ResearchPad - decision-making https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[What makes an effective grants peer reviewer? An exploratory study of the necessary skills]]> https://www.researchpad.co/article/elastic_article_13869 This exploratory mixed methods study describes skills required to be an effective peer reviewer as a member of review panels conducted for federal agencies that fund research, and examines how reviewer experience and the use of technology within such panels impacts reviewer skill development. Two specific review panel formats are considered: in-person face-to-face and virtual video conference. Data were collected through interviews with seven program officers and five expert peer review panelists, and surveys from 51 respondents. Results include the skills reviewers’ consider necessary for effective review panel participation, their assessment of the relative importance of these skills, how they are learned, and how review format affects skill development and improvement. Results are discussed relative to the peer review literature and with consideration of the importance of professional skills needed by successful scientists and peer reviewers.

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<![CDATA[Women’s empowerment as self-compassion?: Empirical observations from  India]]> https://www.researchpad.co/article/elastic_article_13876 Although ICPD brought about an international consensus on the centrality of women’s empowerment and gender equity as desired national goals, the conceptualization and measurement of empowerment in demography and economics have been largely understood in a relational and in a family welfare context where women’s altruistic behaviour within the household is tied either to developmental or child health outcomes. The goals of this study were twofold: (1) to offer an empirical examination of the household level empowerment measure through the theoretical construct of self-compassion and investigate its association with antenatal health, and (2) to ensure robust psychometric quality for this new measure. Drawing data from the nationally representative, multi-topic dataset of 42, 152 households, India Human Development Survey, IHDS II (2011–2012), the study performed a confirmatory factor analysis followed by an OLS estimation to investigate the association between a self-compassionate based empowerment and antenatal care. Empowerment was shown to be positively and significantly associated with antenatal care with significant age and education gradient. A woman’s married status, her relation to the household head and joint family residence created conditions of restricted freedom in terms of her mobility, decision making and sociality. The empowerment measure showed inconsistent associations with social group affiliations and household wealth. The study provided an intellectual starting point to rethink the traditional formulations of empowerment by foregrounding its empirical measure within the relatively unexplored area of social psychology. In the process it addressed measurement gaps in the empowerment-health debate in India and beyond.

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<![CDATA[Breeding practices and trait preferences of smallholder farmers for indigenous sheep in the northwest highlands of Ethiopia: Inputs to design a breeding program]]> https://www.researchpad.co/article/elastic_article_7865 The aim of this study was to identify breeding practices and trait preferences for indigenous sheep in three districts (Estie, Farta and Lay Gayient) located in the northwest highlands of Ethiopia. Questionnaire survey and choice experiment methods were used to collect data from 370 smallholder farmers. Respondents were selected randomly among smallholder farmers who own sheep in the aforementioned districts. A generalized multinomial logit model was employed to examine preferences for sheep attributes, while descriptive statistics and index values were computed to describe sheep breeding practices. Having the highest index value of 0.36, income generation was ranked as the primary reason for keeping sheep, followed by meat and manure sources. The average flock size per smallholder farmer was 10.21 sheep. The majority of the smallholder farmers (91%) have the experience of selecting breeding rams and ewes within their own flock using diverse criteria. Given the highest index value of 0.34, body size was ranked as a primary ram and ewe selection criteria, followed by coat color. Furthermore, choice modeling results revealed that tail type, body size, coat color, growth rate, horn and ear size have shown significant influences on smallholder farmers’ preference for breeding rams (P<0.01). The part-worth utility coefficients were positive for all ram attributes except ear size. For breeding ewes, mothering ability, coat color, body size, lambing interval, growth rate, tail type and litter size have shown significant effects on choice preferences of smallholder farmers (P<0.05). Moreover, significant scale heterogeneity was observed among respondents for ewe attributes (P<0.001). Overall, the results implied that sheep breeding objectives suitable for the northwest highlands of the country can be derived from traits such as linear body measurement, weight and survival at different ages, and lambing intervals. However, selection decisions at the smallholder level should not only be based on estimated breeding values of traits included in the breeding objective but instead, incorporate ways to address farmers’ preference for qualitative traits.

