicating and critiquing). The…

  10. Constructing food choice decisions.

    Sobal, Jeffery; Bisogni, Carole A

    2009-12-01

    Food choice decisions are frequent, multifaceted, situational, dynamic, and complex and lead to food behaviors where people acquire, prepare, serve, give away, store, eat, and clean up. Many disciplines and fields examine decision making. Several classes of theories are applicable to food decision making, including social behavior, social facts, and social definition perspectives. Each offers some insights but also makes limiting assumptions that prevent fully explaining food choice decisions. We used constructionist social definition perspectives to inductively develop a food choice process model that organizes a broad scope of factors and dynamics involved in food behaviors. This food choice process model includes (1) life course events and experiences that establish a food choice trajectory through transitions, turning points, timing, and contexts; (2) influences on food choices that include cultural ideals, personal factors, resources, social factors, and present contexts; and (3) a personal system that develops food choice values, negotiates and balances values, classifies foods and situations, and forms/revises food choice strategies, scripts, and routines. The parts of the model dynamically interact to make food choice decisions leading to food behaviors. No single theory can fully explain decision making in food behavior. Multiple perspectives are needed, including constructionist thinking.

  11. [Darius Staliūnas. Making Russians : meaning and practice of russification in Lithuania and Belarus after 1863

    Woodworth, Bradley D., 1963-

    2011-01-01

    Arvustus: Darius Staliūnas. Making Russians. Meaning and practice of russification in Lithuania and Belarus after 1863. On the boundary of two worlds: identity, freedom, and moral imagination in the Baltica, 11. (Amsterdam : Rodopi, 2007)

  12. Differences in body dissatisfaction, weight-management practices and food choices of high-school students in the Bangkok metropolitan region by gender and school type.

    Chongwatpol, Pitipa; Gates, Gail E

    2016-05-01

    The present study aimed to compare body dissatisfaction, food choices, physical activity and weight-management practices by gender and school type. A questionnaire was used to obtain height, weight, body image perception using Stunkard's figure rating scale, food choices, physical activity and weight-management practices. Nine single- and mixed-gender schools located in Bangkok Metropolitan Region, Thailand. Students in 10th-12th grade, aged 15-18 years (n 2082). Only 18% of females and 21% of males did not indicate body dissatisfaction. About 66% of females selected a thinner ideal figure than their current figure. Among males, 44% wanted a thinner figure, but 35% wanted a bigger figure. However, univariate analysis found differences by school type but not gender in the degree of body dissatisfaction; students in single-gender schools had more body dissatisfaction. Females reported using more weight-management practices but less physical activity, while males reported healthier food choices. Participants in single-gender schools had healthier food choices compared with those in mixed-gender schools. Adolescents who were at increased risk of a greater degree of body dissatisfaction were females, attended single-gender schools, had lower household income, higher BMI and less physical activity. Most participants reported being dissatisfied with their current body shape, but the type and level of dissatisfaction and use of weight-management practices differed by gender and type of school. These findings suggest that programmes to combat body dissatisfaction should address different risk factors in males and females attending single- and mixed-gender schools.

  13. Cooking fuel choices and garbage burning practices as determinants of birth weight: a cross-sectional study in Accra, Ghana

    Amegah Adeladza K

    2012-10-01

    Full Text Available Abstract Background Effect of indoor air pollution (IAP on birth weight remains largely unexplored but yet purported as the most important environmental exposure for pregnant women in developing countries due to the effects of second-hand smoke. We investigated the associations between the determinants of indoor air quality in households and birth weight. Methods A cross-sectional study of 592 mothers and their newborns using postnatal services at the Korle Bu Teaching Hospital located in Accra, Ghana was conducted in 2010 to collect information on characteristics of indoor environment and other potential determinants of fetal growth. Birth weight was recorded from hospital records. Results Household cooking fuel choices and garbage burning practices were determinants of birth weight. Multivariate linear regression analysis adjusting for age, social class, marital status and gravidity of mothers, and sex of neonate resulted in a 243g (95% CI: 496, 11 and 178g (95% CI: 421, 65 reduction in birth weight for use of charcoal, and garbage burning respectively compared with use of LPG only. The estimated reductions in birth weight was not statistically significant. Applying the ordinal scale exposure parameter nonetheless revealed a significant exposure-response relationship between maternal exposures from charcoal use and garbage burning, and birth weight. Generalized linear models adjusting for confounders resulted in a 41% (risk ratio [RR] = 1.41; 95% CI: 0.62, 3.23 and 195% (RR=2.95; 95% CI: 1.10, 7.92 increase in the risk of low birth weight (LBW for use of charcoal, and garbage burning respectively compared with use of LPG only. A combination of charcoal use and household garbage burning during pregnancy on fetal growth resulted in a 429g (95% CI: 259, 599 reduction in birth weight and 316% (RR=4.16; 95% CI: 2.02, 8.59 excess risk of LBW. Sensitivity analysis performed by restricting the analysis to term births produced similar results

  14. Relationship between quality of care and choice of clinical computing system: retrospective analysis of family practice performance under the UK's quality and outcomes framework.

    Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim

    2013-08-02

    To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Retrospective longitudinal study. Data for 2007-2008 to 2010-2011, extracted from the clinical computer systems of general practices in England. All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system.

  15. [Making a low cost IPSec router on Linux and the assessment for practical use].

    Amiki, M; Horio, M

    2001-09-01

    We installed Linux and FreeS/WAN on a PC/AT compatible machine to make an IPSec router. We measured the time of ping/ftp, only in the university, between the university and the external network. Between the university and the external network (the Internet), there were no differences. Therefore, we concluded that CPU load was not remarkable at low speed networks, because packets exchanged via the Internet are small, or compressions of VPN are more effective than encoding and decoding. On the other hand, in the university, the IPSec router performed down about 20-30% compared with normal IP communication, but this is not a serious problem for practical use. Recently, VPN machines are becoming cheaper, but they do not function sufficiently to create a fundamental VPN environment. Therefore, if one wants a fundamental VPN environment at a low cost, we believe you should select a VPN router on Linux.

  16. Decision-making in pediatrics: a practical algorithm to evaluate complementary and alternative medicine for children.

    Renella, Raffaele; Fanconi, Sergio

    2006-07-01

    We herein present a preliminary practical algorithm for evaluating complementary and alternative medicine (CAM) for children which relies on basic bioethical principles and considers the influence of CAM on global child healthcare. CAM is currently involved in almost all sectors of pediatric care and frequently represents a challenge to the pediatrician. The aim of this article is to provide a decision-making tool to assist the physician, especially as it remains difficult to keep up-to-date with the latest developments in the field. The reasonable application of our algorithm together with common sense should enable the pediatrician to decide whether pediatric (P)-CAM represents potential harm to the patient, and allow ethically sound counseling. In conclusion, we propose a pragmatic algorithm designed to evaluate P-CAM, briefly explain the underlying rationale and give a concrete clinical example.

  17. Making space for wind farms: Practices of territorial stigmatisation in rural Denmark

    Rudolph, David Philipp; Kirkegaard, Julia Kirch

    of territorial stigmatisation are mobilised and aligned by developers and municipalities in order to make space for and legitimise large wind farm projects in rural areas. In doing so, the paper will illustrate how stigmatisation practices are embedded in discourses of rurality as ‘Outskirts......Whilst issues of siting wind farms have mostly revolved around their public acceptance resulting from an unequal distribution of local costs and benefits, the perceived fairness of the planning process and the disruption of places, the challenge of finding adequate locations and getting access...... community involvement and ownership of wind farms, access to diminishing spatial resources reflects a key concern for developers, while putting the role of private landowners at the core of successful projects. By drawing on case studies from rural Northern Denmark it will be demonstrated how narratives...

  18. TU-CD-BRD-01: Making Incident Learning Practical and Useful: Challenges and Previous Experiences

    Ezzell, G.

