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Sample records for affect treatment decisions

  1. Physician, Patient and Contextual Factors Affecting Treatment Decisions in Older Adults with Cancer: A Literature Review

    PubMed Central

    Tariman, J. D.; Berry, D. L.; Cochrane, B.; Doorenbos, A.; Schepp, K.

    2010-01-01

    Purpose/Objectives To review physician, patient, and contextual factors that affect treatment decision-making in older adults diagnosed with cancer and relate these factors to theoretical models of decision-making. Data Sources PubMed (1966-April 2010), PsycINFO (1967-April 2010) and CINAHL (1982-April 2010) databases were searched to access relevant medical, psychological and nursing literature. Data Synthesis Physician factors in treatment decisions include physician personal beliefs and values, expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors include personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors include availability of caregiver, lack of insurance, poor financial status, and geographical barrier. The interplay of physician, patient, and contextual factors are not well understood. Existing models of decision-making are not sufficient to explicate TDM process in older adults diagnosed with cancer. Conclusions Clinical studies in older adult patient population using a longitudinal and prospective design are needed to examine real-time interplay of patient, physician, and contextual factors and to better understand how these divergent factors influenced actual treatment decisions. Implications for Nursing Oncology nurses can advocate for a patient’s autonomy during TDM by coaching them to seek evidence-based discussion of various treatment options, benefits and risks assessments, and truthful discussion of the probability of success for each treatment option from their physicians. Oncology nurses must promote an informed treatment decisions that are consistent with a patient’s personal preference and values within the limits of the patient’s personal contexts. PMID:22201670

  2. How decision reversibility affects motivation.

    PubMed

    Bullens, Lottie; van Harreveld, Frenk; Förster, Jens; Higgins, Tory E

    2014-04-01

    The present research examined how decision reversibility can affect motivation. On the basis of extant findings, it was suggested that 1 way it could affect motivation would be to strengthen different regulatory foci, with reversible decision making, compared to irreversible decision making, strengthening prevention-related motivation relatively more than promotion-related motivation. If so, then decision reversibility should have effects associated with the relative differences between prevention and promotion motivation. In 5 studies, we manipulated the reversibility of a decision and used different indicators of regulatory focus motivation to test these predictions. Specifically, Study 1 tested for differences in participants' preference for approach versus avoidance strategies toward a desired end state. In Study 2, we used speed and accuracy performance as indicators of participants' regulatory motivation, and in Study 3, we measured global versus local reaction time performance. In Study 4, we approached the research question in a different way, making use of the value-from-fit hypothesis (Higgins, 2000, 2002). We tested whether a fit between chronic regulatory focus and focus induced by the reversibility of the decision increased participants' subjective positive feelings about the decision outcome. Finally, in Study 5, we tested whether regulatory motivation, induced by decision reversibility, also influenced participants' preference in specific product features. The results generally support our hypothesis showing that, compared to irreversible decisions, reversible decisions strengthen a prevention focus more than a promotion focus. Implications for research on decision making are discussed. PMID:23815456

  3. Models of Affective Decision Making

    PubMed Central

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

    2016-01-01

    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. PMID:27071751

  4. Economic Choices. Political Decisions that Affect You.

    ERIC Educational Resources Information Center

    Fritsche, Joellen M.; And Others

    The purpose of this book is to help students understand why the U.S. Government is involved in the economy, the underlying social values that government tries to promote, and how U.S. economic decisions affect the global economy. It was designed to give them the background they need to form their own opinions about the role of government in the…

  5. Factors, Correlates, Emotional Barriers Affecting Career Decisions of College Students.

    ERIC Educational Resources Information Center

    O'Neil, James M.; And Others

    The correlates of career choice and the problem areas affecting career decisions are important to counseling psychologists. They are important to understanding the complexities of vocational behavior, facilitating differential treatment in counseling, and developing preventive career programs for men, women, and special groups. The effects of the…

  6. Bayesian Decision Support for Adaptive Lung Treatments

    NASA Astrophysics Data System (ADS)

    McShan, Daniel; Luo, Yi; Schipper, Matt; TenHaken, Randall

    2014-03-01

    Purpose: A Bayesian Decision Network will be demonstrated to provide clinical decision support for adaptive lung response-driven treatment management based on evidence that physiologic metrics may correlate better with individual patient response than traditional (population-based) dose and volume-based metrics. Further, there is evidence that information obtained during the course of radiation therapy may further improve response predictions. Methods: Clinical factors were gathered for 58 patients including planned mean lung dose, and the bio-markers IL-8 and TGF-β1 obtained prior to treatment and two weeks into treatment along with complication outcomes for these patients. A Bayesian Decision Network was constructed using Netica 5.0.2 from Norsys linking these clinical factors to obtain a prediction of radiation induced lung disese (RILD) complication. A decision node was added to the network to provide a plan adaption recommendation based on the trade-off between the RILD prediction and complexity of replanning. A utility node provides the weighting cost between the competing factors. Results: The decision node predictions were optimized against the data for the 58 cases. With this decision network solution, one can consider the decision result for a new patient with specific findings to obtain a recommendation to adaptively modify the originally planned treatment course. Conclusions: A Bayesian approach allows handling and propagating probabilistic data in a logical and principled manner. Decision networks provide the further ability to provide utility-based trade-offs, reflecting non-medical but practical cost/benefit analysis. The network demonstrated illustrates the basic concept, but many other factors may affect these decisions and work on building better models are being designed and tested. Acknowledgement: Supported by NIH-P01-CA59827

  7. Parental involvement in paediatric cancer treatment decisions

    PubMed Central

    McKenna, K; Collier, J; Hewitt, M; Blake, H

    2010-01-01

    This study investigated parents' information needs and involvement in decision-making processes affecting the care of children diagnosed with cancer. Interviews and questionnaires were used to assess parental satisfaction in 50 mothers and 16 fathers responsible for 58 children in an English Paediatric Oncology Unit. Parents reported that doctors contributed almost twice as much to the decision-making process as they did, but parental satisfaction was positively correlated with the amount of information provided when giving informed consent. Satisfaction about their involvement in this process relied heavily upon the level of support received from others. Parents consenting to their child's involvement in non-randomised trials perceived themselves to be under greater pressure from others during the decision-making process while those whose children were further along the treatment trajectory were more uncertain about decisions previously made. Findings indicate that the accessibility, support, information and degree of control afforded to parents by healthcare professionals impacts upon their satisfaction with both the decision-making process and their confidence in the decisions thus made. Information and support tailored to parents' specific needs may therefore enhance satisfaction with clinical decision making and reassure parents about decisions made in the long-term interest of their child's health. PMID:19807776

  8. Guarding against discriminatory treatment decisions.

    PubMed

    Griffith, Richard

    2013-10-01

    This article studies a case in which a 52-year-old male patient has early onset dementia, Down's syndrome and an associated heart condition, for which he is prescribed warfarin and digoxin. A district nurse, who is an independent prescriber, monitors and adjusts his medication and takes the required blood sample. The staff at the care home where the patient lives report that the patient is spitting out his medication and they have not been able to persuade him to swallow his tablets for a week. Despite the patient being assessed as lacking capacity to decide treatment decisions, the care home staff argue that his refusal to take medication should be respected and the medication discontinued. Although withdrawing the medication would make caring for the patient less challenging, the district nurse assesses the legal obligations that must be considered before this decision can be considered lawful. PMID:24471220

  9. Incorporating affective bias in models of human decision making

    NASA Technical Reports Server (NTRS)

    Nygren, Thomas E.

    1991-01-01

    Research on human decision making has traditionally focused on how people actually make decisions, how good their decisions are, and how their decisions can be improved. Recent research suggests that this model is inadequate. Affective as well as cognitive components drive the way information about relevant outcomes and events is perceived, integrated, and used in the decision making process. The affective components include how the individual frames outcomes as good or bad, whether the individual anticipates regret in a decision situation, the affective mood state of the individual, and the psychological stress level anticipated or experienced in the decision situation. A focus of the current work has been to propose empirical studies that will attempt to examine in more detail the relationships between the latter two critical affective influences (mood state and stress) on decision making behavior.

  10. Decision support for redesigning wastewater treatment technologies.

    PubMed

    McConville, Jennifer R; Künzle, Rahel; Messmer, Ulrike; Udert, Kai M; Larsen, Tove A

    2014-10-21

    This paper offers a methodology for structuring the design space for innovative process engineering technology development. The methodology is exemplified in the evaluation of a wide variety of treatment technologies for source-separated domestic wastewater within the scope of the Reinvent the Toilet Challenge. It offers a methodology for narrowing down the decision-making field based on a strict interpretation of treatment objectives for undiluted urine and dry feces and macroenvironmental factors (STEEPLED analysis) which influence decision criteria. Such an evaluation identifies promising paths for technology development such as focusing on space-saving processes or the need for more innovation in low-cost, energy-efficient urine treatment methods. Critical macroenvironmental factors, such as housing density, transportation infrastructure, and climate conditions were found to affect technology decisions regarding reactor volume, weight of outputs, energy consumption, atmospheric emissions, investment cost, and net revenue. The analysis also identified a number of qualitative factors that should be carefully weighed when pursuing technology development; such as availability of O&M resources, health and safety goals, and other ethical issues. Use of this methodology allows for coevolution of innovative technology within context constraints; however, for full-scale technology choices in the field, only very mature technologies can be evaluated. PMID:25225855

  11. Dubious delegation: Article III limits on mental health treatment decisions.

    PubMed

    Teitelbaum, Adam

    2012-06-01

    A common condition of supervised release requires a defendant, post-incarceration, to participate in a mental health treatment program. Federal district courts often order probation officers to make certain decisions ancillary to these programs. However, Article III delegation doctrine places limits on such actions. This Note addresses the constitutionality of delegating the "treatment program" decision, in which a probation officer decides which type of treatment the defendant must undergo; the choice is often between inpatient treatment and other less restrictive alternatives. The resolution of this issue ultimately depends on whether this decision constitutes a "judicial act." Finding support in lower court case law, this Note argues that a "judicial act" encompasses decisions affecting the defendant's significant liberty interests. The Supreme Court case law and the mental health literature make clear that significant liberty interests are at stake in these "treatment program" decisions. Thus, delegating the "treatment program" decision to probation officers is unconstitutional under Article III. The Note concludes by suggesting a constitutionally permissible scheme whereby the judge orders a maximally intrusive treatment while giving the probation officer the discretion to choose a less restrictive program. PMID:22708137

  12. Treatment Decisions for Children with Speech-Sound Disorders

    ERIC Educational Resources Information Center

    Kamhi, Alan G.

    2006-01-01

    PURPOSE: In this article, I consider how research, clinical expertise, client values, a clinician's theoretical perspective, and service delivery considerations affect the decisions that clinicians make to treat children with speech-sound disorders (SSD). METHOD: After reviewing the research on phonological treatment, I discuss how a clinician's…

  13. Information and decision-making needs among people with affective disorders – results of an online survey

    PubMed Central

    Liebherz, Sarah; Tlach, Lisa; Härter, Martin; Dirmaier, Jörg

    2015-01-01

    Background Patient decision aids are one possibility for enabling and encouraging patients to participate in medical decisions. Objective This paper aims to describe patients’ information and decision-making needs as a prerequisite for the development of high-quality, web-based patient decision aids for affective disorders. Design We conducted an online cross-sectional survey by using a self-administered questionnaire including items on Internet use, online health information needs, role in decision making, and important treatment decisions, performing descriptive and comparative statistical analyses. Participants A total of 210 people with bipolar disorder/mania as well as 112 people with unipolar depression participated in the survey. Results Both groups specified general information search as their most relevant information need and decisions on treatment setting (inpatient or outpatient) as well as decisions on pharmacological treatment as the most difficult treatment decisions. For participants with unipolar depression, decisions concerning psychotherapeutic treatment were also especially difficult. Most participants of both groups preferred shared decisions but experienced less shared decisions than desired. Discussion and conclusion Our results show the importance of information for patients with affective disorders, with a focus on pharmacological treatment and on the different treatment settings, and highlight patients’ requirements to be involved in the decision-making process. Since our sample reported a chronic course of disease, we do not know if our results are applicable for newly diagnosed patients. Further studies should consider how the reported needs could be addressed in health care practice. PMID:25999698

  14. A Digest of Supreme Court Decisions Affecting Education.

    ERIC Educational Resources Information Center

    Zirkel, Perry A., Ed.

    This digest is a reference tool documenting 144 of the most important Supreme Court cases affecting education from 1859 to 1977, with emphasis on the decisions made during the past 25 years. Each case is written up in a three-part format that provides the facts and background of the case. The cases are organized into five sections: school district…

  15. The structural basis for cancer treatment decisions

    PubMed Central

    Nussinov, Ruth; Jang, Hyunbum; Tsai, Chung-Jung

    2014-01-01

    Cancer treatment decisions rely on genetics, large data screens and clinical pharmacology. Here we point out that genetic analysis and treatment decisions may overlook critical elements in cancer development, progression and drug resistance. Two critical structural elements are missing in genetics-based decision-making: the mechanisms of oncogenic mutations and the cellular network which is rewired in cancer. These lay the foundation for the structural basis for cancer treatment decisions, which is rooted in the physical principles of the molecular conformational behavior of single molecules and their interactions. Improved tumor mutational analysis platforms and knowledge of the redundant pathways which can take over in cancer, may not only supplement known actionable findings, but forecast possible cancer progression and resistance. Such forward-looking can be powerful, endowing the oncologist with mechanistic insight and cancer prognosis, and consequently more informed treatment options. Examples include redundant pathways taking over after inhibition of EGFR constitutive activation, mutations in PIK3CA p110α and p85, and the non-hotspot AKT1 mutants conferring constitutive membrane localization. PMID:25277176

  16. The effect of statutory limitations on the authority of substitute decision makers on the care of patients in the intensive care unit: case examples and review of state laws affecting withdrawing or withholding life-sustaining treatment.

    PubMed

    Venkat, Arvind; Becker, Julianna

    2014-01-01

    While the ethics and critical care literature is replete with discussion of medical futility and the ethics of end-of-life care decisions in the intensive care unit, little attention is paid to the effect of statutory limitations on the authority of substitute decision makers during the course of treatment of patients in the critical care setting. In many jurisdictions, a clear distinction is made between the authority of a health care power of attorney, who is legally designated by a competent adult to make decisions regarding withholding or withdrawing life-sustaining treatment, and of next-of-kin, who are limited in this regard. However, next-of-kin are often relied upon to consent to necessary procedures to advance a patient's medical care. When conflicts arise between critical care physicians and family members regarding projected patient outcome and functional status, these statutory limitations on decision-making authority by next of kin can cause paralysis in the medical care of severely ill patients, leading to practical and ethical impasses. In this article, we will provide case examples of how statutory limitations on substitute decision making authority for next of kin can impede the care of patients. We will also review the varying jurisdictional limitations on the authority of substitute decision makers and explore their implications for patient care in the critical care setting. Finally, we will review possible ethical and legal solutions to resolve these impasses. PMID:22257784

  17. Decision Aids for Multiple-Decision Disease Management as Affected by Weather Input Errors

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Many disease management decision support systems (DSS) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation or estimation from off-site sources, may affect model calculations and manage...

  18. Capturing Treatment Decision Making Among Patients With Solid Tumors and Their Caregivers

    PubMed Central

    Jones, Randy A.; Steeves, Richard; Ropka, Mary E.; Hollen, Patricia

    2013-01-01

    Purpose/Objectives To examine the feasibility and acceptability of using a decision aid with an interactive decision-making process in patients with solid tumors and their caregivers during cancer-related treatment. Research Approach A phenomenologic approach was used to analyze qualitative data, with a focus on the meaning of participants’ lived experiences. Interviews were conducted by telephone or in person. Setting Outpatient clinics at two regional cancer centers. Participants 160 total individuals; 80 patients with newly diagnosed breast (n = 22), advanced-stage prostate (n = 19), or advanced-stage lung (n = 39) cancer, and their caregivers (n = 80). Methodologic Approach Twenty-seven of the 80 pairs engaged in audio recorded interviews that were conducted using a semistructured interview guide. Continuous text immersion revealed themes. Validity of qualitative analysis was achieved by member checking. Findings Significant findings included three themes: (a) the decision aid helped patients and caregivers understand treatment decisions better, (b) the decision aid helped patients and caregivers to be more involved in treatment decisions, and (c) frequent contact with the study nurse was valuable. Conclusions Decision making was more complex than participants expected. The decision aid helped patients and caregivers make satisfying treatment decisions and become integral in a shared treatment decision-making process. Interpretation Decision aids can help patients and their caregivers make difficult treatment decisions affecting quantity and quality of life during cancer treatment. The findings provide valuable information for healthcare providers helping patients and their caregivers make treatment decisions through a shared, informed, decision-making process. Knowledge Translation Decision aids can be helpful with treatment choices. Caregivers’ understanding about treatment is just as important in the decision-making process as the patients

  19. Affective and cognitive mechanisms of risky decision making.

    PubMed

    Shimp, Kristy G; Mitchell, Marci R; Beas, B Sofia; Bizon, Jennifer L; Setlow, Barry

    2015-01-01

    The ability to make advantageous decisions under circumstances in which there is a risk of adverse consequences is an important component of adaptive behavior; however, extremes in risk taking (either high or low) can be maladaptive and are characteristic of a number of neuropsychiatric disorders. To better understand the contributions of various affective and cognitive factors to risky decision making, cohorts of male Long-Evans rats were trained in a "Risky Decision making Task" (RDT), in which they made discrete trial choices between a small, "safe" food reward and a large, "risky" food reward accompanied by varying probabilities of footshock. Experiment 1 evaluated the relative contributions of the affective stimuli (i.e., punishment vs. reward) to RDT performance by parametrically varying the magnitudes of the footshock and large reward. Varying the shock magnitude had a significant impact on choice of the large, "risky" reward, such that greater magnitudes were associated with reduced choice of the large reward. In contrast, varying the large, "risky" reward magnitude had minimal influence on reward choice. Experiment 2 compared individual variability in RDT performance with performance in an attentional set shifting task (assessing cognitive flexibility), a delayed response task (assessing working memory), and a delay discounting task (assessing impulsive choice). Rats characterized as risk averse in the RDT made more perseverative errors on the set shifting task than did their risk taking counterparts, whereas RDT performance was not related to working memory abilities or impulsive choice. In addition, rats that showed greater delay discounting (greater impulsive choice) showed corresponding poorer performance in the working memory task. Together, these results suggest that reward-related decision making under risk of punishment is more strongly influenced by the punishment than by the reward, and that risky and impulsive decision making are associated with

  20. Patient age and general dentists' treatment decisions.

    PubMed

    Dolan, T A; McNaughton, C A; Davidson, S N; Mitchell, G S

    1992-01-01

    To test whether a patient's age plays a role in dentists' treatment planning decisions, a convenience sample of 159 general dentists attending a state dental society annual meeting was presented a vignette including intra-oral photographs, a brief case history and clinical diagnosis of a patient. The patient was partially dentate, and was described as having irreversible pulpitis of tooth #19. Three versions of the vignette were developed, with identical materials and information except for the patient's age (either 44, 65, or 84 years), and were randomly assigned to the participating dentists who were asked to develop a treatment plan for the patient's mandibular arch. The dentists planned limited therapy for the 84 year old because of their assumptions about the patient's brief life expectancy, cost, concern about the inability of the patient to tolerate extensive treatment, and a low cost/benefit ratio. These findings suggest that a patient's age influences general dentists' treatment planning decisions, perhaps limiting the treatment options offered to older adults. Additional research is necessary to further test these associations. PMID:10895734

  1. Language affects patterns of brain activation associated with perceptual decision.

    PubMed

    Tan, Li Hai; Chan, Alice H D; Kay, Paul; Khong, Pek-Lan; Yip, Lawrance K C; Luke, Kang-Kwong

    2008-03-11

    Well over half a century ago, Benjamin Lee Whorf [Carroll JB (1956) Language, Thought, and Reality: Selected Writings of Benjamin Lee Whorf (MIT Press, Cambridge, MA)] proposed that language affects perception and thought and is used to segment nature, a hypothesis that has since been tested by linguistic and behavioral studies. Although clear Whorfian effects have been found, it has not yet been demonstrated that language influences brain activity associated with perception and/or immediate postperceptual processes (referred hereafter as "perceptual decision"). Here, by using functional magnetic resonance imaging, we show that brain regions mediating language processes participate in neural networks activated by perceptual decision. When subjects performed a perceptual discrimination task on easy-to-name and hard-to-name colored squares, largely overlapping cortical regions were identified, which included areas of the occipital cortex critical for color vision and regions in the bilateral frontal gyrus. Crucially, however, in comparison with hard-to-name colored squares, perceptual discrimination of easy-to-name colors evoked stronger activation in the left posterior superior temporal gyrus and inferior parietal lobule, two regions responsible for word-finding processes, as demonstrated by a localizer experiment that uses an explicit color patch naming task. This finding suggests that the language-processing areas of the brain are directly involved in visual perceptual decision, thus providing neuroimaging support for the Whorf hypothesis. PMID:18316728

  2. Serotonin and Dopamine: Unifying Affective, Activational, and Decision Functions

    PubMed Central

    Cools, Roshan; Nakamura, Kae; Daw, Nathaniel D

    2011-01-01

    Serotonin, like dopamine (DA), has long been implicated in adaptive behavior, including decision making and reinforcement learning. However, although the two neuromodulators are tightly related and have a similar degree of functional importance, compared with DA, we have a much less specific understanding about the mechanisms by which serotonin affects behavior. Here, we draw on recent work on computational models of dopaminergic function to suggest a framework by which many of the seemingly diverse functions associated with both DA and serotonin—comprising both affective and activational ones, as well as a number of other functions not overtly related to either—can be seen as consequences of a single root mechanism. PMID:20736991

  3. The value of foresight: how prospection affects decision-making.

    PubMed

    Pezzulo, Giovanni; Rigoli, Francesco

    2011-01-01

    Traditional theories of decision-making assume that utilities are based on the intrinsic value of outcomes; in turn, these values depend on associations between expected outcomes and the current motivational state of the decision-maker. This view disregards the fact that humans (and possibly other animals) have prospection abilities, which permit anticipating future mental processes and motivational and emotional states. For instance, we can evaluate future outcomes in light of the motivational state we expect to have when the outcome is collected, not (only) when we make a decision. Consequently, we can plan for the future and choose to store food to be consumed when we expect to be hungry, not immediately. Furthermore, similarly to any expected outcome, we can assign a value to our anticipated mental processes and emotions. It has been reported that (in some circumstances) human subjects prefer to receive an unavoidable punishment immediately, probably because they are anticipating the dread associated with the time spent waiting for the punishment. This article offers a formal framework to guide neuroeconomic research on how prospection affects decision-making. The model has two characteristics. First, it uses model-based Bayesian inference to describe anticipation of cognitive and motivational processes. Second, the utility-maximization process considers these anticipations in two ways: to evaluate outcomes (e.g., the pleasure of eating a pie is evaluated differently at the beginning of a dinner, when one is hungry, and at the end of the dinner, when one is satiated), and as outcomes having a value themselves (e.g., the case of dread as a cost of waiting for punishment). By explicitly accounting for the relationship between prospection and value, our model provides a framework to reconcile the utility-maximization approach with psychological phenomena such as planning for the future and dread. PMID:21747755

  4. Affective State Influences Perception by Affecting Decision Parameters Underlying Bias and Sensitivity

    PubMed Central

    Lynn, Spencer K.; Zhang, Xuan; Barrett, Lisa Feldman

    2012-01-01

    Studies of the effect of affect on perception often show consistent directional effects of a person’s affective state on perception. Unpleasant emotions have been associated with a “locally focused” style of stimulus evaluation, and positive emotions with a “globally focused” style. Typically, however, studies of affect and perception have not been conducted under the conditions of perceptual uncertainty and behavioral risk inherent to perceptual judgments outside the laboratory. We investigated the influence of perceivers’ experience affect (valence and arousal) on the utility of social threat perception by combining signal detection theory and behavioral economics. We created three perceptual decision environments that systematically differed with respect to factors that underlie uncertainty and risk: the base rate of threat, the costs of incorrect identification threat, and the perceptual similarity of threats and non-threats. We found that no single affective state yielded the best performance on the threat perception task across the three environments. Unpleasant valence promoted calibration of response bias to base rate and costs, high arousal promoted calibration of perceptual sensitivity to perceptual similarity, and low arousal was associated with an optimal adjustment of bias to sensitivity. However, the strength of these associations was conditional upon the difficulty of attaining optimal bias and high sensitivity, such that the effect of the perceiver’s affective state on perception differed with the cause and/or level of uncertainty and risk. PMID:22251054

  5. Parent-Child Engagement in Decision Making and the Development of Adolescent Affective Decision Capacity and Binge Drinking

    PubMed Central

    Xiao, Lin; Bechara, Antoine; Palmer, Paula H.; Trinidad, Dennis R.; Wei, Yonglan; Jia, Yong; Johnson, C. Anderson

    2010-01-01

    The goal of this study was to investigate how parents’ engagement of their child in everyday decision-making influenced their adolescent’s development on two neuropsychological functions, namely, affective decision-making and working memory, and its effect on adolescent binge-drinking behavior. We conducted a longitudinal study of 192 Chinese adolescents. In 10th grade, the adolescents were tested for their affective decision-making ability using the Iowa Gambling Task (IGT) and working memory capacity using the Self-ordered Pointing Test (SOPT). Questionnaires were used to assess perceived parent-child engagement in decision-making, academic performance and drinking behavior. At one-year follow-up, the same neuropsychological tasks and questionnaires were repeated. Results indicate that working memory and academic performance were uninfluenced by parent-child engagement in decision-making. However, compared to adolescents whose parents made solitary decisions for them, adolescents engaged in everyday decision-making showed significant improvement on affective decision capacity and significantly less binge-drinking one year later. These findings suggest that parental engagement of children in everyday decision-making might foster the development of neurocognitive functioning relative to affective decision-making and reduce adolescent substance use behaviors. PMID:21804682

  6. A communication model of shared decision making: accounting for cancer treatment decisions.

    PubMed

    Siminoff, Laura A; Step, Mary M

    2005-07-01

    The authors present a communication model of shared decision making (CMSDM) that explicitly identifies the communication process as the vehicle for decision making in cancer treatment. In this view, decision making is necessarily a sociocommunicative process whereby people enter into a relationship, exchange information, establish preferences, and choose a course of action. The model derives from contemporary notions of behavioral decision making and ethical conceptions of the doctor-patient relationship. This article briefly reviews the theoretical approaches to decision making, notes deficiencies, and embeds a more socially based process into the dynamics of the physician-patient relationship, focusing on cancer treatment decisions. In the CMSDM, decisions depend on (a) antecedent factors that have potential to influence communication, (b) jointly constructed communication climate, and (c) treatment preferences established by the physician and the patient. PMID:16045427

  7. Factors affecting willingness to provide buprenorphine treatment

    PubMed Central

    Netherland, Julie; Botsko, Michael; Egan, James E.; Saxon, Andrew J.; Cunningham, Chinazo O.; Finkelstein, Ruth; Gourevitch, Mark N.; Renner, John A.; Sohler, Nancy; Sullivan, Lynn E.; Weiss, Linda; Fiellin, David A.

    2010-01-01

    Buprenorphine is an effective long-term opioid agonist treatment. As the only pharmacological treatment for opioid dependence readily available in office-based settings, buprenorphine may facilitate a historic shift in addiction treatment from treatment facilities to general medical practices. Although many patients have benefited from the availability of buprenorphine in the United States, almost half of current prescribers are addiction specialists suggesting that buprenorphine treatment has not yet fully penetrated general practice settings. We examined factors affecting willingness to offer buprenorphine treatment among physicians with different levels of prescribing experience. Based on their prescribing practices, physicians were classified as experienced, novice, or as a nonprescriber and asked to assess the extent to which a list of factors impacted their prescription of buprenorphine. Several factors affected willingness to prescribe buprenorphine for all physicians: staff training; access to counseling and alternate treatment; visit time; buprenorphine availability; and pain medications concerns. Compared with other physicians, experienced prescribers were less concerned about induction logistics and access to expert consultation, clinical guidelines, and mental health services. They were more concerned with reimbursement. These data provide important insight into physician concerns about buprenorphine and have implications for practice, education, and policy change that may effectively support widespread adoption of buprenorphine. PMID:18715741

  8. Floral odor learning within the hive affects honeybees' foraging decisions

    NASA Astrophysics Data System (ADS)

    Arenas, Andrés; Fernández, Vanesa M.; Farina, Walter M.

    2007-03-01

    Honeybees learn odor cues quickly and efficiently when visiting rewarding flowers. Memorization of these cues facilitates the localization and recognition of food sources during foraging flights. Bees can also use information gained inside the hive during social interactions with successful foragers. An important information cue that can be learned during these interactions is food odor. However, little is known about how floral odors learned in the hive affect later decisions of foragers in the field. We studied the effect of food scent on foraging preferences when this learning is acquired directly inside the hive. By using in-hive feeders that were removed 24 h before the test, we showed that foragers use the odor information acquired during a 3-day stimulation period with a scented solution during a food-choice situation outside the nest. This bias in food preference is maintained even 24 h after the replacement of all the hive combs. Thus, without being previously collected outside by foragers, food odors learned within the hive can be used during short-range foraging flights. Moreover, correct landings at a dual-choice device after replacing the storing combs suggests that long-term memories formed within the colony can be retrieved while bees search for food in the field.

  9. What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

    PubMed Central

    Lipstein, Ellen A.; Brinkman, William B.; Britto, Maria T.

    2013-01-01

    Background With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. Objective To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Methods Articles presenting original research on parent decision making were identified from MEDLINE (1966–6/2011), using the terms “decision making,” “parent,” and “child.” We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. Results We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents’ preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child’s health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Conclusions Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions. PMID:21969136

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

    PubMed

    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. PMID:27071751

  11. Projection in surrogate decisions about life-sustaining medical treatments.

    PubMed

    Fagerlin, A; Ditto, P H; Danks, J H; Houts, R M; Smucker, W D

    2001-05-01

    To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, suggests that surrogates' own treatment preferences may influence their predictions of others' preferences. In 2 studies (1 involving 60 college student surrogates and a parent, the other involving 361 elderly outpatients and their chosen surrogate decision maker), surrogates predicted whether a close other would want life-sustaining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more closely resembled surrogates' own treatment wishes than they did the wishes of the individual they were trying to predict. Although the majority of prediction errors reflected inaccurate use of surrogates' own treatment preferences, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projection in surrogate decision making is discussed. PMID:11403214

  12. A Decision Fusion Framework for Treatment Recommendation Systems.

    PubMed

    Mei, Jing; Liu, Haifeng; Li, Xiang; Xie, Guotong; Yu, Yiqin

    2015-01-01

    Treatment recommendation is a nontrivial task--it requires not only domain knowledge from evidence-based medicine, but also data insights from descriptive, predictive and prescriptive analysis. A single treatment recommendation system is usually trained or modeled with a limited (size or quality) source. This paper proposes a decision fusion framework, combining both knowledge-driven and data-driven decision engines for treatment recommendation. End users (e.g. using the clinician workstation or mobile apps) could have a comprehensive view of various engines' opinions, as well as the final decision after fusion. For implementation, we leverage several well-known fusion algorithms, such as decision templates and meta classifiers (of logistic and SVM, etc.). Using an outcome-driven evaluation metric, we compare the fusion engine with base engines, and our experimental results show that decision fusion is a promising way towards a more valuable treatment recommendation. PMID:26262059

  13. Negative Affectivity Predicts Individual Differences in Decision Making for Preschoolers

    ERIC Educational Resources Information Center

    Garon, Nancy; Moore, Chris

    2006-01-01

    The authors' goal in conducting this study was to explore the association between temperament and future-oriented decision making. Forty-three preschoolers (mean age = 51 months) were given a child variant of the Iowa Gambling Task (IGT) and asked to choose between a deck with higher immediate rewards and a deck with higher future rewards.…

  14. Students' Perceptions of Factors that Affect College Funding Decisions

    ERIC Educational Resources Information Center

    Porter, Julia Y.; Fossey, W. Richard; Davis, William E.; Burnett, Michael F.; Stuhlmann, Janice; Suchy, Patricia A.

    2006-01-01

    This exploratory study examines the factors that college students perceive are important in helping them make good financial decisions about paying for a college education. The study categorizes and summarizes students' self-reported responses to an open-ended survey question about recommendations for changes in financial aid counseling practices.…

  15. Factors affecting decision-making of patients choosing acupuncture in a public hospital

    PubMed Central

    Koh, Thean Howe Bryan; Kong, Keng He; Low, Yin Peng

    2015-01-01

    Background With increasing evidence to support its practice, acupuncture has been integrated within many hospitals around the world. The purpose of this study is to understand the factors affecting decision making of patients as they select acupuncture treatment for their medical conditions and symptoms within a public hospital. Methods A qualitative study consisting of in depth interviews with 14 patients was conducted. All patients attended an acupuncture clinic within a public hospital. Data collected was analysed via thematic analysis. Results Four main factor groups affecting decision making of patients were identified- factors affecting the level and value of patient-centric care, the confidence and trust patients place within the acupuncture service, the presence of collaborative efforts between acupuncturists and Western medicine practitioners, and the knowledge, culture and belief society has regarding the role of acupuncture and Western medicine. All participants interviewed had more than one factor group present as enablers toward their eventual selection of acupuncture for ailment management. It was also noted that although the majority of participants had sufficient knowledge regarding acupuncture, there were a select few who had misperceptions or no knowledge regarding certain aspects of acupuncture. Conclusions There may be certain patterns in the way patients choose to utilise acupuncture services in public hospitals. Further studies should also be carried out in other public hospitals to analyse the factor groups identified further. PMID:26697443

  16. Medulloblastoma development: tumor biology informs treatment decisions.

    PubMed

    Gopalakrishnan, Vidya; Tao, Rong-Hua; Dobson, Tara; Brugmann, William; Khatua, Soumen

    2015-01-01

    Medulloblastoma is the most common malignant pediatric brain tumor. Current treatments including surgery, craniospinal radiation and high-dose chemotherapy have led to improvement in survival. However, the risk for recurrence as well as significant long-term neurocognitive and endocrine sequelae associated with current treatment modalities underscore the urgent need for novel tumor-specific, normal brain-sparing therapies. It has also provided the impetus for research focused on providing a better understanding of medulloblastoma biology. The expectation is that such studies will lead to the identification of new therapeutic targets and eventually to an increase in personalized treatment approaches. PMID:25768332

  17. Treatment of affective disorders in cardiac disease

    PubMed Central

    Mavrides, Nicole; Nemeroff, Charles B.

    2015-01-01

    Patients with cardiovascular disease (CVD) commonly have syndromal major depression, and depression has been associated with an increased risk of morbidity and mortality. Prevalence of depression is between 17% and 47% in CVD patients. Pharmacologic and psychotherapeutic interventions have long been studied, and in general are safe and somewhat efficacious in decreasing depressive symptoms in patients with CVD. The impact on cardiac outcomes remains unclear. The evidence from randomized controlled clinical trials indicates that antidepressants, especially selective serotonin uptake inhibitors, are overwhelmingly safe, and likely to be effective in the treatment of depression in patients with CVD. This review describes the prevalence of depression in patients with CVD, the physiological links between depression and CVD, the treatment options for affective disorders, and the clinical trials that demonstrate efficacy and safety of antidepressant medications and psychotherapy in this patient population. Great progress has been made in understanding potential mediators between major depressive disorder and CVD—both health behaviors and shared biological risks such as inflammation. PMID:26246788

  18. Development and initial evaluation of a treatment decision dashboard

    PubMed Central

    2013-01-01

    Background For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care. Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. Methods We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. Results The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2

  19. Economy Affects Students' Academic Performance as Well as Spending Decisions

    ERIC Educational Resources Information Center

    Sander, Libby

    2012-01-01

    Like many Americans caught up in the economic downturn, college students are worried about money. Now research indicates that financial worries may affect their academic performance. The author presents the results of this year's National Survey of Student Engagement. The survey reveals that more than a third of seniors and more than a quarter of…

  20. Patients' and parents' concerns and decisions about orthodontic treatment

    PubMed Central

    Aydoğan, Cihan; Alkan, Özer

    2016-01-01

    Objective Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. Methods One hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents. Results Concerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients. Conclusions The results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment. PMID:26877979

  1. The Arithmetic of Emotion: Integration of Incidental and Integral Affect in Judgments and Decisions

    PubMed Central

    Västfjäll, Daniel; Slovic, Paul; Burns, William J.; Erlandsson, Arvid; Koppel, Lina; Asutay, Erkin; Tinghög, Gustav

    2016-01-01

    Research has demonstrated that two types of affect have an influence on judgment and decision making: incidental affect (affect unrelated to a judgment or decision such as a mood) and integral affect (affect that is part of the perceiver’s internal representation of the option or target under consideration). So far, these two lines of research have seldom crossed so that knowledge concerning their combined effects is largely missing. To fill this gap, the present review highlights differences and similarities between integral and incidental affect. Further, common and unique mechanisms that enable these two types of affect to influence judgment and choices are identified. Finally, some basic principles for affect integration when the two sources co-occur are outlined. These mechanisms are discussed in relation to existing work that has focused on incidental or integral affect but not both. PMID:27014136

  2. The Arithmetic of Emotion: Integration of Incidental and Integral Affect in Judgments and Decisions.

    PubMed

    Västfjäll, Daniel; Slovic, Paul; Burns, William J; Erlandsson, Arvid; Koppel, Lina; Asutay, Erkin; Tinghög, Gustav

    2016-01-01

    Research has demonstrated that two types of affect have an influence on judgment and decision making: incidental affect (affect unrelated to a judgment or decision such as a mood) and integral affect (affect that is part of the perceiver's internal representation of the option or target under consideration). So far, these two lines of research have seldom crossed so that knowledge concerning their combined effects is largely missing. To fill this gap, the present review highlights differences and similarities between integral and incidental affect. Further, common and unique mechanisms that enable these two types of affect to influence judgment and choices are identified. Finally, some basic principles for affect integration when the two sources co-occur are outlined. These mechanisms are discussed in relation to existing work that has focused on incidental or integral affect but not both. PMID:27014136

  3. A Pathway to Personalization of Integrated Treatment: Informatics and Decision Science in Psychiatric Rehabilitation

    PubMed Central

    Spaulding, William; Deogun, Jitender

    2011-01-01

    Personalization of treatment is a current strategic goal for improving health care. Integrated treatment approaches such as psychiatric rehabilitation benefit from personalization because they involve matching diverse arrays of treatment options to individually unique profiles of need. The need for personalization is evident in the heterogeneity of people with severe mental illness and in the findings of experimental psychopathology. One pathway to personalization lies in analysis of the judgments and decision making of human experts and other participants as they respond to complex circumstances in pursuit of treatment and rehabilitation goals. Such analysis is aided by computer simulation of human decision making, which in turn informs development of computerized clinical decision support systems. This inspires a research program involving concurrent development of databases, domain ontology, and problem-solving algorithms, toward the goal of personalizing psychiatric rehabilitation through human collaboration with intelligent cyber systems. The immediate hurdle is to demonstrate that clinical decisions beyond diagnosis really do affect outcome. This can be done by supporting the hypothesis that a human treatment team with access to a reasonably comprehensive clinical database that tracks patient status and treatment response over time achieves better outcome than a treatment team without such access, in a controlled experimental trial. Provided the hypothesis can be supported, the near future will see prototype systems that can construct an integrated assessment, formulation, and rehabilitation plan from clinical assessment data and contextual information. This will lead to advanced systems that collaborate with human decision makers to personalize psychiatric rehabilitation and optimize outcome. PMID:21860042

  4. Estrogen treatment affects brain functioning after menopause.

    PubMed

    Bayer, Ulrike; Hausmann, Markus

    2011-12-01

    Sex hormones have powerful neuromodulatory effects on functional brain organization and cognitive functioning. This paper reviews findings from studies investigating the influence of sex hormones in postmenopausal women with and without hormone therapy (HT). Functional brain organization was investigated using different behavioural tasks in postmenopausal women using either estrogen therapy or combined estrogen plus gestagen therapy and age- and IQ-matched postmenopausal women not taking HT. The results revealed HT-related modulations in specific aspects of functional brain organization including functional cerebral asymmetries and interhemispheric interaction. In contrast to younger women during the menstrual cycle, however, it seems that HT, and especially estrogen therapy, after menopause affects intrahemispheric processing rather than interhemispheric interaction. This might be explained by a faster and more pronounced age-related decline in intrahemispheric relative to interhemispheric functioning, which might be associated with higher sensitivity to HT. Taken together, the findings suggest that the female brain retains its plasticity even after reproductive age and remains susceptible to the effects of sex hormones throughout the lifetime, which might help to discover new clinical approaches in the hormonal treatment of neurological and psychiatric disorders. PMID:22120942

  5. Japanese physicians’ preferences for decision making in rheumatoid arthritis treatment

    PubMed Central

    Aoki, Akiko; Ohbu, Sadayoshi

    2016-01-01

    Background Rheumatoid arthritis (RA) is a complex chronic illness requiring continued medical care. During the past decade, the therapeutic options for RA have increased significantly; these often have a higher risk of adverse effects and are more expensive than traditional drugs. Rheumatologists may hence face difficulties when deciding on the optimal modality in initiating or changing treatment. The aim of this study was to explore the Japanese physicians’ usual style of and preferences for decision making regarding RA treatment. Methods This was a cross-sectional study conducted using an Internet survey. Respondents were asked about their usual style of making treatment decisions (perceived style), and their perception of the importance of physicians’ actions and patients’ attitudes. Results Of the 485 physicians who were sent the questionnaire, 157 responded completely (response rate: 32.3%). Ninety-two percent of the respondents were men, and 57% were clinicians with more than 20 years of experience. Their specialties were general medicine (29%), rheumatology (27%), orthopedics (31%), and rehabilitation (12%). Sixty-one (39%) stated that they usually presented multiple treatment options to their patients and selected a decision for them, 42 (27%) shared the decision making with their patients, 34 (22%) let their patients choose the treatment, and 20 (13%) made the treatment decision for the patients. Physicians using the shared decision making (SDM) style desired for their patients to have supportive family and friends, to discuss with nurses, and to follow the doctors’ directions more strongly compared with physicians using the other styles. There were no significant differences in sex, duration of clinical experience, major place of clinical work, and number of patients per month by the styles. More number of rheumatologists and physicians with specialist qualifications stated that they practiced SDM. Conclusion To enhance patient participation

  6. Threat affects risk preferences in movement decision making

    PubMed Central

    O'Brien, Megan K.; Ahmed, Alaa A.