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<![CDATA[Juvenile hormone suppresses aggregation behavior through influencing antennal gene expression in locusts]]> https://www.researchpad.co/article/elastic_article_7742 A behavioral change from shy solitarious individuals to highly social gregarious individuals is critical to the formation of disastrous swarms of locusts. However, the underlying molecular mechanism of behavioral plasticity regulated by hormones is still largely unknown. Here, we investigated the effect of juvenile hormone (JH) on the behavioral transition in fourth-instar gregarious and solitarious locusts. We found that JH induced the behavioral shift of the gregarious locust from attraction to repulsion to the volatiles of gregarious locusts. The solitarious locust significantly decreased repulsion behavior after deprivation of JH by precocene or knockdown of JHAMT, a key enzyme to synthesize JH. JH application on gregarious locusts caused significant expression alteration of genes, especially the olfactory genes TO and CSP in the antennae. We further demonstrated that the JH signaling pathway suppressed aggregation behavior in gregarious locusts by increasing TO1 expression and decreasing CSP3 expression at the same time. Our results suggested that internal physiological factors can directly modulate periphery olfactory system to produce behavioral plasticity.

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<![CDATA[Partition dependence in financial aid distribution to income categories]]> https://www.researchpad.co/article/N0611b39b-d559-4542-a5d9-a69c54a62df4

When allocating resources, people often diversify across categories even when those categories are arbitrary, such that allocations differ when identical sets of options are partitioned differently (“partition dependence”). The first goal of the present work (Experiment 1) was to replicate an experiment by Fox and colleagues in which graduate students exhibited partition dependence when asked how university financial aid should be allocated across arbitrarily partitioned income brackets. Our sample consisted of community members at a liberal arts college where financial aid practices have been recent topics of debate. Because stronger intrinsic preferences can reduce partition dependence, these participants might display little partition dependence with financial aid allocations. Alternatively, a demonstration of strong partition dependence in this population would emphasize the robustness of the effect. The second goal was to extend a “high transparency” modification to the present task context (Experiment 2) in which participants were shown both possible income partitions and randomly assigned themselves to one, to determine whether partition dependence in this paradigm would be reduced by revealing the study design (and the arbitrariness of income categories). Participants demonstrated clear partition dependence in both experiments. Results demonstrate the robustness of partition dependence in this context.

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<![CDATA[Multiple criteria decision analysis approach to consider therapeutic innovations in the emergency department: The methoxyflurane organizational impact in acute trauma pain]]> https://www.researchpad.co/article/N48fe9543-bf7a-4bb3-b7f3-098351efee5f

Background

Acute trauma pain is poorly managed in the emergency department (ED). The reasons are partly organizational: ED crowding and rare trauma care pathways contribute to oligoanalgesia. Anticipating the organizational impact of an innovative care procedure might facilitate the decision-making process and help to optimize pain management.

Methods

We used a multiple criteria decision analysis (MCDA) approach to consider the organizational impact of methoxyflurane (self-administered) in the ED, introduced alone or supported by a trauma care pathway. A MCDA experiment was designed for this specific context, 8 experts in emergency trauma care pathways (leading physicians and pharmacists working in French urban tertiary hospitals) were recruited. The study involved four steps: (i) Selection of organizational criteria for evaluating the innovation’s impact; (ii) assessment of the relative weight of each criterion; (iii) choice of appropriate scenarios for exploring the organizational impact of MEOX under various contexts; and (iv) software-assisted simulation based on pairwise comparisons of the scenarios. The final outcome measure was the expected overall organizational impact of methoxyflurane on a 0-to-100 scale (score >50: positive impact).

Results

Nine organizational criteria were selected. "Mean length of stay in the ED" was the most weighted. Methoxyflurane alone obtained 59 as a total score, with a putative positive impact for eight criteria, and a neutral effect on one. When a trauma care pathway was introduced concomitantly, the impact of methoxyflurane was greater overall (score: 75) and for each individual criterion.

Conclusions

Our model highlighted the putative positive organizational impact of methoxyflurane in the ED—particularly when supported by a trauma care pathway—and the relevance of expert consensus in this particular pharmacoeconomic context. The MCDA approach could be extended to other research fields and healthcare challenges in emergency medicine.