    2015-01-01

    It has long been standard practice in radiation oncology to report internally when a patient’s treatment has not gone as planned and to report events to regulatory agencies when legally required. Most potential errors are caught early and never affect the patient. Quality assurance steps routinely prevent errors from reaching the patient, and these “near misses” are much more frequent than treatment errors. A growing number of radiation oncology facilities have implemented incident learning systems to report and analyze both errors and near misses. Using the term “incident learning” instead of “event reporting” emphasizes the need to use these experiences to change the practice and make future errors less likely and promote an educational, non-punitive environment. There are challenges in making such a system practical and effective. Speakers from institutions of different sizes and practice environments will share their experiences on how to make such a system work and what benefits their clinics have accrued. Questions that will be addressed include: How to create a system that is easy for front line staff to access How to motivate staff to report How to promote the system as positive and educational and not punitive or demeaning How to organize the team for reviewing and responding to reports How to prioritize which reports to discuss in depth How not to dismiss the rest How to identify underlying causes How to design corrective actions and implement change How to develop useful statistics and analysis tools How to coordinate a departmental system with a larger risk management system How to do this without a dedicated quality manager Some speakers’ experience is with in-house systems and some will share experience with the AAPM/ASTRO national Radiation Oncology Incident Learning System (RO-ILS). Reports intended to be of value nationally need to be comprehensible to outsiders; examples of useful reports will be shown. There will be ample time set

  19. TU-CD-BRD-01: Making Incident Learning Practical and Useful: Challenges and Previous Experiences

    Ezzell, G. [Mayo Clinic Arizona (United States)

    2015-06-15

    It has long been standard practice in radiation oncology to report internally when a patient’s treatment has not gone as planned and to report events to regulatory agencies when legally required. Most potential errors are caught early and never affect the patient. Quality assurance steps routinely prevent errors from reaching the patient, and these “near misses” are much more frequent than treatment errors. A growing number of radiation oncology facilities have implemented incident learning systems to report and analyze both errors and near misses. Using the term “incident learning” instead of “event reporting” emphasizes the need to use these experiences to change the practice and make future errors less likely and promote an educational, non-punitive environment. There are challenges in making such a system practical and effective. Speakers from institutions of different sizes and practice environments will share their experiences on how to make such a system work and what benefits their clinics have accrued. Questions that will be addressed include: How to create a system that is easy for front line staff to access How to motivate staff to report How to promote the system as positive and educational and not punitive or demeaning How to organize the team for reviewing and responding to reports How to prioritize which reports to discuss in depth How not to dismiss the rest How to identify underlying causes How to design corrective actions and implement change How to develop useful statistics and analysis tools How to coordinate a departmental system with a larger risk management system How to do this without a dedicated quality manager Some speakers’ experience is with in-house systems and some will share experience with the AAPM/ASTRO national Radiation Oncology Incident Learning System (RO-ILS). Reports intended to be of value nationally need to be comprehensible to outsiders; examples of useful reports will be shown. There will be ample time set

  20. Truth-telling, decision-making, and ethics among cancer patients in nursing practice in China.

    Ling, Dong-Lan; Yu, Hong-Jing; Guo, Hui-Ling

    2017-01-01

    Truth-telling toward terminally ill patients is a challenging ethical issue in healthcare practice. However, there are no existing ethical guidelines or frameworks provided for Chinese nurses in relation to decision-making on truth-telling of terminal illness and the role of nurses thus is not explicit when encountering this issue. The intention of this paper is to provide ethical guidelines or strategies with regards to decision-making on truth-telling of terminal illness for Chinese nurses. This paper initially present a case scenario and then critically discuss the ethical issue in association with ethical principles and philosophical theories. Instead of focusing on attitudes toward truth disclosure, it aims to provide strategies regarding this issue for nurses. It highlights and discusses some of the relevant ethical assumptions around the perceived role of nurses in healthcare settings by focusing on nursing ethical virtues, nursing codes of ethics, and philosophical perspectives. And Confucian culture is discussed to explicate that deontology does not consider family-oriented care in China. Treating each family individually to explore the family's beliefs and values on this issue is essential in healthcare practice and nurses should tailor their own approach to individual needs regarding truth-telling in different situations. Moreover, the Chinese Code of Ethics should be modified to be more specific and applicable. Finally, a narrative ethics approach should be applied and teamwork between nurses, physicians and families should be established to support cancer patients and to ensure their autonomy and hope. Ethical considerations: This paper was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou Medical University. The authors have obtained consent to use the case study and it has been anonymised to preserve the patient's confidentiality.

  1. Information Quality in Regulatory Decision Making: Peer Review versus Good Laboratory Practice.

    McCarty, Lynn S; Borgert, Christopher J; Mihaich, Ellen M

    2012-07-01

    There is an ongoing discussion on the provenance of toxicity testing data regarding how best to ensure its validity and credibility. A central argument is whether journal peer-review procedures are superior to Good Laboratory Practice (GLP) standards employed for compliance with regulatory mandates. We sought to evaluate the rationale for regulatory decision making based on peer-review procedures versus GLP standards. We examined pertinent published literature regarding how scientific data quality and validity are evaluated for peer review, GLP compliance, and development of regulations. Some contend that peer review is a coherent, consistent evaluative procedure providing quality control for experimental data generation, analysis, and reporting sufficient to reliably establish relative merit, whereas GLP is seen as merely a tracking process designed to thwart investigator corruption. This view is not supported by published analyses pointing to subjectivity and variability in peer-review processes. Although GLP is not designed to establish relative merit, it is an internationally accepted quality assurance, quality control method for documenting experimental conduct and data. Neither process is completely sufficient for establishing relative scientific soundness. However, changes occurring both in peer-review processes and in regulatory guidance resulting in clearer, more transparent communication of scientific information point to an emerging convergence in ensuring information quality. The solution to determining relative merit lies in developing a well-documented, generally accepted weight-of-evidence scheme to evaluate both peer-reviewed and GLP information used in regulatory decision making where both merit and specific relevance inform the process.

  2. Producers' Complex Risk Management Choices

    Pennings, J.M.E.; Isengildina, O.; Irwin, S.H.; Garcia, P.; Good, D.L.

    2008-01-01

    Producers have a wide variety of risk management instruments available, making their choice(s) complex. The way producers deal with this complexity can vary and may influence the impact that the determinants, such as risk aversion, have on their choices. A recently developed choice bracketing

  3. Research-Based Knowledge: Researchers' Contribution to Evidence-Based Practice and Policy Making in Career Guidance

    Haug, Erik Hagaseth; Plant, Peter

    2016-01-01

    To present evidence for the outcomes of career guidance is increasingly seen as pivotal for a further professionalization of policy making and service provision. This paper puts an emphasis on researchers' contribution to evidence-based practice and policy making in career guidance. We argue for a broader and more pluralistic research strategy to…

  4. Energy Democracies and Publics in the Making: A Relational Agenda for Research and Practice

    Jason Chilvers

    2018-04-01

    Full Text Available Mainstream approaches to energy democracy and public engagement with energy transitions tend to adopt specific, pre-given meanings of both “democracy” and “publics.” Different approaches impose prescriptive assumptions about the model of participation, the identity of public participants, and what it means to participate well. The rigidity of many existing approaches to energy participation is increasingly being challenged by the ever-multiplying diversity of ways in which citizens participate in energy systems, as consumers in energy markets, protesters against new infrastructures and technologies, as initiators of community energy projects, and as subjects of behavior change interventions, amongst others. This paper is concerned with growing areas of scholarship which seek to understand and explore these emerging energy publics and forms of energy democracy from a relational perspective. Such work, grounded in constructivist and relational ontologies, views forms of participatory democracy and publics as being co-produced, constructed, and emergent through the performance of collective practices. It pays closer attention to power relations, politics, materiality, exclusions, and effects in both understanding and intervening in the making of energy democracy. This in turn shifts the focus from studying discrete unitary forms of “energy democracy” to one of understanding interrelations between multiple diverse energy democracies in wider systems. In this paper, we chart these developments and explore the significant challenges and potential contributions of relational approaches to furthering the theories, methods, and practices of energy democracy and energy public engagement. The paper draws on an expert workshop, and an accompanying review, which brought together leading proponents of contending relational approaches to energy participation in direct conversation for the first time. We use this as a basis to explore tensions

  5. Personal practical theories, self-identity, and astronomy teachers' interactive decision making

    Richmond, Marvin Elliot

    2005-12-01

    Research has suggested that beliefs play a major role in selecting and defining teaching tasks and organizing the knowledge needed to perform those tasks. Teachers, consciously or unconsciously, depend on beliefs because they work in ill-structured domains where traditional problem solving techniques and academic knowledge do not work as well. The goal of this project was to establish, if possible, a causal link between teacher beliefs and interactive decision making through empirical, qualitative research. The hypothesis was, that when faced with those sorts of situations, the participants would fall back on belief systems that did not necessarily have a rational basis. The research focused on astronomy teachers in community colleges. Since most science reform efforts are directed toward primary and secondary schools, community college science teaching remains a neglected area of study. Yet community colleges are predicted to play an increasingly important role in higher education in the near future. For many students, community college science classes may represent their last encounter with formal, academic, science programs. The three participants were interviewed and observed in the classroom over an extended period. Initial interviews were conducted with each participant to capture stated beliefs. After the extensive classroom observations, stimulated recall interviews were held with each participant viewing short, edited segments of the classroom videotapes. No direct causal link between beliefs (in the conventional sense of the word) and participant decision making is apparent from this empirical research. However, the construct of personal practical theories, which includes beliefs as one component, shows promise as a significant determining factor in interactive decision making. Themes have been developed that represent each participant's personal practical theories. The strongest theme, applicable to all participants, is based on the notion of

  6. Deficient neural activity subserving decision-making during reward waiting time in intertemporal choice in adult attention-deficit hyperactivity disorder.