    2015-01-01

    Emotional states such as sadness, anger, and threat have been shown to play a critical role in decision-making processes. Here we addressed the question of whether risk preferences are influenced by postural threat and whether this influence generalizes across motor tasks. We examined risk attitudes in the context of arm-reaching (ARM) and whole-body (WB) leaning movements, expecting that increased postural threat would lead to proportionally similar changes in risk-sensitivity for each motor task. Healthy young adults were shown a series of two-alternative forced-choice lotteries, where they were asked to choose between a riskier lottery and a safer lottery on each trial. Our lotteries consisted of different monetary rewards and target sizes. Subjects performed each choice task at ground level and atop an elevated platform. In the presence of this postural threat, increased physiological arousal was correlated with decreased movement variability. To determine risk-sensitivity, we quantified the frequency with which a subject chose the riskier lottery and fit lottery responses to a choice model based on cumulative prospect theory (CPT). Subjects exhibited idiosyncratic changes in risk-sensitivity between motor tasks and between elevations. However, we found that overweighting of small probabilities increased with postural threat in the WB task, indicating a more cautious, risk-averse strategy is ascribed to the possibility of a fall. Subjects were also more risk-seeking in the WB movements than in ARM at low elevation; this behavior does not seem to derive from consistent distortions in utility or probability representations but may be explained by subjects' inaccurate estimation of their own motor variability. Overall, our findings suggest that implicit threat can modify risk attitudes in the motor domain, and the threat may induce risk-aversion in salient movement tasks. PMID:26106311

  7. Understanding and Utilizing Patient Preferences in Cancer Treatment Decisions.

    PubMed

    Ubel, Peter A

    2016-05-01

    Shared decision-making is a complex endeavor that should take into account the patient's personal preferences regarding treatment options. To truly empower patients to be partners in decision-making, especially in situations in which their preferences are important, physicians must learn to communicate better and to distinguish between what is "medical fact" versus a "value judgement." Knowing what are, when to ask, and how to ask the right questions will help physicians be effective in guiding patients toward the right treatments. PMID:27226516

  8. Factors Affecting Parental Decision-Making Regarding Interventions for Their Child with Autism

    ERIC Educational Resources Information Center

    Hebert, Elizabeth Baltus

    2014-01-01

    Due to the numerous interventions available for children with autism, parents are faced with challenging decisions regarding treatments from the time of diagnosis and throughout their child's life. This exploratory qualitative study investigated the reasons behind parents' decisions about interventions for their child with autism.…

  9. Assessing treatment benefit with competing risks not affected by the randomized treatment.

    PubMed

    Korn, Edward L; Dignam, James J; Freidlin, Boris

    2015-01-30

    The comparison of overall survival curves between treatment arms will always be of interest in a randomized clinical trial involving a life-shortening disease. In some settings, the experimental treatment is only expected to affect the deaths caused by the disease, and the proportion of deaths caused by the disease is relatively low. In these settings, the ability to assess treatment-effect differences between Kaplan-Meier survival curves can be hampered by the large proportion of deaths in both arms that are unrelated to the disease. To address this problem, frequently displayed are cause-specific survival curves or cumulative incidence curves, which respectively censor and immortalize events (deaths) not caused by the disease. However, the differences between the experimental and control treatment arms for these curves overestimate the difference between the overall survival curves for the treatment arms and thus could result in overestimation of the benefit of the experimental treatment for the patients. To address this issue, we propose new estimators of overall survival for the treatment arms that are appropriate when the treatment does not affect the non-disease-related deaths. These new estimators give a more precise estimate of the treatment benefit, potentially enabling future patients to make a more informed decision concerning treatment choice. We also consider the case where an exponential assumption allows the simple presentation of mortality rates as the outcome measures. Applications are given for estimating overall survival in a prostate-cancer treatment randomized clinical trial, and for estimating the overall mortality rates in a prostate-cancer screening trial. PMID:25363739

  10. The Gambler’s Fallacy Is Associated with Weak Affective Decision Making but Strong Cognitive Ability

    PubMed Central

    Xue, Gui; He, Qinghua; Lei, Xuemei; Chen, Chunhui; Liu, Yuyun; Chen, Chuansheng; Lu, Zhong-Lin; Dong, Qi; Bechara, Antoine

    2012-01-01

    Humans demonstrate an inherent bias towards making maladaptive decisions, as shown by a phenomenon known as the gambler’s fallacy (GF). The GF has been traditionally considered as a heuristic bias supported by the fast and automatic intuition system, which can be overcome by the reasoning system. The present study examined an intriguing hypothesis, based on emerging evidence from neuroscience research, that the GF might be attributed to a weak affective but strong cognitive decision making mechanism. With data from a large sample of college students, we found that individuals’ use of the GF strategy was positively correlated with their general intelligence and executive function, such as working memory and conflict resolution, but negatively correlated with their affective decision making capacities, as measured by the Iowa Gambling Task. Our result provides a novel insight into the mechanisms underlying the GF, which highlights the significant role of affective mechanisms in adaptive decision-making. PMID:23071701

  11. Affective Decision-Making and Externalizing Behaviors: The Role of Autonomic Activity

    PubMed Central

    Drabick, Deborah A. G.

    2013-01-01

    We tested a conceptual model involving the inter-relations among affective decision-making (indexed by a gambling task), autonomic nervous system (ANS) activity, and attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms in a largely impoverished, inner city sample of first through third grade children (N=63, 54% male). The present study hypothesized that impaired affective decision-making and decreased sympathetic and parasympathetic activation would be associated with higher levels of ADHD and ODD symptoms, and that low sympathetic and parasympathetic activation during an emotion-inducing task would mediate the relation between affective decision-making and child externalizing symptoms. In support of our model, disadvantageous decision-making on a gambling task was associated with ADHD hyperactivity/impulsivity symptoms among boys, and attenuated sympathetic activation during an emotion-inducing task mediated this relation. Support for the model was not found among girls. PMID:18317919

  12. Decision Support System Development for the Treatment of Maladaptive Behaviors.

    ERIC Educational Resources Information Center

    Hile, Matthew G.; Desrochers, Marcie N.

    The Mental Retardation-Expert (MR-E) is a microcomputer based expert decision support system that provides practitioners with state of the art assistance in the treatment of aggressive, self injurious, and destructive behaviors displayed by individuals with mental retardation or developmental disabilities. This system, based on human experts and…

  13. Redefining self: patients' decision making about treatment for multiple sclerosis.

    PubMed

    Lowden, Diane; Lee, Virginia; Ritchie, Judith A

    2014-08-01

    The treatment of multiple sclerosis (MS) has become possible with the advent of disease-modifying therapies, but little is known about patients' experiences when faced with a complex array of treatment options. The purpose of this phenomenological study was to explore the lived experience of making a first decision about treatment with disease-modifying therapies for relapsing-remitting MS. Nine participants shared their perspectives on negotiating the decision to accept, refuse, or delay treatment. All individuals described a core theme in which decision making about treatment was part of a process of coming to a "redefined self." This core theme included reflections about self-image, quality of life, goals, and being a person with MS. Six common themes supporting this core theme were (a) weighing and deciding what's important, (b) acknowledging the illness as part of oneself, (c) playing the mental game, (d) seeking credible resources, (e) evaluating symptoms and fit with quality of life, and (f) managing the roles and involvement of family. The findings of this study provide a greater understanding about the experience of making a therapeutic choice for those with MS and offer insights for nurses when supporting patients faced with options about treatment. PMID:24875289

  14. Sustainable Decisions Signal Sustainable Relationships: How Purchasing Decisions Affect Perceptions and Romantic Attraction.

    PubMed

    DiDonato, Theresa E; Jakubiak, Brittany K

    2016-01-01

    In the pursuit of love, individuals strategically use luxury products to signal status and other attractive attributes. Might eco-friendly products also signal mate-relevant information? The current research examined inferences from eco-friendly purchases and how they predict perceived suitability for short- and long-term romantic relationships. Participants read descriptions of a stranger's eco-friendly or luxury purchase decisions, reported their perceptions of the purchaser, and indicated their potential romantic interest in the purchaser. The influence of the relative price of the chosen product was also investigated. Compared to luxury purchasers, eco-friendly purchasers were ascribed greater warmth, competence, and good partner traits, but less physical appeal, and they were preferred for long-term but not short-term relationships. The social costs and benefits of "going green" are discussed in light of their implications for environmental sustainability efforts. PMID:25695751

  15. Online Produced Water Treatment Catalog and Decision Tool

    SciTech Connect

    J. Arthur

    2012-03-31

    The objective of this project was to create an internet-based Water Treatment Technology Catalog and Decision Tool that will increase production, decrease costs and enhance environmental protection. This is to be accomplished by pairing an operator's water treatment cost and capacity needs to specific water treatments. This project cataloged existing and emerging produced water treatment technologies and allows operators to identify the most cost-effective approaches for managing their produced water. The tool captures the cost and capabilities of each technology and the disposal and beneficial use options for each region. The tool then takes location, chemical composition, and volumetric data for the operator's water and identifies the most cost effective treatment options for that water. Regulatory requirements or limitations for each location are also addressed. The Produced Water Treatment Catalog and Decision Tool efficiently matches industry decision makers in unconventional natural gas basins with: 1) appropriate and applicable water treatment technologies for their project, 2) relevant information on regulatory and legal issues that may impact the success of their project, and 3) potential beneficial use demands specific to their project area. To ensure the success of this project, it was segmented into seven tasks conducted in three phases over a three year period. The tasks were overseen by a Project Advisory Council (PAC) made up of stakeholders including state and federal agency representatives and industry representatives. ALL Consulting has made the catalog and decision tool available on the Internet for the final year of the project. The second quarter of the second budget period, work was halted based on the February 18, 2011 budget availability; however previous project deliverables were submitted on time and the deliverables for Task 6 and 7 were completed ahead of schedule. Thus the application and catalog were deployed to the public Internet

  16. Treatment limitation decisions under uncertainty: the value of subsequent euthanasia.

    PubMed

    Savulescu, Julian

    1994-01-01

    This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life-supporting treatment. However, his life may be not worth living. If active euthanasia of 'non-terminal' conditions is prohibited, the option of dying will no longer be available. Taking a rational 'wait and see' course may result in being trapped within an unbearable life. On the other hand, sometimes present practice 'lets nature take its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty. PMID:11657375

  17. Breast cancer diagnosis and factors influencing treatment decisions in Ghana.

    PubMed

    Aziato, Lydia; Clegg-Lamptey, Joe Nat A

    2015-01-01

    Researchers in this study explored the reactions of women with breast cancer and identified factors influencing treatment decisions. A qualitative exploratory approach was employed. Participants were recruited from a tertiary hospital and a breast cancer support group. Purposive sampling recruited 12 women. It was found that women identified breast lesions accidentally or intentionally and that diagnosis was delayed. Emotional reactions to diagnosis included shock and sadness. Factors that influenced treatment were the influence of other people, alternative sources of treatment, faith and support, knowledge, "tuning the mind," and effects on intimacy. Health professionals should develop effective communication and counseling skills for clients. PMID:24750095

  18. Affecting others: social appraisal and emotion contagion in everyday decision making.

    PubMed

    Parkinson, Brian; Simons, Gwenda

    2009-08-01

    In a diary study of interpersonal affect transfer, 41 participants reported on decisions involving other people over 3 weeks. Reported anxiety and excitement were reliably related to the perceived anxiety and excitement of another person who was present during decision making. Risk and importance appraisals partially mediated effects of other's anxiety on own anxiety as predicted by social appraisal theory. However, other's emotion remained a significant independent predictor of own emotion after controlling for appraisals, supporting the additional impact of more direct forms of affect transfer such as emotion contagion. Significant affect-transfer effects remained even after controlling for participants' perceptions of the other's emotion in addition to all measured appraisals, confirming that affect transfer does not require explicit registration of someone else's feelings. This research provides some of the clearest evidence for the operation of both social appraisal and automatic affect transfer in everyday social life. PMID:19474455

  19. Angiosomes: how do they affect my treatment?

    PubMed

    Palena, Luis Mariano; Garcia, Luis Fernando; Brigato, Cesare; Sultato, Enrico; Candeo, Alessandro; Baccaglini, Tommaso; Manzi, Marco

    2014-09-01

    The number of diabetic patients is actually increasing all around the world, consequently, critical limb ischemia and ischemic diabetic foot disorders related to the presence of diabetic occlusive arterial disease will represent in the next few years a challenging issue for vascular specialists. Revascularization represents one step in the treatment for the multidisciplinary team, reestablishing an adequate blood flow to the wound area, essential for healing and avoiding major amputations. The targets of revascularization can be established to obtain a "complete" revascularization, treating all tibial and foot vessels or following the angiosome and wound-related artery model, obtaining direct blood flow for the wound. In this article, we summarize our experience in endovascular treatment of diabetic critical limb ischemia, focusing on the angiosome and wound-related artery model of revascularization and the technical challenges in treating below-the-knee and below-the-ankle vessels. PMID:25241316

  20. A systematic review of decision aids for patients making a decision about treatment for early breast cancer.

    PubMed

    Nicholas Zdenkowski; Butow, Phyllis; Tesson, Stephanie; Boyle, Frances

    2016-04-01

    Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted. PMID:27017240

  1. Understanding decisions made about hepatitis C treatment by couples who inject drugs.

    PubMed

    Treloar, C; Rance, J; Bryant, J; Fraser, S

    2016-02-01

    Efforts to increase the number of people having hepatitis C virus (HCV) treatment require understanding how to best deliver services to meet consumers' needs. The general health literature has examined the role that partners can play in supporting health outcomes. This study examines the experiences of couples who inject drugs in relation to knowledge of, decisions about and management of HCV treatment. This is a qualitative interview study of people who inject drugs in couples. Participants were recruited from harm reduction services in two major Australian cities. Couples were interviewed separately. Data were examined using the couple as the unit of analysis and to identify patterns of experience related to the HCV serostatus of couples. Knowledge of HCV and HCV treatment was low and variable but showed some relationship to serostatus. Decisions about HCV treatment were deeply informed by concerns regarding treatment side effects. Positive concordant couples considered 'staging' treatment to ensure that each partner could (in turn) care for the other. People with HCV in serodiscordant relationships may need specific support regarding HCV treatment information. Within positive concordant partnerships, our data indicated the need to support the HCV-positive 'carer' during their partner's treatment. Changing treatment regimens, and their anticipated lower side effect profiles, will need to be actively promoted to ensure that couples understand how these changes affect their treatment options. PMID:26305873

  2. Virtual Characters: Visual Realism Affects Response Time and Decision-Making

    ERIC Educational Resources Information Center

    Sibuma, Bernadette

    2012-01-01

    This study integrates agent research with a neurocognitive technique to study how character faces affect cognitive processing. The N170 event-related potential (ERP) was used to study face processing during simple decision-making tasks. Twenty-five adults responded to facial expressions (fear/neutral) presented in three designs…

  3. Affective Decision-Making and Tactical Behavior of Under-15 Soccer Players

    PubMed Central

    Gonzaga, Adeilton dos Santos; Albuquerque, Maicon Rodrigues; Malloy-Diniz, Leandro Fernandes; Greco, Pablo Juan; Teoldo da Costa, Israel

    2014-01-01

    Affective decision-making is a type of Executive Function related to cost benefit analysis in situations where gains and losses imply direct consequences for the subject. The purpose of this study was to explore the influence of the affective decision-making on tactical behavior in soccer players under the age of 15 years old. The System of Tactical Assessment in Soccer (FUT-SAT) was used to assess tactical behavior. To evaluate affective decision-making, we used the neuropsychological test called The Iowa Gambling Task (IGT). The values of the offensive, defensive and game tactical behavior of participants were used to create performance groups. The low (≤25%) and high (≥75%) groups, according to offensive, defensive and game tactical behavior, were compared and shown to be different. The values of the IGT net score of the participants with low and high tactical behavior were compared using the non-parametric Mann-Whitney test. Statistically significant differences between the groups were observed for Defensive Tactical Behavior (Z = −3.133; p = 0.002; r = −0.355) and Game Tactical Behavior (Z = −2.267; p = 0.023; r = −0.260). According to these results, it is possible to state that affective decision-making can influence the tactical behavior of under-15 soccer players. PMID:24978030

  4. Affective Decision-Making and Externalizing Behaviors: The Role of Autonomic Activity

    ERIC Educational Resources Information Center

    Bubier, Jennifer L.; Drabick, Deborah A. G.

    2008-01-01

    We tested a conceptual model involving the inter-relations among affective decision-making (indexed by a gambling task), autonomic nervous system (ANS) activity, and attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms in a largely impoverished, inner city sample of first through third grade children (N…

  5. Affective decision-making and tactical behavior of under-15 soccer players.

    PubMed

    Gonzaga, Adeilton dos Santos; Albuquerque, Maicon Rodrigues; Malloy-Diniz, Leandro Fernandes; Greco, Pablo Juan; Teoldo da Costa, Israel

    2014-01-01

    Affective decision-making is a type of Executive Function related to cost benefit analysis in situations where gains and losses imply direct consequences for the subject. The purpose of this study was to explore the influence of the affective decision-making on tactical behavior in soccer players under the age of 15 years old. The System of Tactical Assessment in Soccer (FUT-SAT) was used to assess tactical behavior. To evaluate affective decision-making, we used the neuropsychological test called The Iowa Gambling Task (IGT). The values of the offensive, defensive and game tactical behavior of participants were used to create performance groups. The low (≤25%) and high (≥75%) groups, according to offensive, defensive and game tactical behavior, were compared and shown to be different. The values of the IGT net score of the participants with low and high tactical behavior were compared using the non-parametric Mann-Whitney test. Statistically significant differences between the groups were observed for Defensive Tactical Behavior (Z = -3.133; p = 0.002; r = -0.355) and Game Tactical Behavior (Z = -2.267; p = 0.023; r = -0.260). According to these results, it is possible to state that affective decision-making can influence the tactical behavior of under-15 soccer players. PMID:24978030

  6. Factors Affecting Career Decision Making of Mexican and Mexican-American Students.

    ERIC Educational Resources Information Center

    Newlon, Betty J.; Borboa, Roman

    The purpose of this research was to identify the self-reported factors affecting the career decision making of Mexican and Mexican-American students. It was hypothesized that the factor clusters would differ between the two sample populations, Mexican and Mexican-American. It was also hypothesized that these clusters would differ from six clusters…

  7. Factors Affecting Christian Parents' School Choice Decision Processes: A Grounded Theory Study

    ERIC Educational Resources Information Center

    Prichard, Tami G.; Swezey, James A.

    2016-01-01

    This study identifies factors affecting the decision processes for school choice by Christian parents. Grounded theory design incorporated interview transcripts, field notes, and a reflective journal to analyze themes. Comparative analysis, including open, axial, and selective coding, was used to reduce the coded statements to five code families:…

  8. The Influence of Temporal Orientation and Affective Frame on use of Ethical Decision-Making Strategies

    PubMed Central

    Martin, Laura E.; Stenmark, Cheryl K.; Thiel, Chase E.; Antes, Alison L.; Mumford, Michael D.; Connelly, Shane; Devenport, Lynn D.

    2011-01-01

    This study examined the role of temporal orientation and affective frame in the execution of ethical decision-making strategies. In reflecting on a past experience or imagining a future experience, participants thought about experiences that they considered either positive or negative. The participants recorded their thinking about that experience by responding to several questions, and their responses were content-analyzed for the use of ethical decision-making strategies. The findings indicated that a future temporal orientation was associated with greater strategy use. Likewise, a positive affective frame was associated with greater strategy use. Future orientation may permit better strategy execution than a past orientation because it facilitates more objective, balanced contemplation of the reflected-upon situation, and minimizes potential self-threat associated with past behavior. A positive affective frame likely improves strategy execution because it facilitates active analysis of the experience. Future directions and implications of these findings are discussed. PMID:21572582

  9. The orbitofrontal cortex and beyond: from affect to decision-making.

    PubMed

    Rolls, Edmund T; Grabenhorst, Fabian

    2008-11-01

    The orbitofrontal cortex represents the reward or affective value of primary reinforcers including taste, touch, texture, and face expression. It learns to associate other stimuli with these to produce representations of the expected reward value for visual, auditory, and abstract stimuli including monetary reward value. The orbitofrontal cortex thus plays a key role in emotion, by representing the goals for action. The learning process is stimulus-reinforcer association learning. Negative reward prediction error neurons are related to this affective learning. Activations in the orbitofrontal cortex correlate with the subjective emotional experience of affective stimuli, and damage to the orbitofrontal cortex impairs emotion-related learning, emotional behaviour, and subjective affective state. With an origin from beyond the orbitofrontal cortex, top-down attention to affect modulates orbitofrontal cortex representations, and attention to intensity modulates representations in earlier cortical areas of the physical properties of stimuli. Top-down word-level cognitive inputs can bias affective representations in the orbitofrontal cortex, providing a mechanism for cognition to influence emotion. Whereas the orbitofrontal cortex provides a representation of reward or affective value on a continuous scale, areas beyond the orbitofrontal cortex such as the medial prefrontal cortex area 10 are involved in binary decision-making when a choice must be made. For this decision-making, the orbitofrontal cortex provides a representation of each specific reward in a common currency. PMID:18824074

  10. Older and wiser? An affective science perspective on age-related challenges in financial decision making

    PubMed Central

    Kensinger, Elizabeth A.; Munnell, Alicia H.; Sass, Steven A.; Dickerson, Brad C.; Wright, Christopher I.; Barrett, Lisa Feldman

    2011-01-01

    Financial planning decisionss are fundamentally affective in nature; they are decisions related to money, longevity and quality of life. Over the next several decades people will be increasingly responsible for managing their own assets and investments, and they will be subject to the affective influences on active, personal decision-making. Many of these crucial decisions are made and revised across the lifespan, including when to buy or sell a home, how to save for childrens’ education, how to manage healthcare costs, when to retire, how much to save for retirement and how to allocate retirement funds. As average life expectancy increases, many retirees will be faced with inadequate savings to live comfortably until the end of their lives. In the current article, we examine the problems of and potential solutions to inadequate financial planning through the lens of affective science, with an emphasis on how brain-based changes in affective processing with age might contribute to the challenge of financial planning. PMID:20587596

  11. How type of excuse defense, mock juror age, and defendant age affect mock jurors' decisions.

    PubMed

    Higgins, Pamela L; Heath, Wendy P; Grannemann, Bruce D

    2007-08-01

    The authors investigated the effects of mock juror age (younger vs. older), defendant age (22 vs. 65), and type of excuse defense used by defendants (a highly self-inflicted condition, Cocaine Dependency Disorder, vs. a less self-inflicted condition, Posttraumatic Stress Disorder) on mock juror decisions. Ninety-six younger and 96 older adults read a scenario and answered a questionnaire. Results indicated that the defendant using the highly self-inflicted excuse was more likely to receive a guilty verdict and a longer sentence than was the defendant using the less self-inflicted excuse. Older jurors were more certain of their verdicts and saw the defendant as more responsible for his condition than did younger jurors. Defendant age did not affect juror decisions. In addition, excuse type and juror age affected the jurors' perceptions of the victim's responsibility for the attack. The authors discuss the potential influence of juror age on perceptions of defendant responsibility. PMID:17955749

  12. The Fox and the Grapes-How Physical Constraints Affect Value Based Decision Making.

    PubMed

    Gross, Jörg; Woelbert, Eva; Strobel, Martin

    2015-01-01

    One fundamental question in decision making research is how humans compute the values that guide their decisions. Recent studies showed that people assign higher value to goods that are closer to them, even when physical proximity should be irrelevant for the decision from a normative perspective. This phenomenon, however, seems reasonable from an evolutionary perspective. Most foraging decisions of animals involve the trade-off between the value that can be obtained and the associated effort of obtaining. Anticipated effort for physically obtaining a good could therefore affect the subjective value of this good. In this experiment, we test this hypothesis by letting participants state their subjective value for snack food while the effort that would be incurred when reaching for it was manipulated. Even though reaching was not required in the experiment, we find that willingness to pay was significantly lower when subjects wore heavy wristbands on their arms. Thus, when reaching was more difficult, items were perceived as less valuable. Importantly, this was only the case when items were physically in front of the participants but not when items were presented as text on a computer screen. Our results suggest automatic interactions of motor and valuation processes which are unexplored to this date and may account for irrational decisions that occur when reward is particularly easy to reach. PMID:26061087

  13. The Fox and the Grapes—How Physical Constraints Affect Value Based Decision Making

    PubMed Central

    Strobel, Martin

    2015-01-01

    One fundamental question in decision making research is how humans compute the values that guide their decisions. Recent studies showed that people assign higher value to goods that are closer to them, even when physical proximity should be irrelevant for the decision from a normative perspective. This phenomenon, however, seems reasonable from an evolutionary perspective. Most foraging decisions of animals involve the trade-off between the value that can be obtained and the associated effort of obtaining. Anticipated effort for physically obtaining a good could therefore affect the subjective value of this good. In this experiment, we test this hypothesis by letting participants state their subjective value for snack food while the effort that would be incurred when reaching for it was manipulated. Even though reaching was not required in the experiment, we find that willingness to pay was significantly lower when subjects wore heavy wristbands on their arms. Thus, when reaching was more difficult, items were perceived as less valuable. Importantly, this was only the case when items were physically in front of the participants but not when items were presented as text on a computer screen. Our results suggest automatic interactions of motor and valuation processes which are unexplored to this date and may account for irrational decisions that occur when reward is particularly easy to reach. PMID:26061087

  14. Subchronic administration of atomoxetine causes an enduring reduction in context-induced relapse to cocaine seeking without affecting impulsive decision making.

    PubMed

    Broos, Nienke; Loonstra, Rhianne; van Mourik, Yvar; Schetters, Dustin; Schoffelmeer, Anton N M; Pattij, Tommy; De Vries, Taco J

    2015-07-01

    Previous work has established a robust relationship between impulsivity and addiction, and revealed that impulsive decision making predisposes the vulnerability to cocaine-seeking behavior in rats. An important next step is to assess whether elevated relapse vulnerability can be treated via the reduction of impulsive decision making. Therefore, this study explored whether subchronic atomoxetine treatment can reduce relapse vulnerability by reducing impulsive decision making. Rats were trained in the delayed reward task and were subjected to 3 weeks of cocaine self-administration. Following drug self-administration, animals were divided to different experimental groups and received the noradrenaline transporter inhibitor and attention-deficit/hyperactivity disorder drug atomoxetine or vehicle subchronically for 20 days. On days 1 and 10 after treatment cessation, a context-induced reinstatement test was performed. Throughout the entire experiment, changes in impulsive decision making were continuously monitored. Subchronic treatment with atomoxetine reduced context-induced reinstatement both 1 and 10 days after treatment cessation, only in animals receiving no extinction training. Interestingly, neither subchronic nor acute atomoxetine treatments affected impulsive decision making. Our data indicate that the enduring reduction in relapse sensitivity by atomoxetine occurred independent of a reduction in impulsive decision making. Nonetheless, repeated atomoxetine administration seems a promising pharmacotherapeutical strategy to prevent relapse to cocaine seeking in abstinent drug-dependent subjects. PMID:25056833

  15. Dental caries: A complete changeover, PART III: Changeover in the treatment decisions and treatments

    PubMed Central

    Carounanidy, Usha; Sathyanarayanan, R

    2010-01-01

    Comprehensive management of dental caries should involve the management of disease as well as the lesion. Current decision making process in cariology is influenced by numerous factors such as the size/ depth/ activity of the carious lesion and age/ the caries risk status of the patient. Treatment decisions should involve planning the non-operative/ preventive treatment for non-cavitated or early cavitated lesions and also formulating operative treatment for cavitated lesions. Apart from these two responsibilities, a clinician should also be knowledgeable enough to decide when not to interfere in the caries dynamics and how frequently to recall the patient for follow-ups. The non-operative treatment prescriptions vary in dose, intensity and mode of delivery according to the caries risk status. Minimal invasion and maximal conservation of tooth structure has become the essence of current operative treatments. This part of the series elaborates on the paradigm shift in the management of dental caries. PMID:21217948

  16. Human and nature-caused hazards: the affect heuristic causes biased decisions.

    PubMed

    Siegrist, Michael; Sütterlin, Bernadette

    2014-08-01

    People are more concerned about the negative consequences of human hazards compared with natural hazards. Results of four experiments show that the same negative outcome (e.g., number of birds killed by an oil spill) was more negatively evaluated when caused by humans than when caused by nature. Results further show that when identical risk information was provided, participants evaluated nuclear power more negatively compared with solar power. The affect associated with the hazard per se influenced the interpretation of the new information. Furthermore, the affect experienced in the situation fully mediated the evaluation of the negative outcomes of a hazard. People's reliance on the affect heuristic is a challenge for acceptance of cost-benefit analyses because equally negative outcomes are differently evaluated depending on the cause. Symbolically significant information and the affect evoked by this information may result in biased and riskier decisions. PMID:24576178

  17. Time Devours Things: How Impulsivity and Time Affect Temporal Decisions in Pathological Gamblers

    PubMed Central

    Grecucci, Alessandro; Giorgetta, Cinzia; Rattin, Andrea; Guerreschi, Cesare; Sanfey, Alan G.; Bonini, Nicolao

    2014-01-01

    Impulsivity is associated with several psychiatric disorders in which the loss of control of a specific behavior determines the syndrome itself. One particularly interesting population characterized by reported high impulsivity and problematic decision-making are those diagnosed with pathological gambling. However the association between impulsivity and decision making in pathological gambling has been only partially confirmed until now. We tested 23 normal controls and 23 diagnosed pathological gamblers in an intertemporal choice task, as well as other personality trait measurements. Results showed that gamblers scored higher on impulsivity questionnaires, and selected a higher percentage of impatient choices (higher percentage of smaller, sooner rewards), when compared to normal controls. Moreover, gamblers were faster in terms of reaction times at selecting the smaller, sooner options and discounted rewards more rapidly over time. Importantly, regression analyses clarified that self-reported measures of impulsivity played a significant role in biasing decisions towards small but more rapidly available rewards. In the present study we found evidence for impulsivity in personality traits and decisions in pathological gamblers relative to controls. We conclude by speculating on the need to incorporate impulsivity and decision biases in the conceptualization of pathological gambling for a better understanding and treatment of this pathology. PMID:25296184

  18. Use of ultrasound in treatment decisions for patients with rheumatoid arthritis: an observational study in Italy.

    PubMed

    Epis, Oscar; Scioscia, Crescenzio; Locaputo, Antonia; Cappelli, Antonella; Maier, Armin; Rocchetta, Pier Andrea; Tomietto, Paola; Perin, Antonella; Rigon, Chiara; Santo, Leonardo; Casilli, Oriana; Lapadula, Giovanni; Bruschi, Eleonora

    2016-08-01

    In rheumatoid arthritis (RA), treatment response is generally assessed using standard clinical disease activity measures. However, ultrasound has become increasingly popular among rheumatologists to monitor disease activity and response. The purpose of this analysis of ECOgraphic evaluation for STaging ARthritis (ECOSTAR) study data was to determine how ultrasound affects clinicians' decisions about changing treatment in RA. ECOSTAR was an observational, cohort study conducted between March 2010 and December 2012 at nine clinical centers in Italy in RA patients being considered for treatment change. After clinical evaluation of each patient, patients underwent diagnostic ultrasound (US) investigations and each patient was given a total echography score using a combination of scores for joint effusion, synovial hypertrophy, and power Doppler. The US results were provided to the clinicians and the influence of US on the clinicians' treatment choices were recorded. Ninety-five patients screened for study inclusion had confirmed RA (mean age 53.9 years; mean disease duration 8.9 years). Therapy changes were made by clinicians according to the hand and wrist joint US scores: score 0 appeared to have no influence on clinicians' decision to modify treatment, scores >0-3 were associated with a numerically higher estimated probability of not changing therapy than changing therapy, and scores >3 had a greater influence on the clinician to modify therapy and an increased probability of the clinician changing therapy versus not changing therapy. Ultrasonography scores appear to influence treatment decisions in patients with RA, with clinicians appearing less likely to alter treatment regimens in patients with low ultrasound scores and more likely to change treatment regimens when higher scores are obtained. Further research is warranted. PMID:27320945

  19. Inactivation of Parietal Reach Region Affects Reaching But Not Saccade Choices in Internally Guided Decisions

    PubMed Central

    Bonaiuto, James; Kagan, Igor; Andersen, Richard A.

    2015-01-01

    The posterior parietal cortex (PPC) has traditionally been considered important for awareness, spatial perception, and attention. However, recent findings provide evidence that the PPC also encodes information important for making decisions. These findings have initiated a running argument of whether the PPC is critically involved in decision making. To examine this issue, we reversibly inactivated the parietal reach region (PRR), the area of the PPC that is specialized for reaching movements, while two monkeys performed a memory-guided reaching or saccade task. The task included choices between two equally rewarded targets presented simultaneously in opposite visual fields. Free-choice trials were interleaved with instructed trials, in which a single cue presented in the peripheral visual field defined the reach and saccade target unequivocally. We found that PRR inactivation led to a strong reduction of contralesional choices, but only for reaches. On the other hand, saccade choices were not affected by PRR inactivation. Importantly, reaching and saccade movements to single instructed targets remained largely intact. These results cannot be explained as an effector-nonspecific deficit in spatial attention or awareness, since the temporary “lesion” had an impact only on reach choices. Hence, the PPR is a part of a network for reach decisions and not just reach planning. SIGNIFICANCE STATEMENT There has been an ongoing debate on whether the posterior parietal cortex (PPC) represents only spatial awareness, perception, and attention or whether it is also involved in decision making for actions. In this study we explore whether the parietal reach region (PRR), the region of the PPC that is specialized for reaches, is involved in the decision process. We inactivated the PRR while two monkeys performed reach and saccade choices between two targets presented simultaneously in both hemifields. We found that inactivation affected only the reach choices, while leaving

  20. Radiation Treatment in Older Patients: A Framework for Clinical Decision Making

    PubMed Central

    Smith, Grace L.; Smith, Benjamin D.

    2014-01-01

    In older patients, radiation treatment plays a vital role in curative and palliative cancer therapy. Radiation treatment recommendations should be informed by a comprehensive, personalized risk-benefit assessment that evaluates treatment efficacy and toxicity. We review several clinical factors that distinctly affect efficacy and toxicity of radiation treatment in older patients. First, locoregional tumor behavior may be more indolent in older patients for some disease sites but more aggressive for other sites. Assessment of expected locoregional relapse risk informs the magnitude and timeframe of expected radiation treatment benefits. Second, assessment of the competing cancer versus noncancer mortality and morbidity risks contextualizes cancer treatment priorities holistically within patients' entire spectrum and time course of health needs. Third, assessment of functional reserve helps predict patients' acute treatment tolerance, differentiating those patients who are unlikely to benefit from treatment or who are at high risk for treatment complications. Potential radiation treatment options include immediate curative treatment, delayed curative treatment, and no treatment, with additional consideration given to altered radiation target, dose, or sequencing with chemotherapy and/or surgery. Finally, when cure is not feasible, palliative radiation therapy remains valuable for managing symptoms and achieving meaningful quality-of-life improvements. Our proposed decision-making framework integrates these factors to help radiation oncologists formulate strategic treatment recommendations within a multidisciplinary context. Future research is still needed to identify how advanced technologies can be judiciously applied in curative and palliative settings to enhance risk-benefit profiles of radiation treatment in older patients and more accurately quantify treatment efficacy in this group. PMID:25071132

  1. Autism spectrum disorders: a qualitative study of attitudes toward prenatal genetic testing and termination decisions of affected pregnancies.

    PubMed

    Chen, L S; Xu, L; Dhar, S U; Li, M; Talwar, D; Jung, E

    2015-08-01

    In the United States, prenatal genetic testing (PGT) for Autism Spectrum Disorders (ASD) is currently available via clinical genetic services. Such testing may inform parents about their unborn child's risk for ASD, prepare parents for the birth of an affected infant, and allow them to arrange for early interventions. Although PGT for autism has potential benefits, the associated ethical, legal, and social implications (ELSI) should be considered. This first qualitative study employed a hypothetical scenario to explore the attitudes toward PGT and termination decisions of 42 parents of children with ASD. Over half of the participants expressed willingness to undergo PGT for autism. Reasons included better preparation for birth, early and better treatment, termination of affected pregnancy, contribution to research, and curiosity. Of the 31 parents who were either willing or unsure about undergoing the PGT, approximately three-fourths would continue their hypothetical affected pregnancies. Explanations included preparation for birth of the child, bonding or acceptance of existing ASD-affected children, apprehensions about test limitations, and religious concerns. Parents who reported they would terminate the affected pregnancy in this hypothetical situation were primarily Asians. This study contributes to the growing understanding of the ELSI aspects of PGT in clinical practice. PMID:25251361

  2. Nonadjunctive Use of Continuous Glucose Monitoring for Diabetes Treatment Decisions.

    PubMed

    Castle, Jessica R; Jacobs, Peter G

    2016-09-01

    While self-monitoring of blood glucose (SMBG) is the current standard used by people with diabetes to manage glucose levels, recent improvements in accuracy of continuous glucose monitoring (CGM) technology are making it very likely that diabetes-related treatment decisions will soon be made based on CGM values alone. Nonadjunctive use of CGM will lead to a paradigm shift in how patients manage their glucose levels and will require substantial changes in how care providers educate their patients, monitor their progress, and provide feedback to help them manage their diabetes. The approval to use CGM nonadjunctively is also a critical step in the pathway toward FDA approval of an artificial pancreas system, which is further expected to transform diabetes care for people with type 1 diabetes. In this article, we discuss how nonadjunctive CGM is expected to soon replace routine SMBG and how this new usage scenario is expected to transform health outcomes and patient care. PMID:26880390

  3. Generalized Tumor Dose for Treatment Planning Decision Support

    NASA Astrophysics Data System (ADS)

    Zuniga, Areli A.