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<![CDATA[Potential of ToxCast Data in the Safety Assessment of Food Chemicals]]> https://www.researchpad.co/article/N3a66523b-8c4d-46ea-8b75-3f46acbd132f

Abstract

Tox21 and ToxCast are high-throughput in vitro screening programs coordinated by the U.S. National Toxicology Program and the U.S. Environmental Protection Agency, respectively, with the goal of forecasting biological effects in vivo based on bioactivity profiling. The present study investigated whether mechanistic insights in the biological targets of food-relevant chemicals can be obtained from ToxCast results when the chemicals are grouped according to structural similarity. Starting from the 556 direct additives that have been identified in the ToxCast database by Karmaus et al. [Karmaus, A. L., Trautman, T. D., Krishan, M., Filer, D. L., and Fix, L. A. (2017). Curation of food-relevant chemicals in ToxCast. Food Chem. Toxicol.103, 174–182.], the results showed that, despite the limited number of assays in which the chemical groups have been tested, sufficient results are available within so-called “DNA binding” and “nuclear receptor” target families to profile the biological activities of the defined chemical groups for these targets. The most obvious activity identified was the estrogen receptor-mediated actions of the chemical group containing parabens and structurally related gallates, as well the chemical group containing genistein and daidzein (the latter 2 being particularly active toward estrogen receptor β as a potential health benefit). These group effects, as well as the biological activities of other chemical groups, were evaluated in a series of case studies. Overall, the results of the present study suggest that high-throughput screening data could add to the evidence considered for regulatory risk assessment of food chemicals and to the evaluation of desirable effects of nutrients and phytonutrients. The data will be particularly useful for providing mechanistic information and to fill data gaps with read-across.

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<![CDATA[Bioelution, Bioavailability, and Toxicity of Cobalt Compounds Correlate]]> https://www.researchpad.co/article/N70e8f1bc-e6b3-422e-8398-4331d7c3521a

Abstract

Based on the wide use of cobalt substances in a range of important technologies, it has become important to predict the toxicological properties of new or lesser-studied substances as accurately as possible. We studied a group of 6 cobalt substances with inorganic ligands, which were tested for their bioaccessibility (surrogate measure of bioavailability) through in vitro bioelution in simulated gastric and intestinal fluids. Representatives of the group also underwent in vivo blood kinetics and mass balance tests, and both oral acute and repeated dose toxicity (RDT) testing. We were able to show a good correlation between high in vitro bioaccessibility with high in vivo bioavailability and subsequent high in vivo toxicity; consequently, low in vitro bioaccessibility correlated well with low in vivo bioavailability and low in vivo toxicity. In vitro bioelution in simulated gastric fluid was the most precise predictor of the difference in the oral RDT lowest observed adverse effect levels of 2 compounds representing the highly and poorly bioaccessible subset of substances. The 2 compounds cobalt dichloride hexahydrate and tricobalt tetraoxide differed by a factor of 440 in their in vitro bioaccessibility and by a factor of 310 in their RDT lowest observed adverse effect level. In summary, this set of studies shows that solubility, specifically in vitro bioelution in simulated gastric fluid, is a good, yet conservative, predictor of in vivo bioavailability and oral systemic toxicity of inorganic cobalt substances. Bioelution data are therefore an invaluable tool for grouping and read across of cobalt substances for hazard and risk assessment.

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<![CDATA[Altruistic decisions are influenced by the allocation of monetary incentives in a pain-sharing game]]> https://www.researchpad.co/article/5c897771d5eed0c4847d2ce9

Background

Altruistic behavior is essential to the sustainability of society, but our current understanding of its underlying motivation is limited. In addition to the intrinsic motives to help others, based on empathy, extrinsic motives such as monetary incentives and social reputation influence prosociality. The purpose of this study was to examine the underlying motivations of prosocial behavior under constant or increasing extrinsic motivation settings.