    Todokoro, Ayako; Tanaka, Saori C; Kawakubo, Yuki; Yahata, Noriaki; Ishii-Takahashi, Ayaka; Nishimura, Yukika; Kano, Yukiko; Ohtake, Fumio; Kasai, Kiyoto

    2018-04-24

    Impulsivity, which significantly affects social adaptation, is an important target behavioral characteristic in interventions for attention-deficit hyperactivity disorder (ADHD). Typically, people are willing to wait longer to acquire greater rewards. Impulsivity in ADHD may be associated with brain dysfunction in decision-making involving waiting behavior under such situations. We tested the hypothesis that brain circuitry during a period of waiting (i.e., prior to the acquisition of reward) is altered in adults with ADHD. The participants included 14 medication-free adults with ADHD and 16 healthy controls matched for age, sex, IQ, and handedness. The behavioral task had participants choose between a delayed, larger monetary reward and an immediate, smaller monetary reward, where the reward waiting time actually occurred during functional magnetic resonance imaging measurement. We tested for group differences in the contrast values of blood-oxygen-level dependent signals associated with the length of waiting time, calculated using the parametric modulation method. While the two groups did not differ in the time discounting rate, the delay-sensitive contrast values were significantly lower in the caudate and visual cortex in individuals with ADHD. The higher impulsivity scores were significantly associated with lower delay-sensitive contrast values in the caudate and visual cortex. These results suggest that deficient neural activity affects decision-making involving reward waiting time during intertemporal choice tasks, and provide an explanation for the basis of impulsivity in adult ADHD. © 2018 The Author. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and Neurology.

  7. Linking neuroscientific research on decision making to the educational context of novice students assigned to a multiple-choice scientific task involving common misconceptions about electrical circuits

    Patrice ePotvin

    2014-01-01

    Full Text Available Functional magnetic resonance imaging was used to identify the brain-based mechanisms of uncertainty and certainty associated with answers to multiple-choice questions involving common misconceptions about electric circuits. Twenty-two (22 scientifically novice participants (humanities and arts college students were asked, in an fMRI study, whether or not they thought the light bulbs in images presenting electric circuits were lighted up correctly, and if they were certain or uncertain of their answers. When participants reported that they were unsure of their responses, analyses revealed significant activations in brain areas typically involved in uncertainty (anterior cingulate cortex, anterior insula cortex, and superior/dorsomedial frontal cortex and in the left middle/superior temporal lobe. Certainty was associated with large bilateral activations in the occipital and parietal regions usually involved in visuospatial processing. Correct-and-certain answers were associated with activations that suggest a stronger mobilization of visual attention resources when compared to incorrect-and-certain answers. These findings provide insights into brain-based mechanisms of uncertainty that are activated when common misconceptions, identified as such by science education research literature, interfere in decision making in a school-like task. We also discuss the implications of these results from an educational perspective.

  8. Conducting a Discrete-Choice Experiment Study Following Recommendations for Good Research Practices: An Application for Eliciting Patient Preferences for Diabetes Treatments.

    Janssen, Ellen M; Hauber, A Brett; Bridges, John F P

    2018-01-01

    To consolidate and illustrate good research practices in health care to the application and reporting of a study measuring patient preferences for type 2 diabetes mellitus medications, given recent methodological advances in stated-preference methods. The International Society for Pharmacoeconomics and Outcomes Research good research practices and other recommendations were used to conduct a discrete-choice experiment. Members of a US online panel with type 2 diabetes mellitus completed a Web-enabled, self-administered survey that elicited choices between treatment pairs with six attributes at three possible levels each. A D-efficient experimental design blocked 48 choice tasks into three 16-task surveys. Preference estimates were obtained using mixed logit estimation and were used to calculate choice probabilities. A total of 552 participants (51% males) completed the survey. Avoiding 90 minutes of nausea was valued the highest (mean -10.00; 95% confidence interval [CI] -10.53 to -9.47). Participants wanted to avoid low blood glucose during the day and/or night (mean -3.87; 95% CI -4.32 to -3.42) or one pill and one injection per day (mean -7.04; 95% CI -7.63 to -6.45). Participants preferred stable blood glucose 6 d/wk (mean 4.63; 95% CI 4.15 to 5.12) and a 1% decrease in glycated hemoglobin (mean 5.74; 95% CI 5.22 to 6.25). If cost increased by $1, the probability that a treatment profile would be chosen decreased by 1%. These results are consistent with the idea that people have strong preferences for immediate consequences of medication. Despite efforts to produce recommendations, ambiguity surrounding good practices remains and various judgments need to be made when conducting stated-preference studies. To ensure transparency, these judgments should be described and justified. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  9. Teaching evidence-based social work in foundation practice courses: learning from pedagogical choices of allied fields.

    Traube, Dorian E; Pohle, Cara E; Barley, Melissa

    2012-01-01

    The field of social work is attuned to the need to incorporate evidence-based practice education into masters-level curriculum. One question remaining is how to integrate evidence-based practice in the foundation practice courses. Integration of evidence-based practice across the foundation-level curriculum coincides with the Council on Social Work Education's mandate that student's engage in research-informed practice and practice-informed research. Through a discussion of definitions, criticisms, and pedagogy across the allied fields of medicine, nursing, and social work the authors address the current status of evidence-based practice curriculum in foundation-level education. The authors incorporate the lessons learned from allied fields and a Masters of Social Work student's analyses of their experience of evidence-based practice learning to propose an adult-learner model to improve evidence-based practice pedagogy in Social Work.

  10. Disinfectant choices in veterinary practices, shelters and households : ABCD guidelines on safe and effective disinfection for feline environments

    Addie, Diane D; Boucraut-Baralon, Corine; Egberink, Herman; Frymus, Tadeusz; Gruffydd-Jones, Tim; Hartmann, Katrin; Horzinek, Marian C; Hosie, Margaret J; Lloret, Albert; Lutz, Hans; Marsilio, Fulvio; Pennisi, Maria Grazia; Radford, Alan D; Thiry, Etienne; Truyen, Uwe; Möstl, Karin

    OVERVIEW: Regardless of whether a pathogen is viral, bacterial, parasitic, fungal or an emerging unknown, the mainstay of infectious disease control is hygiene, and the cornerstone of good hygiene is effective disinfection. CHALLENGES AND CURRENT CHOICES: Certain pathogens present a challenge to

  11. The Indiana Choice Scholarship Program: Legal Challenges, Program Expansion, and Participation. Informing Policy and Improving Practice. Policy Brief

    Cierniak, Katherine; Billick, Rebecca; Ruddy, Anne-Maree

    2015-01-01

    School choice programs can take a variety of forms, from the provision of various public school options, such as charter schools, to programs which provide funds to offset the cost of students' attendance at a private school. The provision of funds is most often accomplished in two ways: through the provision of state educational funds to be used…

  12. Making sense of biologists' teaching: Two case studies of beliefs and discourse practices

    Fifield, Steven James

    1999-09-01

    Undergraduate science courses are often criticized for their overemphasis of content coverage, neglect of inquiry approaches, and misrepresentation of the nature of science. Because conventional courses are influential models for future science teachers, they are often viewed as impediments to K--12 science education reform. To effectively modify how professors teach, we first need to better understand their beliefs and practices as teachers. This is an interpretive study of how two biology professors (Jim and Sue) make sense of their classroom practices in an introductory undergraduate course. Interviews are used to analyze their beliefs about teaching, learning, and science. Discourse analysis of lectures on classical genetics is used to examine their classroom practices as situated constructions of scientific knowledge. The two professors' held distinct beliefs about teaching and learning that were intricately interwoven with their beliefs about science. Jim's beliefs were largely consistent with conventional approaches to introductory science courses. He thought that introductory courses support the development of knowledge and skills that students need before they can engage in scientific inquiry. Sarah was critical of these conventional approaches. She valued courses that foster active learning and focus on applications of biology that are relevant to students' lives. But she could not enact many of her beliefs due to situational constraints associated with the course. Instead she viewed her efforts to help students succeed in a conventional course as a way to resist her colleagues' expectations that most students cannot do well in science. Discourse analysis of the professors' lectures revealed that they both relied on narratives to represent concepts in classical genetics. These narratives of concepts were distinct from other narrative forms in technical and popular presentations of biology. The relationship among these professors' beliefs and classroom

  13. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

    Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

    2010-05-01

    This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.

  14. Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research.

    Land, Victoria; Parry, Ruth; Seymour, Jane

    2017-12-01

    Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale). © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  15. What factors influence the choice of urban or rural location for future practice of Nepalese medical students? A cross-sectional descriptive study.