    Modern radiation therapy techniques allow for improved target conformity and normal tissue sparing. These highly conformal treatment plans have allowed dose escalation techniques increasing the probability of tumor control. At the same time this conformation has introduced inhomogeneous dose distributions, making delivered dose characterizations more difficult. The concept of equivalent uniform dose (EUD) characterizes a heterogeneous dose distribution within irradiated structures as a single value and has been used in biologically based treatment planning (BBTP); however, there are no substantial validation studies on clinical outcome data supporting EUD's use and therefore has not been widely adopted as decision-making support. These highly conformal treatment plans have also introduced the need for safety margins around the target volume. These margins are designed to minimize geometrical misses, and to compensate for dosimetric and treatment delivery uncertainties. The margin's purpose is to reduce the chance of tumor recurrence. This dissertation introduces a new EUD formulation designed especially for tumor volumes, called generalized Tumor Dose (gTD). It also investigates, as a second objective, margins extensions for potential improvements in local control while maintaining or minimizing toxicity. The suitability of gTD to rank LC was assessed by means of retrospective studies in a head and neck (HN) squamous cell carcinoma (SCC) and non-small cell lung cancer (NSCLC) cohorts. The formulation was optimized based on two datasets (one of each type) and then, model validation was assessed on independent cohorts. The second objective of this dissertation was investigated by ranking the probability of LC of the primary disease adding different margin sizes. In order to do so, an already published EUD formula was used retrospectively in a HN and a NSCLC datasets. Finally, recommendations for the viability to implement this new formulation into a routine treatment

  4. Disaster dilemma: factors affecting decision to come to work during a natural disaster.

    PubMed

    Davidson, Judy E; Sekayan, Ani; Agan, Donna; Good, Linda; Shaw, David; Smilde, Renee

    2009-01-01

    Natural disasters threaten the ability to staff a hospital. The objective of this study was to identify factors influencing decision to come to work during a fire disaster. The authors' hospital experienced a 17-fold increase in no-shows during a fire. Phenomenography was used to explore staff experiences immediately following wildfires. Factors affecting decision to work during a disaster included vulnerability of family, personal safety, and fire proximity. Modifiable factors were identified as follows: past experience with disasters, perceived importance, relationship with the organization, and caring connection with the organization. Employees experienced tension between obligations to family, community, and organization. Pets were seen as family and as important as biological family. Further research is indicated to determine predictive modeling and generalizability. Hospital leaders may influence disaster response by establishing a caring connection, providing resources for family members/pets, and promoting perceived importance of the employee. PMID:20118877

  5. The role of current affect, anticipated affect and spontaneous self-affirmation in decisions to receive self-threatening genetic risk information.

    PubMed

    Ferrer, Rebecca A; Taber, Jennifer M; Klein, William M P; Harris, Peter R; Lewis, Katie L; Biesecker, Leslie G

    2015-01-01

    One reason for not seeking personally threatening information may be negative current and anticipated affective responses. We examined whether current (e.g., worry) and anticipated negative affect predicted intentions to seek sequencing results in the context of an actual genomic sequencing trial (ClinSeq®; n = 545) and whether spontaneous self-affirmation mitigated any (negative) association between affect and intentions. Anticipated affective response negatively predicted intentions to obtain and share results pertaining to both medically actionable and non-actionable disease, whereas current affect was only a marginal predictor. The negative association between anticipated affect and intentions to obtain results pertaining to non-actionable disease was weaker in individuals who were higher in spontaneous self-affirmation. These results have implications for the understanding of current and anticipated affect, self-affirmation and consequential decision-making and contribute to a growing body of evidence on the role of affect in medical decisions. PMID:25482843

  6. Social context and reproductive potential affect worker reproductive decisions in a eusocial insect.

    PubMed

    Yagound, Boris; Blacher, Pierre; Chameron, Stéphane; Châline, Nicolas

    2012-01-01

    Context-dependent decision-making conditions individual plasticity and is an integrant part of alternative reproductive strategies. In eusocial Hymenoptera (ants, bees and wasps), the discovery of worker reproductive parasitism recently challenged the view of workers as a homogeneous collective entity and stressed the need to consider them as autonomous units capable of elaborate choices which influence their fitness returns. The reproductive decisions of individual workers thus need to be investigated and taken into account to understand the regulation of reproduction in insect societies. However, we know virtually nothing about the proximate mechanisms at the basis of worker reproductive decisions. Here, we test the hypothesis that the capacity of workers to reproduce in foreign colonies lies in their ability to react differently according to the colonial context and whether this reaction is influenced by a particular internal state. Using the bumble bee Bombus terrestris, we show that workers exhibit an extremely high reproductive plasticity which is conditioned by the social context they experience. Fertile workers reintroduced into their mother colony reverted to sterility, as expected. On the contrary, a high level of ovary activity persisted in fertile workers introduced into a foreign nest, and this despite more frequent direct contacts with the queen and the brood than control workers. Foreign workers' reproductive decisions were not affected by the resident queen, their level of fertility being similar whether or not the queen was removed from the host colony. Workers' physiological state at the time of introduction is also of crucial importance, since infertile workers failed to develop a reproductive phenotype in a foreign nest. Therefore, both internal and environmental factors appear to condition individual reproductive strategies in this species, suggesting that more complex decision-making mechanisms are involved in the regulation of worker

  7. Parallel effects of processing fluency and positive affect on familiarity-based recognition decisions for faces

    PubMed Central

    Duke, Devin; Fiacconi, Chris M.; Köhler, Stefan

    2014-01-01

    According to attribution models of familiarity assessment, people can use a heuristic in recognition-memory decisions, in which they attribute the subjective ease of processing of a memory probe to a prior encounter with the stimulus in question. Research in social cognition suggests that experienced positive affect may be the proximal cue that signals fluency in various experimental contexts. In the present study, we compared the effects of positive affect and fluency on recognition-memory judgments for faces with neutral emotional expression. We predicted that if positive affect is indeed the critical cue that signals processing fluency at retrieval, then its manipulation should produce effects that closely mirror those produced by manipulations of processing fluency. In two experiments, we employed a masked-priming procedure in combination with a Remember-Know (RK) paradigm that aimed to separate familiarity- from recollection-based memory decisions. In addition, participants performed a prime-discrimination task that allowed us to take inter-individual differences in prime awareness into account. We found highly similar effects of our priming manipulations of processing fluency and of positive affect. In both cases, the critical effect was specific to familiarity-based recognition responses. Moreover, in both experiments it was reflected in a shift toward a more liberal response bias, rather than in changed discrimination. Finally, in both experiments, the effect was found to be related to prime awareness; it was present only in participants who reported a lack of such awareness on the prime-discrimination task. These findings add to a growing body of evidence that points not only to a role of fluency, but also of positive affect in familiarity assessment. As such they are consistent with the idea that fluency itself may be hedonically marked. PMID:24795678

  8. Influence of negative affect on decision making in women with restrictive and binge-purge type anorexia nervosa.

    PubMed

    Danner, Unna N; Sternheim, Lot; Bijsterbosch, Jojanneke M; Dingemans, Alexandra E; Evers, Catharine; van Elburg, Annemarie A

    2016-05-30

    The present study aims to examine the influence of negative affect on decision making in women with anorexia nervosa (AN) compared to healthy control women and, secondly, to assess differences between the restrictive (ANR) and binge-purge (ANBP) subtypes. One hundred four women (32 with ANR, 32 with ANBP, and 40 healthy controls) participated. All women were asked to watch either a negative or a control film fragment, both followed by the Bechara Gambling Task (BGT). Before and after the fragments negative affect was measured. Additionally, relevant characteristics (e.g., overall depressive symptoms) were assessed. Differences in negative affect did not influence decision making performance. Independent of affective state, decision making was found to be impaired in women with ANBP (no learning effect on the BGT), but not in women with ANR. These findings highlight the importance of considering different AN subtypes when examining decision making processes. However, the role of negative affect on decision making remains uncertain. Since other affect related factors such as affect dysregulation may also play a role, future studies on decision making in AN should take the role of affect into account. PMID:27137960

  9. When idols look into the future: fair treatment modulates the affective forecasting error in talent show candidates.

    PubMed

    Feys, Marjolein; Anseel, Frederik

    2015-03-01

    People's affective forecasts are often inaccurate because they tend to overestimate how they will feel after an event. As life decisions are often based on affective forecasts, it is crucial to find ways to manage forecasting errors. We examined the impact of a fair treatment on forecasting errors in candidates in a Belgian reality TV talent show. We found that perceptions of fair treatment increased the forecasting error for losers (a negative audition decision) but decreased it for winners (a positive audition decision). For winners, this effect was even more pronounced when candidates were highly invested in their self-view as a future pop idol whereas for losers, the effect was more pronounced when importance was low. The results in this study point to a potential paradox between maximizing happiness and decreasing forecasting errors. A fair treatment increased the forecasting error for losers, but actually made them happier. PMID:24548171

  10. Abnormal affective decision making revealed in adolescent binge drinkers using a functional magnetic resonance imaging study.

    PubMed

    Xiao, Lin; Bechara, Antoine; Gong, Qiyong; Huang, Xiaoqi; Li, Xiangrui; Xue, Gui; Wong, Savio; Lu, Zhong-Lin; Palmer, Paula; Wei, Yonglan; Jia, Yong; Johnson, C Anderson

    2013-06-01

    The goal of this study was to investigate the neural correlates of affective decision making, as measured by the Iowa Gambling Task (IGT), which are associated with adolescent binge drinking. Fourteen adolescent binge drinkers (16-18 years of age) and 14 age-matched adolescents who had never consumed alcohol--never drinkers--were recruited from local high schools in Chengdu, China. Questionnaires were used to assess academic performance, drinking experience, and urgency. Brain regions activated by the IGT performance were identified with functional magnetic resonance imaging. Results showed that, compared to never drinkers, binge drinkers performed worse on the IGT and showed higher activity in the subcomponents of the decision-making neural circuitry implicated in the execution of emotional and incentive-related behaviors, namely, the left amygdala and insula bilaterally. Moreover, measures of the severity of drinking problems in real life, as well as high urgency scores, were associated with increased activity within the insula, combined with decreased activity within the orbitofrontal cortex. These results suggest that hyperreactivity of a neural system implicated in the execution of emotional and incentive-related behaviors can be associated with socially undesirable behaviors, such as binge drinking, among adolescents. These findings have social implications because they potentially reveal underlying neural mechanisms for making poor decisions, which may increase an individual's risk and vulnerability for alcoholism. PMID:22486330

  11. An Integrative Process Approach on Judgment and Decision Making: The Impact of Arousal, Affect, Motivation, and Cognitive Ability

    ERIC Educational Resources Information Center

    Roets, Arne; Van Hiel, Alain

    2011-01-01

    This article aims to integrate the findings from various research traditions on human judgment and decision making, focusing on four process variables: arousal, affect, motivation, and cognitive capacity/ability. We advocate a broad perspective referred to as the integrative process approach (IPA) of decision making, in which these process…

  12. The Relationships among Three Factors Affecting the Financial Decision-Making Abilities of Adults with Mild Intellectual Disabilities

    ERIC Educational Resources Information Center

    Suto, W. M. I.; Clare, I. C. H.; Holland, A. J.; Watson, P. C.

    2005-01-01

    Among adults with intellectual disabilities (IDs), there is a need not only to assess financial decision-making capacity, but also to understand how it can be maximized. Although increased financial independence is a goal for many people, it is essential that individuals decision-making abilities are sufficient, and many factors may affect the…

  13. Environmental Factors Affecting Pupation Decision in the Horned Flour Beetle Gnatocerus cornutus.

    PubMed

    Ozawa, Takane; Ohta, Kunihiro; Shimada, Masakazu; Okada, Kensuke; Okada, Yasukazu

    2015-04-01

    Social environments often affect the development of organisms. In Tenebrionidae beetles, larval development can be arrested at the final instar stage in the presence of conspecific larvae. This developmental plasticity is considered to be an anti-cannibalistic strategy but the critical environmental determinants and actual effects remain to be elucidated. In this study, we examined the effects of the heterospecific environment, conspecific sexual environment (i.e., presence of conspecific male or female), and abiotic physical stimulation on the pupation decision of the sexually dimorphic horned-flour beetle Gnatocerus cornutus. Additionally, actual anti-cannibalistic or antipredatory effects of developmental arrest were evaluated by analyzing stage-dependent vulnerabilities. When G. cornutus larvae were maintained with a G. cornutus larva, a G. cornutus adult, or T. castaneum adult, the developmental period up to the prepupal stage was significantly elongated, suggesting that the cue is not species-specific. Sexual environment did not affect the timing of pupation in G. cornutus; however, we found that abiotic tactile stimulations by glass beads could repress pupation. We also discovered that prepupal and pupal stages were more vulnerable to cannibalism and predation than the larval stage. These data suggest that G. cornutus larvae use non-species specific tactile stimulation as a decision cue for pupation and it has broader defensive effects against heterospecific predation as well as conspecific cannibalism. PMID:25826068

  14. Individual dispersal decisions affect fitness via maternal rank effects in male rhesus macaques.

    PubMed

    Weiß, Brigitte M; Kulik, Lars; Ruiz-Lambides, Angelina V; Widdig, Anja

    2016-01-01

    Natal dispersal may have considerable social, ecological and evolutionary consequences. While species-specific dispersal strategies have received much attention, individual variation in dispersal decisions and its fitness consequences remain poorly understood. We investigated causes and consequences of natal dispersal age in rhesus macaques (Macaca mulatta), a species with male dispersal. Using long-term demographic and genetic data from a semi-free ranging population on Cayo Santiago, Puerto Rico, we analysed how the social environment such as maternal family, group and population characteristics affected the age at which males leave their natal group. While natal dispersal age was unrelated to most measures of group or population structure, our study confirmed earlier findings that sons of high-ranking mothers dispersed later than sons of low-ranking ones. Natal dispersal age did not affect males' subsequent survival, but males dispersing later were more likely to reproduce. Late dispersers were likely to start reproducing while still residing in their natal group, frequently produced extra-group offspring before natal dispersal and subsequently dispersed to the group in which they had fathered offspring more likely than expected. Hence, the timing of natal dispersal was affected by maternal rank and influenced male reproduction, which, in turn affected which group males dispersed to. PMID:27576465

  15. Evaluating ambivalence: social-cognitive and affective brain regions associated with ambivalent decision-making.

    PubMed

    Nohlen, Hannah U; van Harreveld, Frenk; Rotteveel, Mark; Lelieveld, Gert-Jan; Crone, Eveline A

    2014-07-01

    Ambivalence is a state of inconsistency that is often experienced as affectively aversive. In this functional magnetic resonance imaging study, we investigated the role of cognitive and social-affective processes in the experience of ambivalence and coping with its negative consequences. We examined participants' brain activity during the dichotomous evaluation (pro vs contra) of pretested ambivalent (e.g. alcohol), positive (e.g. happiness) and negative (e.g. genocide) word stimuli. We manipulated evaluation relevance by varying the probability of evaluation consequences, under the hypothesis that ambivalence is experienced as more negative when outcomes are relevant. When making ambivalent evaluations, more activity was found in the anterior cingulate cortex, the insula, the temporal parietal junction (TPJ) and the posterior cingulate cortex (PCC)/precuneus, for both high and low evaluation relevance. After statistically conservative corrections, activity in the TPJ and PCC/precuneus was negatively correlated with experienced ambivalence after scanning, as measured by Priester and Petty's felt ambivalence scale (1996). The findings show that cognitive and social-affective brain areas are involved in the experience of ambivalence. However, these networks are differently associated with subsequent reduction of ambivalence, thus highlighting the importance of understanding both cognitive and affective processes involved in ambivalent decision-making. PMID:23685774

  16. Individual dispersal decisions affect fitness via maternal rank effects in male rhesus macaques

    PubMed Central

    Weiß, Brigitte M.; Kulik, Lars; Ruiz-Lambides, Angelina V.; Widdig, Anja

    2016-01-01

    Natal dispersal may have considerable social, ecological and evolutionary consequences. While species-specific dispersal strategies have received much attention, individual variation in dispersal decisions and its fitness consequences remain poorly understood. We investigated causes and consequences of natal dispersal age in rhesus macaques (Macaca mulatta), a species with male dispersal. Using long-term demographic and genetic data from a semi-free ranging population on Cayo Santiago, Puerto Rico, we analysed how the social environment such as maternal family, group and population characteristics affected the age at which males leave their natal group. While natal dispersal age was unrelated to most measures of group or population structure, our study confirmed earlier findings that sons of high-ranking mothers dispersed later than sons of low-ranking ones. Natal dispersal age did not affect males’ subsequent survival, but males dispersing later were more likely to reproduce. Late dispersers were likely to start reproducing while still residing in their natal group, frequently produced extra-group offspring before natal dispersal and subsequently dispersed to the group in which they had fathered offspring more likely than expected. Hence, the timing of natal dispersal was affected by maternal rank and influenced male reproduction, which, in turn affected which group males dispersed to. PMID:27576465

  17. Decision aids for localized prostate cancer treatment choice: Systematic review and meta-analysis.

    PubMed

    Violette, Philippe D; Agoritsas, Thomas; Alexander, Paul; Riikonen, Jarno; Santti, Henrikki; Agarwal, Arnav; Bhatnagar, Neera; Dahm, Philipp; Montori, Victor; Guyatt, Gordon H; Tikkinen, Kari A O

    2015-01-01

    Patients who are diagnosed with localized prostate cancer need to make critical treatment decisions that are sensitive to their values and preferences. The role of decision aids in facilitating these decisions is unknown. The authors conducted a systematic review of randomized trials of decision aids for localized prostate cancer. Teams of 2 reviewers independently identified, selected, and abstracted data from 14 eligible trials (n = 3377 men), of which 10 were conducted in North America. Of these, 11 trials compared decision aids with usual care, and 3 trials compared decision aids with other decision aids. Two trials suggested a modest positive impact on decisional regret. Results across studies varied widely for decisional conflict (4 studies), satisfaction with decision (2 studies), and knowledge (2 studies). No impact on treatment choices was observed (6 studies). In conclusion, scant evidence at high risk of bias suggests the variable impact of existing decision aids on a limited set of decisional processes and outcomes. Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user-centered design of decision aids that promote shared decision making. PMID:25772796

  18. Fluctuating capacity and advance decision-making in Bipolar Affective Disorder - Self-binding directives and self-determination.

    PubMed

    Gergel, Tania; Owen, Gareth S

    2015-01-01

    For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. PMID:25939286

  19. Fluctuating capacity and advance decision-making in Bipolar Affective Disorder — Self-binding directives and self-determination

    PubMed Central

    Gergel, Tania; Owen, Gareth S.

    2015-01-01

    For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being ‘protected’ through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician–patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. PMID:25939286

  20. Decision analysis and risk models for land development affecting infrastructure systems.

    PubMed

    Thekdi, Shital A; Lambert, James H

    2012-07-01

    Coordination and layering of models to identify risks in complex systems such as large-scale infrastructure of energy, water, and transportation is of current interest across application domains. Such infrastructures are increasingly vulnerable to adjacent commercial and residential land development. Land development can compromise the performance of essential infrastructure systems and increase the costs of maintaining or increasing performance. A risk-informed approach to this topic would be useful to avoid surprise, regret, and the need for costly remedies. This article develops a layering and coordination of models for risk management of land development affecting infrastructure systems. The layers are: system identification, expert elicitation, predictive modeling, comparison of investment alternatives, and implications of current decisions for future options. The modeling layers share a focus on observable factors that most contribute to volatility of land development and land use. The relevant data and expert evidence include current and forecasted growth in population and employment, conservation and preservation rules, land topography and geometries, real estate assessments, market and economic conditions, and other factors. The approach integrates to a decision framework of strategic considerations based on assessing risk, cost, and opportunity in order to prioritize needs and potential remedies that mitigate impacts of land development to the infrastructure systems. The approach is demonstrated for a 5,700-mile multimodal transportation system adjacent to 60,000 tracts of potential land development. PMID:22050390

  1. 76 FR 3077 - Notice of Decision To Revise a Heat Treatment Schedule for Emerald Ash Borer

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-19

    ... accordance with Sec. 305.3(a)(1), we published a notice \\2\\ in the Federal Register on August 25, 2010 (75 FR... Animal and Plant Health Inspection Service Notice of Decision To Revise a Heat Treatment Schedule for... are advising the public of our decision to revise a heat treatment schedule for the emerald ash...

  2. Virtual support for paediatric HIV treatment decision making

    PubMed Central

    Le Doare, Kirsty; Mackie, N E; Kaye, S; Bamford, A; Walters, S; Foster, C

    2015-01-01

    Objective The objective of this study is to review clinical outcomes of recommendations made by a multidisciplinary paediatric virtual clinic (PVC) for complex case management of paediatric HIV as a model of care within a tertiary network. Design A retrospective review of the clinical outcomes of paediatric and adolescent (0–21 years) referrals to the PVC at St. Mary's Hospital, Imperial College Healthcare NHS Trust, London was performed between October 2009 and November 2013. Results 234 referrals were made for 182 children from 37 centres, discussed in 42 meetings (median age 13 years, IQR 10–15 years). Reasons for referral included virological failure (44%), simplification of the current regimen (24%) and antiretroviral drug complications (24%). At latest follow-up, PVC advice had been instituted in 80% of referrals. Suppression following virological failure was achieved in 48% following first referral and 57% following subsequent discussions and was maintained in 95% of children referred for regimen simplification. Following advice, dyslipidaemia resolved in 42% and liver function normalised in 73% with biochemical hepatitis. Adherence support aided resolution of viraemia in nine children and 12% of referrals resulted in additional support, including psychology, social services and mental health input. Conclusions Combined multidisciplinary virtual input with adult expertise in resistance and newer agents, paediatric knowledge of pill swallowing, childhood formulations/weight banding and parental support, assists complex treatment decision making in paediatric HIV infection. The Virtual Clinic model could be applied to the management of other rare complex diseases of childhood within a clinical network. PMID:25549664

  3. Reinforcement Sensitivity Underlying Treatment-Seeking Smokers’ Affect, Smoking Reinforcement Motives, and Affective Responses

    PubMed Central

    Cui, Yong; Robinson, Jason D.; Engelmann, Jeffrey M.; Lam, Cho Y.; Minnix, Jennifer A.; Karam-Hage, Maher; Wetter, David W.; Dani, John A.; Kosten, Thomas R.; Cinciripini, Paul M.

    2014-01-01

    Nicotine dependence has been suggested to be related to reinforcement sensitivity, which encompasses behavioral predispositions either to avoid aversive (behavioral inhibition) or to approach appetitive (behavioral activation) stimuli. Reinforcement sensitivity may shape motives for nicotine use and offer potential targets for personalized smoking cessation therapy. However, little is known regarding how reinforcement sensitivity is related to motivational processes implicated in the maintenance of smoking. Additionally, women and men differ in reinforcement sensitivity, and such difference may cause distinct relationships between reinforcement sensitivity and motivational processes for female and male smokers. In this study, we characterized reinforcement sensitivity in relation to affect, smoking-related reinforcement motives, and affective responses, using self-report and psychophysiological measures, in over 200 smokers before treating them. The Behavioral Inhibition/Activation Scales (BIS/BAS; Carver & White, 1994) was used to measure reinforcement sensitivity. In female and male smokers, BIS was similarly associated with negative affect and negative reinforcement of smoking. But positive affect was positively associated with BAS Drive scores in male smokers, and this association was reversed in female smokers. BIS was positively associated with corrugator electromyographic reactivity towards negative stimuli and left frontal electroencephalogram alpha asymmetry. Female and male smokers showed similar relationships for these physiological measures. These findings suggest that reinforcement sensitivity underpins important motivational processes (e.g., affect), and gender is a moderating factor for these relationships. Future personalized smoking intervention, particularly among more dependent treatment-seeking smokers, may experiment to target individual differences in reinforcement sensitivity. PMID:25621416

  4. Psychosocial predictors of treatment outcome for trauma-affected refugees

    PubMed Central

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per; Vindbjerg, Erik; Mortensen, Erik Lykke; Elklit, Ask

    2016-01-01

    Background The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. Objective The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. Method The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. Results Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. Conclusions The total score of the CTP Predictor Index correlated significantly with outcomes on most

  5. Effect of a perspective-taking intervention on the consideration of pain assessment and treatment decisions

    PubMed Central

    Wandner, Laura D; Torres, Calia A; Bartley, Emily J; George, Steven Z; Robinson, Michael E

    2015-01-01

    Objectives Pain is often poorly managed, highlighting the need to better understand and treat patients’ pain. Research suggests that pain is assessed and treated differently depending on patient sex, race, and/or age. Perspective-taking, whereby one envisions the perspective of another, has been found to reduce racial disparities in pain management. This study used virtual human (VH) technology to examine whether a perspective-taking intervention impacts pain management decisions. Methods Ninety-six participants were randomized to an online treatment or control group and viewed 16 video clips of VHs with standardized levels of pain. Participants provided ratings on the VHs’ pain intensity and their willingness to administer opioids to them. The intervention group received a brief perspective-taking intervention that consisted of having participants imagine how the patient’s suffering could affect his/her life, whereas the control group was asked to wait for the next VH videos to load. A LENS model analysis was used to investigate both group level (nomothetic) and individual level (idiographic) decision policies. A LENS model of analysis is typically used as an analog method for capturing how groups of people and individuals use information in their environment to form judgments. Results Nomothetic results found that participants rated pain higher and were more likely to prescribe opioids to VHs postintervention, irrespective of group. Idiographic results, however, found that the use of cues to make pain management decisions was mitigated by the perspective-taking group. The participants in the perspective-taking group were more likely to think about pain and the patients’ perspective during the intervention, while control participants were more likely to reflect on the VHs’ sex, race, or age. Conclusion A brief intervention may alter participants’ pain management decisions. These results indicate that a brief intervention might be an initial step toward

  6. Heart valve disease in elderly Chinese population: effect of advanced age and comorbidities on treatment decision-making and outcomes

    PubMed Central

    Hu, Kui; Li, Jun; Wan, Yun; Hong, Tao; Lu, Shu-Yang; Guo, Chang-Fa; Wang, Chun-Sheng

    2016-01-01

    Background A considerable proportion of elderly patients with symptomatic severe heart valve disease are treated conservatively despite clear indications for surgical intervention. However, little is known about how advanced age and comorbidities affect treatment decision-making and therapeutic outcomes. Methods Patients (n = 234, mean age: 78.5 ± 3.7 years) with symptomatic severe heart valve disease hospitalized in our center were included. One hundred and fifty-one patients (65%) were treated surgically (surgical group) and 83 (35%) were treated conservatively (conservative group). Factors that affected therapeutic decision-making and treatment outcomes were investigated and long-term survival was explored. Results Isolated aortic valve disease, female sex, chronic renal insufficiency, aged ≥ 80 years, pneumonia, and emergent status were independent factors associated with therapeutic decision-making. In-hospital mortality for the surgical group was 5.3% (8/151). Three patients (3.6%) in the conservative group died during initial hospitalization. Low cardiac output syndrome and chronic renal insufficiency were identified as predictors of in-hospital mortality in the surgical group. Conservative treatment was identified as the single risk factor for late death in the entire study population. The surgical group had better 5-year (77.2% vs. 45.4%, P < 0.0001) and 10-year (34.5% vs. 8.9%, P < 0.0001) survival rates than the conservative group, even when adjusted by propensity score-matched analysis. Conclusions Advanced age and geriatric comorbidities profoundly affect treatment decision-making for severe heart valve disease. Valve surgery in the elderly was not only safe but was also associated with good long-term survival while conservative treatment was unfavorable for patients with symptomatic severe valve disease.

  7. Parent Perspectives on the Decision to Initiate Medication Treatment of Attention-Deficit/Hyperactivity Disorder

    PubMed Central

    Pappadopulos, Elizabeth; Katsiotas, Nikki J.; Berest, Alison; Jensen, Peter S.; Kafantaris, Vivian

    2012-01-01

    distorted ideas about treatment risks. Parents, however, took pride in successfully pursuing efforts to manage their child behaviorally and to avoid medication when possible. Conclusions Focus group data identified social, cognitive, and affective influences on treatment decision making. Results support prior research comparing family/social functioning, physician characteristics, and adherence. Findings suggest that parent attitudes to psychiatric care need to be assessed comprehensively at initial evaluation to aid the development of psychoeducational messages, and a more careful consideration about how parents interpret and respond to adherence-related questioning. PMID:22537185

  8. Affective associations and cognitive beliefs relate to individuals' decisions to perform testicular or breast self-exams.

    PubMed

    Brown-Kramer, Carolyn R; Kiviniemi, Marc T

    2015-08-01

    Affective associations with behavioral practices play an important role in individuals' uptake of a variety of health behaviors. Most work has looked at individual behavioral practices with a direct impact on health; because screening behaviors are conceptually distinct from such behaviors, it is important to examine the interplay of affect and cognition in screening decision making. The current research explored affective and cognitive predictors of testicular and breast self-examination behavior. Young adult participants (N = 184) reported cognitive beliefs and affective associations with testicular self-exam behavior (male participants) and breast self-exam behavior (female participants) and reported their own current screening behavior. In univariable models, affective associations were related to screening behavior for both testicular self-exams and breast self-exams. When examining affective associations and cognitive beliefs as simultaneous predictors, affective associations (but not cognitive beliefs) predicted testicular self-exams, and neither affective associations nor cognitive beliefs were uniquely related to breast self-exams. Moreover, for testicular self-exams, affective associations mediated the relation between cognitive beliefs and screening behavior; no mediation was present for breast self-exam behavior. These findings suggest three potential outcomes: first, that greater consideration of affective associations in testicular self-exam screening decisions may be warranted; second, that breast and testicular self-exams may have different antecedents; and third, that incorporation of affective factors in intervention design might have merit for increasing engagement in some cancer screening behaviors. PMID:25851610

  9. The Role of Positive Affect in Pain and its Treatment

    PubMed Central

    Finan, Patrick H.; Garland, Eric L.

    2014-01-01

    This narrative review summarizes and integrates the available literature on PA and pain to: 1) Provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and chronic pain; 2) Provide a theoretical foundation from which to understand how PA operates in the context of chronic pain; and 3) Highlight how the prevailing psychosocial treatments for chronic pain address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with chronic pain. To that end, we review experimental studies that have assessed the association of evoked PA and pain sensitivity, as well as clinical studies that have assessed the association of naturally occurring PA and clinical pain in the context of chronic pain. The evidence suggests PA influences pain, over and above the influence of NA. We offer an “upward spiral” model of positive affect, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance chronic pain self-management. PMID:24751543

  10. Operative Versus Nonoperative Treatment of Jones Fractures: A Decision Analysis Model.

    PubMed

    Bishop, Julius A; Braun, Hillary J; Hunt, Kenneth J

    2016-01-01

    Optimal management of metadiaphyseal fifth metatarsal fractures (Jones fractures) remains controversial. Decision analysis can optimize clinical decision-making based on available evidence and patient preferences. We conducted a study to establish the determinants of decision-making and to determine the optimal treatment strategy for Jones fractures using a decision analysis model. Probabilities for potential outcomes of operative and nonoperative treatment of Jones fractures were determined from a review of the literature. Patient preferences for outcomes were obtained by questionnaire completed by 32 healthy adults with no history of foot fracture. Derived values were used in the model as a measure of utility. A decision tree was constructed, and fold-back and sensitivity analyses were performed to determine optimal treatment. Nonoperative treatment was associated with a value of 7.74, and operative treatment with an intramedullary screw was associated with a value of 7.88 given the outcome probabilities and utilities studied, making operative treatment the optimal strategy. When parameters were varied, nonoperative treatment was favored when the likelihood of healing with nonoperative treatment rose above 82% and when the probability of healing after surgery fell below 92%. In this decision analysis model, operative fixation is the preferred management strategy for Jones fractures. PMID:26991586

  11. Power to Punish Norm Violations Affects the Neural Processes of Fairness-Related Decision Making

    PubMed Central

    Cheng, Xuemei; Zheng, Li; Li, Lin; Guo, Xiuyan; Wang, Qianfeng; Lord, Anton; Hu, Zengxi; Yang, Guang

    2015-01-01

    Punishing norm violations is considered an important motive during rejection of unfair offers in the ultimatum game (UG). The present study investigates the impact of the power to punish norm violations on people’s responses to unfairness and associated neural correlates. In the UG condition participants had the power to punish norm violations, while an alternate condition, the impunity game (IG), was presented where participants had no power to punish norm violations since rejection only reduced the responder’s income to zero. Results showed that unfair offers were rejected more often in UG compared to IG. At the neural level, anterior insula and dorsal anterior cingulate cortex were more active when participants received and rejected unfair offers in both UG and IG. Moreover, greater dorsolateral prefrontal cortex activity was observed when participants rejected than accepted unfair offers in UG but not in IG. Ventromedial prefrontal cortex activation was higher in UG than IG when unfair offers were accepted as well as when rejecting unfair offers in IG as opposed to UG. Taken together, our results demonstrate that the power to punish norm violations affects not only people’s behavioral responses to unfairness but also the neural correlates of the fairness-related social decision-making process. PMID:26696858

  12. Power to Punish Norm Violations Affects the Neural Processes of Fairness-Related Decision Making.

    PubMed

    Cheng, Xuemei; Zheng, Li; Li, Lin; Guo, Xiuyan; Wang, Qianfeng; Lord, Anton; Hu, Zengxi; Yang, Guang

    2015-01-01

    Punishing norm violations is considered an important motive during rejection of unfair offers in the ultimatum game (UG). The present study investigates the impact of the power to punish norm violations on people's responses to unfairness and associated neural correlates. In the UG condition participants had the power to punish norm violations, while an alternate condition, the impunity game (IG), was presented where participants had no power to punish norm violations since rejection only reduced the responder's income to zero. Results showed that unfair offers were rejected more often in UG compared to IG. At the neural level, anterior insula and dorsal anterior cingulate cortex were more active when participants received and rejected unfair offers in both UG and IG. Moreover, greater dorsolateral prefrontal cortex activity was observed when participants rejected than accepted unfair offers in UG but not in IG. Ventromedial prefrontal cortex activation was higher in UG than IG when unfair offers were accepted as well as when rejecting unfair offers in IG as opposed to UG. Taken together, our results demonstrate that the power to punish norm violations affects not only people's behavioral responses to unfairness but also the neural correlates of the fairness-related social decision-making process. PMID:26696858

  13. Geriatric consultation can aid in complex treatment decisions for elderly cancer patients.

    PubMed

    Schiphorst, A H W; Ten Bokkel Huinink, D; Breumelhof, R; Burgmans, J P J; Pronk, A; Hamaker, M E

    2016-05-01

    Treatment decisions for elderly cancer patients can be challenging. A geriatric assessment may identify unknown medical conditions, give insight on patients' ability to tolerate treatment and guide treatment decisions. Our aim was to study the value of a geriatric consultation in oncological decision-making. Data on cancer patients referred for geriatric consultation for clinical optimisation or due to uncertainty regarding their optimal treatment strategy were prospectively analysed. Outcome of geriatric evaluations, non-oncological interventions and suggested adaptations of oncological treatment proposals were evaluated. Seventy-two patients were referred for consultation, over half of which in a curative treatment setting. Prevalence of geriatric syndromes was 93%, previously undiagnosed conditions were identified in 49% of patients and non-oncological interventions were initiated in 56%. Time was spent discussing patients' priorities (53% of consultations), expectations on treatment (50%) and advance care planning (14%). For 82% of patients, suggestions were made regarding the optimal treatment decision: a more intensive treatment was recommended in 39%, a less intensive therapy for 42% and in 19% only supportive care was suggested. The results demonstrate that a geriatric consultation can aid in complex treatment decisions and may allow for a reduction in over- and undertreatment of elderly cancer patients. PMID:26211484

  14. onlineDeCISion.org: a web-based decision aid for DCIS treatment.

    PubMed

    Ozanne, Elissa M; Schneider, Katharine H; Soeteman, Djøra; Stout, Natasha; Schrag, Deborah; Fordis, Michael; Punglia, Rinaa S

    2015-11-01

    Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.​org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.​org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions. PMID:26475704

  15. Primary Care Providers’ Initial Treatment Decisions and Antidepressant Prescribing for Adolescent Depression

    PubMed Central

    Radovic, Ana; Farris, Coreen; Reynolds, Kerry; Reis, Evelyn C.; Miller, Elizabeth; Stein, Bradley D.

    2014-01-01

    OBJECTIVE Adolescent depression is a serious and undertreated public health problem. Nonetheless, pediatric primary care providers (PCPs) may have low rates of antidepressant prescribing due to structural and training barriers. We examined the impact of symptom severity and provider characteristics on initial depression treatment decisions in a setting with fewer structural barriers, an integrated behavioral health network. METHOD We administered a cross sectional survey to 58 PCPs within a large pediatric practice network. We compared PCP reports of initial treatment decisions in response to two vignettes describing depressed adolescents with either moderate or severe symptoms. We measured PCP depression knowledge, attitudes toward addressing psychosocial concerns, demographics, and practice characteristics. RESULTS Few PCPs (25% for moderate, 32% for severe) recommended an antidepressant. Compared with treatment recommendations for moderate depression, severe depression was associated with a greater likelihood of child psychiatry referral (OR 5.50[95% CI 2.47-12.2] p<.001). Depression severity did not affect the likelihood of antidepressant recommendation (OR 1.58[95% CI 0.80-3.11] p=.19). Antidepressants were more likely to be recommended by PCPs with greater depression knowledge (OR 1.72[95% CI 1.14-2.59] p=.009) and access to an on-site mental health provider (OR 5.13[95% CI 1.24-21.2] p=.02) and less likely to be recommended by PCPs who reported higher provider burden when addressing psychosocial concerns (OR 0.85[95% CI 0.75-0.98] p=.02). CONCLUSION PCPs infrequently recommended antidepressants for adolescents, regardless of depression severity. Continued PCP support through experiential training, accounting for provider burden when addressing psychosocial concerns, and co-management with mental health providers may increase PCPs’ antidepressant prescribing. PMID:24336091

  16. Anterior and posterior subareas of the dorsolateral frontal cortex in socially relevant decisions based on masked affect expressions

    PubMed Central

    Prochnow, Denise; Brunheim, Sascha; Kossack, Hannes; Eickhoff, Simon B.; Markowitsch, Hans J.; Seitz, Rüdiger J.

    2015-01-01

    Socially-relevant decisions are based on clearly recognizable but also not consciously accessible affective stimuli. We studied the role of the dorsolateral frontal cortex (DLFC) in decision-making on masked affect expressions using functional magnetic resonance imaging. Our paradigm permitted us to capture brain activity during a pre-decision phase when the subjects viewed emotional expressions below the threshold of subjective awareness, and during the decision phase, which was based on verbal descriptions as the choice criterion. Using meta-analytic connectivity modeling, we found that the preparatory phase of the decision was associated with activity in a right-posterior portion of the DLFC featuring co-activations in the left-inferior frontal cortex. During the subsequent decision a right-anterior and more dorsal portion of the DLFC became activated, exhibiting a different co-activation pattern. These results provide evidence for partially independent sub-regions within the DLFC, supporting the notion of dual associative processes in intuitive judgments. PMID:26236464

  17. Older Adults Newly Diagnosed with Symptomatic Myeloma Want to Participate in Treatment Decision Making

    PubMed Central

    Tariman, Joseph D.; Doorenbos, Ardith; Schepp, Karen G.; Singhal, Seema; Berry, Donna L.