Methods

An experimental task, Altruistic Pain Sharing, was developed in which the participants were asked to share the other participants’ pain. In the session with monetary incentives, the incentives were given either constantly (CONSTANT condition) or proportionally (INCREASING condition), to the amount of shared pain. In addition, monetary incentives were not provided in the NO session. The participants experienced different amounts of mechanical pain at the beginning of the task and chose the number of pain stimulations to share, based on their experiences.

Results

Compared to the NO session, the INCREASING session exhibited a rise in the mean of shared pain, but not the CONSTANT session. Furthermore, there was a distinct tendency to receive less pain than the other participant in the CONSTANT session, and a tendency to receive more pain than the other participant in the INCREASING session.

Conclusion

Prosocial behavior was influenced by the presence, as well as the form, of the extrinsic monetary incentives. Our study shows that rewards incentivize individuals to demonstrate a higher level of prosocial behavior, implying that prosocial behavior is itself a mixture of intrinsic and extrinsic motivations, and that an effectively designed rewards system may function to enhance prosocial behavior.

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<![CDATA[Microlearning for patient safety: Crew resource management training in 15-minutes]]> https://www.researchpad.co/article/5c8accebd5eed0c4849902fc

Objectives

We sought to establish the feasibility of chunking crew resource management (CRM) training into micro-size interventions and to compare different training approaches in the context of micro-learning.

Design

We evaluated whether participants in micro-learning CRM activities achieved learning objectives following training. In a between-subjects design, groups were observed for behaviour during a simulation that was part of a 15-minute modular intervention and tested for recollection afterwards.

Participants

The 129 participants recruited for this study were medical students, who already had relevant experience treating patients.

Interventions

The experimental setting involved three 5-minute components: video, simulation, and debriefing. Different groups viewed videos involving different didactic concepts: one group observed a videotaped concrete example of a medical care team applying a CRM tool (example group), and one group observed a videotaped lecture on the same topic (lecture group).

Main outcome measures

All simulations were videotaped and coded in detail for the occurrence of and time spent engaging in team behaviour and medical care. Questionnaires were administered before, immediately after, and two weeks after the intervention. We compared the groups’ behaviour during the simulation (team cooperation and medical care), retention of knowledge from the training content, and results of the evaluation.

Results

Both groups exhibited most of the behaviours included in the content of the instructional videos during the simulations and recollected information 2 weeks later. The example group exhibited significantly more of the training content during the simulation and demonstrated better retention 2 weeks later. Although the example group spent more time on team coordination, there was no difference in the number of executed medical measures.

Conclusion

Delivering CRM training in chunks of relatively short and highly standardised interventions appears feasible. In this study, the form of didactical presentation caused a difference in learning success between groups: a traditional lecture was outperformed by an instructional video demonstrating a practical example.

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<![CDATA[Cyborg groups enhance face recognition in crowded environments]]> https://www.researchpad.co/article/5c89773bd5eed0c4847d2790

Recognizing a person in a crowded environment is a challenging, yet critical, visual-search task for both humans and machine-vision algorithms. This paper explores the possibility of combining a residual neural network (ResNet), brain-computer interfaces (BCIs) and human participants to create “cyborgs” that improve decision making. Human participants and a ResNet undertook the same face-recognition experiment. BCIs were used to decode the decision confidence of humans from their EEG signals. Different types of cyborg groups were created, including either only humans (with or without the BCI) or groups of humans and the ResNet. Cyborg groups decisions were obtained weighing individual decisions by confidence estimates. Results show that groups of cyborgs are significantly more accurate (up to 35%) than the ResNet, the average participant, and equally-sized groups of humans not assisted by technology. These results suggest that melding humans, BCI, and machine-vision technology could significantly improve decision-making in realistic scenarios.

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<![CDATA[Implementing the INTERGROWTH-21st gestational dating and fetal and newborn growth standards in peri-urban Nairobi, Kenya: Provider experiences, uptake and clinical decision-making]]> https://www.researchpad.co/article/5c8c1980d5eed0c484b4d7dd

Background

Perinatal and newborn complications are major risk factors for unfavorable fetal and neonatal outcomes. Gestational dating and growth monitoring can be instrumental in the identification and management of high-risk pregnancies and births. The INTERGROWTH-21st Project developed the first global standards for gestational dating and fetal and newborn growth monitoring, supplying a toolkit for clinicians. This study aimed to assess the feasibility and acceptability of the first known implementation study of these standards in a low resource setting.