    Sapkota, Bhim Prasad; Amatya, Archana

    2015-11-10

    Nepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians. Although there is some documentation about the reasons physicians elect to leave Nepal to work abroad, very little is known about the salient factors that influence the choice of an urban versus rural practice setting for those physicians who do not migrate. In recent years, around 1000 medical students became doctors within Nepal, but their distribution in rural locations is not adequate. The purpose of this study was to explore what factors influence the choice of urban or rural location for the future clinical practice of Nepalese medical students in the final year of their program A cross-sectional descriptive study design was used for this study involving Nepalese medical students in their final year of study and currently doing an internship in a medical college. The sample consisted of 393 medical students from four medical colleges in Nepal that were selected randomly. An anonymous self-administered questionnaire was used for data collection. To determine the association with rural location choice for their future practice setting, a comparison was done that involved demographic, socio-economic, and educational factors. Data were entered in EpiData and analyzed by using SPSS version 16. Among the 393 respondents, two thirds were male (66.9%) and more than half were below 25 years of age. Almost all (93%) respondents were single and about two thirds (63.4%) were of Brahmin and Chhetri ethnic origin. About two thirds (64.1%) of the respondents were born in a rural setting, and 58.8% and 53.3% had a place of rearing and permanent address in a rural location, respectively. The predictors of future rural location choice for their clinical practice (based on the bivariate analysis) included: (a) Rural (versus urban) place of birth, place of rearing, and permanent address (b) Source of family income (service, business, and agriculture

  16. Validity of Medical Student Questionnaire Data in Prediction of Rural Practice Choice and Its Association With Service Orientation.

    Shannon, C Ken; Jackson, Jodie

    2015-01-01

    The validity of medical student projection of, and predictors for, rural practice and the association of a measure of service orientation, projected practice accessibility to the indigent, were investigated. West Virginia (WV) medical student online pre- and postrural rotation questionnaire data were collected during the time period 2001-2009. Of the 1,517 respondent students, submissions by 1,271 met the time interval criterion for inclusion in analyses. Subsequent WV licensing data were available for 461 in 2013. These 2 databases were used to assess for validity of projection of rural practice, for predictors of rural practice, and for student projected accessibility of the future practice to indigent patients. There were statistically significant associations between both pre- and postrotation projections of rural practice and subsequent rural practice. The most significant independent predictors of rural practice were student rural background, reported primary care intent, prediction of rural practice and projection of greater accessibility of the future practice to indigent patients. For scoring of practice access, there were trends for higher scoring by rural students and rural practitioners, with greater pre-post increases for those with urban hometowns. This study demonstrates the utility of medical student questionnaires for projections of numbers of future rural physicians. It suggests that students with a rural background, rural practice intent, or greater service orientation are more likely to enter rural practice. It also suggests that students, particularly those with urban hometowns, are influenced by rural rotation experiences in forecasting greater practice accessibility and in entering rural practice. © 2015 National Rural Health Association.

  17. Decision Making in Reference to Model of Marketing Predictive Analytics – Theory and Practice

    Piotr Tarka

    2014-03-01

    Full Text Available Purpose: The objective of this paper is to describe concepts and assumptions of predictive marketing analytics in reference to decision making. In particular, we highlight issues pertaining to the importance of data and the modern approach to data analysis and processing with the purpose of solving real marketing problems that companies encounter in business. Methodology: In this paper authors provide two study cases showing how, and to what extent predictive marketing analytics work can be useful in practice e.g., investigation of the marketing environment. The two cases are based on organizations operating mainly on Web site domain. The fi rst part of this article, begins a discussion with the explanation of a general idea of predictive marketing analytics. The second part runs through opportunities it creates for companies in the process of building strong competitive advantage in the market. The paper article ends with a brief comparison of predictive analytics versus traditional marketing-mix analysis. Findings: Analytics play an extremely important role in the current process of business management based on planning, organizing, implementing and controlling marketing activities. Predictive analytics provides the actual and current picture of the external environment. They also explain what problems are faced with the company in business activities. Analytics tailor marketing solutions to the right time and place at minimum costs. In fact they control the effi ciency and simultaneously increases the effectiveness of the firm. Practical implications: Based on the study cases comparing two enterprises carrying business activities in different areas, one can say that predictive analytics has far more been embraces extensively than classical marketing-mix analyses. The predictive approach yields greater speed of data collection and analysis, stronger predictive accuracy, better obtained competitor data, and more transparent models where one can

  18. Statutory Regulation of Traditional Medicine Practitioners and Practices: The Need for Distinct Policy Making Guidelines.

    Ijaz, Nadine; Boon, Heather

    2018-04-01

    The World Health Organization (WHO) has called for the increased statutory regulation of traditional and complementary medicine practitioners and practices, currently implemented in about half of nations surveyed. According to recent WHO data, however, the absence of policy guidelines in this area represents a significant barrier to implementation of such professional regulations. This commentary reviews several key challenges that distinguish the statutory regulation of traditional medicine practitioners and practices from biomedical professional regulation, providing a foundation for the development of policy making parameters in this area. Foremost in this regard are the ongoing impacts of the European colonial encounter, which reinforce biomedicine's disproportionate political dominance across the globe despite traditional medicine's ongoing widespread use (particularly in the global South). In this light, the authors discuss the conceptual and historical underpinnings of contemporary professional regulatory structures, the tensions between institutional and informal traditional medicine training pathways, and the policy challenges presented by the prospect of standardizing internally diverse indigenous healing approaches. Epistemic and evidentiary tensions, as well as the policy complexities surrounding the intersection of cultural and clinical considerations, present additional challenges to regulators. Conceptualizing professional regulation as an intellectual property claim under the law, the authors further consider what it means to protect traditional knowledge and prevent misappropriation in this context. Overall, the authors propose that innovative professional regulatory approaches are needed in this area to address safety, quality of care, and accessibility as key public interest concerns, while prioritizing the redress of historical inequities, protection of diverse indigenous knowledges, and delivery of care to underserved populations.

  19. Making the hard decisions: Ethical care decisions in wartime nursing practice.

    Agazio, Janice; Goodman, Petra

    Codes of ethics set forth standards of ethical conduct for nurses. However, nurses involved in wartime operations, or disasters, may often have their moral compass challenged by the patient care decisions necessary under adverse conditions. Reverse triage, resource allocation, and promotion of patient autonomy present multiple challenges to meeting commonly applied ethical principles. The purpose of this study was to use the International Council of Nursing code of ethics as a framework to organize the ethical issues emerging from wartime nursing. This article represents a secondary analysis of two studies using thematic analysis to identify ethical issues encountered by military nurses during the recent conflicts in Iraq and Afghanistan. Data were collected from nurses deployed from 2002 to 2015 and from 111 military nurses during focused interviews. Across both studies, issues such as resource allocation, patient triage, cultural differences, and equitable treatment for all emerged as challenges within the wartime environment. Nurses were at a loss at times as to how best to manage the situations and recommended that more education is needed in ethical decision making before, during, and after deployment as a debriefing strategy. Similar issues have been documented in military and disaster literature indicating that such challenges are not limited to the recent conflicts but cross time and location. By better understanding how nurses define, assess, and manage the ethical situations they encounter in wartime nursing practice, military nurses can better prepare for future conflicts, provide mentorship and targeted education to hopefully reducing any feelings of moral distress, and promote ethical decision making that will best promote outcomes in accordance with nursing's ethical codes. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Business management practices in the power industry: Decision making in a market economy

    Brown, J.H. [Fieldstone Private Capital Group, New York, NY (United States); Rosel, V. [Fieldstone Private Capital Group, Prague (Czechoslovakia)

    1995-12-01

    Management of a free market power industry, or managing the transition from a planned economy to a free market one, is driven by a fundamental economic premise - it is unrealistic (and economically unsound) to try to shelter end users (manufacturers or otherwise) from the true cost of energy: (i) energy prices are a function of fuel inputs (ii) fuel inputs are world priced (iii) end users must pay prices based on true costs Trying to counter any of these dictates will cause economic inefficiencies and misallocations. Managers of energy production in a free market economy must therefore learn to acquire data, and learn to extrapolate. As information is never complete, or perfect, managers must learn to consider contingencies, alternatives and options. In a free market economy, the decision to build a power facility is not controlled simply by the recognition of a perceived need for more power in an area. Because survival in a free market economy requires making a profit, as part for the decision process managers must: (i) talk to their customers to determine power needs into the future (ii) talk to their input suppliers, and arrange contracts (iii) make sure that there is a spread between cost and revenue As stated this is a simple recipe, but is difficult in practice. To perform any forecasting, managers must acquire control over cost, so as to have a base from which to judge the continued profitability or potential profitability, of any current activity or future ventures. It should be noted that planning for the future is difficult at any time but even more so when moving through an era where in the entire economy is undergoing systemic changes. Historic customer base, and historic supply arrangements, may not mean much. Therefore, managers must keep acquiring information, and updating forecasts.

  1. An Evaluation of the Value of Choice-Making Opportunities in Single-Operant Arrangements: Simple Fixed- and Progressive-Ratio Schedules

    Tiger, Jeffrey H.; Toussaint, Karen A.; Roath, Christopher T.

    2010-01-01

    The current study compared the effects of choice and no-choice reinforcement conditions on the task responding of 3 children with autism across 2 single-operant paradigm reinforcer assessments. The first assessment employed simple fixed-ratio (FR) schedules; the second used progressive-ratio (PR) schedules. The latter assessment identified the…

  2. Effective choices for diagnostic imaging in clinical practice. Excerpts from a report of a WHO Scientific Group on Clinical Diagnostic Imaging

    1992-01-01

    There are so many different methods of diagnostic imaging that medical practitioners may need guidance to choose the best through the maze of options for each clinical problem. Advice may be required for more than just the first choice, because the first imaging procedure does not always give the desired answer and, depending on the results, further imaging may have to undertaken. The alternative is to submit the patient to a barrage of imaging and hope that one type, at least provides the diagnosis. This is a quite unacceptable way to practice medicine because of the cost and the risk of radiation damage from unnecessary examinations. The choice of the most effective imaging is often difficult and frequently controversial. The sequence to be followed vries with many factors: the equipment available, the skills of the practitioner, the expected quality of the results, the quality of interpretation, and conclusion which can be drawn

  3. "Latte rural": the tangible and intangible factors important in the choice of a rural practice by recent GP graduates.