    2014-01-01

    Purpose/Objectives The purpose of the study was to describe the preferences for participation in decision making of older patients newly diagnosed with symptomatic myeloma and to explore the association between sociodemographic variables and decisional role preferences. Design Descriptive, cross sectional design Setting Subjects’ homes and two large academic cancer centers. Sample The convenience sample consisted of 20 older adults (60 years of age and above) with symptomatic myeloma diagnosed within the past 6 months. Methods The Control Preferences Scale was administered followed by an in-person one-time semi-structured interview. Main Research Variables Role preferences for participation in treatment decision-making, age, gender, race, work status, personal relationship status, education, and income. Findings 55% (n=11) of the subjects had preferred a shared role with the physician and 40% (n=8) had preferred to make the decisions after seriously considering the opinion of their physicians. Only one subject preferred to leave the decision to the doctor as long as the doctor considered the patient’s treatment preferences. Sociodemographic characteristics had no impact on preferences for participation in treatment decision-making. Conclusions The study findings indicate that older adults newly diagnosed with myeloma wanted to participate during treatment decision-making. Oncology nurses must respect the patient's desired role preference and oncology clinicians must listen to the patient and allow them to be autonomous in making treatment decisions if the patient so desire such control in the decision-making process. A culture of equipoise between the patient and the clinician during TDM must be cultivated in order to achieve the patient's desired level of participation. More studies that focus on supporting and involving patients diagnosed with myeloma in the decision-making process are needed in order to influence clinical practice and policy. Practice

  18. Emotion and decision-making: affect-driven belief systems in anxiety and depression

    PubMed Central

    Paulus, Martin P.; Yu, Angela J.

    2012-01-01

    Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches to the link between emotion and decision-making, and focus on research with anxious or depressed individuals that reveals how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We then discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression and outline the broader implications of this approach. PMID:22898207

  19. Epilepsy Surgery: Factors That Affect Patient Decision-Making in Choosing or Deferring a Procedure

    PubMed Central

    Anderson, Christopher Todd; Mani, Ram; Lawler, Kathy; Pollard, John R.

    2013-01-01

    Surgical resection for well-selected patients with refractory epilepsy provides seizure freedom approximately two-thirds of the time. Despite this, many good candidates for surgery, after a presurgical workup, ultimately do not consent to a procedure. The reasons why patients decline potentially effective surgery are not completely understood. We explored the socio cultural, medical, personal, and psychological differences between candidates who chose (n = 23) and those who declined surgical intervention (n = 9). We created a novel questionnaire addressing a range of possible factors important in patient decision making. We found that patients who declined surgery were less bothered by their epilepsy (despite comparable severity), more anxious about surgery, and less likely to listen to their doctors (and others) and had more comorbid psychiatric disease. Patients who chose surgery were more embarrassed by their seizures, more interested in being “seizure-free”, and less anxious about specific aspects of surgery. Patient attitudes, beliefs, and anxiety serve as barriers to ideal care. These results can provide opportunities for education, treatment, and intervention. Additionally, patients who fit a profile of someone who is likely to defer surgery may not be appropriate for risky and expensive presurgical testing. PMID:24159385

  20. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches

    PubMed Central

    Melrose, Sherri

    2015-01-01

    Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as “winter blues.” Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ). Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counselling. This paper provides an overview of SAD. PMID:26688752

  1. Young Children's Affective Decision-Making in a Gambling Task: Does Difficulty in Learning the Gain/Loss Schedule Matter?

    ERIC Educational Resources Information Center

    Gao, Shan; Wei, Yonggang; Bai, Junjie; Lin, Chongde; Li, Hong

    2009-01-01

    This research investigated the development of affective decision-making (ADM) during early childhood, in particular role of difficulty in learning a gain/loss schedule. In Experiment 1, we administrated the Children's Gambling Task (CGT) to 60 Chinese children aged 3 and 4, replicating the results obtained by Kerr and Zelazo [Kerr, A., & Zelazo,…

  2. The Appleton Consensus: suggested international guidelines for decisions to forgo medical treatment.

    PubMed

    1989-03-13

    Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forgo Medical Treatment. The guidelines deal with four specific decision-making circumstances. 1. Five guidelines were created for decisions involving competent patients or patients who executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom "no substituted judgment" can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities given the reality of scarce health resources. PMID:2929046

  3. May tropospheric noise in satellite radar data affect decision making results?

    NASA Astrophysics Data System (ADS)

    Bloutsos, Aristeidis; Bekri, Eleni; Moschas, Fanis; Saltogianni, Vasso; Stiros, Stathis; Yannopoulos, Panayotis

    2015-04-01

    Meteorological and air pollution conditions affect the satellite positioning signals. To investigate the uncertainty introduced in these signals in various meteorological and air pollution conditions, an array of GPS/GNSS stations and another of meteorological and air pollution stations has been established. The study area is expanded next to Patraikos and Corinth Gulf (NW Peloponnisos, Greece), which is characterized by high variability sequences from hot to cold weather, low to high relative humidity and clear to cloudy or/and Sahara dusty atmosphere, as a result of the particular geographical and topographical features of the study area. The GNSS recordings from several stations with very high vertical separation (with altitude up to 1600m and with a gradient of up to 20%) are analyzed in order to control in some extend both the vertical and the horizontal variability of the atmospheric effects, as well as the noise of geodetic recordings. Then, the GPS results will be combined with meteorological and atmospheric pollution data, as well as satellite radar data, in order to evaluate the enhanced troposphere noise in satellite radar and to estimate the magnitude of uncertainty that may cause alterations to decision making results in the management of water and other natural resources. This project takes advantage of GPS stations established in wider study area in the framework of the Corinth Rift Laboratory (http://crlab.eu/) in conjunction to the air pollution and meteorological monitoring stations of the Environmental Engineering Laboratory of the Department of Civil Engineering of the University of Patras. Regarding GPS stations, the project has been partly funded by the PLATO Project of the Greek Secretariat for Research and Technology.

  4. Factors Affecting Faculty Members' Decision to Teach or Not to Teach Online in Higher Education

    ERIC Educational Resources Information Center

    Zhen, Yurui; Garthwait, Abigail; Pratt, Phillip

    2008-01-01

    This study identified the important factors influencing faculty members' decision to use or not to use any form of online course management applications (OCMA) in higher education. A polynomial logistic analysis led to a statistical-artifact hypothesis: factors did exist that correlated faculty members' technology adoption decisions. Motivational…

  5. SLUDGE TREATMENT PROJECT KOP CONCEPTUAL DESIGN CONTROL DECISION REPORT

    SciTech Connect

    CARRO CA

    2010-03-09

    This control decision addresses the Knock-Out Pot (KOP) Disposition KOP Processing System (KPS) conceptual design. The KPS functions to (1) retrieve KOP material from canisters, (2) remove particles less than 600 {micro}m in size and low density materials from the KOP material, (3) load the KOP material into Multi-Canister Overpack (MCO) baskets, and (4) stage the MCO baskets for subsequent loading into MCOs. Hazard and accident analyses of the KPS conceptual design have been performed to incorporate safety into the design process. The hazard analysis is documented in PRC-STP-00098, Knock-Out Pot Disposition Project Conceptual Design Hazard Analysis. The accident analysis is documented in PRC-STP-CN-N-00167, Knock-Out Pot Disposition Sub-Project Canister Over Lift Accident Analysis. Based on the results of these analyses, and analyses performed in support of MCO transportation and MCO processing and storage activities at the Cold Vacuum Drying Facility (CVDF) and Canister Storage Building (CSB), control decision meetings were held to determine the controls required to protect onsite and offsite receptors and facility workers. At the conceptual design stage, these controls are primarily defined by their safety functions. Safety significant structures, systems, and components (SSCs) that could provide the identified safety functions have been selected for the conceptual design. It is anticipated that some safety SSCs identified herein will be reclassified based on hazard and accident analyses performed in support of preliminary and detailed design.

  6. Take a stand on your decisions, or take a sit: posture does not affect risk preferences in an economic task

    PubMed Central

    O’Brien, Megan K.

    2014-01-01

    Physiological and emotional states can affect our decision-making processes, even when these states are seemingly insignificant to the decision at hand. We examined whether posture and postural threat affect decisions in a non-related economic domain. Healthy young adults made a series of choices between economic lotteries in various conditions, including changes in body posture (sitting vs. standing) and changes in elevation (ground level vs. atop a 0.8-meter-high platform). We compared three metrics between conditions to assess changes in risk-sensitivity: frequency of risky choices, and parameter fits of both utility and probability weighting parameters using cumulative prospect theory. We also measured skin conductance level to evaluate physiological response to the postural threat. Our results demonstrate that body posture does not significantly affect decision making. Secondly, despite increased skin conductance level, economic risk-sensitivity was unaffected by increased threat. Our findings indicate that economic choices are fairly robust to the physiological and emotional changes that result from posture or postural threat. PMID:25083345

  7. Treatment decisions based on scalar and functional baseline covariates.

    PubMed

    Ciarleglio, Adam; Petkova, Eva; Ogden, R Todd; Tarpey, Thaddeus

    2015-12-01

    The amount and complexity of patient-level data being collected in randomized-controlled trials offer both opportunities and challenges for developing personalized rules for assigning treatment for a given disease or ailment. For example, trials examining treatments for major depressive disorder are not only collecting typical baseline data such as age, gender, or scores on various tests, but also data that measure the structure and function of the brain such as images from magnetic resonance imaging (MRI), functional MRI (fMRI), or electroencephalography (EEG). These latter types of data have an inherent structure and may be considered as functional data. We propose an approach that uses baseline covariates, both scalars and functions, to aid in the selection of an optimal treatment. In addition to providing information on which treatment should be selected for a new patient, the estimated regime has the potential to provide insight into the relationship between treatment response and the set of baseline covariates. Our approach can be viewed as an extension of "advantage learning" to include both scalar and functional covariates. We describe our method and how to implement it using existing software. Empirical performance of our method is evaluated with simulated data in a variety of settings and also applied to data arising from a study of patients with major depressive disorder from whom baseline scalar covariates as well as functional data from EEG are available. PMID:26111145

  8. Development of instruments to measure the quality of breast cancer treatment decisions

    PubMed Central

    Lee, Clara N.; Dominik, Rosalie; Levin, Carrie A.; Barry, Michael J.; Cosenza, Carol; O’Connor, Annette M.; Mulley, Albert G.; Sepucha, Karen R.

    2010-01-01

    Background Women with early stage breast cancer face a multitude of decisions. The quality of a decision can be measured by the extent to which the treatment reflects what’s most important to an informed patient. Reliable and valid measures of patients’ knowledge and their goals and concerns related to breast cancer treatments are needed to assess decision quality. Objective To identify a set of key facts and goals relevant to each of three breast cancer treatment decisions (surgery, reconstruction, and adjuvant chemotherapy and hormone therapy) and to evaluate the validity of the methods used to identify them. Methods Candidate facts and goals were chosen based on evidence review and qualitative studies with breast cancer patients and providers. Cross-sectional surveys of patients and providers were conducted for each decision. The accuracy, importance, and completeness of the items were examined. Results 38 facts (11–14 per decision) and 27 goals (8–10 per decision) were identified. An average of 17 patients and 21 providers responded to each survey. The sets of facts were accurate and complete for all three decisions. The sets of goals and concerns were important for surgery and reconstruction, but not chemotherapy/hormone therapy. Patients and providers disagreed about the relative importance of several key facts and goals. Conclusion Overall, breast cancer patients and providers found the sets of facts and goals accurate, important, and complete for three treatment decisions. Because patients’ and providers’ perspectives are different, it is vital that instrument development should include items reflecting both views. PMID:20550591

  9. Oxygen desaturation during night sleep affects decision-making in patients with obstructive sleep apnea.

    PubMed

    Delazer, Margarete; Zamarian, Laura; Frauscher, Birgit; Mitterling, Thomas; Stefani, Ambra; Heidbreder, Anna; Högl, Birgit

    2016-08-01

    This study assessed decision-making and its associations with executive functions and sleep-related factors in patients with obstructive sleep apnea. Thirty patients with untreated obstructive sleep apnea and 20 healthy age- and education-matched controls performed the Iowa Gambling Task, a decision-making task under initial ambiguity, as well as an extensive neuropsychological test battery. Patients, but not controls, also underwent a detailed polysomnographic assessment. Results of group analyses showed that patients performed at the same level of controls on the Iowa Gambling Task. However, the proportion of risky performers was significantly higher in the patient group than in the control group. Decision-making did not correlate with executive functions and subjective ratings of sleepiness, whereas there was a significant positive correlation between advantageous performance on the Iowa Gambling Task and percentage of N2 sleep, minimal oxygen saturation, average oxygen saturation and time spent below 90% oxygen saturation level. Also, the minimal oxygen saturation accounted for 27% of variance in decision-making. In conclusion, this study shows that a subgroup of patients with obstructive sleep apnea may be at risk of disadvantageous decision-making under ambiguity. Among the sleep-related factors, oxygen saturation is a significant predictor of advantageous decision-making. PMID:26899164

  10. Factors affecting elementary principals' and teachers' decisions to support outdoor field trips

    NASA Astrophysics Data System (ADS)

    Kaspar, Michael Joseph

    Outdoor field trips are recommended in science education reform, yet they are not frequently taken. Barriers may prevent elementary public school teachers from participating in outdoor field trips (Mirka, 1973; Falk & Balling, 1979; Ham, 1988; Orion, 1993). To determine what would increase students' attendance at a nature preserve, factors that may affect elementary private and public school principals' and teachers' decisions to support field trips were identified and compared. Private school principals supported field trips. They believed field trips were safe, and easy to arrange, and that the field trips helped students experience culture in the community. Experienced public school principals who were supportive and believed field trips should be required believed field trips fit into the teacher's lesson plan and were taken for enrichment. Public school principals who were less experienced with field trips believed field trips should be extracurricular. They believed that field trips served as a reward, and that they needed more information. They did not support field trips. Private school teachers believed that field trips did not have overly demanding administrative concerns. They believed field trips were safe, easy to arrange, and were supported by their administrator. Public school teachers who supported field trips and believed field trips should be required were white, female, experienced, and older. They believed that field trips were safe, easy to arrange, enjoyable, and that they had enough help to conduct trips. Public school teachers who may not support trips had administrative concerns, and they did not believe field trips met the needs of students. These were male, white or non-white, young or middle-aged, and less experienced. They may believe field trips are a waste of time and money. They believed they had a nonsupportive administrator. Money for transportation was a barrier for older public school teachers and principals. No improvement on

  11. Decision-making capacity for treatment in psychiatric and medical in-patients: cross-sectional, comparative study†

    PubMed Central

    Owen, Gareth S.; Szmukler, George; Richardson, Genevra; David, Anthony S.; Raymont, Vanessa; Freyenhagen, Fabian; Martin, Wayne; Hotopf, Matthew

    2013-01-01

    Background Is the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients? Aims To compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice. Method A secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool - Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability. Results Most people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P = 0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P<0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P<0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P = 0.02). Conclusions Among those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting. PMID:23969482

  12. Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression

    PubMed Central

    Barr, Paul J; Forcino, Rachel C; Mishra, Manish; Blitzer, Rachel; Elwyn, Glyn

    2016-01-01

    Objective To identify information priorities for consumers and clinicians making depression treatment decisions and assess shared decision-making (SDM) in routine depression care. Design 20 questions related to common features of depression treatments were provided. Participants were initially asked to select which features were important, and in a second stage they were asked to rank their top 5 ‘important features’ in order of importance. Clinicians were asked to provide rankings according to both consumer and clinician perspectives. Consumers completed CollaboRATE, a measure of SDM. Multiple logistic regression analysis identified consumer characteristics associated with CollaboRATE scores. Setting Online cross-sectional surveys fielded in September to December 2014. Participants We administered surveys to convenience samples of US adults with depression and clinicians who treat depression. Consumer sampling was targeted to reflect age, gender and educational attainment of adults with depression in the USA. Primary outcome measures Information priority rankings; CollaboRATE, a 3-item consumer-reported measure of SDM. Results 972 consumers and 244 clinicians completed the surveys. The highest ranked question for both consumers and clinicians was ‘Will the treatment work?’ Clinicians were aware of consumers’ priorities, yet did not always prioritise that information themselves, particularly insurance coverage and cost of treatment. Only 18% of consumers reported high levels of SDM. Working with a psychiatrist (OR 1.87; 95% CI 1.07 to 3.26) and female gender (OR 2.04; 95% CI 1.25 to 3.34) were associated with top CollaboRATE scores. Conclusions While clinicians know what information is important to consumers making depression treatment decisions, they do not always address these concerns. This mismatch, coupled with low SDM, adversely affects the quality of depression care. Development of a decision support intervention based on our findings can improve

  13. The Role of Culture in Families' Treatment Decisions for Children with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Mandell, David S.; Novak, Maytali

    2005-01-01

    There is little information available about how and why parents of children with autism spectrum disorders (ASD) make decisions regarding which of the many available treatments to implement with their children. Given the lack of available information regarding treatment efficacy, it is likely that parents' beliefs about child development,…

  14. Intergenerational Differences and Similarities in Life-Sustaining Treatment Attitudes and Decision Factors.

    ERIC Educational Resources Information Center

    Mills, Terry L.; Wilmoth, Janet M.

    2002-01-01

    A cross-sectional sample of three-generation families was used to evaluate life-sustaining medical treatment attitudes and decision factors. Results show that the older generation perceived mental capacity, family burden, and pain as most important considerations. Among the middle generation the type of life-sustaining treatment was important. The…

  15. The Effects of Treatment Needs and Prior Social Services Use on Juvenile Court Decision Making

    ERIC Educational Resources Information Center

    Schwalbe, Craig S.; Hatcher, Schnavia Smith; Maschi, Tina

    2009-01-01

    Every year, juvenile court judges commit large numbers of delinquent youths to institutional placements. Prior research indicates that both legal and extra-legal factors influence this decision-making process. Less frequently examined is the role of treatment needs and prior social services use. This study examined the influence of treatment needs…

  16. Reducing Aversion to Side Effects in Preventive Medical Treatment Decisions

    ERIC Educational Resources Information Center

    Waters, Erika A.; Weinstein, Neil D.; Colditz, Graham A.; Emmons, Karen M.

    2007-01-01

    Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by…

  17. Neural correlates of decision making after unfair treatment

    PubMed Central

    Wu, Yan; Zang, Yufeng; Yuan, Binke; Tian, Xuehong

    2015-01-01

    Empirical evidence indicates that people are inequity averse. However, it is unclear whether and how suffering unfairness impacts subsequent behavior. We investigated the consequences of unfair treatment in subsequent interactions with new interaction partners and the associated neural mechanisms. Participants were experimentally manipulated to experience fair or unfair treatment in the ultimatum game (UG), and subsequently, they were given the opportunity to retaliate in the dictator game (DG) in their interactions with players who had not played a role in the previous fair or unfair treatment. The results showed that participants dictated less money to unrelated partners after frequently receiving unfair offers in the previous UG (vs. frequently receiving fair offers in the previous UG), but only when they were first exposed to unfair UG/DG. Stronger activation in the right dorsal anterior insula was found during receiving unfair offers and during the subsequent offer-considering phase. The regional homogeneity (ReHo), a measure of the local synchronization of neighboring voxels in resting-state brain activity, in the left ventral anterior insula and left superior temporal pole was positively correlated with the behavior change. These findings suggest that unfair treatment may encourage a spread of unfairness, and that the anterior insula may be not only engaged in signaling social norm violations, but also recruited in guiding subsequent adaptive behaviors. PMID:25798102

  18. The influence of family ties on men's prostate cancer screening, biopsy, and treatment decisions.

    PubMed

    Shaw, Eric K; Scott, John G; Ferrante, Jeanne M

    2013-11-01

    Extensive research has focused on understanding family dynamics of men with prostate cancer. However, little qualitative work has examined the role of family ties on men's prostate cancer decisions across the spectrum of screening, diagnosis, and treatment. Using data from a larger study, we qualitatively explored the influence of family ties on men's prostate cancer decisions. Semistructured interviews were conducted with men ages ≥50 (N = 64), and data were analyzed using a grounded theory approach and a series of immersion/crystallization cycles. Three major themes of spousal/family member influence were identified: (a) spousal/family member alliance marked by open communication and shared decision making, (b) men who actively opposed spouse/family member pressure and made final decisions themselves, and (c) men who yielded to spouse/family member pressure. Our findings provide insights into men's relational dynamics that are important to consider for the shared decision-making process across the prostate cancer spectrum. PMID:23459024

  19. Management of hypertensive crises: the scientific basis for treatment decisions.

    PubMed

    Blumenfeld, J D; Laragh, J H

    2001-11-01

    The spectrum of disorders associated with an elevated blood pressure (BP) encompasses chronic uncomplicated hypertension and the hypertensive crises, including hypertensive urgencies and emergencies. Although these syndromes vary widely in their presentations, clinical courses, and outcomes they share pathophysiologic mechanisms and, consequently, therapeutic responses to specifically targeted antihypertensive drug types. Nevertheless, hypertensive crises are often treated with drugs which, in that setting are either unsafe or are of unsubstantiated efficacy. The purpose of this review is to examine the pathophysiology of commonly encountered hypertensive crises, including stroke, hypertensive encephalopathy, aortic dissection, acute pulmonary edema, and preeclampsia-eclampsia and to provide a rational approach to their treatment based upon relevant pathophysiologic and pharmacologic principles. Measurement of plasma renin activity (PRA) level often provides insight regarding pathophysiology and predicts efficacy of antihypertensive treatments in the individual patient. However, in hypertensive crises, drug therapy is initiated before the PRA level is known. Nevertheless, the renin-angiotensin dependence (R-type) or volume dependence (V-type) of hypertension can often be deduced by the BP response to drugs that interrupt the renin system (R-drugs) or that decrease body volume (V-drugs). Based upon these considerations, a treatment algorithm is provided to guide drug selection in patients presenting with a hypertensive crisis. PMID:11724216

  20. External factors affecting decision-making and use of evidence in an Australian public health policy environment.

    PubMed

    Zardo, Pauline; Collie, Alex; Livingstone, Charles

    2014-05-01

    This study examined external factors affecting policy and program decision-making in a specific public health policy context: injury prevention and rehabilitation compensation in the Australian state of Victoria. The aim was twofold: identify external factors that affect policy and program decision-making in this specific context; use this evidence to inform targeting of interventions aimed at increasing research use in this context. Qualitative interviews were undertaken from June 2011 to January 2012 with 33 employees from two state government agencies. Key factors identified were stakeholder feedback and action, government and ministerial input, legal feedback and action, injured persons and the media. The identified external factors were able to significantly influence policy and program decision-making processes: acting as both barriers and facilitators, depending on the particular issue at hand. The factors with the most influence were the Minister and government, lawyers, and agency stakeholders, particularly health providers, trade unions and employer groups. This research revealed that interventions aimed at increasing use of research in this context must target and harness the influence of these groups. This research provides critical insights for researchers seeking to design interventions to increase use of research in policy environments and influence decision-making in Victorian injury prevention and rehabilitation compensation. PMID:24632115

  1. Clinical Decision-Making in Community Children’s Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment

    PubMed Central

    Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.

    2014-01-01

    Background Mental health professionals’ decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective The present study explored the role of prior training in evidence-based treatments on clinicians’ assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Methods Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog “think aloud” method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. Results MANOVA results were significant for EBT training status such that EBT trained clinicians’ displayed cognitive processes more closely aligned with “expert” decision-makers and non-EBT trained clinicians’ decision processes were more similar to “novice” decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. Conclusion This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians’ decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice. PMID:25892901

  2. To Push or Not to Push? Affective Influences on Moral Judgment Depend on Decision Frame

    ERIC Educational Resources Information Center

    Pastotter, Bernhard; Gleixner, Sabine; Neuhauser, Theresa; Bauml, Karl-Heinz T.

    2013-01-01

    People's moods can influence moral judgment. Such influences may arise because moods affect moral emotion, or because moods affect moral thought. The present study provides evidence that, at least in the footbridge dilemma, moods affect moral thought. The results of two experiments are reported in which, after induction of positive, negative, or…

  3. Factors Affecting the Corporate Decision-Making Process of Air Transport Manufacturers

    NASA Technical Reports Server (NTRS)

    Ollila, R. G.; Hill, J. D.; Noton, B. R.; Duffy, M. A.; Epstein, M. M.

    1976-01-01

    Fuel economy is a pivotal question influencing the future sale and utilization of commercial aircraft. The NASA Aircraft Energy Efficiency (ACEE) Program Office has a program intended to accelerate the readiness of advanced technologies for energy efficient aircraft. Because the decision to develop a new airframe or engine is a major financial hazard for manufacturers, it is important to know what factors influence the decision making process. A method is described for identifying and ranking individuals and organizations involved at each stage of commercial air transport development, and the barriers that must be overcome in adopting new technologies.

  4. Decision regret following treatment for localized breast cancer: is regret stable over time?

    PubMed Central

    Martinez, Kathryn A.; Li, Yun; Resnicow, Ken; Graff, John J.; Hamilton, Ann S.; Hawley, Sarah T

    2015-01-01

    Background While studies suggest most women have little regret regarding their breast cancer treatment decisions immediately following treatment, to date no studies have evaluated how regret may change over time. Objective To measure the stability of post-treatment decision regret over time among women with breast cancer. Methods Women diagnosed with breast cancer between August 2005 and May 2007 reported to the Detroit, Michigan or Los Angeles County Surveillance Epidemiology and End Results (SEER) registry completed surveys at 9 months following diagnosis (Time 1) and again approximately 4 years later (Time 2). A decision regret scale consisting of 5 items was summed to create two decision regret scores at both Time 1 and Time 2 (range: 0 to 20). Multivariable linear regression was used to examine change in regret from 9 months to 4 years. Independent variables included surgery type, receipt of reconstruction, and recurrence status at follow-up. The model controlled for demographic and clinical factors. Results The analytic sample included 1,536 women. Mean regret in the overall sample was 4.9 at Time 1 and 5.4 at Time 2 (p<0.001). In the multivariable linear model, we found no difference in change in decision regret over time by surgery type. Reporting a new diagnosis of breast cancer at Time 2 was associated with 2.6 point increase in regret over time, compared to women without an additional diagnosis (p=0.003). Receipt of reconstruction was not associated with change in decision regret over time. Conclusions Decision regret following treatment was low and relatively stable over time for most women. Those facing an additional diagnosis of breast cancer following treatment may be at risk for elevated regret-related distress. PMID:25532824

  5. Confidentiality and treatment decisions of minor clients: a health professional's dilemma & policy makers challenge.

    PubMed

    Jackson, Margot Karen; Burns, Katharina Kovacs; Richter, Magdalena S

    2014-01-01

    Issues relating to confidentiality and consent for physical and mental health treatment with minor clients can pose challenges health care providers. Decisions need to be made regarding these issues despite the absence of clear, direct, or comprehensive policies and legislation. In order to fully understand the scope of this topic, a systemic review of several pieces of legislation and guidelines related to this topic are examined. These include the: Canadian Human Rights Act, Children's Rights: International and National Laws and Practices, Health Information Act, Gillick Competence and Medical Emancipation, Freedom of Information and Protection of Privacy Act, Child, Youth and Family Enhancement Act, Common Law Mature Minor Doctrine, and Alberta Health Services Consent to Treatment/Practice(s) Minor/Mature Minor. In order to assist health professionals with decisions regarding confidentiality and treatment with minor clients a case study and guide for decision-making is also presented. PMID:25032089

  6. Relative Saliency in Change Signals Affects Perceptual Comparison and Decision Processes in Change Detection

    ERIC Educational Resources Information Center

    Yang, Cheng-Ta

    2011-01-01

    Change detection requires perceptual comparison and decision processes on different features of multiattribute objects. How relative salience between two feature-changes influences the processes has not been addressed. This study used the systems factorial technology to investigate the processes when detecting changes in a Gabor patch with visual…

  7. Subjective Variables Affecting Funding Decisions by Federal Research & Development Agencies: The Grantsmanship Game.

    ERIC Educational Resources Information Center

    Shapek, Raymond A.

    1984-01-01

    There are many misconceptions about how funding decisions are made within federal agencies. Observations of how bias creeps into an otherwise objective evaluation process are presented, and hints are offered on improving the probability of receiving federal support. (Author/MLW)

  8. Inferential Judgments Affecting the Decision-Making Process in the Attorney General's Commission on Pornography.

    ERIC Educational Resources Information Center

    Gouran, Dennis S.

    Although the Attorney General's Commission on Pornography, also known as the Meese Commission, has been criticized excessively at times for threatening freedom of speech and press and individual rights to privacy, an analysis of its "Final Report" reveals numerous deficiencies in the Commission's decision-making process. These deficiencies,…

  9. Does the Availability of Parental Health Insurance Affect the College Enrollment Decision of Young Americans?

    ERIC Educational Resources Information Center

    Jung, Juergen; Hall, Diane M. Harnek; Rhoads, Thomas

    2013-01-01

    The present study examines whether the college enrollment decision of young individuals (student full-time, student part-time, and non-student) depends on health insurance coverage via a parent's family health plan. Our findings indicate that the availability of parental health insurance can have significant effects on the probability that a young…

  10. Factors Affecting Long-Term-Care Residents' Decision-Making Processes as They Formulate Advance Directives

    ERIC Educational Resources Information Center

    Lambert, Heather C.; McColl, Mary Ann; Gilbert, Julie; Wong, Jiahui; Murray, Gale; Shortt, Samuel E. D.

    2005-01-01

    Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a…

  11. IMPACT: How ORE Findings Have Affected Decisions in Austin and Beyond.

    ERIC Educational Resources Information Center

    Wilkinson, David, Ed.; Ligon, Glynn, Ed.

    Over the years, findings of the Office of Research and Evaluation (ORE) of the Austin (Texas) Independent School District (AISD) have had a significant impact on decisions made in the district and sometimes beyond it. The ORE's impact in the AISD is reviewed in 16 areas. Some of the major findings are summarized: (1) ORE studies of retention in…

  12. Plant-mediated decisions by an herbivore affect oviposition pattern and subsequent egg parasitism

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Natural enemies are important mortality factors for herbivores and thus may influence herbivore population dynamics. In response to natural enemy pressure, herbivores can alter life history decisions, such as oviposition behavior, so that offspring are protected from natural enemies. One such stra...

  13. Does Family Group Decision Making Affect Child Welfare Outcomes? Findings from a Randomized Control Study

    ERIC Educational Resources Information Center

    Berzin, Stephanie Cosner; Cohen, Ed; Thomas, Karen; Dawson, William C.

    2008-01-01

    This article describes the evaluation of two family group decision-making programs administered under the California Title IV-E Waiver Demonstration Project. This is the only evaluation using random assignment to examine FGDM. Overall, results did not indicate more positive outcomes for children receiving the intervention, but did indicate that…

  14. Age Differences in Affective Decision Making as Indexed by Performance on the Iowa Gambling Task

    ERIC Educational Resources Information Center

    Cauffman, Elizabeth; Shulman, Elizabeth P.; Steinberg, Laurence; Claus, Eric; Banich, Marie T.; Graham, Sandra; Woolard, Jennifer

    2010-01-01

    Contemporary perspectives on age differences in risk taking, informed by advances in developmental neuroscience, have emphasized the need to examine the ways in which emotional and cognitive factors interact to influence decision making. In the present study, a diverse sample of 901 individuals between the ages of 10 and 30 were administered a…

  15. Conflict and user involvement in drug misuse treatment decision-making: a qualitative study

    PubMed Central

    Fischer, Jan; Neale, Joanne; Bloor, Michael; Jenkins, Nicholas

    2008-01-01

    Background This paper examines client/staff conflict and user involvement in drug misuse treatment decision-making. Methods Seventy-nine in-depth interviews were conducted with new treatment clients in two residential and two community drug treatment agencies. Fifty-nine of these clients were interviewed again after twelve weeks. Twenty-seven interviews were also conducted with staff, who were the keyworkers for the interviewed clients. Results Drug users did not expect, desire or prepare for conflict at treatment entry. They reported few actual conflicts within the treatment setting, but routinely discussed latent conflicts – that is, negative experiences and problematic aspects of current or previous treatment that could potentially escalate into overt disputes. Conflict resulted in a number of possible outcomes, including the premature termination of treatment; staff deciding on the appropriate outcome; the client appealing to the governance structure of the agency; brokered compromise; and staff skilfully eliciting client consent for staff decisions. Conclusion Although the implementation of user involvement in drug treatment decision-making has the potential to trigger high levels of staff-client conflict, latent conflict is more common than overt conflict and not all conflict is negative. Drug users generally want to be co-operative at treatment entry and often adopt non-confrontational forms of covert resistance to decisions about which they disagree. Staff sometimes deploy user involvement as a strategy for managing conflict and soliciting client compliance to treatment protocols. Suggestions for minimising and avoiding harmful conflict in treatment settings are given. PMID:18837989

  16. Combine or Separate Future Pain? The Impact of Current Pain on Decisions about Future Dental Treatments

    PubMed Central

    Andrade, Eduardo B.; Bianchini, Marco Aurélio; Lucchiari, Newton

    2013-01-01

    Patients are often given the option of undergoing future painful treatments in one or multiple sessions (e.g., extracting two wisdom teeth on one or two different days). In a randomized controlled field experiment, we investigated the impact of transient pain on patients’ decision to combine or separate future periodontal treatments. The main results show that most patients preferred to have the future treatments take place in one session when they made their choice after a painless examination (i.e., general clinical exam). However, the patients’ preference for combining the future treatments did not differ from chance when the choice was made immediately following a painful examination (i.e., pocketing and bleeding on probing exam). The impact of pain on decision making is observed within and between participants. Current pain seems to lead patients to question their ability to endure future painful treatments in one session. PMID:23704972

  17. The nurse's role in treatment decisions for the child with neurological impairment.

    PubMed

    Duffy, Lisa V

    2009-10-01

    Healthcare providers are often faced with ethical dilemmas when making treatment decisions for a child with neurological impairment. Problems may stem from the fact that the wishes of the family may be in opposition to what the healthcare team feels is in the best interest of the child. There are many factors that need to be considered when determining treatment options for the child with neurological impairment. Nurses are in a unique position to advocate for the involvement of the child's family in making these difficult decisions. PMID:19835240

  18. The medical visit context of treatment decision-making and the therapeutic relationship.

    PubMed

    Roter, Debra

    2000-03-01

    The ascendance of the autonomy paradigm in treatment decision-making has evolved over the past several decades to the point where few bioethicists would question that it is the guiding value driving health-care provider behaviour. In achieving quasi-legal status, decision-making has come to be regarded as a formality largely removed from the broader context of medical communication and the therapeutic relationship within which care is delivered. Moreover, disregard for individual patient preference, resistance, reluctance, or incompetence has at times produced pro forma and useless autonomy rituals. Failures of this kind, have been largely attributed to the psychological dynamics of the patients, physicians, illnesses, and contexts that characterize the medical decision. There has been little attempt to provide a framework for accommodating or understanding the larger social context and social influences that contribute to this variation. Applying Paulo Freire's participatory social orientation model to the context of the medical visit suggests a framework for viewing the impact of physicians' communication behaviours on patients' capacity for treatment decision-making. Physicians' use of communication strategies can act to reinforce an experience of patient dependence or self-reliance in regard to the patient-physician relationship generally and treatment decision-making, in particular. Certain communications enhance patient participation in the medical visit's dialogue, contribute to patient engagement in problem posing and problem-solving, and finally, facilitate patient confidence and competence to undertake autonomous action. The purpose of this essay is to place treatment decision-making within the broader context of the therapeutic relationship, and to describe ways in which routine medical visit communication can accommodate individual patient preferences and help develop and further patient capacity for autonomous decision-making. PMID:11281908

  19. Client Preferences Affect Treatment Satisfaction, Completion, and Clinical Outcome: A Meta-Analysis

    PubMed Central

    Lindhiem, Oliver; Bennett, Charles B.; Trentacosta, Christopher J.; McLear, Caitlin

    2014-01-01

    We conducted a meta-analysis on the effects of client preferences on treatment satisfaction, completion, and clinical outcome. Our search of the literature resulted in 34 empirical articles describing 32 unique clinical trials that either randomized some clients to an active choice condition (shared decision making condition or choice of treatment) or assessed client preferences. Clients who were involved in shared decision making, chose a treatment condition, or otherwise received their preferred treatment evidenced higher treatment satisfaction (ESd = .34; p < .001), increased completion rates (ESOR = 1.37; ESd = .17; p < .001), and superior clinical outcome (ESd = .15; p < .0001), compared to clients who were not involved in shared decision making, did not choose a treatment condition, or otherwise did not receive their preferred treatment. Although the effect sizes are modest in magnitude, they were generally consistent across several potential moderating variables including study design (preference versus active choice), psychoeducation (informed versus uninformed), setting (inpatient versus outpatient), client diagnosis (mental health versus other), and unit of randomization (client versus provider). Our findings highlight the clinical benefit of assessing client preferences, providing treatment choices when two or more efficacious options are available, and involving clients in treatment-related decisions when treatment options are not available. PMID:25189522

  20. Does family group decision making affect child welfare outcomes? Findings from a randomized control study.

    PubMed

    Berzin, Stephanie Cosner; Cohen, Ed; Thomas, Karen; Dawson, William C

    2008-01-01

    This article describes the evaluation of two family group decision-making programs (FGDM; Fresno n = 60; Riverside n = 50) administered under the California Title IV-E Waiver Demonstration Project. This is the only evaluation using random assignment to examine FGDM. Overall, results did not indicate more positive outcomes for children receiving the intervention, but did indicate that children were not worse than those receiving traditional services; outcomes examined were related to child safety, placement stability, and permanence. PMID:19391466

  1. Analysis on factors affecting household customers decision in using electricity at peak time and its correlation towards saving electricity

    NASA Astrophysics Data System (ADS)

    Pasasa, Linus; Marbun, Parlin; Mariza, Ita

    2015-09-01

    The purpose of this paper is to study and analyse the factors affecting customer decisions in using electricity at peak-load hours (between 17.00 to 22.00 WIB) and their behaviors towards electricity conservation in Indonesian household. The underlying rationale is to influence a reduction in energy consumption by stimulating energy saving behaviors, thereby reducing the impact of energy use on the environment. How is the correlation between the decisions in using electricity during peak load hours with the household customer's behavior towards saving electricity? The primary data is obtained by distributing questionnaires to customers of PT. PLN Jakarta Raya and Tangerang Distribution from Household segment. The data is analysed using the Structural Equation Model (SEM) and AMOS Software. The research is finding that all factors (Personal, Social, PLN Services, Psychological, and Cultural) are positively influence customer decision in using electricity at peak load hours. There is a correlation between the decisions in using electricity during peak load hours with the household customer's behavior towards saving electricity.