Methods

The study was performed in two 12-month phases from March 2016 to March 2018 at Jacaranda Health, a private maternity hospital in peri-urban Nairobi, Kenya. In-depth interviews, focus group discussions and a provider survey were utilized to evaluate providers’ experiences during implementation. Client chart data, for pregnant women attending antenatal care and/or delivering at Jacaranda Health along with their newborns, were captured to assess uptake and effect of the standards on clinical decision-making.

Results

Facility-level support and provider buy-in proved to be critical factors driving the success of implementing the standards. However, additional support was needed to strengthen capacity to conduct and interpret ultrasounds and maintain motivation among providers. We observed a significant increase in the uptake of obstetric ultrasounds, particularly gestational dating, during the implementation of the standards. Although no significant changes were detected in the identification of high-risk pregnancies, referrals and deliveries by Cesarean section during implementation, we did observe a significant reduction in inductions for post-date. No significant barriers were reported regarding the use of the newborn standards. Over 80% of providers advocated for the standards to remain in place with some enhancements related mainly to training, advocacy and procurement.

Conclusions

The findings are timely with increasing global adoption of the standards and the challenging and multi-faceted nature of translating new, evidence-based guidelines into routine clinical practice.

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<![CDATA[Variable weights theory and its application to multi-attribute group decision making with intuitionistic fuzzy numbers on determining decision maker’s weights]]> https://www.researchpad.co/article/5c89771bd5eed0c4847d2486

The determination of the weights of decision makers (DMs) is an important problem in multi-attribute group decision making. Many approaches have been presented to determine DMs’ weights. However, the computed weight vectors of DMs are usually assumed to be constant in existing studies, and this may cause irrationalities in the decision results. Therefore, this article proposes a novel method to determine DMs’ weights based on variable weights theory in which the evaluation information is described as intuitionistic fuzzy sets (IFSs). First, DMs provide their assessment with IFSs, and the intuitionistic fuzzy weighted averaging (IFWA) operator is applied to obtain weighted decision matrix based on the prior given DMs’ and attributes’ weights. Second, the DMs’ weights are obtained based on variable weights theory, and an alternative decision can be computed. Finally, the converted value of the achieved IFS of each alternative is calculated, and the best appropriate alternative is acquired. Two illustrative examples and the comparisons with exsiting approaches are also used to reflect the effectiveness of the proposed approach.

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<![CDATA[Determining the exact location of a public bicycle station—The optimal distance between the building entrance/exit and the station]]> https://www.researchpad.co/article/5c76fe3ed5eed0c484e5b76e

As a sustainable mode of transportation, public bicycles significantly improve daily mobility. The location of stations is a key element for the success of a public bicycle system, as a long walking distance will reduce people’s willingness to use this mode of transportation. Building forms in China are different from the open type seen abroad. Many residential, office and school areas are enclosed by walls, and pedestrian flow is concentrated at the entrances/exits of these areas. Therefore, the station must be located close to the building entrance/exit. Previous studies on station location located the stations only per zone, without providing the exact locations of the stations in the zones. This paper considers the optimal distance between the building entrance/exit and the station to determine the exact station locations. The results can serve as a reference for the planning and optimization of public bicycle stations. A questionnaire survey was conducted in Beijing to determine users’ walking distances to the stations. The results indicated that the walking distance decay laws of stations were different for different land uses. Moreover, a binary logistic model was developed to verify that users with different travel purposes have different walking distances. Based on the above results, we explored the optimal distances and tolerable distances between the building entrance/exit and the station for different land uses. These distances can be used to determine exact station locations to meet users’ physiological and psychological needs.