    Laurence, Caroline O; Williamson, Victoria; Sumner, Karen E; Fleming, Jenny

    2010-01-01

    A large of amount of literature exists on the factors that influence the recruitment and retention of rural general practitioners (GPs) in Australia and other countries. The selection of a rural practice location is known to be influenced by professional, personal and family, community and economic factors. Most of this research has been undertaken on the either the baby boomer generation or their predecessors, and this is likely to have influenced the responses gained. Generation X and Y doctors are known to have a different perception regarding workload, lifestyle and the support required to practise. The aim of this study was to explore, from a Generation X perspective, factors deemed important by general practice graduates in selecting a rural practice at completion of their training. The study also aimed to identify the process general practice graduates use to identify a potential rural practice, and when they commence this process. Semi-structured interviews were held with 15 rural pathway general practice registrars in their final year of training with 2 regional training providers in South Australia. The interview topics included source of information on potential practices, their ideal rural practice and community, the process used to select a practice, and when they commenced this process. Phenomenological hermeneutic thematic analysis of interview transcripts was undertaken to identify themes and sub-themes. For an ideal rural practice, registrars wished to work in a practice with a friendly atmosphere, good business structure, support from senior GPs and in close proximity to a hospital. They also wanted reasonable on-call arrangements, the chance to develop further skills (such as anaesthetics or obstetrics) and the freedom to practise according to their interests. They also emphasised the importance of a good team and an ethical practice. In terms of community, registrars wanted a positive living place, access to amenities such as childcare, good

  4. Not all choices are created equal: Task-relevant choices enhance motor learning compared to task-irrelevant choices.

    Carter, Michael J; Ste-Marie, Diane M

    2017-12-01

    Lewthwaite et al. (2015) reported that the learning benefits of exercising choice (i.e., their self-controlled condition) are not restricted to task-relevant features (e.g., feedback). They found that choosing one's golf ball color (Exp. 1) or choosing which of two tasks to perform at a later time plus which of two artworks to hang (Exp. 2) resulted in better retention than did being denied these same choices (i.e., yoked condition). The researchers concluded that the learning benefits derived from choice, whether irrelevant or relevant to the to-be-learned task, are predominantly motivational because choice is intrinsically rewarding and satisfies basic psychological needs. However, the absence of a group that made task-relevant choices and the lack of psychological measures significantly weakened their conclusions. Here, we investigated how task-relevant and task-irrelevant choices affect motor-skill learning. Participants practiced a spatiotemporal motor task in either a task-relevant group (choice over feedback schedule), a task-irrelevant group (choice over the color of an arm-wrap plus game selection), or a no-choice group. The results showed significantly greater learning in the task-relevant group than in both the task-irrelevant and no-choice groups, who did not differ significantly. Critically, these learning differences were not attributed to differences in perceptions of competence or autonomy, but instead to superior error-estimation abilities. These results challenge the perspective that motivational influences are the root cause of self-controlled learning advantages. Instead, the findings add to the growing evidence highlighting that the informational value gained from task-relevant choices makes a greater relative contribution to these advantages than motivational influences do.

  5. "Suffering" in palliative sedation: Conceptual Analysis and Implications for Decision-Making in Clinical Practice.

    Bozzaro, Claudia; Schildmann, Jan

    2018-04-21

    Palliative sedation is an increasingly used and, simultaneously, challenging practice at the end of life. Many controversies associated with this therapy are rooted in implicit differences regarding the understanding of "suffering" as prerequisite for palliative sedation. The aim of this paper is to inform the current debates by a conceptual analysis of two different philosophical accounts of suffering, (1) the subjective and holistic concept and (2) the objective and gradual concept and by a clinical-ethical analysis of the implications of each account for decisions about palliative sedation. We will show that while the subjective and holistic account of suffering fits well with the holistic approach of palliative care, there are considerable challenges to justify limits to requests for palliative sedation. By contrast, the objective and gradual account fits well with the need for an objective basis for clinical decisions in the context of palliative sedation, but runs the risk of falling short when considering the individual and subjective experience of suffering at the end of life. We will conclude with a plea for the necessity of further combined conceptual and empirical research to develop a sound and feasible understanding of suffering which can contribute to consistent decision-making about palliative sedation. Copyright © 2018. Published by Elsevier Inc.

  6. Make your small practice thrive. Physicians moving from big practices to small must know the business side of medicine.

    Cowan, D

    2001-01-01

    Trying to gain a measure of control over their working lives, some physicians are abandoning large group practices for smaller groups. Large groups enjoy whole teams of people performing vital business tasks. Small practices rely on one or two key physicians and managers to tackle everything from customer service to marketing, medical records to human resources. Learn valuable tips for thriving in a small environment and using that extra control to achieve job satisfaction.

  7. Views of Evidence-Based Practice: Social Workers' Code of Ethics and Accreditation Standards as Guides for Choice

    Gambrill, Eileen

    2007-01-01

    Different views of evidence-based practice (EBP) include defining it as the use of empirically-validated treatments and practice guidelines (i.e., the EBPs approach) in contrast to the broad philosophy and related evolving process described by the originators. Social workers can draw on their code of ethics and accreditation standards both to…

  8. Factors Influencing Choices of Contextualized versus Traditional Practices with Children and Adolescents Who Have Traumatic Brain Injury

    Koole, Heather; Nelson, Nickola W.; Curtis, Amy B.

    2015-01-01

    Purpose: This preliminary investigation examined speech-language pathologists' (SLPs') use of contextualized practices (i.e., functional, personally relevant, nonhierarchical, and collaborative) compared with traditional practices (i.e., clinical, generic, hierarchical, and expert driven) with school-age children and adolescents with traumatic…

  9. Supermarket and Grocery Store–Based Interventions to Promote Healthful Food Choices and Eating Practices: A Systematic Review

    Meinen, Amy M.; Nitzke, Susan A.; Martinez-Donate, Ana P.

    2013-01-01

    Introduction Increasingly high rates of obesity have heightened interest among researchers and practitioners in identifying evidence-based interventions to increase access to healthful foods and beverages. Because most food purchasing decisions are made in food stores, such settings are optimal for interventions aimed at influencing these decisions. The objective of this review was to synthesize the evidence on supermarket and grocery store interventions to promote healthful food choices. Methods We searched PubMed through July 2012 to identify original research articles evaluating supermarket and grocery store interventions that promoted healthful food choices. We categorized each intervention by type of intervention strategy and extracted and summarized data on each intervention. We developed a scoring system for evaluating each intervention and assigned points for study design, effectiveness, reach, and availability of evidence. We averaged points for each intervention category and compared the strength of the evidence for each category. Results We identified 58 articles and characterized 33 interventions. We found 7 strategies used alone or in combination. The most frequently used strategy was the combination of point-of-purchase and promotion and advertising (15 interventions); evidence for this category was scored as sufficient. On average, of 3 points possible, the intervention categories scored 2.6 for study design, 1.1 for effectiveness, 0.3 for reach, and 2 for availability of evidence. Three categories showed sufficient evidence; 4 showed insufficient evidence; none showed strong evidence. Conclusion More rigorous testing of interventions aimed at improving food and beverage choices in food stores, including their effect on diet and health outcomes, is needed. PMID:23578398

  10. Practice makes perfect: self-reported adherence a positive marker of inhaler technique maintenance.

    Azzi, Elizabeth; Srour, Pamela; Armour, Carol; Rand, Cynthia; Bosnic-Anticevich, Sinthia

    2017-04-24

    determine the key predictors of inhaler technique maintenance from factors including age, asthma knowledge and perceived future risks. Correct inhaler technique at initial assessment was the strongest predictor of long-term success, but this was strengthened further when patients reported good adherence to their own medication regimen. This suggests that maintaining correct inhaler technique is more than just a physical skill. Careful guidance towards this 'practice makes perfect' approach may improve patients' long-term technique maintenance.

  11. Best Practices for Making Scientific Data Discoverable and Accessible through Integrated, Standards-Based Data Portals

    Lucido, J. M.