  2. Pathways to Aggression in Schizophrenia Affect Results of Treatment

    PubMed Central

    Volavka, Jan; Citrome, Leslie

    2011-01-01

    Schizophrenia elevates the risk for aggressive behavior and violent crime, and different approaches have been used to manage this problem. The results of such treatments vary. One reason for this variation is that aggressive behavior in schizophrenia is heterogeneous in origin. This heterogeneity has usually not been accounted for in treatment trials nor is it adequately appreciated in routine clinical treatment planning. Here, we review pathways that may lead to the development of aggressive behavior in patients with schizophrenia and discuss their impact on treatment. Elements in these pathways include predisposing factors such as genotype and prenatal toxic effects, development of psychotic symptoms and neurocognitive impairments, substance abuse, nonadherence to treatment, childhood maltreatment, conduct disorder, comorbid antisocial personality disorder/psychopathy, and stressful experiences in adult life. Clinicians’ knowledge of the patient’s historical trajectory along these pathways may inform the choice of optimal treatment of aggressive behavior. Clozapine has superior antiaggressive activity in comparison with other antipsychotics and with all other pharmacological treatments. It is usually effective when aggressive behavior is related to psychotic symptoms. However, in many patients, aggression is at least partly based on other factors such as comorbid substance use disorder, comorbid antisocial personality disorder/psychopathy, or current stress. These conditions which are sometimes underdiagnosed in clinical practice must be addressed by appropriate adjunctive psychosocial approaches or other treatments. Treatment adherence has a crucial role in the prevention of aggressive behavior in schizophrenia patients. PMID:21562140

  3. A Tribute to Charlie Chaplin: Induced Positive Affect Improves Reward-Based Decision-Learning in Parkinson’s Disease

    PubMed Central

    Ridderinkhof, K. Richard; van Wouwe, Nelleke C.; Band, Guido P. H.; Wylie, Scott A.; Van der Stigchel, Stefan; van Hees, Pieter; Buitenweg, Jessika; van de Vijver, Irene; van den Wildenberg, Wery P. M.

    2012-01-01

    Reward-based decision-learning refers to the process of learning to select those actions that lead to rewards while avoiding actions that lead to punishments. This process, known to rely on dopaminergic activity in striatal brain regions, is compromised in Parkinson’s disease (PD). We hypothesized that such decision-learning deficits are alleviated by induced positive affect, which is thought to incur transient boosts in midbrain and striatal dopaminergic activity. Computational measures of probabilistic reward-based decision-learning were determined for 51 patients diagnosed with PD. Previous work has shown these measures to rely on the nucleus caudatus (outcome evaluation during the early phases of learning) and the putamen (reward prediction during later phases of learning). We observed that induced positive affect facilitated learning, through its effects on reward prediction rather than outcome evaluation. Viewing a few minutes of comedy clips served to remedy dopamine-related problems associated with frontostriatal circuitry and, consequently, learning to predict which actions will yield reward. PMID:22707944

  4. A tribute to charlie chaplin: induced positive affect improves reward-based decision-learning in Parkinson's disease.

    PubMed

    Ridderinkhof, K Richard; van Wouwe, Nelleke C; Band, Guido P H; Wylie, Scott A; Van der Stigchel, Stefan; van Hees, Pieter; Buitenweg, Jessika; van de Vijver, Irene; van den Wildenberg, Wery P M

    2012-01-01

    Reward-based decision-learning refers to the process of learning to select those actions that lead to rewards while avoiding actions that lead to punishments. This process, known to rely on dopaminergic activity in striatal brain regions, is compromised in Parkinson's disease (PD). We hypothesized that such decision-learning deficits are alleviated by induced positive affect, which is thought to incur transient boosts in midbrain and striatal dopaminergic activity. Computational measures of probabilistic reward-based decision-learning were determined for 51 patients diagnosed with PD. Previous work has shown these measures to rely on the nucleus caudatus (outcome evaluation during the early phases of learning) and the putamen (reward prediction during later phases of learning). We observed that induced positive affect facilitated learning, through its effects on reward prediction rather than outcome evaluation. Viewing a few minutes of comedy clips served to remedy dopamine-related problems associated with frontostriatal circuitry and, consequently, learning to predict which actions will yield reward. PMID:22707944

  5. Affect of the unconscious: visually suppressed angry faces modulate our decisions.

    PubMed

    Almeida, Jorge; Pajtas, Petra E; Mahon, Bradford Z; Nakayama, Ken; Caramazza, Alfonso

    2013-03-01

    Emotional and affective processing imposes itself over cognitive processes and modulates our perception of the surrounding environment. In two experiments, we addressed the issue of whether nonconscious processing of affect can take place even under deep states of unawareness, such as those induced by interocular suppression techniques, and can elicit an affective response that can influence our understanding of the surrounding environment. In Experiment 1, participants judged the likeability of an unfamiliar item--a Chinese character--that was preceded by a face expressing a particular emotion (either happy or angry). The face was rendered invisible through an interocular suppression technique (continuous flash suppression; CFS). In Experiment 2, backward masking (BM), a less robust masking technique, was used to render the facial expressions invisible. We found that despite equivalent phenomenological suppression of the visual primes under CFS and BM, different patterns of affective processing were obtained with the two masking techniques. Under BM, nonconscious affective priming was obtained for both happy and angry invisible facial expressions. However, under CFS, nonconscious affective priming was obtained only for angry facial expressions. We discuss an interpretation of this dissociation between affective processing and visual masking techniques in terms of distinct routes from the retina to the amygdala. PMID:23224765

  6. Decision making for HIV prevention and treatment scale up: Bridging the gap between theory and practice

    PubMed Central

    Alistar, Sabina S.; Brandeau, Margaret L.

    2011-01-01

    Background Effectively controlling the HIV epidemic will require efficient use of limited resources. Despite ambitious global goals for HIV prevention and treatment scale up, few comprehensive practical tools exist to inform such decisions. Methods We briefly summarize modeling approaches for resource allocation for epidemic control, and discuss the practical limitations of these models. We describe typical challenges of HIV resource allocation in practice and some of the tools used by decision makers. We identify the characteristics needed in a model that can effectively support planners in decision making about HIV prevention and treatment scale up. Results An effective model to support HIV scale-up decisions will be flexible, with capability for parameter customization and incorporation of uncertainty. Such a model needs certain key technical features: it must capture epidemic effects; account for how intervention effectiveness depends on the target population and the level of scale up; capture benefit and cost differentials for packages of interventions versus single interventions, including both treatment and prevention interventions; incorporate key constraints on potential funding allocations; identify optimal or near-optimal solutions; and estimate the impact of HIV interventions on the health care system and the resulting resource needs. Additionally, an effective model needs a user-friendly design and structure, ease of calibration and validation, and accessibility to decision makers in all settings. Conclusions Resource allocation theory can make a significant contribution to decision making about HIV prevention and treatment scale up. What remains now is to develop models that can bridge the gap between theory and practice. PMID:21191118

  7. Decision-Making in Prostate Cancer: Active Surveillance Over Other Treatment Options.

    PubMed

    Bayliss, David; Duff, Jed; Stricker, Phil; Walker, Kim

    2016-01-01

    A qualitative-descriptive study of four patients with prostate cancer used the Cognitive-Social Health Information Processing framework to understand how and why men diagnosed with prostate cancer choose active surveillance over other treatment options. In accordance with the literature, it was found that the surgeon or general practitioner's recommendation was the most influential factor when patients are making a treatment decision. PMID:27501595

  8. Empirically and Clinically Useful Decision Making in Psychotherapy: Differential Predictions with Treatment Response Models

    ERIC Educational Resources Information Center

    Lutz, Wolfgang; Saunders, Stephen M.; Leon, Scott C.; Martinovich, Zoran; Kosfelder, Joachim; Schulte, Dietmar; Grawe, Klaus; Tholen, Sven

    2006-01-01

    In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research…

  9. Lay Referral Patterns Involved in Cardiac Treatment Decision Making among Middle-Aged and Older Adults

    ERIC Educational Resources Information Center

    Schoenberg, Nancy E.; Amey, Cheryl H.; Stoller, Eleanor Palo; Muldoon, Susan B.

    2003-01-01

    Purpose: This study examined age and contextually related factors that are influential in lay referral patterns during cardiac treatment decision making. Design and Methods: A complementary design was used. The Myocardial Infarction (MI) Onset Study identified demographic correlates of who sought medical care for 1,388 MI (heart attack) survivors.…

  10. Dentist-Patient Interactions in Treatment Decision-Making: A Qualitative Study.

    ERIC Educational Resources Information Center

    Redford, Maryann; Gift, Helen C.

    1997-01-01

    A University of North Carolina study using focus groups of dentists and patients found dentist-patient interactions play an important role in treatment decision-making, and are predicated on non-clinical factors, including dentists' intuition and judgment and patient impressions of dentists' examination styles, personalities, and interpersonal…

  11. The Impact of Reading a Clinical Study on Treatment Decisions of Physicians and Residents.

    ERIC Educational Resources Information Center

    Bergman, David A.; Pantell, Robert H.

    1986-01-01

    A study of the effect of reading a recent clinical study on pediatricians', pediatric residents', and family practitioners' decisions concerning treatment of a common, potentially serious problem revealed a considerable influence but physician difficulty in using probability data and reliance on intuition rather than calculation. (MSE)

  12. Prenatal genetic testing: an investigation of determining factors affecting the decision-making process.

    PubMed

    Pivetti, Monica; Melotti, Giannino

    2013-02-01

    Despite the increase in popularity of prenatal genetic testing, relatively little is known about the role psychological factors play in the decision-making process. In this analogue study, a sample of Italian female university students was used to investigate determining factors that predict the intention of undergoing prenatal genetic testing. Structural Equation Modelling was used to describe the dynamic interplay between knowledge, beliefs, attitudes and health-related behaviour such as prenatal genetic testing. Following the Theory of Reasoned Action, three dimensions predicted the intention to undergo prenatal genetic testing: the need for more scientific information, a positive attitude towards genetic testing, and the inclination to terminate pregnancy after receiving a positive test result. Results showed that less religious women tended to be more in favour of prenatal tests and in undertaking such tests. This preliminary study provides genetic counsellors and policy makers with a clearer picture of their clients' motives and attitudes behind the decision-making process of prenatal genetic testing, contributing to improving both the communication process between counsellors and their clients and the organization of genetic services. PMID:22477148

  13. Epistemic motivation affects the processing of negative emotional stimuli in interpersonal decisions

    PubMed Central

    Wei, Zhenyu; Ruz, María; Zhao, Zhiying; Zheng, Yong

    2015-01-01

    The present electrophysiological study investigated the role of the need for cognitive closure (NFC) in emotional processing. The NFC is conceptualized as an epistemic motive that is related to how and why people seek out information in social environments. Event-related potentials were recorded while individuals with high NFC (i.e., low epistemic motivation) or low NFC (i.e., high epistemic motivation) performed a modified Ultimatum Game, in which the emotions of happy or angry game agents were employed to predict their most likely offer. High-NFC participants more closely adhered to the decisions rules of the game than low-NFC individuals did. The electrophysiological results showed that the dispositional NFC modified early perceptual components (N170, N200, and P200). The potentials showed that high-NFC subjects had a processing bias to angry faces, whereas low-NFC individuals exhibited no such effects. These findings indicated that high-NFC individuals were more sensitive to negative emotional stimuli than low-NFC individuals in an interpersonal decision-making task. PMID:26257698

  14. Antenatal Glucocorticoid Treatment Affects Hippocampal Development in Mice

    PubMed Central

    Noorlander, Cornelle W.; Tijsseling, Deodata; Hessel, Ellen V. S.; de Vries, Willem B.; Derks, Jan B.

    2014-01-01

    Synthetic glucocorticoids are administered to pregnant women at risk for preterm delivery, to enhance fetal lung maturation. The benefit of this treatment is well established, however caution is necessary because of possible unwanted side effects on development of different organ systems, including the brain. Actions of glucocorticoids are mediated by corticosteroid receptors, which are highly expressed in the hippocampus, a brain structure involved in cognitive functions. Therefore, we analyzed the effects of a single antenatal dexamethasone treatment on the development of the mouse hippocampus. A clinically relevant dose of dexamethasone (0.4 mg/kg) was administered to pregnant mice at embryonic day 15.5 and the hippocampus was analyzed from embryonic day 16 until adulthood. We investigated the effects of dexamethasone treatment on anatomical changes, apoptosis and proliferation in the hippocampus, hippocampal volume and on total body weight. Our results show that dexamethasone treatment reduced body weight and hippocampal volume transiently during development, but these effects were no longer detected at adulthood. Dexamethasone treatment increased the number of apoptotic cells in the hippocampus until birth, but postnatally no effects of dexamethasone treatment on apoptosis were found. During the phase with increased apoptosis, dexamethasone treatment reduced the number of proliferating cells in the subgranular zone of the dentate gyrus. The number of proliferative cells was increased at postnatal day 5 and 10, but was decreased again at the adult stage. This latter long-term and negative effect of antenatal dexamethasone treatment on the number of proliferative cells in the hippocampus may have important implications for hippocampal network function. PMID:24465645

  15. Emotion, rationality, and decision-making: how to link affective and social neuroscience with social theory

    PubMed Central

    Verweij, Marco; Senior, Timothy J.; Domínguez D., Juan F.; Turner, Robert

    2015-01-01

    In this paper, we argue for a stronger engagement between concepts in affective and social neuroscience on the one hand, and theories from the fields of anthropology, economics, political science, and sociology on the other. Affective and social neuroscience could provide an additional assessment of social theories. We argue that some of the most influential social theories of the last four decades—rational choice theory, behavioral economics, and post-structuralism—contain assumptions that are inconsistent with key findings in affective and social neuroscience. We also show that another approach from the social sciences—plural rationality theory—shows greater compatibility with these findings. We further claim that, in their turn, social theories can strengthen affective and social neuroscience. The former can provide more precise formulations of the social phenomena that neuroscientific models have targeted, can help neuroscientists who build these models become more aware of their social and cultural biases, and can even improve the models themselves. To illustrate, we show how plural rationality theory can be used to further specify and test the somatic marker hypothesis. Thus, we aim to accelerate the much-needed merger of social theories with affective and social neuroscience. PMID:26441506

  16. The Appleton Consensus: suggested international guidelines for decisions to forego medical treatment.

    PubMed

    Stanley, J M

    1989-09-01

    Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forego Medical Treatment. The guidelines deal with four specific decision-making circumstances: 1. Five guidelines were created for decisions involving competent patients or patients who have executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom 'no substituted judgement' can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities, given the reality of scarce health resources (1). The term 'physician' is used in the American sense, synonymous with 'medical practitioner'. PMID:2677379

  17. Does Treatment Duration Affect Outcome After Radiotherapy for Prostate Cancer?

    SciTech Connect

    D'Ambrosio, David J.; Li Tianyu; Horwitz, Eric M.; Chen, David Y.T.; Pollack, Alan; Buyyounouski, Mark K.

    2008-12-01

    Purpose: The protraction of external beam radiotherapy (RT) time is detrimental in several disease sites. In prostate cancer, the overall treatment time can be considerable, as can the potential for treatment breaks. We evaluated the effect of elapsed treatment time on outcome after RT for prostate cancer. Methods and Materials: Between April 1989 and November 2004, 1,796 men with prostate cancer were treated with RT alone. The nontreatment day ratio (NTDR) was defined as the number of nontreatment days divided by the total elapsed days of RT. This ratio was used to account for the relationship between treatment duration and total RT dose. Men were stratified into low risk (n = 789), intermediate risk (n = 798), and high risk (n = 209) using a single-factor model. Results: The 10-year freedom from biochemical failure (FFBF) rate was 68% for a NTDR <33% vs. 58% for NTDR {>=}33% (p = 0.02; BF was defined as a prostate-specific antigen nadir + 2 ng/mL). In the low-risk group, the 10-year FFBF rate was 82% for NTDR <33% vs. 57% for NTDR {>=}33% (p = 0.0019). The NTDR was independently predictive for FFBF (p = 0.03), in addition to T stage (p = 0.005) and initial prostate-specific antigen level (p < 0.0001) on multivariate analysis, including Gleason score and radiation dose. The NTDR was not a significant predictor of FFBF when examined in the intermediate-risk group, high-risk group, or all risk groups combined. Conclusions: A proportionally longer treatment duration was identified as an adverse factor in low-risk patients. Treatment breaks resulting in a NTDR of {>=}33% (e.g., four or more breaks during a 40-fraction treatment, 5 d/wk) should be avoided.

  18. Cervical dilatation and grade of doctor affects the interval between decision and result of fetal scalp blood sampling in labour.

    PubMed

    Rimmer, Stephanie; Roberts, Stephen A; Heazell, Alexander E P

    2016-08-01

    Fetal scalp blood sampling (FSBS) is used to provide information regarding fetal acid-base status during labour. This study assessed the interval between the decision to perform the procedure and obtaining the result and evaluated whether it is affected by cervical dilatation or the experience of the doctor. The median time for FSBS was 10 min. When cervical dilatation was ≤4 cm samples took approximately 30% longer to obtain. After adjustment for dilation, there were no significant differences between different grades of doctors. FSBS is shorter than previously reported; clinicians should be aware that procedures in early labour take longer to complete. PMID:26399279

  19. Data Mining for Understanding and Improving Decision-making Affecting Ground Delay Programs

    NASA Technical Reports Server (NTRS)

    Kulkarni, Deepak; Wang, Yao; Sridhar, Banavar

    2013-01-01

    The continuous growth in the demand for air transportation results in an imbalance between airspace capacity and traffic demand. The airspace capacity of a region depends on the ability of the system to maintain safe separation between aircraft in the region. In addition to growing demand, the airspace capacity is severely limited by convective weather. During such conditions, traffic managers at the FAA's Air Traffic Control System Command Center (ATCSCC) and dispatchers at various Airlines' Operations Center (AOC) collaborate to mitigate the demand-capacity imbalance caused by weather. The end result is the implementation of a set of Traffic Flow Management (TFM) initiatives such as ground delay programs, reroute advisories, flow metering, and ground stops. Data Mining is the automated process of analyzing large sets of data and then extracting patterns in the data. Data mining tools are capable of predicting behaviors and future trends, allowing an organization to benefit from past experience in making knowledge-driven decisions.

  20. Comparing social factors affecting recommender decisions in online and educational social network

    NASA Astrophysics Data System (ADS)

    MartÍn, Estefanía; Hernán-Losada, Isidoro; Haya, Pablo A.

    2016-01-01

    In the educational context, there is an increasing interest in learning networks. Recommender systems (RSs) can play an important role in achieving educational objectives. Although we can find many papers focused on recommendation techniques and algorithms, in general, less attention has been dedicated to social factors that influence the recommendation process. This process could be improved if we had a deeper understanding of the social factors that influence the quality or validity of a suggestion made by the RS. This work elucidates and analyses the social factors that influence the design and decision-making process of RSs. We conducted a survey in which 126 undergraduate students were asked to extract which are the main factors for improving suggestions when they are interacting with an Online Social Network (OSN) or in an Educational Social Network (ESN). The results show that different factors have to be considered depending on the type of network.

  1. Affective Priming in a Lexical Decision Task: Is There an Effect of Words' Concreteness?

    ERIC Educational Resources Information Center

    Ferré, Pilar; Sánchez-Casas, Rosa

    2014-01-01

    Affective priming occurs when responses to a target are facilitated when it is preceded by a prime congruent in valence. We conducted two experiments in order to test whether this is a genuine emotional effect or rather it can be accounted for by semantic relatedness between primes and targets. With this aim, semantic relatedness and emotional…

  2. How Will Welfare Reform Affect Childbearing and Family Structure Decisions? Discussion Paper.

    ERIC Educational Resources Information Center

    Peters, H. Elizabeth; Plotnick, Robert D.; Jeong, Se-Ook

    This paper summarizes changes in key elements of welfare policy and in closely related policies on child support enforcement and sex education and family planning programs. Drawing on a conceptual framework that highlights how incentives created by public policy can affect demographic behaviors, the paper concludes that, as Congress intended,…

  3. Orbitofrontal or accumbens dopamine depletion does not affect risk-based decision making in rats.

    PubMed

    Mai, Bettina; Hauber, Wolfgang

    2015-09-01

    Considerable evidence has implicated dopamine (DA) signals in target regions of midbrain DA neurons such as the medial prefrontal cortex or the core region of the nucleus accumbens in controlling risk-based decision-making. However, to date little is known about the contribution of DA in the orbitofrontal cortex (OFC) and the medial shell region of the nucleus accumbens (AcbS) to risk-based decision-making. Here we examined in rats the effects of 6-hydroxydopamine-induced DA depletions of the OFC and AcbS on risky choice using an instrumental two-lever choice task that requires the assessment of fixed within-session reward probabilities that were shifted across subsequent sessions, i.e., rats had to choose between two levers, a small/certain lever that delivered one certain food reward (one pellet at p = 1) and a large/risky lever that delivered a larger uncertain food reward with decreasing probabilities across subsequent sessions (four pellets at p = 0.75, 0.5, 0.25, 0.125, 0.0625). Results show that systemic administration of amphetamine or cocaine increased the preference for the large/risky lever. Results further demonstrate that, like sham controls, rats with OFC or AcbS DA depletion were sensitive to changes in probabilities for obtaining the large/risky reward across sessions and displayed probabilistic discounting. These findings point to the view that the basal capacity to evaluate the magnitude and likelihood of rewards associated with alternative courses of action as well as long-term changes of reward probabilities does not rely on DA input to the AcbS or OFC. PMID:25860659

  4. Data Mining for Understanding and Impriving Decision-Making Affecting Ground Delay Programs

    NASA Technical Reports Server (NTRS)

    Kulkarni, Deepak; Wang, Yao Xun; Sridhar, Banavar

    2013-01-01

    The continuous growth in the demand for air transportation results in an imbalance between airspace capacity and traffic demand. The airspace capacity of a region depends on the ability of the system to maintain safe separation between aircraft in the region. In addition to growing demand, the airspace capacity is severely limited by convective weather. During such conditions, traffic managers at the FAA's Air Traffic Control System Command Center (ATCSCC) and dispatchers at various Airlines' Operations Center (AOC) collaborate to mitigate the demand-capacity imbalance caused by weather. The end result is the implementation of a set of Traffic Flow Management (TFM) initiatives such as ground delay programs, reroute advisories, flow metering, and ground stops. Data Mining is the automated process of analyzing large sets of data and then extracting patterns in the data. Data mining tools are capable of predicting behaviors and future trends, allowing an organization to benefit from past experience in making knowledge-driven decisions. The work reported in this paper is focused on ground delay programs. Data mining algorithms have the potential to develop associations between weather patterns and the corresponding ground delay program responses. If successful, they can be used to improve and standardize TFM decision resulting in better predictability of traffic flows on days with reliable weather forecasts. The approach here seeks to develop a set of data mining and machine learning models and apply them to historical archives of weather observations and forecasts and TFM initiatives to determine the extent to which the theory can predict and explain the observed traffic flow behaviors.

  5. Risky Decision-Making but Not Delay Discounting Improves during Inpatient Treatment of Polysubstance Dependent Alcoholics

    PubMed Central

    De Wilde, Bieke; Bechara, Antoine; Sabbe, Bernard; Hulstijn, Wouter; Dom, Geert

    2013-01-01

    Background: High levels of impulsivity, characteristics of addicted patients, are known to be important predictors of relapse. However, so far, little is known about the stability or variability of two main components of impulsivity (delay discounting and decision-making). The present study examined the changes in impulsivity during the first week of an abstinence based, behavioral orientated inpatient treatment program. Method: Thirty-seven polysubstance dependent alcoholics completed the Delay Discounting Task (DDT), and the Iowa Gambling Task (IGT) using the original version with decks A′B′C′D′, and an alternative version with decks K′L′M′N′, for measuring decision-making, after 2 and 6 weeks of active treatment. Results: It was found that performances on the IGT changed during treatment while performances on the DDT did not (test-retest period: 4 weeks). Conclusion: The results provide preliminary evidence that improvements in decision-making might be related to treatment effects. All patients followed a highly structured cognitive-behavioral treatment program, which might have enhanced their executive functioning (coping skills training). PMID:24027538

  6. Preferences and flexibility in decision-making among dental clinicians regarding the treatment of multirooted teeth: an interactive communication device-based survey at two academic conferences

    PubMed Central

    2016-01-01

    Purpose Decision-making by dental and medical experts can be influenced by their biases, interests, and experiences, and academic arguments about controversial issues may additionally be considered indirect experiences capable of affecting decision-making. This study reports on the use of interactive communication devices to evaluate preferences and flexibility in decision-making among dental care providers who attended two distinct academic conferences. Methods Two debates were presented by a team of two lecturers at two academic conferences (focusing on periodontology and implant dentistry, respectively) and the audience members of each session were surveyed. Before each lecture, two case modules about the diagnosis and treatment of multirooted molar lesions were provided, and interactive communication devices were used to collect responses about decision-making preferences in treatment planning immediately before and after a debate about treatment strategies. Results In total, 81 and 84 completed answers from both conferences were obtained for the first and second case modules, respectively. The preferred treatment plan differed significantly according to the focus of the conference, and a tendency emerged for the clinicians participating in each conference to express uniform preferences. However, attending the debates resulted in significant changes in decision-making preferences regardless of the conference focus or the characteristics of the participants. Conclusions Our findings suggest that providing continuing education via debates on controversial issues may be effective in widening conceptual knowledge and reducing biases among experts in the dental and medical fields. PMID:27382505

  7. Cancer treatment decision-making processes for older patients with complex needs: a qualitative study

    PubMed Central

    Hughes, Jane; Farrington, Naomi; Richardson, Alison

    2015-01-01

    Objectives Although older people can experience complex health and social care needs alongside a primary cancer diagnosis, little is understood about how cancer treatment decisions are made for this population. This study aimed to investigate how cancer treatment decisions are formulated for older people with complex health and social care needs and the factors that shape these processes. Design Qualitative study involving semistructured interviews and non-participant observations. Framework approach used for data analysis. Setting Breast and colorectal cancer services in five English NHS hospital trusts. Participants Interviews: purposive sample of 22 clinicians directly involved in a face-to-face clinical role with patients regarding cancer treatment and care, maximising variation across clinical roles, tumour types and trusts. Observations: purposive sample of five cancer multidisciplinary meetings, maximising variation across location, team size and tumour type. Results The initial stages of cancer treatment decision-making are team-based, medically dominated and focused on the cancer. For patients with complex health and social care needs that extend beyond cancer pathology, later and less visible stages in the decision-making process are more haphazard and may result in less effective and workable treatment plans, as individual clinicians struggle to devise and deliver these plans without breaching time-based targets. Conclusions Service targets that focus resources solely on the presenting disease can disadvantage older patients with complex health and social care needs that extend beyond this primary diagnosis. Care should be taken to ensure time-based targets do not disincentivise thorough and timely assessment that can lead to the formulation of treatment plans tailored to individual needs and circumstances. PMID:26667015

  8. Factors Affecting Treatment Acceptability for Psychostimulant Medication versus Psychoeducational Intervention.

    ERIC Educational Resources Information Center

    Stinnett, Terry A.; Crawford, Stephanie A.; Gillespie, Marci D.; Cruce, Michael K.; Langford, Courtney A.

    2001-01-01

    Examines future teachers' judgments of acceptability for two common treatments for children with the Attention Deficit Hyperactivity Disorder (ADHD) label. In this study, the ADHD label evoked greater expectations of attentional difficulties even when the pattern of functioning was similar to nonlabeled children. On the other hand, children with…

  9. Provider and patient correlates of provider decisions to recommend HCV treatment to HIV co-infected patients.

    PubMed

    Wagner, Glenn; Osilla, Karen Chan; Garnett, Jeffrey; Ghosh-Dastidar, Bonnie; Bhatti, Laveeza; Witt, Mallory; Goetz, Matthew Bidwell

    2012-01-01

    Despite low uptake of hepatitis C virus (HCV) treatment among HIV co-infected patients, few studies have examined the factors that contribute to provider decisions to recommend treatment. Surveys of 173 co-infected patients and their primary care providers, as well as patient chart data, were collected at 3 HIV clinics in Los Angeles; 73% of the patients had any history of being recommended HCV treatment. Multivariate predictors of being offered treatment included being Caucasian, greater HCV knowledge, receiving depression treatment if depressed, and one's provider having a lower weekly patient load and more years working at the study site. These findings suggest that provider decisions to recommend HCV treatment are influenced by patient factors including race and psychosocial treatment readiness, as well as characteristics of their own practice and treatment philosophy. With changes to HCV treatment soon to emerge, further evaluation of factors influencing treatment decisions is needed to improve HCV treatment uptake. PMID:22564797

  10. How Patient Interactions with a Computer-Based Video Intervention Affect Decisions to Test for HIV

    ERIC Educational Resources Information Center

    Aronson, Ian David; Rajan, Sonali; Marsch, Lisa A.; Bania, Theodore C.

    2014-01-01

    The current study examines predictors of HIV test acceptance among emergency department patients who received an educational video intervention designed to increase HIV testing. A total of 202 patients in the main treatment areas of a high-volume, urban hospital emergency department used inexpensive netbook computers to watch brief educational…

  11. Protein source and choice of anticoagulant decisively affect nanoparticle protein corona and cellular uptake

    NASA Astrophysics Data System (ADS)

    Schöttler, S.; Klein, Katja; Landfester, K.; Mailänder, V.

    2016-03-01

    Protein adsorption on nanoparticles has been a focus of the field of nanocarrier research in the past few years and more and more papers are dealing with increasingly detailed lists of proteins adsorbed to a plethora of nanocarriers. While there is an urgent need to understand the influence of this protein corona on nanocarriers' interactions with cells the strong impact of the protein source on corona formation and the consequence for interaction with different cell types are factors that are regularly neglected, but should be taken into account for a meaningful analysis. In this study, the importance of the choice of protein source used for in vitro protein corona analysis is concisely investigated. Major and decisive differences in cellular uptake of a polystyrene nanoparticle incubated in fetal bovine serum, human serum, human citrate and heparin plasma are reported. Furthermore, the protein compositions are determined for coronas formed in the respective incubation media. A strong influence of heparin, which is used as an anticoagulant for plasma generation, on cell interaction is demonstrated. While heparin enhances the uptake into macrophages, it prevents internalization into HeLa cells. Taken together we can give the recommendation that human plasma anticoagulated with citrate seems to give the most relevant results for in vitro studies of nanoparticle uptake.Protein adsorption on nanoparticles has been a focus of the field of nanocarrier research in the past few years and more and more papers are dealing with increasingly detailed lists of proteins adsorbed to a plethora of nanocarriers. While there is an urgent need to understand the influence of this protein corona on nanocarriers' interactions with cells the strong impact of the protein source on corona formation and the consequence for interaction with different cell types are factors that are regularly neglected, but should be taken into account for a meaningful analysis. In this study, the importance

  12. Factors Affecting Career Decision-Making: Further Validation of the O'Neil Career-Sex Role Model and the Career Factor Checklist.

    ERIC Educational Resources Information Center

    Meinecke, Christine; O'Neil, James M.

    Many correlates of vocational choice have been suggested by career development theorists. A career decision-making model developed by O'Neil, Meeker, and Borgers suggests six factors (individual, societal, familial, socioeconomic, situational, psychosocial-emotional) that affect both sex role socialization and career decision-making. The validity…

  13. HIV Treatment as Prevention: Models, Data, and Questions—Towards Evidence-Based Decision-Making

    PubMed Central

    2012-01-01

    Antiretroviral therapy (ART) for those infected with HIV can prevent onward transmission of infection, but biological efficacy alone is not enough to guide policy decisions about the role of ART in reducing HIV incidence. Epidemiology, economics, demography, statistics, biology, and mathematical modelling will be central in framing key decisions in the optimal use of ART. PLoS Medicine, with the HIV Modelling Consortium, has commissioned a set of articles that examine different aspects of HIV treatment as prevention with a forward-looking research agenda. Interlocking themes across these articles are discussed in this introduction. We hope that this article, and others in the collection, will provide a foundation upon which greater collaborations between disciplines will be formed, and will afford deeper insights into the key factors involved, to help strengthen the support for evidence-based decision-making in HIV prevention. PMID:22802739

  14. Factors that affect adolescents' adherence to diabetes treatment.

    PubMed

    Cox, Laura; Hunt, Jane

    2015-02-01

    There is strong evidence suggesting young people with type 1 diabetes experience difficulties adhering to their treatment regimens. The purpose of this literature review is to identify reasons for a lack of compliance in adolescents to allow nurses to develop knowledge to help improve treatment adherence. A literature search was undertaken by searching databases using key terms and inclusion criteria identified. The three themes are: parental influence, peer influence and depression. Findings indicate parental influence may be the main contributing factor towards non-compliance; however, associations between themes imply non-compliance is a result of a combination of factors. Limitations have been highlighted from the articles reviewed and provide opportunity for future research. PMID:25671752

  15. ZNF804A variants confer risk for heroin addiction and affect decision making and gray matter volume in heroin abusers.

    PubMed

    Sun, Yan; Zhao, Li-Yan; Wang, Gui-Bin; Yue, Wei-Hua; He, Yong; Shu, Ni; Lin, Qi-Xiang; Wang, Fan; Li, Jia-Li; Chen, Na; Wang, Hui-Min; Kosten, Thomas R; Feng, Jia-Jia; Wang, Jun; Tang, Yu-De; Liu, Shu-Xue; Deng, Gui-Fa; Diao, Gan-Huan; Tan, Yun-Long; Han, Hong-Bin; Lin, Lu; Shi, Jie

    2016-05-01

    Drug addiction shares common neurobiological pathways and risk genes with other psychiatric diseases, including psychosis. One of the commonly identified risk genes associated with broad psychosis has been ZNF804A. We sought to test whether psychosis risk variants in ZNF804A increase the risk of heroin addiction by modulating neurocognitive performance and gray matter volume (GMV) in heroin addiction. Using case-control genetic analysis, we compared the distribution of ZNF804A variants (genotype and haplotype) in 1035 heroin abusers and 2887 healthy subjects. We also compared neurocognitive performance (impulsivity, global cognitive ability and decision-making ability) in 224 subjects and GMV in 154 subjects based on the ZNF804A variants. We found significant differences in the distribution of ZNF804A intronic variants (rs1344706 and rs7597593) allele and haplotype frequencies between the heroin and control groups. Decision-making impairment was worse in heroin abusers who carried the ZNF804A risk allele and haplotype. Subjects who carried more risk alleles and haplotypes of ZNF804A had greater GMV in the bilateral insular cortex, right temporal cortex and superior parietal cortex. The interaction between heroin addiction and ZNF804A variants affected GMV in the left sensorimotor cortex. Our findings revealed several ZNF804A variants that were significantly associated with the risk of heroin addiction, and these variants affected decision making and GMV in heroin abusers compared with controls. The precise neural mechanisms that underlie these associations are unknown, which requires future investigations of the effects of ZNF804A on both dopamine neurotransmission and the relative increases in the volume of various brain areas. PMID:25708696

  16. Factors affecting the decision to undergo risk-reducing salpingo-oophorectomy among women with BRCA gene mutation.

    PubMed

    Kim, Dongwon; Kang, Eunyoung; Hwang, Euijun; Sun, Young; Hwang, Yoonsun; Yom, Cha Kyong; Kim, Kidong; No, Jae Hong; Kim, Yong-Beom; Kim, Sung-Won

    2013-12-01

    The objective of this study was to identify factors that affect the decision to undergo risk-reducing salpingo-oophorectomy (RRSO) in BRCA1 or BRCA2 mutations carriers in South Korea. The medical records of 124 women who had been found to have BRCA1 or BRCA2 gene mutation at our institution between May 2003 and December 2011 were reviewed. The carriers were divided into RRSO and non-RRSO groups for comparison of their clinicopathologic, socio-economic, and psychosocial factors. Of the 71 carriers eligible for RRSO, 21 had undergone RRSO. In univariate analysis, classification of carriers into 3 groups by decade of life (4th, 5th, or 6th and later decade) and subsequent analysis revealed that 52.6% of carriers in the 5th decade had undergone RRSO, a rate significantly higher than that of the other age groups (p = 0.007). The RRSO rate was higher in carriers with a personal history of breast cancer than in those without (39.2% vs. 5.0%, p = 0.004), in carriers with a family history of breast cancer than in those without (35.5% vs. 11.8%, p = 0.065), and in carriers with a family history of ovarian cancer than in those carriers without a family history (66.7% vs. 24.2%, p = 0.016). Multivariate analysis identified age and personal history of breast cancer as independent factors affecting the decision to undergo RRSO. Age and personal history of breast cancer are important factors in the decision to undergo, and should thus be considered when counseling BRCA1/2 mutation carriers. PMID:23504064

  17. [Patients in pre-dialysis: decision taking and free choice of treatment].