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<![CDATA[Applications of artificial neural networks in health care organizational decision-making: A scoping review]]> https://www.researchpad.co/article/5c75ac5bd5eed0c484d08619

Health care organizations are leveraging machine-learning techniques, such as artificial neural networks (ANN), to improve delivery of care at a reduced cost. Applications of ANN to diagnosis are well-known; however, ANN are increasingly used to inform health care management decisions. We provide a seminal review of the applications of ANN to health care organizational decision-making. We screened 3,397 articles from six databases with coverage of Health Administration, Computer Science and Business Administration. We extracted study characteristics, aim, methodology and context (including level of analysis) from 80 articles meeting inclusion criteria. Articles were published from 1997–2018 and originated from 24 countries, with a plurality of papers (26 articles) published by authors from the United States. Types of ANN used included ANN (36 articles), feed-forward networks (25 articles), or hybrid models (23 articles); reported accuracy varied from 50% to 100%. The majority of ANN informed decision-making at the micro level (61 articles), between patients and health care providers. Fewer ANN were deployed for intra-organizational (meso- level, 29 articles) and system, policy or inter-organizational (macro- level, 10 articles) decision-making. Our review identifies key characteristics and drivers for market uptake of ANN for health care organizational decision-making to guide further adoption of this technique.

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<![CDATA[Structured reporting of prostate magnetic resonance imaging has the potential to improve interdisciplinary communication]]> https://www.researchpad.co/article/5c75abfdd5eed0c484d07f7d

Background

Effective interdisciplinary communication of imaging findings is vital for patient care, as referring physicians depend on the contained information for the decision-making and subsequent treatment. Traditional radiology reports contain non-structured free text and potentially tangled information in narrative language, which can hamper the information transfer and diminish the clarity of the report. Therefore, this study investigates whether newly developed structured reports (SRs) of prostate magnetic resonance imaging (MRI) can improve interdisciplinary communication, as compared to non-structured reports (NSRs).

Methods

50 NSRs and 50 SRs describing a single prostatic lesion were presented to four urologists with expert level experience in prostate cancer surgery or targeted MRI TRUS fusion biopsy. They were subsequently asked to plot the tumor location in a 2-dimensional prostate diagram and to answer a questionnaire focusing on information on clinically relevant key features as well as the perceived structure of the report. A validated scoring system that distinguishes between “major” and “minor” mistakes was used to evaluate the accuracy of the plotting of the tumor position in the prostate diagram.

Results

The mean total score for accuracy for SRs was significantly higher than for NSRs (28.46 [range 13.33–30.0] vs. 21.75 [range 0.0–30.0], p < 0.01). The overall rates of major mistakes (54% vs. 10%) and minor mistakes (74% vs. 22%) were significantly higher (p < 0.01) for NSRs than for SRs. The rate of radiologist re-consultations was significantly lower (p < 0.01) for SRs than for NSRs (19% vs. 85%). Furthermore, SRs were rated as significantly superior to NSRs in regard to determining the clinical tumor stage (p < 0.01), the quality of the summary (4.4 vs. 2.5; p < 0.01), and overall satisfaction with the report (4.5 vs. 2.3; p < 0.01), and as more valuable for further clinical decision-making and surgical planning (p < 0.01).

Conclusions

Structured reporting of prostate MRI has the potential to improve interdisciplinary communication. Through SRs, expert urologists were able to more accurately assess the exact location of single prostate cancer lesions, which can facilitate surgical planning. Furthermore, structured reporting of prostate MRI leads to a higher satisfaction level of the referring physician.

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<![CDATA[Orangutans (Pongo abelii) make flexible decisions relative to reward quality and tool functionality in a multi-dimensional tool-use task]]> https://www.researchpad.co/article/5c6dca02d5eed0c48452a6b6

Making economic decisions in a natural foraging situation that involves the use of tools may require an animal to consider more levels of relational complexity than merely deciding between an immediate and a delayed food option. We used the same method previously used with Goffin´s cockatoos to investigate the orangutans’ flexibility for making the most profitable decisions when confronted with five different settings that included one or two different apparatuses, two different tools and two food items (one more preferred than the other). We found that orangutans made profitable decisions relative to reward quality, when the task required the subjects to select a tool over an immediately accessible food reward. Furthermore, most subjects were sensitive to work-effort when the immediate and the delayed option (directly accessible by using a tool) led to the same outcome. Most subjects continued to make profitable decisions that required taking into account the tool functionality. In a final multidimensional task design in which subjects had to simultaneously focus on two apparatuses, two reward qualities and two different tools, the orangutans chose the functional tool to access the high quality reward.