    2013-12-01

    Scientists in the fields of hydrology, geophysics, and climatology are increasingly using the vast quantity of publicly-available data to address broadly-scoped scientific questions. For example, researchers studying contamination of nearshore waters could use a combination of radar indicated precipitation, modeled water currents, and various sources of in-situ monitoring data to predict water quality near a beach. In discovering, gathering, visualizing and analyzing potentially useful data sets, data portals have become invaluable tools. The most effective data portals often aggregate distributed data sets seamlessly and allow multiple avenues for accessing the underlying data, facilitated by the use of open standards. Additionally, adequate metadata are necessary for attribution, documentation of provenance and relating data sets to one another. Metadata also enable thematic, geospatial and temporal indexing of data sets and entities. Furthermore, effective portals make use of common vocabularies for scientific methods, units of measure, geologic features, chemical, and biological constituents as they allow investigators to correctly interpret and utilize data from external sources. One application that employs these principles is the National Ground Water Monitoring Network (NGWMN) Data Portal (http://cida.usgs.gov/ngwmn), which makes groundwater data from distributed data providers available through a single, publicly accessible web application by mediating and aggregating native data exposed via web services on-the-fly into Open Geospatial Consortium (OGC) compliant service output. That output may be accessed either through the map-based user interface or through the aforementioned OGC web services. Furthermore, the Geo Data Portal (http://cida.usgs.gov/climate/gdp/), which is a system that provides users with data access, subsetting and geospatial processing of large and complex climate and land use data, exemplifies the application of International Standards

  12. Team climate for innovation: what difference does it make in general practice?

    Proudfoot, Judith; Jayasinghe, Upali W; Holton, Chris; Grimm, Jane; Bubner, Tanya; Amoroso, Cheryl; Beilby, Justin; Harris, Mark F

    2007-06-01

    Teamwork in primary healthcare is associated with patient care processes and staff outcomes. The ability of teams to be innovative is a hypothesized mechanism. We examined the characteristics of general practices with good team climate for innovation, and assessed the impact of climate on chronically ill patients' assessment of their care and on the job satisfaction of the staff. Large cross-sectional study. Australian general practices. A total of 654 general practitioners and staff and 7505 chronically ill patients from 93 general practices in 6 Australian states and territories. The Team Climate Inventory and the Overall Job Satisfaction Scale, customized for use with general practices, were administered to general practitioners and practice staff, and the General Practice Assessment Survey was administered to patients. Practice characteristics were collected by survey from the principal doctor or practice manager. Mean scores of team climate in Australian general practices were similar to those reported in the UK, except that in our study there was no association between the number of doctors in a practice and their team climate. Better team climate was found in practices with fewer non-clinical staff. Team climate predicted the job satisfaction of the general practitioners and staff, irrespective of the number of practice staff. Better team climate was associated with greater satisfaction by patients with their care. Team climate is important for patient and staff satisfaction. In large general practices, separate sub-cultures may exist between administrative and clinical staff, which has implications for designing effective team interventions.

  13. An Experimental Decision-Making Paradigm to Distinguish Guilt and Regret and Their Self-Regulating Function via Loss Averse Choice Behavior

    Wagner, Ullrich; Handke, Lisa; Dörfel, Denise; Walter, Henrik

    2012-01-01

    Both guilt and regret typically result from counterfactual evaluations of personal choices that caused a negative outcome and are thought to regulate human decisions by people’s motivation to avoid these emotions. Despite these similarities, studies asking people to describe typical situations of guilt and regret identified the social dimension as a fundamental distinguishing factor, showing that guilt but not regret specifically occurs for choices in interpersonal (social) contexts. However,...

  14. The making of nursing practice law in Lebanon: a policy analysis case study.

    El-Jardali, Fadi; Hammoud, Rawan; Younan, Lina; Nuwayhid, Helen Samaha; Abdallah, Nadine; Alameddine, Mohammad; Bou-Karroum, Lama; Salman, Lana

    2014-09-05

    Evidence-informed decisions can strengthen health systems, improve health, and reduce health inequities. Despite the Beijing, Montreux, and Bamako calls for action, literature shows that research evidence is underemployed in policymaking, especially in the East Mediterranean region (EMR). Selecting the draft nursing practice law as a case study, this policy analysis exercise aims at generating in-depth insights on the public policymaking process, identifying the factors that influence policymaking and assessing to what extent evidence is used in this process. This study utilized a qualitative research design using a case study approach and was conducted in two phases: data collection and analysis, and validation. In the first phase, data was collected through key informant interviews that covered 17 stakeholders. In the second phase, a panel discussion was organized to validate the findings, identify any gaps, and gain insights and feedback of the panelists. Thematic analysis was conducted and guided by the Walt & Gilson's "Policy Triangle Framework" as themes were categorized into content, actors, process, and context. Findings shed light on the complex nature of health policymaking and the unstructured approach of decision making. This study uncovered the barriers that hindered the progress of the draft nursing law and the main barriers against the use of evidence in policymaking. Findings also uncovered the risk involved in the use of international recommendations without the involvement of stakeholders and without accounting for contextual factors and implementation barriers. Findings were interpreted within the context of the Lebanese political environment and the power play between stakeholders, taking into account equity considerations. This policy analysis exercise presents findings that are helpful for policymakers and all other stakeholders and can feed into revising the draft nursing law to reach an effective alternative that is feasible in Lebanon. Our

  15. [Cancer screening in clinical practice: the value of shared decision-making].

    Cornuz, Jacques; Junod, Noëlle; Pasche, Olivier; Guessous, Idris

    2010-07-14

    Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making.

  16. Blending critical realist and emancipatory practice development methodologies: making critical realism work in nursing research.

    Parlour, Randal

    2012-12-01

    This paper examines the efficacy of facilitation as a practice development intervention in changing practice within an Older Person setting and in implementing evidence into practice. It outlines the influences exerted by the critical realist paradigm in guiding emancipatory practice development activities and, in particular, how the former may be employed within an emancipatory practice development study to elucidate and increase understanding pertinent to causation and outcomes. The methodology is based upon an emancipatory practice development approach set within a realistic evaluation framework. This allows for systematic analysis of the social and contextual elements that influence the explication of outcomes associated with facilitation. The study is concentrated upon five practice development cycles, within which a sequence of iterative processes is integrated. The authors assert that combining critical realist and emancipatory processes offers a robust and practical method for translating evidence and implementing changes in practice, as the former affirms or falsifies the influence that emancipatory processes exert on attaining culture shift, and enabling transformation towards effective clinical practice. A new framework for practice development is proposed that establishes methodological coherency between emancipatory practice development and realistic evaluation. This augments the existing theoretical bases for both these approaches by contributing new theoretical and methodological understandings of causation.

  17. Informed Food Choice

    Coff, Christian

    2014-01-01

    of informed food choice. An informed food choice is an enlightened food choice made by the individual based on the information made available. Food choices are made when shopping for food or when eating/drinking, and information is believed to give clarity to the options by increasing market transparency......Food production and consumption influence health, the environment, social structures, etc. For this reason consumers are increasingly interested in information about these effects. Disclosure of information about the consequences of food production and consumption is essential for the idea......, supporting rationality (the best choice), consumers’ self-governance (autonomy) and life coherence (integrity). On a practical level, informed food choice remains an ideal to strive for, as information on food often is inadequate....

  18. Can Food Stamps Do More to Improve Food Choices? An Economic Perspective--Higher Cost of Food in Some Areas May Affect Food Stamp Households' Ability To Make Healthy Food Choices

    Nord, Mark; Hopwood, Heather

    2007-01-01

    The cost of “enough food,” estimated from the amount that low- and medium-income households in a geographic area report needing to spend to just meet their food needs, differs substantially across States and among metropolitan areas. In areas with high food costs, many food-stamp recipients are likely to have inadequate food resources to support healthy food choices.

  19. [GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction].

    Alonso-Coello, Pablo; Schünemann, Holger J; Moberg, Jenny; Brignardello-Petersen, Romina; Akl, Elie A; Davoli, Marina; Treweek, Shaun; Mustafa, Reem A; Rada, Gabriel; Rosenbaum, Sarah; Morelli, Angela; Guyatt, Gordon H; Oxman, Andrew D

    Clinicians, guideline developers, and policymakers sometimes neglect important criteria, give undue weight to criteria, and do not use the best available evidence to inform their judgments. Explicit and transparent systems for decision making can help to ensure that all important criteria are considered and that decisions are informed by the best available research evidence. The GRADE Working Group has developed Evidence to Decision (EtD) frameworks for the different type of recommendations or decisions. The purpose of EtD frameworks is to help people use evidence in a structured and transparent way to inform decisions in the context of clinical recommendations, coverage decisions, and health system or public health recommendations and decisions. EtD frameworks have a common structure that includes formulation of the question, an assessment of the evidence, and drawing conclusions, though there are some differences between frameworks for each type of decision. EtD frameworks inform users about the judgments that were made and the evidence supporting those judgments by making the basis for decisions transparent to target audiences. EtD frameworks also facilitate dissemination of recommendations and enable decision makers in other jurisdictions to adopt recommendations or decisions, or adapt them to their context. This article is a translation of the original article published in British Medical Journal. The EtD frameworks are currently used in the Clinical Practice Guideline Programme of the Spanish National Health System, co-ordinated by GuíaSalud. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    Blanker, M.H.; Koerhuis-Roessink, M.; Swart, S.J.; Zuurmond, W.W.A.; van der Heide, A.; Perez, R.S.G.M.; Rietjens, J.A.C.