    PubMed

    Sarrias Lorenz, X; Bardón Otero, E; Vila Paz, M L

    2008-01-01

    Predialysis is a clinical situation in which the patient has significant impairment of kidney function that will ultimately lead to either death or inclusion in kidney replacement therapy (dialysis and/or transplantation). Since a practical and effective dialysis technique was introduced, the length and quality of survival of patients with end-stage renal failure has constantly increased. Contraindications for dialysis are almost never of a renal origin. The obstacles are the concomitant diseases of the patient. The age of the patient may be one of these obstacles. The average age at initiation of dialysis in our country is currently 67 years and over 50% of patients are 60 years old or older. Decision making: From an ethical viewpoint, there is a consensus in stating that anything that can technically be done, should be done. The principle of nonmaleficence and respect for the autonomy of the patients are "prima facie" principles when the physician has doubts as to whether dialysis provides a benefit to the patient. The principle of autonomy, which makes the patient a competent subject of treatment, allows a framework of shared decisions to be created in which the physician uses his knowledge and experiences in assessing the risk and benefits of dialysis including the alternative of no dialysis. The competent patient, duly informed, will chose the option that is best for him and take the decision. Principle of treatment proportionality: This principle states that there is a moral obligation to implement all therapeutic measures that show a relationship of due proportion between the resources used and the expected result. Dialysis is in principle a proportional treatment for end-stage renal failure. However, it may become a disproportional treatment because of the physical and mental conditions of the elderly patient. The good that is sought with institution of treatment can cause a harm to the patient that justifies noninclusion of the patient in dialysis

  18. Factors affecting the performance of stormwater treatment wetlands.

    PubMed

    Carleton, J N; Grizzard, T J; Godrej, A N; Post, H E

    2001-04-01

    Data from 35 studies on 49 wetland systems used to treat stormwater runoff or runoff-impacted surface waters were examined and compared in order to identify any obvious trends that may aid future stormwater treatment wetland design efforts. Despite the intermittent nature of hydrologic and pollutant inputs from stormwater runoff, our analysis demonstrates that steady-state first-order plug-flow models commonly used to analyze wastewater treatment wetlands can be adapted for use with stormwater wetlands. Long-term pollutant removals are analyzed as functions of long-term mean hydraulic loading rate and nominal detention time. First-order removal rate constants for total phosphorus, ammonia, and nitrate generated in this fashion are demonstrated to be similar to values reported in the literature for wastewater treatment wetlands. Constituent removals are also demonstrated via regression analyses to be functions of the ratio of wetland area to watershed area. Resulting equations between these variables can be used as preliminary design tools in the absence of more site-specific details, with the understanding that they should be employed cautiously. PMID:11317903

  19. The cognitive processes underlying affective decision-making predicting adolescent smoking behaviors in a longitudinal study

    PubMed Central

    Xiao, Lin; Koritzky, Gilly; Johnson, C. Anderson; Bechara, Antoine

    2013-01-01

    This study investigates the relationship between three different cognitive processes underlying the Iowa Gambling Task (IGT) and adolescent smoking behaviors in a longitudinal study. We conducted a longitudinal study of 181 Chinese adolescents in Chengdu City, China. The participants were followed from 10th to 11th grade. When they were in the 10th grade (Time 1), we tested these adolescents' decision-making using the IGT and working memory capacity using the Self-ordered Pointing Test (SOPT). Self-report questionnaires were used to assess school academic performance and smoking behaviors. The same questionnaires were completed again at the 1-year follow-up (Time 2). The Expectancy-Valence (EV) Model was applied to distill the IGT performance into three different underlying psychological components: (i) a motivational component which indicates the subjective weight the adolescents assign to gains vs. losses; (ii) a learning-rate component which indicates the sensitivity to recent outcomes vs. past experiences; and (iii) a response component which indicates how consistent the adolescents are between learning and responding. The subjective weight to gains vs. losses at Time 1 significantly predicted current smokers and current smoking levels at Time 2, controlling for demographic variables and baseline smoking behaviors. Therefore, by decomposing the IGT into three different psychological components, we found that the motivational process of weight gain vs. losses may serve as a neuropsychological marker to predict adolescent smoking behaviors in a general youth population. PMID:24101911

  20. A Diffusion Model Analysis of Decision Biases Affecting Delayed Recognition of Emotional Stimuli

    PubMed Central

    Bowen, Holly J.; Spaniol, Julia; Patel, Ronak; Voss, Andreas

    2016-01-01

    Previous empirical work suggests that emotion can influence accuracy and cognitive biases underlying recognition memory, depending on the experimental conditions. The current study examines the effects of arousal and valence on delayed recognition memory using the diffusion model, which allows the separation of two decision biases thought to underlie memory: response bias and memory bias. Memory bias has not been given much attention in the literature but can provide insight into the retrieval dynamics of emotion modulated memory. Participants viewed emotional pictorial stimuli; half were given a recognition test 1-day later and the other half 7-days later. Analyses revealed that emotional valence generally evokes liberal responding, whereas high arousal evokes liberal responding only at a short retention interval. The memory bias analyses indicated that participants experienced greater familiarity with high-arousal compared to low-arousal items and this pattern became more pronounced as study-test lag increased; positive items evoke greater familiarity compared to negative and this pattern remained stable across retention interval. The findings provide insight into the separate contributions of valence and arousal to the cognitive mechanisms underlying delayed emotion modulated memory. PMID:26784108

  1. Post-Decision Wagering Affects Metacognitive Awareness of Emotional Stimuli: An Event Related Potential Study.

    PubMed

    Wierzchoń, Michał; Wronka, Eligiusz; Paulewicz, Borysław; Szczepanowski, Remigiusz

    2016-01-01

    The present research investigated metacognitive awareness of emotional stimuli and its psychophysiological correlates. We used a backward masking task presenting participants with fearful or neutral faces. We asked participants for face discrimination and then probed their metacognitive awareness with confidence rating (CR) and post-decision wagering (PDW) scales. We also analysed psychophysiological correlates of awareness with event-related potential (ERP) components: P1, N170, early posterior negativity (EPN), and P3. We have not observed any differences between PDW and CR conditions in the emotion identification task. However, the "aware" ratings were associated with increased accuracy performance. This effect was more pronounced in PDW, especially for fearful faces, suggesting that emotional stimuli awareness may be enhanced by monetary incentives. EEG analysis showed larger N170, EPN and P3 amplitudes in aware compared to unaware trials. It also appeared that both EPN and P3 ERP components were more pronounced in the PDW condition, especially when emotional faces were presented. Taken together, our ERP findings suggest that metacognitive awareness of emotional stimuli depends on the effectiveness of both early and late visual information processing. Our study also indicates that awareness of emotional stimuli can be enhanced by the motivation induced by wagering. PMID:27490816

  2. Protein source and choice of anticoagulant decisively affect nanoparticle protein corona and cellular uptake.

    PubMed

    Schöttler, S; Klein, Katja; Landfester, K; Mailänder, V

    2016-03-14

    Protein adsorption on nanoparticles has been a focus of the field of nanocarrier research in the past few years and more and more papers are dealing with increasingly detailed lists of proteins adsorbed to a plethora of nanocarriers. While there is an urgent need to understand the influence of this protein corona on nanocarriers' interactions with cells the strong impact of the protein source on corona formation and the consequence for interaction with different cell types are factors that are regularly neglected, but should be taken into account for a meaningful analysis. In this study, the importance of the choice of protein source used for in vitro protein corona analysis is concisely investigated. Major and decisive differences in cellular uptake of a polystyrene nanoparticle incubated in fetal bovine serum, human serum, human citrate and heparin plasma are reported. Furthermore, the protein compositions are determined for coronas formed in the respective incubation media. A strong influence of heparin, which is used as an anticoagulant for plasma generation, on cell interaction is demonstrated. While heparin enhances the uptake into macrophages, it prevents internalization into HeLa cells. Taken together we can give the recommendation that human plasma anticoagulated with citrate seems to give the most relevant results for in vitro studies of nanoparticle uptake. PMID:26804616

  3. Post-Decision Wagering Affects Metacognitive Awareness of Emotional Stimuli: An Event Related Potential Study

    PubMed Central

    Wierzchoń, Michał; Wronka, Eligiusz; Paulewicz, Borysław; Szczepanowski, Remigiusz

    2016-01-01

    The present research investigated metacognitive awareness of emotional stimuli and its psychophysiological correlates. We used a backward masking task presenting participants with fearful or neutral faces. We asked participants for face discrimination and then probed their metacognitive awareness with confidence rating (CR) and post-decision wagering (PDW) scales. We also analysed psychophysiological correlates of awareness with event-related potential (ERP) components: P1, N170, early posterior negativity (EPN), and P3. We have not observed any differences between PDW and CR conditions in the emotion identification task. However, the "aware" ratings were associated with increased accuracy performance. This effect was more pronounced in PDW, especially for fearful faces, suggesting that emotional stimuli awareness may be enhanced by monetary incentives. EEG analysis showed larger N170, EPN and P3 amplitudes in aware compared to unaware trials. It also appeared that both EPN and P3 ERP components were more pronounced in the PDW condition, especially when emotional faces were presented. Taken together, our ERP findings suggest that metacognitive awareness of emotional stimuli depends on the effectiveness of both early and late visual information processing. Our study also indicates that awareness of emotional stimuli can be enhanced by the motivation induced by wagering. PMID:27490816

  4. Intra-household relations and treatment decision-making for childhood illness: a Kenyan case study.

    PubMed

    Molyneux, C S; Murira, G; Masha, J; Snow, R W

    2002-01-01

    This study, conducted on the Kenyan coast, assesses the effect of intra-household relations on maternal treatment-seeking. Rural and urban Mijikenda mothers' responses to childhood fevers in the last 2 weeks (n=317), and to childhood convulsions in the previous year (n=43), were documented through survey work. The intra-household relations and decision-making dynamics surrounding maternal responses were explored through in-depth individual and group interviews, primarily with women (n=223). Responses to convulsions were more likely than responses to fevers to include a healer consultation (p<0.0001), and less likely to include the purchase of over-the-counter medications (p<0.0001). Mothers received financial or advisory assistance from others in 71% (n=236) of actions taken outside the household in response to fevers. In-depth interviews suggested that general agreement on appropriate therapy results in relatively few intra-household conflicts over the treatment of fevers. Disputes over perceived cause and appropriate therapy of convulsions, however, highlighted the importance of age, gender and relationship to household head in intra-household relations and treatment decision-making. Although mothers' treatment-seeking preferences are often circumscribed by these relations, a number of strategies can be drawn upon to circumvent 'inappropriate' decisions, sometimes with implications for future household responses to similar syndromes. The findings highlight the complexity of intra-household relations and treatment decision-making dynamics. Tentative implications for interventions aimed at improving the home management of malaria, and for further research, are presented. PMID:11814209

  5. Withholding treatment and intellectual disability: Second survey on end-of-life decisions in Switzerland

    PubMed Central

    Wicki, Monika T

    2016-01-01

    Background: As people live longer, they are more likely to die over a prolonged period from incurable, chronic illnesses that occur more frequently in old age. Therefore, people will experience an increase in end-of-life discussions and decisions. Aim: The aim of this study was to explore the prevalence and nature of end-of-life decisions for people with disabilities in Swiss residential homes. Design: A cross-sectional survey in the three biggest German-speaking regions in Switzerland (N = 209) was conducted. Setting: All of the residential homes for adults with disabilities (N = 209) were invited to participate in a cross-sectional survey. The response quote was 76.7%. Directors provided information on 82 deaths. Chi-square and t-tests were used to study differences in prevalence and nature of end-of-life decisions between people with intellectual disability (ID) and people with other disabilities. Results: An end-of-life decision was taken in 53.7% of the cases (n = 44). For people with ID, the decision to withhold treatment had been taken more often (28.9%, 13 cases) than for people with other disabilities (8.1%, 3 cases) (χ2 (1, N = 82) = 5.58, p = 0.017). Conclusion: The study provides insight in end-of-life decision-making for people with disabilities in Switzerland. The results have implications on surrogate decision-making for people with ID living in residential homes. As the study partly confirms the results of previous studies, further studies will be necessary. PMID:27408720

  6. She left, he left: how employment and satisfaction affect women's and men's decisions to leave marriages.

    PubMed

    Sayer, Liana C; England, Paula; Allison, Paul D; Kangas, Nicole

    2011-05-01

    Studies examining determinants of divorce have largely ignored differences between factors that elevate wives' and husbands' initiation of divorce. The authors use longitudinal data and a latent class model embedded in a competing-risks event history model to assess distinct predictors of wives and husbands leaving marriages. They find that when men are not employed, either spouse is more likely to leave. When wives report better-than-average marital satisfaction, their employment affects neither spouse's exit. However, when wives report below-average marital satisfaction, their employment makes it more likely they will leave. The authors' findings suggest that theories of divorce require "gendering" to reflect asymmetric gender change. PMID:21932472

  7. Treatment decision-making and information-seeking preferences in women with pelvic floor disorders

    PubMed Central

    Raker, Christina A.; Myers, Deborah L.; Clark, Melissa A.

    2010-01-01

    Introduction and hypothesis The Autonomy Preference Index (API) and Control Preferences Scale (CPS) measure information-seeking and decision-making preferences. Our objective was to validate these scales in women with pelvic floor disorders (PFDs) and identify variables associated with decision-making preferences. Methods Women seeking care for PFDs completed the API and the CPS. Psychometric properties were determined. Multivariable analyses were used to identify correlates of information-seeking and decision-making preferences. Results One hundred ten women were recruited. Both scales demonstrated good psychometric properties (intraclass correlation coefficient=0.5 to 0.7; Cronbach’s alpha = 0.8 for the API, and r=−0.3 between the API and CPS). Based on scores, women had strong preferences to be well informed, but were more neutral in their decision-making preferences. In multivariable analyses, higher education levels were associated with a stronger desire for seeking medical information. Conclusions Women seeking care for PFDs vary in their preferences for participating in treatment decisions. PMID:20424822

  8. Treatment of envenomation by Echis coloratus (mid-east saw scaled viper): a decision tree.

    PubMed

    Gilon, D; Shalev, O; Benbassat, J

    1989-01-01

    Envenomation by Echis coloratus causes a transient hemostatic failure. Systemic symptoms, hypotension and evident bleeding are rare, with only one reported fatality. In this paper, we examine the decision to treat victims of Echis coloratus by a specific horse antiserum. The decision model considers the mortality of treated and untreated envenomation, and the side effects of antiserum treatment: fatal anaphylaxis, serum sickness and increased risk of death after a possible repeated exposure to horse antiserum in the future. The results of the analysis are not sensitive to variations in the probability of side effects of antiserum treatment. They are sensitive to variations in the risk of bleeding after envenomation, in the degree of reduction of this risk by antiserum treatment and in the risk of dying after an event of bleeding. Prompt administration of antiserum appears to be the treatment of choice if it reduces the risk of bleeding from 23.6% to 20.3% and if 1.6% or more of the bleeding events are fatal. We conclude that presently available data support antiserum treatment of victims of Echis coloratus who present with hemostatic failure, even though the advantage imparted by this treatment appears to be small. PMID:2683230

  9. How does AIDS illness affect women's residential decisions? Findings from an ethnographic study in a Cape Town township.

    PubMed

    Bray, Rachel

    2009-06-01

    This paper explores the nature and consequences of residential decision-making for women on treatment for AIDS illness in a poor urban settlement in South Africa. Drawing on ethnographic data collected over a two-year period, it points to the subtle shifts in 'householding' practices and kinship relationships prompted by women's individual experiences and understanding of their HIV status, illness and treatment. Women's decisions to move or to arrange that other family members move can be explained by pre-existing threats to individual wellbeing or family residential security. But an HIV diagnosis can intensify a mother's thoughts and actions in relation to residential and emotional security, in particular on behalf of her children. In a context where extended periods of childcare by rural relatives is common, mothers with AIDS illness may gather all their children in their home to offer direct care, achieve intimacy and facilitate disclosure. They are likely to avoid making frequent contact with, and demands on, their elderly parents. Siblings are favoured as co-residents and confidants in disclosure, but their long-term support is contingent on reciprocity. Partners, where present, are valued for economic, social and emotional security. Women attempt to balance their children's nurturing, in the short and long term, with care of the self. Their efforts do not always succeed and can incur high costs to their wellbeing and relationships with their children. PMID:25875568

  10. Applying the least restrictive alternative principle to treatment decisions: A legal and behavioral analysis

    PubMed Central

    Johnston, J. M.; Sherman, Robert A.

    1993-01-01

    The least restrictive alternative concept is widely used in mental health law. This paper addresses how the concept has been applied to treatment decisions. The paper offers both a legal and a behavioral analysis to some problems that have emerged in recent years concerning the selection of behavioral procedures used to change client behavior. The paper also offers ways of improving the application of the concept, which involve developing a more behaviorally functional perspective toward restrictiveness. PMID:22478138

  11. Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations.

    PubMed

    Angell, Beth; Bolden, Galina B

    2015-08-01

    Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. PMID:26046726

  12. Justifying medication decisions in mental health care: Psychiatrists’ accounts for treatment recommendations

    PubMed Central

    Angell, Beth; Bolden, Galina B.

    2015-01-01

    Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients’ concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists’ orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. PMID:26046726

  13. Control policies for a water-treatment system using the Markov Decision Process.

    NASA Astrophysics Data System (ADS)

    Chiam, Tze; Mitchell, Cary; Yih, Yuehwern

    In order to build a decision-making tool for choosing a control policy from a set of predefined policies for a water-treatment system, a simulation was developed. This technology-independent simulation focuses on the functions of a simplified representation of the water system based on documentation by NASA in the Baseline Value and Assumption Documents (BVAD). The clean-water requirement (consumption) and dirty-water generation (production) are based on crewmember demographics, activity schedules, and intensity of each activity. The water system consists of hygiene and potable-water subsystems. The hygiene-water subsystem supplies water for purposes such as laundry, urinal flush, dish wash, oral hygiene, and shower. The potable-water subsystem supplies water for drinking and re-hydration of food. Due to a lack of stochastic property descriptions for a real-world system in the BVAD, stochastic variables are introduced in this research to reflect a more realistic system. These variables describe the magnitude of deviation of system variables from their theoretical values through predetermined statistical distributions. These variables include hygiene and potable-water-treatment efficiencies, amounts of hygiene and potable water consumed, and amount of dirty water produced following potable-water consumption. Conditions of the system occurring hourly result from the intricate interaction of crewmembers and the water system. The primary measure of the condition of the system is the "state" representation of the system, assessed at the beginning of every hour. Conditions of the system examined include the amount of clean water available for consumption, amount of overflow (in excess of storage capacity) of clean and dirty water, amount of hourly water deficiency, amount of accumulated water deficiency, etc. State transitions of the system based on these assessments are affected by the stochastic properties of the system described above. The transitions also depend on

  14. How communication affects prescription decisions in consultations for acute illness in children: a systematic review and meta-ethnography

    PubMed Central

    2014-01-01

    Background Communication within primary care consultations for children with acute illness can be problematic for parents and clinicians, with potential misunderstandings contributing to over–prescription of antibiotics. This review aimed to synthesise the evidence in relation to communication and decision making in consultations for children with common acute illness. Methods A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, SSCI, SIGLE, Dissertation Express and NHS economic evaluation databases was conducted. Studies of primary care settings in high income countries which made direct observations of consultations and reported qualitative data were included. Included studies were appraised using the process recommended by the Cochrane Qualitative Methods Group. Credibility was assessed as high for most studies but transferability was usually assessed low or unclear. Data were synthesised using a meta–ethnographic approach. Results Thirty–five papers and 2 theses reporting on 13 studies were included, 7 of these focussed on children with respiratory tract infections (RTI) and the remaining 6 included children with any presenting illness. Parent communication focussed on their concerns and information needs, whereas clinician communication focussed on diagnosis and treatment decisions. During information exchanges, parents often sought to justify the need for the consultation, while clinicians frequently used problem minimising language, resulting in parents and clinicians sometimes talking at cross–purposes. In the context of RTIs, a range of parent communication behaviours were interpreted by clinicians as indicating an expectation for antibiotics; however, most were ambiguous and could also be interpreted as raising concerns or requests for further information. The perceived expectation for antibiotics often changed clinician decision making into clinician–parent negotiation. Conclusions Misunderstandings occurred due to parents and clinicians

  15. Bibliotherapy Treatment for Children with Adjustment Difficulties: A Comparison of Affective and Cognitive Bibliotherapy

    ERIC Educational Resources Information Center

    Betzalel, Nurit; Shechtman, Zipora

    2010-01-01

    This study compared outcomes following cognitive and affective bibliotherapy treatment with 79 children and adolescents in a residential home in Israel. Treatment children were compared to a control-no treatment group from the same home. Anxiety was measured through a self-report measure (Revised Children's Manifest Anxiety Scale; Reynolds &…

  16. Survivor needs or logistical convenience? Factors shaping decisions to deliver relief to earthquake-affected communities, Pakistan 2005-06.

    PubMed

    Benini, Aldo; Conley, Charles; Dittemore, Brody; Waksman, Zachary

    2009-03-01

    In Bureaucratizing the Good Samaritan, Waters (2001) argues that bureaucratic rationality distracts humanitarian agencies from the needs of the people they are supposed to assist, in favour of other values that their institutional frameworks dictate. We test his claim by investigating the response to the Pakistan 2005 earthquake. One of us (Dittemore) worked with the United Nations Joint Logistics Centre in the theatre, managing a relief cargo shipment database. The response, known as 'Operation Winter Race', was hampered by extreme logistical challenges, but ultimately succeeded in averting a second disaster resulting from cold and starvation. We use statistical models to probe whether survivor needs significantly guided decisions to deliver relief to affected communities. Needs assessments remained incomplete and incoherent. We measure needs through proxy indicators and integrate them, on a Geographic Information System (GIS) platform, with logistics and relief delivery data. We find that, despite strong logistics effects, needs orientations were significant. However, the strength of decision factors varies between commodity types (food versus clothing and shelter versus reconstruction materials) as well as over the different phases of the response. This study confirms Thomas's observation that logistics databases are rich 'repositories of data that can be analyzed to provide post-event learning' (Thomas, 2003, p. 4). This article is an invitation for others to engage in creative humanitarian data management. PMID:18513312

  17. Cognitive and affective components of mental workload: Understanding the effects of each on human decision making behavior

    NASA Technical Reports Server (NTRS)

    Nygren, Thomas E.

    1992-01-01

    Human factors and ergonomics researchers have recognized for some time the increasing importance of understanding the role of the construct of mental workload in flight research. Current models of mental workload suggest that it is a multidimensional and complex construct, but one that has proved difficult to measure. Because of this difficulty, emphasis has usually been placed on using direct reports through subjective measures such as rating scales to assess levels of mental workload. The NASA Task Load Index (NASA/TLX, Hart and Staveland) has been shown to be a highly reliable and sensitive measure of perceived mental workload. But a problem with measures like TLX is that there is still considerable disagreement as to what it is about mental workload that these subjective measures are actually measuring. The empirical use of subjective workload measures has largely been to provide estimates of the cognitive components of the actual mental workload required for a task. However, my research suggests that these measures may, in fact have greater potential in accurately assessing the affective components of workload. That is, for example, TLX may be more likely to assess the positive and negative feelings associated with varying workload levels, which in turn may potentially influence the decision making behavior that directly bears on performance and safety issues. Pilots, for example, are often called upon to complete many complex tasks that are high in mental workload, stress, and frustration, and that have significant dynamic decision making components -- often ones that involve risk as well.

  18. Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

    PubMed Central

    Wilson, Sandra R.; Strub, Peg; Buist, A. Sonia; Knowles, Sarah B.; Lavori, Philip W.; Lapidus, Jodi; Vollmer, William M.

    2010-01-01

    Rationale: Poor adherence to asthma controller medications results in poor treatment outcomes. Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care. Methods: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters. Measurements and Main Results: Refill adherence was measured using continuous medication acquisition (CMA) indices—the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P < 0.0001) and long-acting β-agonist adherence (CMA, 0.51 vs. 0.40; P = 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P < 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P = 0.03) and long-acting β-agonist adherence (CMA, 0.51 vs. 0.41; P = 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P = 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures. Conclusions: Negotiating patients' treatment decisions

  19. Target templates: the precision of mental representations affects attentional guidance and decision-making in visual search

    PubMed Central

    Hout, Michael C.; Goldinger, Stephen D.

    2014-01-01

    When people look for things in the environment, they use target templates—mental representations of the objects they are attempting to locate—to guide attention and to assess incoming visual input as potential targets. However, unlike laboratory participants, searchers in the real world rarely have perfect knowledge regarding the potential appearance of targets. In seven experiments, we examined how the precision of target templates affects the ability to conduct visual search. Specifically, we degraded template precision in two ways: 1) by contaminating searchers’ templates with inaccurate features, and 2) by introducing extraneous features to the template that were unhelpful. We recorded eye movements to allow inferences regarding the relative extents to which attentional guidance and decision-making are hindered by template imprecision. Our findings support a dual-function theory of the target template and highlight the importance of examining template precision in visual search. PMID:25214306

  20. SU-D-BRD-05: Decision Opportunities in Radiation Therapy Treatments

    SciTech Connect

    Watkins, W.T.; Siebers, J.V.

    2014-06-01

    Purpose: A method to reveal tradeoffs in radiation therapy treatments is introduced in order to aid in clinical, patient-specific decision making. Methods: A clinically acceptable treatment plan was varied for two patients, a stereotactic body radiation therapy (SBRT) lung cancer case and a pituitary case, in order to reveal decision opportunities. Plans were optimized such that non-zero dose-volume objectives were defined for all organs at risk (OARS). At fixed planning target volume (PTV) dose, a single OAR is sacrificed, i.e. the weight of the dose volume objective is deceased, and potential dosimetric benefits in other regions of interest are identified. If tradeoffs are identified, plans are stored and presented as decision opportunities. Results: Clinically relevant tradeoffs were revealed by sacrificing individual OARs. The SBRT lung case was planned according to the Radiotherapy-Oncology Group (RTOG) 0813 protocol, but by violating the high-dose protocol objective (>2 cm from the PTV) in the patient's lung, mean heart dose was reduced by 1.7 Gy and the great vessel V20 was reduced from 42% to 2%. Tradeoffs in dose to the chestwall and heart were also revealed, an increase of 6 Gy in chestwall-Dmax reduces heart mean dose by 0.9 Gy and mean dose to the great vessels by 2.6 Gy. For the pituitary tumor, sacrificing the right parotid gland (increasing mean dose from 7.8 Gy to 14.1 Gy) spares the temporal lobes bilaterally (V20 is reduced by 4%) and left parotid mean dose is reduced from 6.4 Gy to 5.2 Gy. Conclusion: Clinical tradeoffs in radiation therapy treatment planning are revealed by sacrificing individual OARS. By revealing these tradeoffs, decision making in plan selection is simplified and can be considered in the context of patient-specific quality of life.

  1. Young Breast Cancer Survivors: Their Perspectives on Treatment Decisions and Fertility Concerns

    PubMed Central

    Gorman, Jessica R.; Usita, Paula; Madlensky, Lisa; Pierce, John P.

    2010-01-01

    Background Younger women diagnosed with breast cancer are more likely to have survival concerns related to fertility, which may influence their treatment decisions. Objective This qualitative study explores how young women make cancer treatment decisions and the role of fertility concerns in that process. Intervention/Methods We used purposeful sampling to identify a diverse group of 20 young breast cancer survivors, half of whom had a child after breast cancer. We conducted open-ended telephone interviews and used cross-case, inductive analysis to identify themes. Results The main themes were: 1) I was young, I wanted to do everything possible to move forward with my life and not to have the cancer come back, 2) Fertility concerns are different for every woman 3) My oncologist was great… a huge part of my survivorship, and 4) They didn’t tell me about my options and I didn’t think about fertility until it was too late. Conclusions While fertility was important to many participants, treatment decisions were mainly motivated by survival concerns. Fertility concerns depended on life circumstances and the timing in relation to diagnosis varied. There is a need for improved information regarding the impact of treatment on fertility and fertility preservation options, even if concerns are not expressed at diagnosis. Implications for Practice It is critical that cancer care providers provide timely information regarding fertility. Oncology nurses are particularly well-positioned to serve this role by communicating with patients about their fertility concerns and reproductive planning prior to treatment and throughout the course of survivorship. PMID:20697269

  2. [Human body meridian spatial decision support system for clinical treatment and teaching of acupuncture and moxibustion].

    PubMed

    Wu, Dehua

    2016-01-01

    The spatial position and distribution of human body meridian are expressed limitedly in the decision support system (DSS) of acupuncture and moxibustion at present, which leads to the failure to give the effective quantitative analysis on the spatial range and the difficulty for the decision-maker to provide a realistic spatial decision environment. Focusing on the limit spatial expression in DSS of acupuncture and moxibustion, it was proposed that on the basis of the geographic information system, in association of DSS technology, the design idea was developed on the human body meridian spatial DSS. With the 4-layer service-oriented architecture adopted, the data center integrated development platform was taken as the system development environment. The hierarchical organization was done for the spatial data of human body meridian via the directory tree. The structured query language (SQL) server was used to achieve the unified management of spatial data and attribute data. The technologies of architecture, configuration and plug-in development model were integrated to achieve the data inquiry, buffer analysis and program evaluation of the human body meridian spatial DSS. The research results show that the human body meridian spatial DSS could reflect realistically the spatial characteristics of the spatial position and distribution of human body meridian and met the constantly changeable demand of users. It has the powerful spatial analysis function and assists with the scientific decision in clinical treatment and teaching of acupuncture and moxibustion. It is the new attempt to the informatization research of human body meridian. PMID:26946752

  3. The influence of clinician emotion on decisions in child and adolescent eating disorder treatment: a survey of self and others.

    PubMed

    Lafrance Robinson, Adele; Kosmerly, Stacey

    2015-01-01

    Eating disorder clinicians from various disciplines participated in one of two surveys: the "self" group (n = 143) completed a survey assessing the negative influence of emotions on their own clinical decisions, while the "other" group (n = 145) completed a parallel version of the survey that assessed their perceptions of the negative influence of emotion in their colleagues. Both groups endorsed this phenomenon to some degree, although differences in reporting were noted between groups. The perceived negative influence of emotion with regards to specific treatment decisions fell within three categories: decisions regarding food and weight, decisions regarding the involvement of the family in treatment, and decisions related to autonomy and control. Decisions regarding the involvement of the family were perceived to be the most emotionally charged, in particular the involvement of a critical or dismissive parent. PMID:25401960

  4. Application of an environmental decision support system to a water quality trading program affected by surface water diversions.

    PubMed

    Obropta, Christopher C; Niazi, Mehran; Kardos, Josef S

    2008-12-01

    Environmental decision support systems (EDSSs) are an emerging tool used to integrate the evaluation of highly complex and interrelated physicochemical, biological, hydrological, social, and economic aspects of environmental problems. An EDSS approach is developed to address hot-spot concerns for a water quality trading program intended to implement the total maximum daily load (TMDL) for phosphorus in the Non-Tidal Passaic River Basin of New Jersey. Twenty-two wastewater treatment plants (WWTPs) spread throughout the watershed are considered the major sources of phosphorus loading to the river system. Periodic surface water diversions to a major reservoir from the confluence of two key tributaries alter the natural hydrology of the watershed and must be considered in the development of a trading framework that ensures protection of water quality. An EDSS is applied that enables the selection of a water quality trading framework that protects the watershed from phosphorus-induced hot spots. The EDSS employs Simon's (1960) three stages of the decision-making process: intelligence, design, and choice. The identification of two potential hot spots and three diversion scenarios enables the delineation of three management areas for buying and selling of phosphorus credits among WWTPs. The result shows that the most conservative option entails consideration of two possible diversion scenarios, and trading between management areas is restricted accordingly. The method described here is believed to be the first application of an EDSS to a water quality trading program that explicitly accounts for surface water diversions. PMID:18592303

  5. Application of an Environmental Decision Support System to a Water Quality Trading Program Affected by Surface Water Diversions

    NASA Astrophysics Data System (ADS)

    Obropta, Christopher C.; Niazi, Mehran; Kardos, Josef S.

    2008-12-01

    Environmental decision support systems (EDSSs) are an emerging tool used to integrate the evaluation of highly complex and interrelated physicochemical, biological, hydrological, social, and economic aspects of environmental problems. An EDSS approach is developed to address hot-spot concerns for a water quality trading program intended to implement the total maximum daily load (TMDL) for phosphorus in the Non-Tidal Passaic River Basin of New Jersey. Twenty-two wastewater treatment plants (WWTPs) spread throughout the watershed are considered the major sources of phosphorus loading to the river system. Periodic surface water diversions to a major reservoir from the confluence of two key tributaries alter the natural hydrology of the watershed and must be considered in the development of a trading framework that ensures protection of water quality. An EDSS is applied that enables the selection of a water quality trading framework that protects the watershed from phosphorus-induced hot spots. The EDSS employs Simon’s (1960) three stages of the decision-making process: intelligence, design, and choice. The identification of two potential hot spots and three diversion scenarios enables the delineation of three management areas for buying and selling of phosphorus credits among WWTPs. The result shows that the most conservative option entails consideration of two possible diversion scenarios, and trading between management areas is restricted accordingly. The method described here is believed to be the first application of an EDSS to a water quality trading program that explicitly accounts for surface water diversions.

  6. Measurement of affective state during chronic nicotine treatment and withdrawal by affective taste reactivity in mice: the role of endocannabinoids.

    PubMed

    Wing, Victoria C; Cagniard, Barbara; Murphy, Niall P; Shoaib, Mohammed

    2009-10-01

    Despite tobacco being highly addictive, it is unclear if nicotine has significant affective properties. To address this, we studied taste reactions to gustatory stimuli, palatable sucrose and unpalatable quinine, which are believed to reflect ongoing affective state. Taste reactivity was assessed during chronic nicotine administration and spontaneous withdrawal and the role of the endogenous cannabinoids was also investigated. C57BL6J mice were implanted with intraoral fistula to allow passive administration of solutions. In the first study, taste reactivity was tracked throughout chronic vehicle or nicotine (12 mg/kg/day) infusion via osmotic minipumps and spontaneous withdrawal following removal of minipumps. In the second study, the endocannabinoid CB1-receptor antagonist AM251 (1, 3 and 10mg/kg, intraperitoneal) or vehicle was acutely administered before taste reactivity measurement during chronic nicotine administration. Chronic nicotine treatment and spontaneous withdrawal did not influence taste reactions to sucrose or quinine. AM251 decreased positive reactions to sucrose and increased negative reactions to quinine. The effects of AM251 were respectively attenuated and enhanced in nicotine infused mice. These results suggest chronic nicotine exposure and withdrawal has no apparent affective sequelae, as probed by taste reactivity, and thus may not explain the difficulty tobacco-users have in achieving abstinence. In contrast, endocannabinoids elevate affective state in drug-naïve animals and changes in endogenous endocannabinoid tone may underlie compensations in affective state during chronic nicotine exposure. PMID:19540830

  7. Assessing the Value of New Treatments for Hepatitis C: Are International Decision Makers Getting this Right?

    PubMed

    Woods, Beth; Faria, Rita; Griffin, Susan

    2016-05-01

    Health systems worldwide are facing difficult choices about the use of a series of highly effective but costly new treatments for hepatitis C. In this paper we discuss how the National Institute for Health and Care Excellence in England and Wales, the Common Drug Review in Canada and the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia have approached the appraisal of these drugs. We argue that with the exception of the PBAC, assessments of the new drugs have not adequately accounted for their large financial burden. Given the potential health system impact of reimbursing these drugs, the use of lower cost-effectiveness thresholds should be considered. None of the decision-making processes included a comparison of the full range of treatment pathways. In particular, comparisons of using the new drugs as first- versus second-line drugs were omitted from all appraisals, as were comparisons with delayed treatment strategies whereby treatment is withheld until more severe disease stages. Omission of comparators leads to inaccurate estimates of cost effectiveness and potentially sub-optimal decision making. Lessons learned from these appraisals should be considered in future appraisals, particularly the upcoming assessments of the 'blockbuster' PCSK9 inhibitors for hypercholesterolaemia. PMID:26714687

  8. Clinical impact of treatment timing for chronic hepatitis C infection: a decision model

    PubMed Central

    Pho, M T; Jensen, D M; Meltzer, D O; Kim, A Y; Linas, B P

    2015-01-01

    Recent advances in the treatment of hepatitis C virus (HCV) infection have led to the availability of both highly efficacious interferon-containing and interferon-sparing regimens. However, the use of such therapies faces restrictions due to high costs. For patients who are medically eligible to receive interferon, the choice between the two will likely be impacted by preferences surrounding interferon, severity of disease, coverage policies and out-of-pocket costs. We developed a decision model to quantify the trade-offs between immediate, interferon-containing therapy and delayed, interferon-free therapy for patients with chronic, genotype 1 HCV infection. We projected the quality-adjusted life expectancy stratified by the presence or absence of cirrhosis for four strategies: (i) no treatment; (ii) immediate, one-time treatment with an interferon-containing regimen; (iii) immediate treatment as above with the opportunity for retreatment in patients who fail to achieve sustained virologic response with interferon-free therapy in 1 year; and (iv) delayed therapy with interferon-free therapy in 1 year. When compared to one-time immediate treatment with the interferon-containing regimen, delayed treatment with the interferon-free regimen in 1 year resulted in longer life expectancy, with a 0.2 quality-adjusted life year (QALY) increase in noncirrhotic patients, and a 1.1 QALY increase in patients with cirrhosis. This superiority in health benefits was lost when wait time for interferon-free therapy was greater than 3–3.2 years. In this modelling analysis, interferon-free therapy resulted in superior health benefits compared to immediate therapy with interferon until wait time exceeded 3–3.2 years. Such data can inform decision-making regarding treatment initiation for HCV as healthcare financing evolves. PMID:26135026

  9. Staging laparoscopy improves treatment decision-making for advanced gastric cancer

    PubMed Central

    Hu, Yan-Feng; Deng, Zhen-Wei; Liu, Hao; Mou, Ting-Yu; Chen, Tao; Lu, Xin; Wang, Da; Yu, Jiang; Li, Guo-Xin

    2016-01-01

    AIM: To evaluate the clinical value of staging laparoscopy in treatment decision-making for advanced gastric cancer (GC). METHODS: Clinical data of 582 patients with advanced GC were retrospectively analyzed. All patients underwent staging laparoscopy. The strength of agreement between computed tomography (CT) stage, endoscopic ultrasound (EUS) stage, laparoscopic stage, and final stage were determined by weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. A χ2 test was used to analyze the correlation between peritoneal metastasis or positive cytology and clinical characteristics. RESULTS: Among the 582 patients, the distributions of pathological T classifications were T2/3 (153, 26.3%), T4a (262, 45.0%), and T4b (167, 28.7%). Treatment plans for 211 (36.3%) patients were changed after staging laparoscopy was performed. Two (10.5%) of 19 patients in M1 regained the opportunity for potential radical resection by staging laparoscopy. Unnecessary laparotomy was avoided in 71 (12.2%) patients. The strength of agreement between preoperative T stage and final T stage was in almost perfect agreement (Kw = 0.838; 95% confidence interval (CI): 0.803-0.872; P < 0.05) for staging laparoscopy; compared with CT and EUS, which was in fair agreement. The strength of agreement between preoperative M stage and final M stage was in almost perfect agreement (Kw = 0.990; 95% CI: 0.977-1.000; P < 0.05) for staging laparoscopy; compared with CT, which was in slight agreement. Multivariate analysis revealed that tumor size (≥ 40 mm), depth of tumor invasion (T4b), and Borrmann type (III or IV) were significantly correlated with either peritoneal metastasis or positive cytology. The best performance in diagnosing P-positive was obtained when two or three risk factors existed. CONCLUSION: Staging laparoscopy can improve treatment decision-making for advanced GC and decrease unnecessary exploratory laparotomy. PMID:26855545

  10. Multicriteria decision approaches to support sustainable drainage options for the treatment of highway and urban runoff.

    PubMed

    Ellis, J B; Deutsch, J-C; Mouchel, J-M; Scholes, L; Revitt, M D

    2004-12-01

    The control and treatment of urban and highway runoff involves a variety of stakeholders in the selection of sustainable drainage systems (SUDS) as the design process needs to consider not only water quantity but also water quality and amenity. Thus, technical, environmental/ecological, social/community and economic cost factors become prime potential sustainability criteria in terms of assessing long-term, cost-effective drainage options. The paper develops a multicriteria analysis methodology for the evaluation and accreditation of SUDS structures within the context of an overall decision-support framework. Approaches independently developed in the UK and France are outlined with the common multicriteria structures defining generic performance criteria together with supporting benchmark standards and exclusion thresholds. A French case study is presented to illustrate the approach and to highlight the inherent constraints and subjectivity embedded in the decision-making process. PMID:15504512

  11. To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles

    PubMed Central

    Lee, Yew Kong; Lee, Ping Yein; Cheong, Ai Theng; Ng, Chirk Jenn; Abdullah, Khatijah Lim; Ong, Teng Aik; Razack, Azad Hassan Abdul

    2015-01-01

    Aim To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders’ decision making roles in localized prostate cancer (PCa) treatment. Methods Qualitative interviews and focus groups were conducted with HCPs treating PCa. Data was analysed using a thematic approach. Four in-depth interviews and three focus group discussions were conducted between December 2012 and March 2013 using a topic guide. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Findings The participants comprised private urologists (n = 4), government urologists (n = 6), urology trainees (n = 6), government policy maker (n = 1) and oncologists (n = 3). HCP perceptions of the roles of the three parties involved (HCPs, patients, family) included: HCP as the main decision maker, HCP as a guide to patients’ decision making, HCP as a facilitator to family involvement, patients as main decision maker and patient prefers HCP to decide. HCPs preferred to share the decision with patients due to equipoise between prostate treatment options. Family culture was important as family members often decided on the patient’s treatment due to Malaysia’s close-knit family culture. Conclusions A range of decision making roles were reported by HCPs. It is thus important that stakeholder roles are clarified during PCa treatment decisions. HCPs need to cultivate an awareness of sociocultural norms and family dynamics when supporting non-Western patients in making decisions about PCa. PMID:26559947

  12. A Social Approach to Decision-Making Capacity: Exploratory Research with People with Experience of Mental Health Treatment

    ERIC Educational Resources Information Center

    McDaid, Shari; Delaney, Sarah

    2011-01-01

    This paper reports on exploratory, qualitative research conducted with eight people with experience of mental health treatment about their understanding of decision-making capacity. While acknowledging that there are times when mental or emotional distress can interfere with the capacity to make decisions, participants described how their capacity…

  13. Reducing microplastics from facial exfoliating cleansers in wastewater through treatment versus consumer product decisions.