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<![CDATA[The growing pains of physician-administration relationships in an academic medical center and the effects on physician engagement]]> https://www.researchpad.co/article/5c6dc9c0d5eed0c48452a138

Background

Physician engagement has become a key metric for healthcare leadership and is associated with better healthcare outcomes. However, engagement tends to be low and difficult to measure and improve. This study sought to efficiently characterize the professional cultural dynamics between physicians and administrators at an academic hospital and how those dynamics affect physician engagement.

Materials and methods

A qualitative mixed methods analysis was completed in 6 weeks, consisting of a preliminary analysis of the hospital system’s history that was used to purposefully recruit 20 physicians across specialties and 20 healthcare administrators across management levels for semi-structured interviews and observation. Participation rates of 77% (20/26) and 83% (20/24) were achieved for physicians and administrators, respectively. Cohorts consisted of equal numbers of men and women with experience ranging from 1 to 35 years within the organization. Field notes and transcripts were systematically analyzed using an iterative inductive-deductive approach. Emergent themes were presented and discussed with approximately 400 physicians and administrators within the organization to assess validity and which results were most meaningful.

Results & discussion

This investigation indicated a professional cultural disconnect was undermining efforts to improve physician engagement. This disconnect was further complicated by a minority (10%) not believing an issue existed and conflicting connotations not readily perceived by participants who often offered similar solutions. Physicians and administrators felt these results accurately reflected their realities and used this information as a common language to plan targeted interventions to improve physician engagement. Limitations of the study included its cross-sectional nature with a modest sample size at a single institution.

Conclusions

A qualitative mixed methods analysis efficiently identified professional cultural barriers within an academic hospital to serve as an institution-specific guide to improving physician engagement.

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<![CDATA[Investigating pathways linking women’s status and empowerment to skilled attendance at birth in Tanzania: A structural equation modeling approach]]> https://www.researchpad.co/article/5c6dc9cbd5eed0c48452a1e8

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa where use of a skilled birth attendant (SBA) at delivery has remained low. Despite the recognized importance of women’s empowerment as a key determinant of maternal and newborn health, evidence from sub-Saharan Africa is more limited. Using data from the 2010 Tanzania Demographic and Health Survey (n = 4,340), this study employs a robust method–structural equation modeling (SEM)–to investigate the complex and multidimensional pathways through which women’s empowerment affects SBA use. The results show that women’s education and household decision-making are positively associated with SBA use. However, not all empowerment dimensions have similar effects. Attitudes towards sex negotiation and violence as well as early marriage are not significant factors in Tanzania. Mediation analysis also confirms the indirect effect of education on SBA use only through household decision-making. The findings underscore the utility of structural equation modeling when examining complex and multidimensional constructs, such as empowerment, and demonstrate potential causal inference to better inform policy and programmatic recommendations.

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<![CDATA[Predicting change: Approximate inference under explicit representation of temporal structure in changing environments]]> https://www.researchpad.co/article/5c5ca27ed5eed0c48441e4cc

In our daily lives timing of our actions plays an essential role when we navigate the complex everyday environment. It is an open question though how the representations of the temporal structure of the world influence our behavior. Here we propose a probabilistic model with an explicit representation of state durations which may provide novel insights in how the brain predicts upcoming changes. We illustrate several properties of the behavioral model using a standard reversal learning design and compare its task performance to standard reinforcement learning models. Furthermore, using experimental data, we demonstrate how the model can be applied to identify participants’ beliefs about the latent temporal task structure. We found that roughly one quarter of participants seem to have learned the latent temporal structure and used it to anticipate changes, whereas the remaining participants’ behavior did not show signs of anticipatory responses, suggesting a lack of precise temporal expectations. We expect that the introduced behavioral model will allow, in future studies, for a systematic investigation of how participants learn the underlying temporal structure of task environments and how these representations shape behavior.

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