    2012-01-01

    Background: Little is known about pressure from patients or relatives on physician's decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using

  1. Workplace Learning in the New Zealand Apple Industry Network: A New Co-Design Method for Government "Practice Making"

    Hill, Roberta; Capper, Phillip; Wilson, Ken; Whatman, Richard; Wong, Karen

    2007-01-01

    Purpose: The purpose of this paper is to describe how, from 2004-2006, a New Zealand research team experimented with the "change laboratory" learning process to create a new method of government policy development and implementation, referred to as "practice-making". The apple industry in Hawke's Bay was chosen because of the…

  2. A Qualitative Analysis of Patients' Perceptions of Shared Decision Making in the Emergency Department: "Let Me Know I Have a Choice".

    Schoenfeld, Elizabeth M; Goff, Sarah L; Downs, Gwendolyn; Wenger, Robert J; Lindenauer, Peter K; Mazor, Kathleen M

    2018-03-25

    Despite increasing attention to the use of shared decision making (SDM) in the emergency department (ED), little is known about ED patients' perspectives regarding this practice. We sought to explore the use of SDM from the perspectives of ED patients, focusing on what affects patients' desired level of involvement and what barriers and facilitators patients find most relevant to their experience. We conducted semistructured interviews with a purposive sample of ED patients or their proxies at two sites. An interview guide was developed from existing literature and expert consensus and based on a framework underscoring the importance of both knowledge and power. Interviews were recorded, transcribed, and analyzed in an iterative process by a three-person coding team. Emergent themes were identified, discussed, and organized. Twenty-nine patients and proxies participated. The mean age of participants was 56 years (range, 20 to 89 years), and 13 were female. Participants were diverse in regard to race/ethnicity, education, number of previous ED visits, and presence of chronic conditions. All participants wanted some degree of involvement in decision making. Participants who made statements suggesting high self-efficacy and those who expressed mistrust of the health care system or previous negative experiences wanted a greater degree of involvement. Facilitators to involvement included familiarity with the decision at hand, physicians' good communication skills, and clearly delineated options. Some participants felt that their own relative lack of knowledge, compared to that of the physicians, made their involvement inappropriate or unwanted. Many participants had no expectation for SDM and although they did want involvement when asked explicitly, they were otherwise likely to defer to physicians without discussion. Many did not recognize opportunities for SDM in their clinical care. This exploration of ED patients' perceptions of SDM suggests that most patients want

  3. Consumer choice : Linking consumer intentions to actual purchase of GM labeled food products

    Sleenhoff, S.; Osseweijer, P.

    2013-01-01

    With a mandatory labeling scheme for GM food in Europe since 2004 measuring actual consumer choice in practice has become possible. Anticipating Europeans negative attitude toward GM food, the labeling was enforced to allow consumers to make an informed choice. We studied consumers actual purchase

  4. Opportunities for Improving Army Modeling and Simulation Development: Making Fundamental Adjustments and Borrowing Commercial Business Practices

    Lee, John

    2000-01-01

    .... This paper briefly explores project management principles, leadership theory, and commercial business practices, suggesting improvements to the Army's modeling and simulation development process...

  5. An Experimental Decision-Making Paradigm to Distinguish Guilt and Regret and Their Self-Regulating Function via Loss Averse Choice Behavior.

    Wagner, Ullrich; Handke, Lisa; Dörfel, Denise; Walter, Henrik

    2012-01-01

    Both guilt and regret typically result from counterfactual evaluations of personal choices that caused a negative outcome and are thought to regulate human decisions by people's motivation to avoid these emotions. Despite these similarities, studies asking people to describe typical situations of guilt and regret identified the social dimension as a fundamental distinguishing factor, showing that guilt but not regret specifically occurs for choices in interpersonal (social) contexts. However, an experimental paradigm to investigate this distinction systematically by inducing emotions of guilt and regret online is still missing. Here, extending existing procedures, we introduce such a paradigm, in which participants choose in each trial between two lotteries, with the outcome of the chosen lottery (gain or loss) being either assigned to themselves (intrapersonal trials) or to another person (interpersonal trials). After results of both the chosen and the unchosen lottery were shown, subjects rated how they felt about the outcome, including ratings of guilt and regret. Trait Guilt (TG) was determined for all participants in order to take their general inclination to experience guilt into account. Results confirmed that guilt but not regret specifically occurred in an interpersonal context. Percentages of loss averse choices (choosing the lottery with the lower possible monetary loss) were determined as indicators of regulation via guilt and regret avoidance. High TG scorers generally made more loss averse choices than low TG scorers, while trial-by-trial analyses showed that low TG scorers used their feelings of guilt more specifically to avoid the same emotional experience in subsequent choices. Our results confirm the social dimension as the critical factor distinguishing guilt from regret and identify TG as an important moderator determining the way in which guilt vs. regret can regulate their own occurrence by influencing choice strategies.

  6. An experimental decision-making paradigm to distinguish guilt and regret and their self-regulating function via loss-averse choice behavior

    Ullrich eWagner

    2012-10-01

    Full Text Available Both guilt and regret typically result from counterfactual evaluations of personal choices that caused a negative outcome and are thought to regulate human decisions by people’s motivation to avoid these emotions. Despite these similarities, studies asking people to describe typical situations of guilt and regret identified the social dimension as a fundamental distinguishing factor, showing that guilt but not regret specifically occurs for choices in interpersonal (social contexts. However, an experimental paradigm to investigate this distinction systematically by inducing emotions of guilt and regret online is still missing. Here, extending existing procedures, we introduce such a paradigm, in which participants choose in each trial between two lotteries, with the outcome of the chosen lottery (gain or loss being either assigned to themselves (intrapersonal trials or to another person (interpersonal trials. After results of both the chosen and the unchosen lottery were shown, subjects rated how they felt about the outcome, including ratings of guilt and regret. Trait Guilt (TG was determined for all participants in order to take their general inclination to experience guilt into account. Results confirmed that guilt but not regret specifically occurred in an interpersonal context. Percentages of loss averse choices (choosing the lottery with the lower possible monetary loss were determined as indicators of regulation via guilt and regret avoidance. High TG scorers generally made more loss averse choices than low TG scorers, while trial-by-trial analyses showed that low TG scorers used their feelings of guilt more specifically to avoid the same emotional experience in subsequent choices. Our results confirm the social dimension as the critical factor distinguishing guilt from regret and identify TG as an important moderator determining the way in which guilt vs. regret can regulate their own occurrence by influencing choice strategies.

  7. An Experimental Decision-Making Paradigm to Distinguish Guilt and Regret and Their Self-Regulating Function via Loss Averse Choice Behavior

    Wagner, Ullrich; Handke, Lisa; Dörfel, Denise; Walter, Henrik

    2012-01-01

    Both guilt and regret typically result from counterfactual evaluations of personal choices that caused a negative outcome and are thought to regulate human decisions by people’s motivation to avoid these emotions. Despite these similarities, studies asking people to describe typical situations of guilt and regret identified the social dimension as a fundamental distinguishing factor, showing that guilt but not regret specifically occurs for choices in interpersonal (social) contexts. However, an experimental paradigm to investigate this distinction systematically by inducing emotions of guilt and regret online is still missing. Here, extending existing procedures, we introduce such a paradigm, in which participants choose in each trial between two lotteries, with the outcome of the chosen lottery (gain or loss) being either assigned to themselves (intrapersonal trials) or to another person (interpersonal trials). After results of both the chosen and the unchosen lottery were shown, subjects rated how they felt about the outcome, including ratings of guilt and regret. Trait Guilt (TG) was determined for all participants in order to take their general inclination to experience guilt into account. Results confirmed that guilt but not regret specifically occurred in an interpersonal context. Percentages of loss averse choices (choosing the lottery with the lower possible monetary loss) were determined as indicators of regulation via guilt and regret avoidance. High TG scorers generally made more loss averse choices than low TG scorers, while trial-by-trial analyses showed that low TG scorers used their feelings of guilt more specifically to avoid the same emotional experience in subsequent choices. Our results confirm the social dimension as the critical factor distinguishing guilt from regret and identify TG as an important moderator determining the way in which guilt vs. regret can regulate their own occurrence by influencing choice strategies. PMID:23133433

  8. ESD practice through global approach -7-year practices of developing science lessen modules and fostering integrated decision making ability-