    PubMed

    Chang, Michelle

    2015-12-15

    Microplastics (<5mm) have been discovered in fresh and saltwater ecosystems, sediments, and wastewater effluent around the world. Their ability to persist and accumulate up food chains should be a concern as research is still experimenting with techniques to assess their long-term effects on the environment. I sought to characterize the microbeads found in facial exfoliating cleansers so as to better understand how to reduce this source of pollution through consumer use and wastewater treatment solutions. By sampling products from national-grossing cosmetic personal care brands, I was able to gather information on the size, color, volume, mass, and concentration of polyethylene beads in the cleansers. From that data, I modeled onto a consumer survey the estimated volume of microplastics entering a wastewater stream. Through inquiry, I learned the practices of two local wastewater treatment facilities. My findings show that consumer decisions and treatment protocols both play crucial parts in minimizing microplastic pollution. PMID:26563542

  14. Innovation Attributes and Adoption Decisions: Perspectives from Leaders of a National Sample of Addiction Treatment Organizations

    PubMed Central

    Knudsen, Hannah K.; Roman, Paul M

    2014-01-01

    Drawing on diffusion theory to further knowledge about evidence-based practices (EBPs) in the treatment of substance use disorders (SUDs), this study describes the perceived importance of innovation attributes in adoption decisions within a national sample of SUD treatment organizations. Face-to-face interviews were conducted with leaders of 307 organizations. A typology differentiated organizations reporting: (1) adoption of a treatment innovation in the past year (“recent adoption”), (2) plans to adopt an innovation in the upcoming year (“planned adoption”), or (3) no actual or planned adoption (“non-adoption”). About 30.7% of organizations reported recent adoption, 20.5% indicated planned adoption, and 48.8% were non-adopters. Leaders of organizations reporting recent adoption (n = 93) or planned adoption (n = 62) rated the importance of innovation attributes, including relative advantage, compatibility, complexity, and observability, on these adoption decisions using a Likert scale that ranged from 0 to 5. Innovation attributes most strongly endorsed were consistency with the program's treatment philosophy (mean = 4.47, SD = 1.03), improvement in the program's reputation with referral sources (mean = 4.00, SD = 1.33), reputational improvement with clients and their families (mean = 3.98, SD = 1.31), and reductions in treatment dropout (mean = 3.75, SD = 1.54). Innovation characteristics reflecting organizational growth and implementation costs were less strongly endorsed. Adopters and planners were generally similar in their importance ratings. There were modest differences in importance ratings when pharmacological innovations were compared to psychosocial interventions. These findings are consistent with diffusion theory and suggest that efforts to link EBPs with client satisfaction and potential reputational benefits may enhance the diffusion of EBPs. Attention to these attributes when developing and evaluating SUD treatment interventions may

  15. CURVES: a mnemonic for determining medical decision-making capacity and providing emergency treatment in the acute setting.

    PubMed

    Chow, Grant V; Czarny, Matthew J; Hughes, Mark T; Carrese, Joseph A

    2010-02-01

    The evaluation of medical decision-making capacity and provision of emergency treatment in the acute care setting may present a significant challenge for both physicians-in-training and attending physicians. Although absolutely essential to the proper care of patients, recalling criteria for decision-making capacity may prove cumbersome during a medical emergency. Likewise, the requirements for providing emergency treatment must be fulfilled. This article presents a mnemonic (CURVES: Choose and Communicate, Understand, Reason, Value, Emergency, Surrogate) that addresses the abilities a patient must possess in order to have decision-making capacity, as well as the essentials of emergency treatment. It may be used in conjunction with, or in place of, lengthier capacity-assessment tools, particularly when time is of the essence. In addition, the proposed tool assists the practitioner in deciding whether emergency treatment may be administered, and in documenting medical decisions made during an acute event. PMID:20133288

  16. Shared Decision-Making in the Primary Care Treatment of Late-Life Major Depression: A Needed New Intervention?

    PubMed Central

    Raue, Patrick J.; Schulberg, Herbert C.; Lewis-Fernandez, Roberto; Boutin-Foster, Carla; Hoffman, Amy S.; Bruce, Martha L.

    2010-01-01

    Objective We suggest that clinicians consider models of shared decision-making for their potential ability to improve the treatment of major depression in the primary care setting and overcome limitations of collaborative care and other interventions. Methods We explore the characteristics and techniques of patient-clinician shared decision-making, with particular emphasis on this model’s relevance to the unique treatment concerns of depressed older adults. Results We describe a shared decision-making intervention to engage older adults in depression treatment in the primary care sector. Conclusions It is timely to examine shared decision-making models for elderly depressed primary care patients given their potential ability to improve treatment adherence and clinical outcomes. PMID:19946872

  17. The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care

    PubMed Central

    2014-01-01

    Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis. When treating bipolar patients, the primary care physician has an integral role in coordinating the multidisciplinary network. Pharmacologic treatment underpins both short- and long-term management of bipolar disorder. Maintenance treatment to prevent relapse is frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms. Regardless of the treatment approach that is selected, monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health. This article describes key decision-making steps in the management of bipolar disorder from the primary care perspective: from initial clinical suspicion to confirmation of the diagnosis to decision-making in acute and longer-term management and the importance of patient monitoring. PMID:25317368

  18. Factors affecting ionizing radiation phytosanitary treatments, and implications for research and generic treatments

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Phytosanitary irradiation (PI) treatments are promising measures to overcome quarantine barriers to trade and are currently used in several countries. Although PI has advantages compared with other treatments, one disadvantage bedevils research approval/application: organisms may remain alive afte...

  19. Chronic atomoxetine treatment during adolescence does not influence decision-making on a rodent gambling task, but does modulate amphetamine's effect on impulsive action in adulthood.

    PubMed

    Silveira, Mason M; Murch, W Spencer; Clark, Luke; Winstanley, Catharine A

    2016-06-01

    In addition to the symptoms of inattention, hyperactivity, and impulsivity, individuals with attention deficit hyperactivity disorder exhibit impaired performance on tests of real-world cost/benefit decision-making. Atomoxetine, a nonstimulant drug approved for the treatment of attention deficit hyperactivity disorder, is a selective norepinephrine reuptake inhibitor administered chronically during adolescence, a time during which the frontal brain regions necessary for executive function undergo extensive maturation. This treatment protocol can affect behavior well into adulthood, but whether it produces long-term changes in complex decision-making has not been investigated. Twenty-four Long-Evans rats were administered saline or 1.0 mg/kg atomoxetine daily from postnatal day 40 to 54. Two weeks after treatment, the adult rats were trained and assessed on the rodent gambling task, in which the animals chose from four options varying in reward, punishment, and uncertainty. Impulsive action was also measured by recording the number of premature responses made. Regardless of the treatment administered during adolescence, rats learned to favor the advantageous options characterized by small, low-penalty rewards in lieu of the larger, higher-penalty reward options. Rodent gambling task performance was then assessed following acute treatment with atomoxetine (0.1-1.0 mg/kg) and amphetamine (0.3-1.5 mg/kg). Across groups, the highest dose of atomoxetine impaired decision-making and decreased premature responding at all doses tested. Amphetamine also impaired choice performance, but selectively increased impulsive action in rats that had previously received atomoxetine treatment during adolescence. These findings contribute to our understanding of the long-term effects associated with chronic adolescent atomoxetine exposure and suggest that this treatment does not alter decision-making under conditions of risk and uncertainty in adulthood. PMID:26650252

  20. Positive Affect and Processes of Recovery among Treatment-Seeking Methamphetamine Users

    PubMed Central

    Carrico, Adam W.; Woods, William J.; Siever, Michael D.; Discepola, Michael V.; Dilwort, Samantha E.; Neilands, Torsten B.; Miller, Nicole; Moskowitz, Judith Tedlie

    2015-01-01

    Background Revised Stress and Coping Theory proposes that positive affect serves adaptive functions, independent of negative affect. However, scant research has examined whether, how, and under what circumstances positive affect is associated with decreased substance use. Methods Eighty-eight methamphetamine-using men who have sex with men (MSM) completed the baseline assessment for substance abuse treatment outcome study which included measures of positive and negative affect, cognitive-behavioral change processes (i.e., approach-oriented coping, self-efficacy for managing methamphetamine triggers, and abstinence-related action tendencies), abstinence-specific social support, and self-reported substance use. Participants also provided a urine sample for toxicology screening. Results After controlling for demographic characteristics and negative affect, higher positive affect was independently associated with greater approach-oriented coping, abstinence-related action tendencies, and abstinence-specific social support. Positive affect was also independently associated with greater self-efficacy for managing methamphetamine triggers, but only at lower levels of negative affect. Through these cognitive-behavioral and social pathways, positive affect was indirectly associated with lower frequency of stimulant use in the past 30 days, lower odds of reporting stimulant use two or more days in a row, and lower odds of providing a urine sample that was reactive for stimulant metabolites. On the other hand, negative affect was not indirectly associated with any measure of stimulant use. Conclusions Clinical research is needed to examine the pathways whereby positive affect may predict better substance abuse treatment outcomes. PMID:23684632

  1. Laboratory Medicine in the Clinical Decision Support for Treatment of Hypercholesterolemia: Pharmacogenetics of Statins.

    PubMed

    Ruaño, Gualberto; Seip, Richard; Windemuth, Andreas; Wu, Alan H B; Thompson, Paul D

    2016-09-01

    Statin responsiveness is an area of great research interest given the success of the drug class in the treatment of hypercholesterolemia and in primary and secondary prevention of cardiovascular disease. Interrogation of the patient's genome for gene variants will eventually guide anti-hyperlipidemic intervention. In this review, we discuss methodological approaches to discover genetic markers predictive of class-wide and drug-specific statin efficacy and safety. Notable pharmacogenetic findings are summarized from hypothesis-free genome wide and hypothesis-led candidate gene association studies. Physiogenomic models and clinical decision support systems will be required for DNA-guided statin therapy to reach practical use in medicine. PMID:27514463

  2. Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument

    PubMed Central

    Heggland, Liv-Helen; Øgaard, Torvald; Mikkelsen, Aslaug; Hausken, Kjell

    2012-01-01

    The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items), formulation of options (4 items), integration of information (4 items), and control (3 items). The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation. PMID:22830010

  3. Avoidant decision-making in social anxiety disorder: A laboratory task linked to in vivo anxiety and treatment outcome.

    PubMed

    Pittig, Andre; Alpers, Georg W; Niles, Andrea N; Craske, Michelle G

    2015-10-01

    Recent studies on reward-based decision-making in the presence of anxiety-related stimuli demonstrated that approach-avoidance conflicts can be assessed under controlled laboratory conditions. However, the clinical relevance of these decision conflicts has not been demonstrated. To this end, the present study investigated avoidant decisions in treatment-seeking individuals with social anxiety disorder (SAD). In a gambling task, advantageous choices to maximize gains were associated with task-irrelevant angry faces and disadvantageous choices with happy faces. The clinical relevance of avoidant decisions for in vivo anxiety in a social stress situation (public speaking) were examined (n = 44). In a subsample (n = 20), the predictive value for a reduction of avoidance following behavioral therapy was also evaluated. Results indicated a close link between more frequent avoidant decisions and elevated in vivo anxiety. Moreover, individuals who showed a deficit in the goal-directed adjustment of their decisions also showed higher and sustained distress during the social stressor and reported less decrease of avoidance following treatment. The findings highlight the importance of an avoidant decision-making style for the experience of acute distress and the maintenance of avoidance in SAD. Assessing avoidant decision-making may help to predict the response to behavioral treatments. PMID:26301755

  4. Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration.

    PubMed

    Pieterse, A H; Baas-Thijssen, M C M; Marijnen, C A M; Stiggelbout, A M

    2008-09-16

    Patient participation in treatment decision-making is being increasingly advocated, although cancer treatments are often guideline-driven. Trade-offs between benefits and side effects underlying guidelines are made by clinicians. Evidence suggests that clinicians are inaccurate at predicting patient values. The aim was to assess what role oncologists and cancer patients prefer in deciding about treatment, and how they view patient participation in treatment decision-making. Seventy disease-free cancer patients and 60 oncologists (surgical, radiation, and medical) were interviewed about their role preferences using the Control Preferences Scale (CPS) and about their views on patient participation using closed- and open-ended questions. Almost all participants preferred treatment decisions to be the outcome of a shared process. Clinicians viewed participation more often as reaching an agreement, whereas 23% of patients defined participation exclusively as being informed. Of the participants, > or = 81% thought not all patients are able to participate and > or = 74% thought clinicians are not always able to weigh the pros and cons of treatment for patients, especially not quality as compared with length of life. Clinicians seemed reluctant to share probability information on the likely impact of adjuvant treatment. Clinicians should acknowledge the legitimacy of patients' values in treatment decisions. Guidelines should recommend elicitation of patient values at specific decision points. PMID:18781148

  5. Factors that Affect Treatment Expectations of Outpatients with Substance Use Problems

    ERIC Educational Resources Information Center

    Raylu, Namrata; Kaur, Inderjit

    2012-01-01

    The study assessed treatment expectations (TE) of outpatients with substance use problems as well as factors that affect their TE. Participants were 200 outpatients presenting at three community based substance abuse treatment services. Results of general linear modelling analyses showed that outpatients with substance use problems have higher…

  6. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries

    PubMed Central

    Graham, Shelli; Clerinx, Cathy; Bernick, Brian A; Krassan, Mitchell; Mirkin, Sebastian; Currie, Heather

    2016-01-01

    Objective To assess women’s behaviours and attitudes regarding the treatment of menopausal symptoms in five European countries. Study design Women aged ≥45 years in France, Germany, Italy, Spain, and the United Kingdom participated in an internet survey. Completers were those who reported menopausal symptoms and had treated their symptoms. Women were equally stratified by age (45–54 years, 55–64 years, ≥65 years). Main outcome measures Behaviours, attitudes, and experiences regarding treatment of menopausal symptoms. Results Of 3890 peri- to postmenopausal women screened, 67% experienced symptoms and 54% sought either medical input or some treatment concerning their symptoms. Hot flushes, the most common symptom, decreased with age but remained prevalent after age 64. Roughly 75% of women who sought relief consulted a physician, mostly a gynaecologist or a general practitioner (GP) as in the United Kingdom. The decision to seek treatment was influenced by age, number, and severity of symptoms. Approximately 79% visiting a physician received prescription therapy. Of the women who received non-hormone therapy (HT) treatment instead of HT: patients refused HT (20–44%), physicians did not discuss HT (32–46%), or advised against HT (24–43%). Women in the United Kingdom were most familiar with and favorable to HT. Interest in a new HT (34–50%) was higher than use (19–28%). Conclusions Menopausal symptoms are common, persistent, and bothersome, but many fail to seek treatment. Sources and types of treatment vary among age groups and countries. Education regarding women’s attitudes toward treatment should be provided to those physicians who treat menopausal symptoms in each country. PMID:26895640

  7. How Much are Emergency Medicine Specialists’ Decisions Reliable in the Diagnosis and Treatment of Pediatric Fractures?

    PubMed Central

    Mardani-Kivi, Mohsen; Zohrevandi, Behzad; Saheb-Ekhtiari, Khashayar; Hashemi-Motlagh, Keyvan

    2016-01-01

    Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared. Results: In total, there were 108 patients (54 patients in each group) with a mean age of 8.1±3.3 years. Identical diagnosis in 48 cases (88.9%) of distal radius and 36 cases (66.7%) of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8%) received identical treatment. Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education. PMID:26894221

  8. Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury

    PubMed Central

    Ahn, Henry; Bailey, Christopher S.; Rivers, Carly S.; Noonan, Vanessa K.; Tsai, Eve C.; Fourney, Daryl R.; Attabib, Najmedden; Kwon, Brian K.; Christie, Sean D.; Fehlings, Michael G.; Finkelstein, Joel; Hurlbert, R. John; Townson, Andrea; Parent, Stefan; Drew, Brian; Chen, Jason; Dvorak, Marcel F.

    2015-01-01

    Background: Older people are at increased risk of traumatic spinal cord injury from falls. We evaluated the impact of older age (≥ 70 yr) on treatment decisions and outcomes. Methods: We identified patients with traumatic spinal cord injury for whom consent and detailed data were available from among patients recruited (2004–2013) at any of the 31 acute care and rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry. Patients were assessed by age group (< 70 v. ≥ 70 yr). The primary outcome was the rate of acute surgical treatment. We used bivariate and multivariate regression models to assess patient and injury-related factors associated with receiving surgical treatment and with the timing of surgery after arrival to a participating centre. Results: Of the 1440 patients included in our study cohort, 167 (11.6%) were 70 years or older at the time of injury. Older patients were more likely than younger patients to be injured by falling (83.1% v. 37.4%; p < 0.001), to have a cervical injury (78.0% v. 61.6%; p = 0.001), to have less severe injuries on admission (American Spinal Injury Association Impairment Scale grade C or D: 70.5% v. 46.9%; p < 0.001), to have a longer stay in an acute care hospital (median 35 v. 28 d; p < 0.005) and to have a higher in-hospital mortality (4.2% v. 0.6%; p < 0.001). Multivariate analysis did not show that age of 70 years or more at injury was associated with a decreased likelihood of surgical treatment (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI] 0.22–1.07). An unplanned sensitivity analysis with different age thresholds showed that a threshold of 65 years was associated with a decreased chance of surgical treatment (OR 0.39, 95% CI 0.19–0.80). Older patients who underwent surgical treatment had a significantly longer wait time from admission to surgery than younger patients (37 v. 19 h; p < 0.001). Interpretation: We found chronological age to be a factor influencing

  9. Dynamic Association Between Negative Affect and Alcohol Lapses Following Alcohol Treatment

    PubMed Central

    Witkiewitz, Katie; Villarroel, Nadia Aracelliz

    2009-01-01

    Clinical research has found a strong association between negative affect and returning to alcohol use after a period of abstinence. Yet little is known about the probability of a lapse given a particular level of negative affect or whether there is a reciprocal relationship between negative affect and alcohol use across time. The goal of the current study was to examine the association between negative affect and drinking behavior in the 1st year following alcohol treatment. The authors applied an associative latent transition analysis to the Project MATCH outpatient data (n = 952) and then replicated the model in the Project MATCH aftercare data (n = 774). Changes in drinking following treatment were significantly associated with current and prior changes in negative affect, and changes in negative affect were related to prior changes in drinking (effect size range = 0.13–0.33). The results supported the hypothesis that negative affect and alcohol lapses are dynamically linked and suggest that targeting the relationship between negative affect and alcohol use could greatly decrease the probability of lapses and improve alcohol treatment outcomes. PMID:19634957

  10. Dynamic association between negative affect and alcohol lapses following alcohol treatment.

    PubMed

    Witkiewitz, Katie; Villarroel, Nadia Aracelliz

    2009-08-01

    Clinical research has found a strong association between negative affect and returning to alcohol use after a period of abstinence. Yet little is known about the probability of a lapse given a particular level of negative affect or whether there is a reciprocal relationship between negative affect and alcohol use across time. The goal of the current study was to examine the association between negative affect and drinking behavior in the 1st year following alcohol treatment. The authors applied an associative latent transition analysis to the Project MATCH outpatient data (n = 952) and then replicated the model in the Project MATCH aftercare data (n = 774). Changes in drinking following treatment were significantly associated with current and prior changes in negative affect, and changes in negative affect were related to prior changes in drinking (effect size range = 0.13-0.33). The results supported the hypothesis that negative affect and alcohol lapses are dynamically linked and suggest that targeting the relationship between negative affect and alcohol use could greatly decrease the probability of lapses and improve alcohol treatment outcomes. PMID:19634957

  11. Operator decision support system for integrated wastewater management including wastewater treatment plants and receiving water bodies.

    PubMed

    Kim, Minsoo; Kim, Yejin; Kim, Hyosoo; Piao, Wenhua; Kim, Changwon

    2016-06-01

    An operator decision support system (ODSS) is proposed to support operators of wastewater treatment plants (WWTPs) in making appropriate decisions. This system accounts for water quality (WQ) variations in WWTP influent and effluent and in the receiving water body (RWB). The proposed system is comprised of two diagnosis modules, three prediction modules, and a scenario-based supporting module (SSM). In the diagnosis modules, the WQs of the influent and effluent WWTP and of the RWB are assessed via multivariate analysis. Three prediction modules based on the k-nearest neighbors (k-NN) method, activated sludge model no. 2d (ASM2d) model, and QUAL2E model are used to forecast WQs for 3 days in advance. To compare various operating alternatives, SSM is applied to test various predetermined operating conditions in terms of overall oxygen transfer coefficient (Kla), waste sludge flow rate (Qw), return sludge flow rate (Qr), and internal recycle flow rate (Qir). In the case of unacceptable total phosphorus (TP), SSM provides appropriate information for the chemical treatment. The constructed ODSS was tested using data collected from Geumho River, which was the RWB, and S WWTP in Daegu City, South Korea. The results demonstrate the capability of the proposed ODSS to provide WWTP operators with more objective qualitative and quantitative assessments of WWTP and RWB WQs. Moreover, the current study shows that ODSS, using data collected from the study area, can be used to identify operational alternatives through SSM at an integrated urban wastewater management level. PMID:26893178

  12. Making decisions about treatment for young people diagnosed with depressive disorders: a qualitative study of clinicians’ experiences

    PubMed Central

    2013-01-01

    Background The imperative to provide effective treatment for young people diagnosed with depressive disorders is complicated by several factors including the unclear effectiveness of treatment options. Within this context, little is known about how treatment decisions are made for this population. Methods In order to explore the experiences and beliefs of clinicians about treatment decision making for this population, semi-structured, qualitative interviews were conducted with 22 psychiatrists, general practitioners and allied health professionals from health care settings including specialist mental health services and primary health care. Interviews were audio taped, transcribed verbatim and analysed using thematic analysis. Results Clinicians largely reported and endorsed a collaborative model of treatment decision making for youth depression, although several exceptions to this approach were also described (e.g. when risk issues were present), highlighting a need to adapt the decision-making style to the characteristics and needs of the client. A differentiation was made between the decision-making processes (e.g. sharing of information) and who makes the decision. Caregiver involvement was seen as optional, especially in situations where no caregivers were involved, but ideal and useful if the caregivers were supportive. Gaps between the type and amount of information clinicians wanted to give their clients and what they actually gave them were reported (e.g. having fact sheets on hand). A broad range of barriers to involving clients and caregivers in decision-making processes were described relating to four levels (client and caregiver, clinician, service and broader levels) and suggestions were given to help overcome these barriers, including up-to-date, accessible and relevant information. Conclusions The current data support a collaborative model of treatment decision making for youth depression which: 1) focuses on the decision-making processes rather

  13. Management of frontal sinus fractures--treatment decision based on metric dislocation extent.

    PubMed

    Dalla Torre, Daniel; Burtscher, Doris; Kloss-Brandstätter, Anita; Rasse, Michael; Kloss, Frank

    2014-10-01

    The treatment of frontal sinus fractures is still a matter of research in neurosurgical and craniofacial surgery. The present study aimed to determine new criteria regarding surgical or observational treatment, especially concerning the fracture dislocation. Clinical information on 164 consecutive patients with fractures of the frontal sinus, treated at the Department of Craniomaxillofacial Surgery of the Medical University of Innsbruck from 2006 to 2010, have been evaluated. 23 female (14%) and 141 male (86%) patients suffered mainly from traffic (31.7%) and sports accidents (28.0%), followed by work accidents (20.1%), violence (3.7%) and accidents at home (3.1%). 51.8% presented an isolated fracture of the anterior wall, 47.6% both anterior and posterior wall fracture, 0.6% an isolated posterior wall fracture. Injury of the nasofrontal duct was found in 29.2%, CSF liquorrhoea in 15.9%. In total, 44.5% of the patients underwent surgical therapy, 55.5% were treated conservatively by observation. Treatment decision depended significantly on concomitant injuries of the nasofrontal duct and the presence of rhinoliquorrhoea as well as on the fracture dislocation. A new classification of frontal sinus fractures depending on their maximum dislocation is proposed. In addition, a treatment algorithm considering displacement, liquorrhoea and injury of the nasofrontal duct is presented. PMID:24942098

  14. Perspectives of parents on making decisions about the care and treatment of a child with cancer: a review of literature.

    PubMed

    Markward, Martha J; Benner, Kalea; Freese, Rebekah

    2013-12-01

    This review focuses on parental decision making regarding the care and treatment of children with cancer. Articles were abstracted from the following sources: Ovid Databases (Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effects, Medline, and Social Work Abstracts) and EBSCOhost (Academic Search Premier and Academic Search Complete) using smart text. The criteria for the search were publications between 2005 and 2012 and publication in peer-review journals. The descriptors used were parents of children with cancer, decision making, decisions about childhood cancer, and parents. The search yielded 59 references, but after duplicates, as well as dated and irrelevant articles were removed, 17 articles were identified that focused specifically on the decisions parents make regarding the care and treatment of children with cancer. Coders agreed that the child's quality of life/well-being, parental hope/expectations, support/supportive care, communication, and information were important themes in considering the decisions parents made regarding the care and treatment of children with cancer. These themes provide insight into the needs of parents in making decisions about the care and treatment of children with cancer. PMID:24377769

  15. Actual and Perceived Gender Differences in the Accuracy of Surrogate Decisions about Life-Sustaining Medical Treatment among Older Spouses

    ERIC Educational Resources Information Center

    Zettel-Watson, Laura; Ditto, Peter H.; Danks, Joseph H.; Smucker, William D.

    2008-01-01

    This study examined the influence of surrogate gender on the accuracy of substituted judgments about the use of life-sustaining treatment in a sample of 249 older adults and their self-selected surrogate decision-makers. Overall, wives were more accurate than husbands at predicting their spouses' treatment wishes. Surrogates' perceptions of their…

  16. How Performance Information Affects Human-Capital Investment Decisions: The Impact of Test-Score Labels on Educational Outcomes. NBER Working Paper No. 17120

    ERIC Educational Resources Information Center

    Papay, John P.; Murnane, Richard J.; Willett, John B.

    2011-01-01

    Students receive abundant information about their educational performance, but how this information affects future educational-investment decisions is not well understood. Increasingly common sources of information are state-mandated standardized tests. On these tests, students receive a score and a label that summarizes their performance. Using a…

  17. Factors that Affect the Decision of Refugee and Immigrant Students to Pursue Higher Education in Tennessee: The Case of Egyptian, Somali, Kurdish and Mexican Students

    ERIC Educational Resources Information Center

    Weldegebriel, Mengistu H.

    2011-01-01

    Refugee and immigrant students face challenges in pursuing higher education. This study examined factors that affect the decision of refugees and immigrant students to pursue higher education in Tennessee. The factors included cultural capital these students acquire from their parents and families; cultural difference they have with the mainstream…

  18. Can You Hear Me? The Right of Young Children to Participate in Decisions Affecting Them. Working Papers in Early Childhood Development, No. 36

    ERIC Educational Resources Information Center

    Lansdown, Gerison

    2005-01-01

    "Can You Hear Me? The Right of Young Children to Participate in Decisions Affecting Them" emphasises that participation enhances children's self-esteem and confidence, promotes their overall capacities, produces better outcomes, strengthens understanding of and commitment to democratic processes and protects children more effectively.…

  19. What Can Parents Do? A Review of State Laws Regarding Decision Making for Adolescent Drug Abuse and Mental Health Treatment

    PubMed Central

    Kerwin, MaryLouise E.; Kirby, Kimberly C.; Speziali, Dominic; Duggan, Morgan; Mellitz, Cynthia; Versek, Brian; McNamara, Ashley

    2013-01-01

    This study examined US state laws regarding parental and adolescent decision-making for substance use and mental health inpatient and outpatient treatment. State statues for requiring parental consent favored mental health over drug abuse treatment and inpatient over outpatient modalities. Parental consent was sufficient in 53%–61% of the states for inpatient treatment, but only for 39% – 46% of the states for outpatient treatment. State laws favored the rights of minors to access drug treatment without parental consent, and to do so at a younger age than for mental health treatment. Implications for how these laws may impact parents seeking help for their children are discussed. PMID:25870511

  20. Toward Personalized Smoking-Cessation Treatment: Using a Predictive Modeling Approach to Guide Decisions Regarding Stimulant Medication Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Smokers

    PubMed Central

    Luo, Sean X.; Covey, Lirio S.; Hu, Mei-Chen; Levin, Frances R.; Nunes, Edward V.; Winhusen, Theresa M.

    2015-01-01

    Background and Objectives Osmotic-release oral system methylphenidate (OROS-MPH) did not show overall benefit as an adjunct smoking cessation treatment for adult smokers with ADHD in a randomized, placebo-controlled, multicenter clinical trial. A secondary analysis revealed a significant interaction between ADHD symptom severity and treatment-response to OROS-MPH, but did not account for other baseline covariates or estimate the magnitude of improvement in outcome if treatment were optimized. This present study addressed the gaps in how this relationship should inform clinical practice. Methods Using data from the Adult Smokers with ADHD Trial (N = 255, six sites in five US States), we build predictive models to calculate the probability of achieving prolonged abstinence, verified by self-report, and expired carbon monoxide measurement. We evaluate the potential improvement in achieving prolonged abstinence with and without stratification on baseline ADHD severity. Results Predictive modeling demonstrates that the interaction between baseline ADHD severity and treatment group is not affected by adjusting for other baseline covariates. A clinical trial simulation shows that giving OROS-MPH to patients with baseline Adult ADHD Symptom Rating Scale (ADHD-RS) >35 and placebo to those with ADHD-RS ≤35 would significantly improve the prolonged abstinence rate (52 ± 8% vs. 42 ± 5%, p < .001). Conclusions and Scientific Significance In smokers with ADHD, utilization of a simple decision rule that stratifies patients based on baseline ADHD severity can enhance overall achievement of prolonged smoking abstinence. Similar analysis methods should be considered for future clinical trials for other substance use disorders. PMID:25659348

  1. [The role of PET/CT in decision-making during cancer treatment. Clinical experience].

    PubMed

    Sinkó, Dániel; Landherr, László

    2012-12-01

    Nowadays PET/CT examinations have got more and more important role during cancer treatment. It has importance not only in diagnostic examination and staging but also in the radiation planning process and measuring the therapeutic effect. From November 2006 to November 2010 there were 153 PET/CT examinations requested by the Oncology Outpatient Clinic, Uzsoki Hospital. Nine patients were excluded from the examination. In the clinical trial we have aimed to measure what the correlation between the oncologists' questions and the PET/CT results was, in how many cases the PET/CT had influence on therapeutic decision-making. In the case of the patients waiting for the operation we compared the results of the pathological examinations to the results of the PET/CT. The oncologists got the expected answers in 79 cases, while in 45 cases the answers were negative. In 10 cases there were no definite answers. Ten cases proved to be false negative or false positive based on the later pathological examination. As a result of the PET/CT findings the originally planned therapeutic decisions or the therapies in process have been modified in 77 cases. To sum up, the PET/CT gave the expected answers to the oncologists' questions in more than half of the cases (54.9%) and modified the originally prescribed therapy in 53.5% of the cases. PMID:23236592

  2. Does Physical Loading Affect The Speed and Accuracy of Tactical Decision-Making in Elite Junior Soccer Players?

    PubMed

    Frýbort, Pavel; Kokštejn, Jakub; Musálek, Martin; Süss, Vladimír

    2016-06-01

    A soccer player's capability to control and manage his behaviour in a game situation is a prerequisite, reflecting not only swift and accurate tactical decision-making, but also prompt implementation of a motor task during intermittent exercise conditions. The purpose of this study was to analyse the relationship between varying exercise intensity and the visual-motor response time and the accuracy of motor response in an offensive game situation in soccer. The participants (n = 42) were male, semi-professional, soccer players (M age 18.0 ± 0.9 years) and trained five times a week. Each player performed four different modes of exercise intensity on the treadmill (motor inactivity, aerobic, intermittent and anaerobic activity). After the end of each exercise, visual-motor response time and accuracy of motor response were assessed. Players' motion was captured by digital video camera. ANOVA indicated no significant difference (p = 0.090) in the accuracy of motor response between the four exercise intensity modes. Practical significance (Z-test = 0.31) was found in visual-motor response time between exercise with dominant involvement of aerobic metabolism, and intense intermittent exercise. A medium size effect (Z-test = 0.34) was also found in visual-motor response time between exercise with dominant involvement of aerobic metabolism and exercise with dominant involvement of anaerobic metabolism, which was confirmed by ANOVA (897.02 ± 57.46 vs. 940.95 ± 71.14; p = 0.002). The results showed that different modes of exercise intensity do not adversely affect the accuracy of motor responses; however, high-intensity exercise has a negative effect on visual-motor response time in comparison to moderate intensity exercise. Key pointsDifferent exercise intensity modes did not affect the accuracy of motor response.Anaerobic, highly intensive short-term exercise significantly decreased the visual-motor response time in comparison with aerobic exercise.Further research

  3. Does Physical Loading Affect The Speed and Accuracy of Tactical Decision-Making in Elite Junior Soccer Players?

    PubMed Central

    Frýbort, Pavel; Kokštejn, Jakub; Musálek, Martin; Süss, Vladimír

    2016-01-01

    A soccer player’s capability to control and manage his behaviour in a game situation is a prerequisite, reflecting not only swift and accurate tactical decision-making, but also prompt implementation of a motor task during intermittent exercise conditions. The purpose of this study was to analyse the relationship between varying exercise intensity and the visual-motor response time and the accuracy of motor response in an offensive game situation in soccer. The participants (n = 42) were male, semi-professional, soccer players (M age 18.0 ± 0.9 years) and trained five times a week. Each player performed four different modes of exercise intensity on the treadmill (motor inactivity, aerobic, intermittent and anaerobic activity). After the end of each exercise, visual-motor response time and accuracy of motor response were assessed. Players’ motion was captured by digital video camera. ANOVA indicated no significant difference (p = 0.090) in the accuracy of motor response between the four exercise intensity modes. Practical significance (Z-test = 0.31) was found in visual-motor response time between exercise with dominant involvement of aerobic metabolism, and intense intermittent exercise. A medium size effect (Z-test = 0.34) was also found in visual-motor response time between exercise with dominant involvement of aerobic metabolism and exercise with dominant involvement of anaerobic metabolism, which was confirmed by ANOVA (897.02 ± 57.46 vs. 940.95 ± 71.14; p = 0.002). The results showed that different modes of exercise intensity do not adversely affect the accuracy of motor responses; however, high-intensity exercise has a negative effect on visual-motor response time in comparison to moderate intensity exercise. Key points Different exercise intensity modes did not affect the accuracy of motor response. Anaerobic, highly intensive short-term exercise significantly decreased the visual-motor response time in comparison with aerobic exercise. Further

  4. The vexing problem of defining the meaning, role and measurement of values in treatment decision-making.

    PubMed

    Charles, Cathy; Gafni, Amiram

    2014-03-01

    Two international movements, evidence-based medicine (EBM) and shared decision-making (SDM) have grappled for some time with issues related to defining the meaning, role and measurement of values/preferences in their respective models of treatment decision-making. In this article, we identify and describe unresolved problems in the way that each movement addresses these issues. The starting point for this discussion is that at least two essential ingredients are needed for treatment decision-making: research information about treatment options and their potential benefits and risks; and the values/preferences of participants in the decision-making process. Both the EBM and SDM movements have encountered difficulties in defining the meaning, role and measurement of values/preferences in treatment decision-making. In the EBM model of practice, there is no clear and consistent definition of patient values/preferences and no guidance is provided on how to integrate these into an EBM model of practice. Methods advocated to measure patient values are also problematic. Within the SDM movement, patient values/preferences tend to be defined and measured in a restrictive and reductionist way as patient preferences for treatment options or attributes of options, while broader underlying value structures are ignored. In both models of practice, the meaning and expected role of physician values in decision-making are unclear. Values clarification exercises embedded in patient decision aids are suggested by SDM advocates to identify and communicate patient values/preferences for different treatment outcomes. Such exercises have the potential to impose a particular decision-making theory and/or process onto patients, which can change the way they think about and process information, potentially impeding them from making decisions that are consistent with their true values. The tasks of clarifying the meaning, role and measurement of values/preferences in treatment decision

  5. Decision support tools for proton therapy ePR: intelligent treatment planning navigator and radiation toxicity tool for evaluating of prostate cancer treatment

    NASA Astrophysics Data System (ADS)

    Le, Anh H.; Deshpande, Ruchi; Liu, Brent J.

    2010-03-01

    The electronic patient record (ePR) has been developed for prostate cancer patients treated with proton therapy. The ePR has functionality to accept digital input from patient data, perform outcome analysis and patient and physician profiling, provide clinical decision support and suggest courses of treatment, and distribute information across different platforms and health information systems. In previous years, we have presented the infrastructure of a medical imaging informatics based ePR for PT with functionality to accept digital patient information and distribute this information across geographical location using Internet protocol. In this paper, we present the ePR decision support tools which utilize the imaging processing tools and data collected in the ePR. The two decision support tools including the treatment plan navigator and radiation toxicity tool are presented to evaluate prostate cancer treatment to improve proton therapy operation and improve treatment outcomes analysis.

  6. A Clinical Decision Support System for Femoral Peripheral Arterial Disease Treatment

    PubMed Central

    Yurtkuran, Alkın; Tok, Mustafa

    2013-01-01

    One of the major challenges of providing reliable healthcare services is to diagnose and treat diseases in an accurate and timely manner. Recently, many researchers have successfully used artificial neural networks as a diagnostic assessment tool. In this study, the validation of such an assessment tool has been developed for treatment of the femoral peripheral arterial disease using a radial basis function neural network (RBFNN). A data set for training the RBFNN has been prepared by analyzing records of patients who had been treated by the thoracic and cardiovascular surgery clinic of a university hospital. The data set includes 186 patient records having 16 characteristic features associated with a binary treatment decision, namely, being a medical or a surgical one. K-means clustering algorithm has been used to determine the parameters of radial basis functions and the number of hidden nodes of the RBFNN is determined experimentally. For performance evaluation, the proposed RBFNN was compared to three different multilayer perceptron models having Pareto optimal hidden layer combinations using various performance indicators. Results of comparison indicate that the RBFNN can be used as an effective assessment tool for femoral peripheral arterial disease treatment. PMID:24382983

  7. Precedent autonomy should be respected in life-sustaining treatment decisions.

    PubMed

    Hebron, Allison Leslie; McGee, Summer

    2014-10-01

    In the 2011 landmark case of W v M, the English Court of Protection ruled that it was unlawful to withdraw artificial nutrition and hydration from a woman who had been in a minimally conscious state for 8 years. From the perspective of the court, the absence of a written advance directive negated the woman's previous, autonomous interests and, consequently, emphasis was given to her current welfare and well-being. While life itself is a moral good, prolonging life for a person in regular pain with no hope of recovering to a more complete state of awareness simply because that person only verbalized her wishes about her treatment decisions seems to drastically undervalue the principle of autonomy. We refute the notion that it is the role of the court to prolong life insofar as it can and argue that withholding and withdrawing life sustaining technologies from patients in a minimally conscious state can be ethically justified. PMID:24567422

  8. The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making.

    PubMed

    Welie, Jos Vm; Ten Have, Henk Amj

    2014-01-01

    Withholding or withdrawing a life-sustaining treatment tends to be very challenging for health care providers, patients, and their family members alike. When a patient's life seems to be nearing its end, it is generally felt that the morally best approach is to try a new intervention, continue all treatments, attempt an experimental course of action, in short, do something. In contrast to this common practice, the authors argue that in most instances, the morally safer route is actually to forgo life-sustaining treatments, particularly when their likelihood to effectuate a truly beneficial outcome has become small relative to the odds of harming the patient. The ethical analysis proceeds in three stages. First, the difference between neglectful omission and passive acquiescence is explained. Next, the two necessary conditions for any medical treatment, i.e., that it is medically indicated and that consent is obtained, are applied to life-sustaining interventions. Finally, the difference between withholding and withdrawing a life-sustaining treatment is discussed. In the second part of the paper the authors show how these theoretical-ethical considerations can guide clinical-ethical decision making. A case vignette is presented about a patient who cannot be weaned off the ventilator post-surgery. The ethical analysis of this case proceeds through three stages. First, it is shown that and why withdrawal of the ventilator in this case does not equate assistance in suicide or euthanasia. Next, the question is raised whether continued ventilation can be justified medically, or has become futile. Finally, the need for the health care team to obtain consent for the continuation of the ventilation is discussed. PMID:24618004

  9. Fellowship and Practice Composition Affect Surgical Decision Making in Patients with Adult Degenerative Scoliosis: Spinal Deformity versus Degenerative Spinal Surgeons

    PubMed Central

    Protopsaltis, Themistocles; Patel, Ashish; Yoo, Andrew; Lonner, Baron

    2015-01-01

    Background For the Adult Degenerative Scoliosis (ADS) patient with radiculopathy, there is no clear data in the literature to guide the spine surgeon's decision making in choosing between limited decompression alone, short segment fusion, or longer arthrodesis of the deformity. This study investigates the differences in operative planning, for patients with ADS and radiculopathy, between two groups of spine surgeons based on fellowship experience and practice composition. Methods Six Degenerative Spine surgeons (Group 1) and 6 Spinal Deformity surgeons (Group 2) were shown 7 cases of patients with ADS and radiculopathy. Surgeons completed a questionnaire detailing their planned operative intervention including the number of fusion levels, if any, approach, choice of bone graft, and interbody device. Pearson Correlation was used to investigate the association between fellowship training, practice composition, number of levels fused, and other variables. Intraclass correlation (ICC) analysis was used to investigate the internal consistency among the groups. Results There was a direct correlation between fellowship deformity experience and practice composition (r=0.75, p<0.01), and between deformity practice composition and the number of planned fusion levels (r=0.90, p<0.001). Group 1 surgeons fused a mean 3.7 vertebral levels (range 0-6.7), while Group 2 surgeons fused a mean 10.8 levels (range 4-16.5). Group 2 surgeons fused a significantly greater number of levels for each case than degenerative surgeons on paired student t-test (p=0.002). Group 1 surgeons chose decompression alone more commonly than deformity surgeons (p<0.05). Group 2 surgeons had significantly higher group consistency by ICC analysis (p=0.004). Conclusions Fellowship and practice composition influence the physician's surgical planning in ADS. There is a lack of standardized treatment paradigms for the management of radiculopathy in patients with ADS. PMID:26114090

  10. Hydrologic Treatments Affect Gaseous Carbon Loss From Organic Soils, Twitchell Island, California, October 1995-December 1997

    USGS Publications Warehouse

    Miller, Robin L.; Hastings, Lauren; Fujii, Roger

    2000-01-01

    Subsidence of organic soils in the Sacramento-San Joaquin Delta, California, has increased the potential for levee failure and flooding in the region. Because oxidation of the peat soils is a primary cause of subsidence, reversion of affected lands to wetlands has been proposed as a mitigation tool. To test this hypothesis, three 10 x 10 meter enclosures were built on Twitchell Island in the Delta and managed as different wetland habitats. Emissions of carbon dioxide and methane were measured in situ from October 1995 through December 1997, from the systems that developed under the different water-management treatments. Treatments included a seasonal control (SC) under current island management conditions; reverse flooding (RF), where the land is intentionally flooded from early dry season until midsummer; permanent shallow flooding (F); and a more deeply flooded, open-water (OW) treatment. Hydrologic treatments affected microbial processes, plant community and temperature dynamics which, in turn, affected carbon cycling. Water-management treatments with a period of flooding significantly decreased gaseous carbon emissions compared to the seasonal control. Permanent flooding treatments showed significantly higher methane fluxes than treatments with some period of aerobic conditions. Shallow flooding treatments created conditions that support cattail [Typha species (spp.)] marshes, while deep flooding precluded emergent vegetation. Carbon inputs to the permanent shallow flooding treatment tended to be greater than the measured losses. This suggests that permanent shallow flooding has the greatest potential for managing subsidence of these soils by generating organic substrate more rapidly than is lost through decomposition. Carbon input estimates of plant biomass compared to measurements of gaseous carbon losses indicate the potential for mitigation of subsidence through hydrologic management of the organic soils in the area.