    Kajiyama, Kosei

    2016-04-01

    Hiroshima University High School (HUHS) has devised and carried out overseas exchange programs on ESD issues for 7 years. These programs have been carried out as a part of a government-aided project called SSH (Super Science High School) *1. To start with, we had cooperative study program with a school in Germany in 2009, and next year with a school in Korea, and then gradually have expanded the cooperative schools. Since 2013, we have worked with schools in four countries; Korea, Thailand, Czech and Germany. Science lesson modules here refers to an assembly of a set of lessons, newly developed and improved for the project. These modules characteristically require the students to make decisions by themselves on given problems. In the course of the decision making, students learn what kind of data or facts should be presented as evidence and how they can make their decisions known to others. Among several modules we have designed, the one introduced here deals with the use of solar energy, which we carried out with a school in Korea in 2014-2015. It also includes lessons of the fuel cells using energy from hydrogen gas generated by solar cells. It aims to develop global human resources through carefully planned activities. First, the students of both schools make mixed groups and conduct experiments in physics, chemistry or biology on a given problem related to solar energy. Then they discuss in groups using data obtained from the experiments and through the Internet as evidence. After the thorough discussion, each group gives a presentation on their decision. The analysis of the presentations and the questionnaire to the students revealed the following points: 1) Students have come to have multidimensional perspectives on the utilization of solar energy. 2) Students have come to combine the results of different experiments when making decisions. 3) Students have developed flexible attitudes toward other cultures. 4) Students have developed communication skills in

  9. Making Connections to Re-engage Young People in Learning: dimensions of practice

    Andrew Chodkiewicz

    2010-08-01

    Full Text Available The education of young people who have previously been excluded from formal education is a field often associated with a high risk of failure – failure for the learners, teachers and the program. In researching the teaching practices in this field, it is tempting for the researcher to do so through the lens of what they perceive as the pedagogical theories that should be informing contemporary practice. In the field of literacy and numeracy education, the social practices approach has gained prominence among researchers who are sympathetic to a socio-cultural study of literacy and numeracy because of its inclusiveness of multiple literacies and numeracies that can be found in different social contexts. This article analyses one of four case studies in a research project on the teaching practices of experienced literacy and numeracy teachers: teaching literacy and numeracy to socially excluded young people in an inner city youth centre. In their research, the authors had to critically challenge their taken for granted assumptions about what a pedagogy informed by a social practices approach to literacy and numeracy should look like. The teaching methods that they observed at the youth centre, while clearly effective – particularly in establishing connections with the learners to form strong relationships of mutual trust -  appeared on the surface to defy some of the key features of a social practices approach. In understanding the apparent contradictions between what the authors had expected to see and what they were seeing, Kemmis’s framework for the study of practice that is based on the notion of practices as reflexive and dialectical proved fruitful. The framework allowed us to interpret both the theory (the social practices approach to literacy and numeracy and the practices at the youth centre in more  nuanced ways that deepened our appreciation of the theory – practice relationship.

  10. Medical Students' vs. Family Physicians' Assessment of Practical and Logical Values of Pathophysiology Multiple-Choice Questions

    Secic, Damir; Husremovic, Dzenana; Kapur, Eldan; Jatic, Zaim; Hadziahmetovic, Nina; Vojnikovic, Benjamin; Fajkic, Almir; Meholjic, Amir; Bradic, Lejla; Hadzic, Amila

    2017-01-01

    Testing strategies can either have a very positive or negative effect on the learning process. The aim of this study was to examine the degree of consistency in evaluating the practicality and logic of questions from a medical school pathophysiology test, between students and family medicine doctors. The study engaged 77 family medicine doctors…

  11. ‘Just a GP’: a mixed method study of undermining of general practice as a career choice in the UK

    Alberti, Hugh; Collingwood, Helen; Merritt, Kymberlee

    2017-01-01

    Objectives Failure to recruit sufficient applicants to general practice (GP) training has been a problem both nationally and internationally for many years and undermining of GP is one possible contributing factor. The aim of our study was to ascertain what comments, both negative and positive, are being made in UK clinical settings to GP trainees about GP and to further explore these comments and their influence on career choice. Methodology We conducted a mixed methods study. We surveyed all foundation doctors and GP trainees within one region of Health Education England regarding any comments they experienced relating to a career in GP. We also conducted six focus groups with early GP trainees to discuss any comments that they experienced and whether these comments had any influence on their or others career choice. Results Positive comments reported by trainees centred around the concept that choosing GP is a positive, family-focused choice which facilities a good work–life balance. Workload was the most common negative comment, alongside the notion of being ‘just a GP’; the belief that GP is boring, a waste of training and a second-class career choice. The reasons for and origin of the comments are multifactorial in nature. Thematic analysis of the focus groups identified key factors such as previous exposure to and experience of GP, family members who were GPs, GP role models, demographics of the clinician and referral behaviour. Trainees perceived that negative comments may be discouraging others from choosing GP as a career. Conclusion Our study demonstrates that negative comments towards GP as a career do exist within clinical settings and are having a potential impact on poor recruitment rates to GP training. We have identified areas in which further negative comments could be prevented by changing perceptions of GP as a career. Additional time spent in GP as undergraduates and postgraduates, and positive GP role models, could particularly benefit

  12. School Nurses' Professional Practice in the HPV Vaccine Decision-Making Process

    Rosen, Brittany L.; Ashwood, Daniel; Richardson, George B.

    2016-01-01

    Because U.S. human papillomavirus (HPV) vaccination rates remain low, we evaluated school nurses' knowledge, attitudes, perceptions of their role as opinion leaders, self-efficacy, intention, and professional practice regarding the HPV vaccine and determined if these variables influenced their professional practice concerning the HPV vaccine. We…

  13. Making framing of uncertainty in water management practice explicit by using a participant-structured approach

    Isendahl, N.; Dewulf, A.; Pahl-Wostl, C.

    2010-01-01

    By now, the need for addressing uncertainty in the management of water resources is widely recognized, yet there is little expertise and experience how to effectively deal with uncertainty in practice. Uncertainties in water management practice so far are mostly dealt with intuitively or based on

  14. Risk and Strategic Decision-Making in Developing Evidence-Based Practice Guidelines

    Wilczynski, Susan M.

    2012-01-01

    Evidence-based practice (EBP) represents an important approach to educating and treating individuals diagnosed with disabilities or disorders. Understanding research findings is the cornerstone of EBP. The methodology of systematic reviews, which involves carefully analyzing research findings, can result a practice guideline that recommends…

  15. EFL Teachers' Beliefs/Practices Correspondence in Reading Instruction: Does Language Teacher Education Make a Difference?

    Karimi, Mohammad Nabi; Dehghani, Asieh

    2016-01-01

    The present study examined EFL teachers' theoretical orientations towards reading, their reading instructional practices and the correspondence between the theoretical orientations/practices. The study participants were 80 male and female Iranian EFL teachers teaching at a number of private English language institutes. Half of the teachers were…

  16. Translating shared decision-making into health care clinical practices: Proof of concepts.

    Legare, F.; Elwyn, G.; Fishbein, M.; Fremont, P.; Frosch, D.; Gagnon, M.P.; Kenny, D.A.; Labrecque, M.; Stacey, D.; St-Jacques, S.; Weijden, G.D.E.M. van der

    2008-01-01

    ABSTRACT: BACKGROUND: There is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal

  17. Shifting the Focus: Children's Image-Making Practices and Their Implications for Analysis

    Lomax, Helen Jayne

    2012-01-01

    This paper provides analytic focus on the productive and editorial contexts of children and young people's image-making, making visible its implications for the analysis of photographs. Drawing on participatory research in which children and young people worked alongside researchers to create a visual narrative of their lived experiences of…

  18. The Practices and Politics of Making Policy: Irrigation Management Transfer in Mexico

    Rap, E.R.; Wester, P.

    2013-01-01

    This article argues that policy making is an interactive and ongoing process that transcends the spatio-temporal boundaries drawn by a linear, rational or instrumental model of policy. We construct this argument by analysing the making of the Irrigation Management Transfer (IMT) policy in Mexico in

  19. Prerequisites for data-based decision making in the classroom: Research evidence and practical illustrations

    Hoogland, Inge; Schildkamp, Kim; van der Kleij, Fabienne; Heitink, Maaike Christine; Kippers, Wilma Berdien; Veldkamp, Bernard P.; Dijkstra, Anne M.

    2016-01-01

    Data-based decision making can lead to increased student learning. The desired effects of increased student learning can only be realized if data-based decision making is implemented successfully. Therefore, a systematic literature review was conducted to identify prerequisites of such successful

  20. Decision-making in general practice: the effect of financial incentives on the use of laboratory analyses.

    Munkerud, Siri Fauli

    2012-04-01

    This paper examines the reaction of general practitioners (GPs) to a reform in 2004 in the remuneration system for using laboratory services in general practice. The purpose of this paper is to study whether income motivation exists regarding the use of laboratory services in general practice, and if so, the degree of income motivation among general practitioners (GPs) in Norway. We argue that the degree of income motivation is stronger when the physicians are uncertain about the utility of the laboratory service in question. We have panel data from actual physician-patient encounters in general practices in the years 2001-2004 and use discrete choice analysis and random effects models. Estimation results show that an increase in the fees will lead to a small but significant increase in use. The reform led to minor changes in the use of laboratory analyses in GPs' offices, and we argue that financial incentives were diluted because they were in conflict with medical recommendations and existing medical practice. The patient's age has the most influence and the results support the hypothesis that the impact of income increases with increasing uncertainty about diagnosis and treatment. The policy implication of our results is that financial incentives alone are not an effective tool for influencing the use of laboratory services in GPs' offices.