  11. How will surface treatments affect the translucency of porcelain laminate veneers?

    PubMed Central

    Turgut, Sedanur; Ayaz, Elif Aydogan; Korkmaz, Fatih Mehmet; Ulusoy, Kıvanç Utku; Bagis, Yildirim Hakan

    2014-01-01

    PURPOSE The purpose of this study was to evaluate whether surface treatments affect the translucency of laminate veneers with different shades and thicknesses. MATERIALS AND METHODS A total of 224 disc-shaped ceramic veneers were prepared from A1, A3, HT (High Translucent) and HO (High Opaque) shades of IPS e.max Press (Ivoclar Vivadent) with 0.5 mm and 1.0 mm thicknesses. The ceramics were divided into four groups for surface treatments. Group C: no surface treatments; Group HF: etched with hydrofluoric acid; Group SB: sandblasted with 50-µm Al2O3; and Group L; irradiated with an Er;YAG laser. A translucent shade of resin cement (Rely X Veneer, 3M ESPE) was chosen for cementation. The color values of the veneers were measured with a colorimeter and translucency parameter (TP) values were calculated. A three-way ANOVA with interactions for TP values was performed and Bonferroni tests were used when appropriate (α=0.05). RESULTS There were significant interactions between the surface treatments, ceramic shades and thicknesses (P=.001). For the 0.5-mm-thick specimens there were significant differences after the SB and L treatments. There was no significant difference between the HF and C treatments for any shades or thicknesses (P>.05). For the 1-mm-thick ceramics, there was only a significant difference between the L and C treatments for the HT shade ceramics (P=.01). There were also significant differences between the SB and C treatments except not for the HO shades (P=.768). CONCLUSION The SB and L treatments caused laminate veneers to become more opaque; however, HF treatment did not affect the TP values. When the laminate veneers were thinner, both the shade of the ceramic and the SB and laser treatments had a greater effect on the TP values. PMID:24605200

  12. Complex treatment of trophic affections with vascular patients using monochromatic red light and hyperbaric oxygenation

    NASA Astrophysics Data System (ADS)

    Babkina, Zinaida M.; Vasilyev, Mikhail V.; Zakharov, Vyacheslav P.; Nikolayev, Viktor V.; Babkin, Vasily I.; Samoday, Valery G.; Zon, Boris A.; Pakhomov, Gennady V.; Naskidashvili, Vasily I.; Kumin, Anatoly A.

    1996-11-01

    Monochromatic red light irradiation therapy of trophic skin affections with vascular patients permits to receive positive results with small wounds. A combination of monochromatic red light and hyperbaric oxygenation is most perspective when conducting a complex therapy of trophic wounds not more than 40 mm2 and allows to diminish time of treatment almost two times.

  13. Selection of an appropriate wastewater treatment technology: a scenario-based multiple-attribute decision-making approach.

    PubMed

    Kalbar, Pradip P; Karmakar, Subhankar; Asolekar, Shyam R

    2012-12-30

    Many technological alternatives for wastewater treatment are available, ranging from advanced technologies to conventional treatment options. It is difficult to select the most appropriate technology from among a set of available alternatives to treat wastewater at a particular location. Many factors, such as capital costs, operation and maintenance costs and land requirement, are involved in the decision-making process. Sustainability criteria must also be incorporated into the decision-making process such that appropriate technologies are selected for developing economies such as that of India. A scenario-based multiple-attribute decision-making (MADM) methodology has been developed and applied to the selection of wastewater treatment alternative. The four most commonly used wastewater treatment technologies for treatment of municipal wastewater in India are ranked for various scenarios. Six scenarios are developed that capture the regional and local societal priorities of urban, suburban and rural areas and translate them into the mathematical algorithm of the MADM methodology. The articulated scenarios depict the most commonly encountered decision-making situations in addressing technology selection for wastewater treatment in India. A widely used compensatory MADM technique, TOPSIS, has been selected to rank the alternatives. Seven criteria with twelve indicators are formulated to evaluate the alternatives. Different weight matrices are used for each scenario, depending on the priorities of the scenario. This study shows that it is difficult to select the most appropriate wastewater treatment alternative under the "no scenario" condition (equal weights given to each attribute), and the decision-making methodology presented in this paper effectively identifies the most appropriate wastewater treatment alternative for each of the scenarios. PMID:23023038

  14. Competence to make treatment decisions in anorexia nervosa: thinking processes and values

    PubMed Central

    Tan, Dr. Jacinta O. A.; Hope, Professor Tony; Stewart, Dr. Anne; Fitzpatrick, Professor Raymond

    2005-01-01

    This paper explores the ethical and conceptual implications of the findings from an empirical study of decision-making capacity in anorexia nervosa. In the study, ten female patients aged 13 to 21 years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semi-structured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient participants were also tested using the MacCAT-T test of competence. This is a formalised, structured interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing, and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches or current standardised tests of competence. PMID:18066393

  15. Dry heat treatment affects wheat bran surface properties and hydration kinetics.

    PubMed

    Jacobs, Pieter J; Hemdane, Sami; Delcour, Jan A; Courtin, Christophe M

    2016-07-15

    Heat stabilization of wheat bran aims at inactivation of enzymes which may cause rancidity and processability issues. Such treatments may however cause additional unanticipated phenomena which may affect wheat bran technological properties. In this work, the impact of toasting on wheat bran hydration capacity and hydration kinetics was studied. Hydration properties were assessed using the Enslin-Neff and drainage centrifugation water retention capacity methods, thermogravimetric analysis and contact angle goniometry, next to more traditional methods. While equilibrium hydration properties of bran were not affected by the heat treatment, the rate at which the heat treated bran hydrated was, however, very significantly reduced compared to the untreated bran. This phenomenon was found to originate from the formation of a lipid coating during the treatment rendering the bran surface hydrophobic. These insights help to understand and partially account for the modified processability of heat treated bran in food applications. PMID:26948645

  16. Economic comparison of common treatment protocols and J5 vaccination for clinical mastitis in dairy herds using optimized culling decisions.

    PubMed

    Kessels, J A; Cha, E; Johnson, S K; Welcome, F L; Kristensen, A R; Gröhn, Y T

    2016-05-01

    This study used an existing dynamic optimization model to compare costs of common treatment protocols and J5 vaccination for clinical mastitis in US dairy herds. Clinical mastitis is an infection of the mammary gland causing major economic losses in dairy herds due to reduced milk production, reduced conception, and increased risk of mortality and culling for infected cows. Treatment protocols were developed to reflect common practices in dairy herds. These included targeted therapy following pathogen identification, and therapy without pathogen identification using a broad-spectrum antimicrobial or treating with the cheapest treatment option. The cost-benefit of J5 vaccination was also estimated. Effects of treatment were accounted for as changes in treatment costs, milk loss due to mastitis, milk discarded due to treatment, and mortality. Following ineffective treatments, secondary decisions included extending the current treatment, alternative treatment, discontinuing treatment, and pathogen identification followed by recommended treatment. Average net returns for treatment protocols and vaccination were generated using an existing dynamic programming model. This model incorporates cow and pathogen characteristics to optimize management decisions to treat, inseminate, or cull cows. Of the treatment protocols where 100% of cows received recommended treatment, pathogen-specific identification followed by recommended therapy yielded the highest average net returns per cow per year. Out of all treatment scenarios, the highest net returns were achieved with selecting the cheapest treatment option and discontinuing treatment, or alternate treatment with a similar spectrum therapy; however, this may not account for the full consequences of giving nonrecommended therapies to cows with clinical mastitis. Vaccination increased average net returns in all scenarios. PMID:26947301

  17. Primary care professional’s perspectives on treatment decision making for depression with African Americans and Latinos in primary care practice

    PubMed Central

    Patel, Sapana R.; Schnall, Rebecca; Little, Virna; Lewis-Fernández, Roberto; Pincus, Harold Alan

    2013-01-01

    Increasing interest has been shown in shared decision making (SDM) to improve mental health care communication between underserved immigrant minorities and their providers. Nonetheless, very little is known about this process. The following is a qualitative study of fifteen primary care providers at two Federally Qualified Health Centers in New York and their experience during depression treatment decision making. Respondents described a process characterized in between shared and paternalistic models of treatment decision making. Barriers to shared decision making included discordant models of illness, stigma, varying role expectations and decision readiness. Respondents reported strategies used to overcome barriers including understanding illness perceptions and the role of the community in the treatment process, dispelling stigma using cultural terms, orienting patients to treatment and remaining available regarding the treatment decision. Findings from this study have implications for planning SDM interventions to guide primary care providers through treatment engagement for depression. PMID:24104206

  18. Delay of Treatment Initiation Does Not Adversely Affect Survival Outcome in Breast Cancer

    PubMed Central

    Yoo, Tae-Kyung; Han, Wonshik; Moon, Hyeong-Gon; Kim, Jisun; Lee, Jun Woo; Kim, Min Kyoon; Lee, Eunshin; Kim, Jongjin; Noh, Dong-Young

    2016-01-01

    Purpose Previous studies examining the relationship between time to treatment and survival outcome in breast cancer have shown inconsistent results. The aim of this study was to analyze the overall impact of delay of treatment initiation on patient survival and to determine whether certain subgroups require more prompt initiation of treatment. Materials and Methods This study is a retrospective analysis of stage I-III patients who were treated in a single tertiary institution between 2005 and 2008. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to evaluate the impact of interval between diagnosis and treatment initiation in breast cancer and various subgroups. Results A total of 1,702 patients were included. Factors associated with longer delay of treatment initiation were diagnosis at another hospital, medical comorbidities, and procedures performed before admission for surgery. An interval between diagnosis and treatment initiation as a continuous variable or with a cutoff value of 15, 30, 45, and 60 days had no impact on disease-free survival (DFS). Subgroup analyses for hormone-responsiveness, triple-negative breast cancer, young age, clinical stage, and type of initial treatment showed no significant association between longer delay of treatment initiation and DFS. Conclusion Our results show that an interval between diagnosis and treatment initiation of 60 days or shorter does not appear to adversely affect DFS in breast cancer. PMID:26511801

  19. Factors influencing the decision about orthodontic treatment. A longitudinal study among 11- and 15-year-olds and their parents.

    PubMed

    Birkeland, K; Katle, A; Løvgreen, S; Bøe, O E; Wisth, P J

    1999-01-01

    The aims of the study were to evaluate the attitude towards orthodontic treatment among 11-(T1) and 15-year-old children (T2) and their parents, to present the distribution of referral rate and treatment uptake by a treatment need index assessed at T1 and to elucidate factors influencing the decision about orthodontic treatment in the period from T1 to T2. A group of 359 children and their parents answered separate questionnaires at T1, and 293 families responded to a follow-up study 4 years later. For the clinical examination, 224 children participated after exclusion of children in active treatment. The dental study casts were assessed by the Index of Orthodontic Treatment Need (IOTN). The mean referral rate was 56%, with a variation from 40% to 71% among different dental clinics. About 44% of the children had completed or were undergoing orthodontic treatment at T2. No significant sex differences among referred and treated children were discovered. Aesthetic motives were the most frequently reported subjective reason for orthodontic care. The untreated group expressed diminishing treatment desire in the follow-up period. The logistic regression analysis selected Dental Health Component (DHC) grades as a strong predictor for treatment uptake, followed by parents' concern and attitude to braces, while the 11-year-olds' own orthodontic concern was less significant. Children in the untreated group with late treatment decisions (T2) were best predicted by Aesthetic Component (AC) changes from T1 to T2. The results indicate that dentists play a key role in determining orthodontic treatment levels. High referral rates secured low risk of denying care to some patients. Treatment decision may be guided by the orthodontist. However, individual variation in attitude and desire influence treatment uptake even among children with great need. PMID:10546413

  20. Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature

    PubMed Central

    Friedrichs, Anke; Spies, Maren; Härter, Martin; Buchholz, Angela

    2016-01-01

    Background Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients’ preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD. Methods An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool. Results N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques. Discussion Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients’ preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding

  1. The Application of Climate Risk Informed Decision Analysis to the Ioland Water Treatment Plant in Lusaka, Zambia

    NASA Astrophysics Data System (ADS)

    Kucharski, John; Tkach, Mark; Olszewski, Jennifer; Chaudhry, Rabia; Mendoza, Guillermo

    2016-04-01

    This presentation demonstrates the application of Climate Risk Informed Decision Analysis (CRIDA) at Zambia's principal water treatment facility, The Iolanda Water Treatment Plant. The water treatment plant is prone to unacceptable failures during periods of low hydropower production at the Kafue Gorge Dam Hydroelectric Power Plant. The case study explores approaches of increasing the water treatment plant's ability to deliver acceptable levels of service under the range of current and potential future climate states. The objective of the study is to investigate alternative investments to build system resilience that might have been informed by the CRIDA process, and to evaluate the extra resource requirements by a bilateral donor agency to implement the CRIDA process. The case study begins with an assessment of the water treatment plant's vulnerability to climate change. It does so by following general principals described in "Confronting Climate Uncertainty in Water Resource Planning and Project Design: the Decision Tree Framework". By utilizing relatively simple bootstrapping methods a range of possible future climate states is generated while avoiding the use of more complex and costly downscaling methodologies; that are beyond the budget and technical capacity of many teams. The resulting climate vulnerabilities and uncertainty in the climate states that produce them are analyzed as part of a "Level of Concern" analysis. CRIDA principals are then applied to this Level of Concern analysis in order to arrive at a set of actionable water management decisions. The principal goals of water resource management is to transform variable, uncertain hydrology into dependable services (e.g. water supply, flood risk reduction, ecosystem benefits, hydropower production, etc…). Traditional approaches to climate adaptation require the generation of predicted future climate states but do little guide decision makers how this information should impact decision making. In

  2. Er:YAG Laser Dental Treatment of Patients Affected by Epidermolysis Bullosa

    PubMed Central

    Galeotti, Angela; D'Antò, Vincenzo; Gentile, Tina; Giancristoforo, Simona; Romeo, Umberto

    2014-01-01

    Aim. The purpose of this study was to evaluate the efficacy of Er:YAG laser used for treating hard dental tissue in patients with epidermolysis bullosa (EB). Methods. We report two cases of EB in which an Er:YAG laser was used for conservative treatments. In the first case, the Er:YAG laser (2,940 μm, 265 mJ, 25 Hz) was used to treat caries on a deciduous maxillary canine in an 8-year-old male patient affected by dystrophic EB. In the second case, we treated a 26-year-old female patient, affected by junctional EB, with generalized enamel hypoplasia, and an Er:YAG laser (2,940 μm, 265 mJ, 25 Hz) was used to remove the damaged enamel on maxillary incisors. Results. The use of the Er:YAG laser, with the appropriate energy, was effective in the selective removal of carious tissue and enamel hypoplasia. During dental treatment with the Er:YAG laser, patients required only a few interruptions due to the absence of pain, vibration, and noise. Conclusions. Laser treatment of hard dental tissues is a valuable choice for patients affected by EB since it is less invasive compared to conventional treatment, resulting in improved patient compliance. PMID:25431688

  3. Ischemic Compression After Trigger Point Injection Affect the Treatment of Myofascial Trigger Points

    PubMed Central

    Kim, Soo A; Oh, Ki Young; Choi, Won Hyuck

    2013-01-01

    Objective To investigate the effects of trigger point injection with or without ischemic compression in treatment of myofascial trigger points in the upper trapezius muscle. Methods Sixty patients with active myofascial trigger points in upper trapezius muscle were randomly divided into three groups: group 1 (n=20) received only trigger point injections, group 2 (n=20) received trigger point injections with 30 seconds of ischemic compression, and group 3 (n=20) received trigger point injections with 60 seconds of ischemic compression. The visual analogue scale, pressure pain threshold, and range of motion of the neck were assessed before treatment, immediately after treatment, and 1 week after treatment. Korean Neck Disability Indexes were assessed before treatment and 1 week after treatment. Results We found a significant improvement in all assessment parameters (p<0.05) in all groups. But, receiving trigger point injections with ischemic compression group showed significant improvement as compared with the receiving only trigger point injections group. And no significant differences between receiving 30 seconds of ischemic compression group and 60 seconds of ischemic compression group. Conclusion This study demonstrated the effectiveness of ischemic compression for myofascial trigger point. Trigger point injections combined with ischemic compression shows better effects on treatment of myofascial trigger points in the upper trapezius muscle than the only trigger point injections therapy. But the duration of ischemic compression did not affect treatment of myofascial trigger point. PMID:24020035

  4. The Involvement of Parents in Healthcare Decisions Where Adult Children Are at Risk of Lacking Decision-Making Capacity: A Qualitative Study of Treatment Decisions in Epilepsy

    ERIC Educational Resources Information Center

    Redley, M.; Prince, E.; Bateman, N.; Pennington, M.; Wood, N.; Croudace, T.; Ring, H.

    2013-01-01

    Background: Patients with intellectual disabilities (ID) receive health care by proxy. It is family members and/or paid support staff who must recognise health problems, communicate with clinicians, and report the benefits, if any, of a particular treatment. At the same time international and national statutes protect and promote the right of…

  5. Choosing a Physician Depends on How You Want to Feel: The Role of Ideal Affect in Health-Related Decision-Making

    PubMed Central

    Sims, Tamara; Tsai, Jeanne L.; Koopmann-Holm, Birgit; Thomas, Ewart A.C.; Goldstein, Mary K.

    2014-01-01

    When given a choice, how do people decide which physician to select? Although significant research has demonstrated that how people actually feel (their “actual affect”) influences their health care preferences, how people ideally want to feel (their “ideal affect”) may play an even greater role. Specifically, we predicted that people trust physicians whose affective characteristics match their ideal affect, which leads people to prefer those physicians more. Consistent with this prediction, the more participants wanted to feel high arousal positive states on average ([ideal HAP]; e.g., excited), the more likely they were to select a HAP-focused physician. Similarly, the more people wanted to feel low arousal positive states on average ([ideal LAP]; e.g., calm), the more likely they were to select a LAP-focused physician. Also as predicted, these links were mediated by perceived physician trustworthiness. Notably, while participants’ ideal affect predicted physician preference, actual affect (how much people actually felt HAP and LAP on average) did not. These findings suggest that people base even serious decisions on how they want to feel and highlight the importance of considering ideal affect in models of decision making, person perception, and patient physician communication. PMID:24188062

  6. Computeer-based decision support tools for evaluation of actions affecting flow and water quality in the San Joaquin Basin

    SciTech Connect

    Quinn, N.W.T.

    1993-01-01

    This document is a preliminary effort to draw together some of the important simulation models that are available to Reclamation or that have been developed by Reclamation since 1987. This document has also attempted to lay out a framework by which these models might be used both for the purposes for which they were originally intended and to support the analysis of other issues that relate to the hydrology and to salt and water quality management within the San Joaquin Valley. To be successful as components of a larger Decision Support System the models should to be linked together using custom designed interfaces that permit data sharing between models and that are easy to use. Several initiatives are currently underway within Reclamation to develop GIS - based and graphics - based decision support systems to improve the general level of understanding of the models currently in use, to standardize the methodology used in making planning and operations studies and to permit improved data analysis, interpretation and display. The decision support systems should allow greater participation in the planning process, allow the analysis of innovative actions that are currently difficult to study with present models and should lead to better integrated and more comprehensive plans and policy decisions in future years.

  7. International and cross-cultural dimensions of treatment decisions for neonates.

    PubMed

    Lantos, John D

    2015-10-01

    Neonatal mortality rates vary widely among countries. According to data from the World Health Organization, neonatal mortality in low- and low-middle-income countries is ∼30 per 1000 babies. In upper middle-income countries, that number was just 10 per 1000. In the highest-income countries, it was <5 per 1000. These data may not be accurate. Many countries do not report the tiniest babies as live births. Thus, their reported infant mortality rates are much lower than their actual infant mortality rates. Another big difference between countries is in the rate at which congenital anomalies are diagnosed prenatally and the rate at which pregnancies are terminated by induced abortion. International comparisons therefore reflect differences in the way countries define live birth, the comprehensiveness of the reporting of live births even by their own definitions, differences in the prevalence of congenital anomalies, the rate at which those congenital anomalies are diagnosed prenatally, and the percentage of pregnancies with congenital anomalies that end in abortion. This article reviews these differences and discusses the implications for the ways in which we think about international differences in decisions about life-sustaining treatment. PMID:26072059

  8. Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions.

    PubMed

    Pang, M C

    1999-06-01

    The first part of this paper examines the practice of informed treatment decisions in the protective medical system in China today. The second part examines how health care professionals in China perceive and carry out their responsibilities when relaying information to vulnerable patients, based on the findings of an empirical study that I had undertaken to examine the moral experience of nurses in practice situations. In the Chinese medical ethics tradition, refinement [jing] in skills and sincerity [cheng] in relating to patients are two cardinal virtues that health care professionals are required to possess. This notion of absolute sincerity carries a strong sense of parental protectiveness. The empirical findings reveal that most nurses are ambivalent about telling the truth to patients. Truth-telling would become an insincere act if a patient were to lose hope and confidence in life after learning of his or her disease. In this system of protective medical care, it is arguable as to whose interests are being protected: the patient, the family or the hospital. I would suggest that the interests of the hospital and the family members who legitimately represent the patient's interests are being honoured, but at the expense of the patient's right to know. PMID:10390681

  9. Mechanisms of Behavioral and Affective Treatment Outcomes in a Cognitive Behavioral Intervention for Boys.

    PubMed

    Burke, Jeffrey D; Loeber, Rolf

    2016-01-01

    Evidence for effective treatment for behavioral problems continues to grow, yet evidence about the effective mechanisms underlying those interventions has lagged behind. The Stop Now and Plan (SNAP) program is a multicomponent intervention for boys between 6 and 11. This study tested putative treatment mechanisms using data from 252 boys in a randomized controlled trial of SNAP versus treatment as usual. SNAP includes a 3 month group treatment period followed by individualized intervention, which persisted through the 15 month study period. Measures were administered in four waves: at baseline and at 3, 9 and 15 months after baseline. A hierarchical linear modeling strategy was used. SNAP was associated with improved problem-solving skills, prosocial behavior, emotion regulation skills, and reduced parental stress. Prosocial behavior, emotion regulation skills and reduced parental stress partially mediated improvements in child aggression. Improved emotion regulation skills partially mediated treatment-related child anxious-depressed outcomes. Improvements in parenting behaviors did not differ between treatment conditions. The results suggest that independent processes may drive affective and behavioral outcomes, with some specificity regarding the mechanisms related to differing treatment outcomes. PMID:25619927

  10. Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review

    PubMed Central

    Treuer, Tamás; Méndez, Luis; Montgomery, William; Wu, Shenghu

    2016-01-01

    The purpose of this paper was to systematically review the literature related to research about the factors affecting treatment adherence and discontinuation of atomoxetine in pediatric, adolescent, and adult patients with attention-deficit/hyperactivity disorder (ADHD). Medline was systematically searched using the following prespecified terms: “ADHD”, “Adherence”, “Compliance”, “Discontinuation”, and “Atomoxetine”. We identified 31 articles that met all inclusion and exclusion criteria. The findings from this review indicate that persistence and adherence to atomoxetine treatment were generally high. Factors found to influence adherence and nonadherence to atomoxetine treatment in ADHD in this review include age, sex, the definition of response used, length of treatment, initial dose of treatment, comorbid conditions, and reimbursement. Tolerability was cited as an important reason for treatment discontinuation. More research is needed to understand those factors that can help to identify patients at risk for poor adherence and interventions that could improve treatment adherence early in the stage of this illness to secure a better long-term prognosis. PMID:27217754

  11. Factors affecting treatment adherence to atomoxetine in ADHD: a systematic review.

    PubMed

    Treuer, Tamás; Méndez, Luis; Montgomery, William; Wu, Shenghu

    2016-01-01

    The purpose of this paper was to systematically review the literature related to research about the factors affecting treatment adherence and discontinuation of atomoxetine in pediatric, adolescent, and adult patients with attention-deficit/hyperactivity disorder (ADHD). Medline was systematically searched using the following prespecified terms: "ADHD", "Adherence", "Compliance", "Discontinuation", and "Atomoxetine". We identified 31 articles that met all inclusion and exclusion criteria. The findings from this review indicate that persistence and adherence to atomoxetine treatment were generally high. Factors found to influence adherence and nonadherence to atomoxetine treatment in ADHD in this review include age, sex, the definition of response used, length of treatment, initial dose of treatment, comorbid conditions, and reimbursement. Tolerability was cited as an important reason for treatment discontinuation. More research is needed to understand those factors that can help to identify patients at risk for poor adherence and interventions that could improve treatment adherence early in the stage of this illness to secure a better long-term prognosis. PMID:27217754

  12. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population

    PubMed Central

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-01-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES—in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective–Threshold–Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr−1). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  13. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population.

    PubMed

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-11-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES-in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective-Threshold-Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr(-1)). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  14. Inter-Institutional Variation in Management Decisions for Treatment of Four Common Cancers: A Multi-Institutional Cohort Study

    PubMed Central

    Weeks, Jane C.; Uno, Hajime; Taback, Nathan; Ting, Gladys; Cronin, Angel; D’Amico, Thomas A.; Friedberg, Jonathan W.; Schrag, Deborah

    2015-01-01

    Background When clinical practice is governed by evidenced-based guidelines and there is consensus regarding their validity, practice variation should be minimal. Where evidence gaps exist, greater variation is expected. Objective To systematically assess inter-institutional variation in management decisions for 4 common cancers. Design Multi-institutional observational cohort study of cancer patients diagnosed between July 2006 through May 2011 and observed through December 31, 2011. Setting 18 cancer centers participating in the formulation of treatment guidelines and systematic outcomes assessment through the National Comprehensive Cancer Network. Patients 25,589 patients with incident cancer of the breast, colorectum, lung, or non-Hodgkin’s lymphoma (NHL). Measurements Inter-institutional variation for 171 binary management decisions with varying levels of supporting evidence. For each decision, variation was characterized by the median absolute deviation (MAD) of the center-specific proportions. Results Inter-institutional variation was high (MAD >10%) for 35/171 (20%) oncology management decisions. This included: 9/22 (41%) for NHL, 16/76 (21%) for breast, 7/47 (15%) for lung, and 3/26 (12%) for colorectal. Decisions involving imaging and/or diagnostic procedures accounted for 46% and chemotherapy regimen choice for 37% of high variance decisions. The evidence grade underpinning the 35 high variance decisions was level I for 0%, 2A for 49% and 2B/other for 51%. Limitations Physician identifiers were unavailable, and results may not generalize outside of major cancer centers. Conclusions The substantial variation in institutional practice manifest among cancer centers reveals a lack of consensus about optimal management for common clinical scenarios. For clinicians, awareness of management decisions with high variation should prompt attention to patient preferences. For health systems, high variation can be used to prioritize comparative effectiveness

  15. Short-term oleoyl-estrone treatment affects capacity to manage lipids in rat adipose tissue

    PubMed Central

    Salas, Anna; Noé, Véronique; Ciudad, Carlos J; Romero, M Mar; Remesar, Xavier; Esteve, Montserrat

    2007-01-01

    Background Short-term OE (oleoyl-estrone) treatment causes significant decreases in rat weight mainly due to adipose tissue loss. The aim of this work was to determine if OE treatment affects the expression of genes that regulate lipid metabolism in white adipose tissue. Results Gene expression in adipose tissue from female treated rats (48 hours) was analysed by hybridization to cDNA arrays and levels of specific mRNAs were determined by real-time PCR. Treatment with OE decreased the expression of 232 genes and up-regulated 75 other genes in mesenteric white adipose tissue. The use of real-time PCR validate that, in mesenteric white adipose tissue, mRNA levels for Lipoprotein Lipase (LPL) were decreased by 52%, those of Fatty Acid Synthase (FAS) by 95%, those of Hormone Sensible Lipase (HSL) by 32%, those of Acetyl CoA Carboxylase (ACC) by 92%, those of Carnitine Palmitoyltransferase 1b (CPT1b) by 45%, and those of Fatty Acid Transport Protein 1 (FATP1) and Adipocyte Fatty Acid Binding Protein (FABP4) by 52% and 49%, respectively. Conversely, Tumour Necrosis Factor (TNFα) values showed overexpression (198%). Conclusion Short-term treatment with OE affects adipose tissue capacity to extract fatty acids from lipoproteins and to deal with fatty acid transport and metabolism. PMID:17725831

  16. Applications of Text Messaging, and Bibliotherapy for Treatment of Patients Affected by Depressive Symptoms

    PubMed Central

    Taleban, Roya; Zamani, Ahmadreza; Moafi, Mohammad; Jiryaee, Nasrin; Khadivi, Reza

    2016-01-01

    Background: Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. Methods: This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, <18 years, and cell phone accessibility. Mental retardation, drug and alcohol abuse, visual disability, dementia, suicide attempt history, electrotherapy, and receiving psychological interventions were our not met criteria. Our patient outcomes comprised intensity of depressive symptom and treatment compliance. The first two trials were requested to study instructive booklets in 30 days while the second cohort was demanded to study the booklet in accordance with the daily delivered text messaging. Results: Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P < 0.001). Based on treatment compliance, the interactive effect of group factor and the time factor was statistically significant. Conclusions: It seems that bibliotherapy could efficiently decrease the intensity of depressive symptoms. Nevertheless, in comparison with our booklet trial, the text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment. PMID:27076884

  17. Light treatment improves sleep quality and negative affectiveness in high arctic residents during winter.

    PubMed

    Paul, Michel A; Love, Ryan J; Hawton, Andrea; Brett, Kaighley; McCreary, Donald R; Arendt, Josephine

    2015-01-01

    The seasonal extremes of photoperiod in the high Arctic place particular strain on the human circadian system, which leads to trouble sleeping and increased feelings of negative affect in the winter months. To qualify for our study, potential participants had to have been at Canadian Forces Station (CFS) Alert (82° 30' 00″ N) for at least 2 weeks. Subjects filled out questionnaires regarding sleep difficulty, psychological well-being and mood and wore Actigraphs to obtain objective sleep data. Saliva was collected at regular intervals on two occasions, 2 weeks apart, to measure melatonin and assess melatonin onset. Individuals with a melatonin rhythm that was in disaccord with their sleep schedule were given individualized daily light treatment interventions based on their pretreatment salivary melatonin profile. The light treatment prescribed to seven of the twelve subjects was effective in improving sleep quality both subjectively, based on questionnaire results, and objectively, based on the actigraphic data. The treatment also caused a significant reduction in negative affect among the participants. Since the treatment is noninvasive and has minimal associated side effects, our results support the use of the light visors at CFS Alert and other northern outposts during the winter for individuals who are experiencing sleep difficulty or low mood. PMID:25580574

  18. Primary Care Provider Views About Usefulness and Dissemination of a Web-Based Depression Treatment Information Decision Aid

    PubMed Central

    Westmacott, Robin; Walker, John R; Vardanyan, Gohar

    2016-01-01

    Background Decisions related to mental health are often complex, problems often remain undetected and untreated, information unavailable or not used, and treatment decisions frequently not informed by best practice or patient preferences. Objective The objective of this paper was to obtain the opinions of health professionals working in primary health care settings about a Web-based information decision aid (IDA) for patients concerning treatment options for depression and the dissemination of the resources in primary care settings. Methods Participants were recruited from primary care clinics in Winnipeg and Ottawa, Canada, and included 48 family physicians, nurses, and primary care staff. The study design was a qualitative framework analytic approach of 5 focus groups. Focus groups were conducted during regular staff meetings, were digitally recorded, and transcripts created. Analysis involved a content and theme analysis. Results Seven key themes emerged including the key role of the primary care provider, common questions about treatments, treatment barriers, sources of patient information, concern about quality and quantity of available information, positive opinions about the IDA, and disseminating the IDA. The most common questions mentioned were about medication and side effects and alternatives to medication. Patients have limited access to alternative treatment options owing to cost and availability. Conclusions Practitioners evaluated the IDA positively. The resources were described as useful, supportive of providers’ messages, and accessible for patients. There was unanimous consensus that information needs to be available electronically through the Internet. PMID:27277709

  19. Miscanthus as a feedstock for fast-pyrolysis: does agronomic treatment affect quality?

    PubMed

    Hodgson, E M; Fahmi, R; Yates, N; Barraclough, T; Shield, I; Allison, G; Bridgwater, A V; Donnison, I S

    2010-08-01

    The objectives of the experiment were to assess the impact of nitrogen (N) and potassium (K) fertiliser application on the cell wall composition and fast-pyrolysis conversion quality of the commercially cultivated hybrid Miscanthus x giganteus. Five different fertiliser treatments were applied to mature Miscanthus plants which were sampled at five intervals over a growing season. The different fertiliser treatments produced significant variation in concentrations of cell wall components and ash within the biomass and affected the composition and quality of the resulting fast-pyrolysis liquids. The results indicated that application of high rates of N fertiliser had a negative effect on feedstock quality for this conversion pathway: reducing the proportion of cell wall components and increasing accumulation of ash in the harvested biomass. No exclusive effect of potassium fertiliser was observed. The low-N fertiliser treatment produced high quality, low ash-high lignin biomass most suitable as a feedstock for thermo-chemical conversion. PMID:20338753

  20. State of the art psychopharmacological treatment options in seasonal affective disorder.

    PubMed

    Yildiz, Mesut; Batmaz, Sedat; Songur, Emrah; Oral, Esat Timuçin

    2016-03-01

    Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly. PMID:26938817

  1. Fat, weather, and date affect migratory songbirds’ departure decisions, routes, and time it takes to cross the Gulf of Mexico

    USGS Publications Warehouse

    Deppe, Jill L.; Ward, Michael P.; Bolus, Rachel; Diehl, Robert H.; Celis-Murillo, A.; Zenzal, Theodore J.; Moore, Frank R.; Benson, Thomas J.; Smolinsky, Jaclyn A.; Schofield, Lynn N.; Enstrom, David A.; Paxton, Eben; Bohrer, Gil; Beveroth, Tara A.; Raim, Arlo; Obringer, Renee L.; Delaney, David; Cochran, William W.

    2015-01-01

    Approximately two thirds of migratory songbirds in eastern North America negotiate the Gulf of Mexico (GOM), where inclement weather coupled with no refueling or resting opportunities can be lethal. However, decisions made when navigating such features and their consequences remain largely unknown due to technological limitations of tracking small animals over large areas. We used automated radio telemetry to track three songbird species (Red-eyed Vireo, Swainson’s Thrush, Wood Thrush) from coastal Alabama to the northern Yucatan Peninsula (YP) during fall migration. Detecting songbirds after crossing ∼1,000 km of open water allowed us to examine intrinsic (age, wing length, fat) and extrinsic (weather, date) variables shaping departure decisions, arrival at the YP, and crossing times. Large fat reserves and low humidity, indicative of beneficial synoptic weather patterns, favored southward departure across the Gulf. Individuals detected in the YP departed with large fat reserves and later in the fall with profitable winds, and flight durations (mean = 22.4 h) were positively related to wind profit. Age was not related to departure behavior, arrival, or travel time. However, vireos negotiated the GOM differently than thrushes, including different departure decisions, lower probability of detection in the YP, and longer crossing times. Defense of winter territories by thrushes but not vireos and species-specific foraging habits may explain the divergent migratory behaviors. Fat reserves appear extremely important to departure decisions and arrival in the YP. As habitat along the GOM is degraded, birds may be limited in their ability to acquire fat to cross the Gulf.

  2. Fat, weather, and date affect migratory songbirds' departure decisions, routes, and time it takes to cross the Gulf of Mexico.

    PubMed

    Deppe, Jill L; Ward, Michael P; Bolus, Rachel T; Diehl, Robert H; Celis-Murillo, Antonio; Zenzal, Theodore J; Moore, Frank R; Benson, Thomas J; Smolinsky, Jaclyn A; Schofield, Lynn N; Enstrom, David A; Paxton, Eben H; Bohrer, Gil; Beveroth, Tara A; Raim, Arlo; Obringer, Renee L; Delaney, David; Cochran, William W

    2015-11-17

    Approximately two thirds of migratory songbirds in eastern North America negotiate the Gulf of Mexico (GOM), where inclement weather coupled with no refueling or resting opportunities can be lethal. However, decisions made when navigating such features and their consequences remain largely unknown due to technological limitations of tracking small animals over large areas. We used automated radio telemetry to track three songbird species (Red-eyed Vireo, Swainson's Thrush, Wood Thrush) from coastal Alabama to the northern Yucatan Peninsula (YP) during fall migration. Detecting songbirds after crossing ∼1,000 km of open water allowed us to examine intrinsic (age, wing length, fat) and extrinsic (weather, date) variables shaping departure decisions, arrival at the YP, and crossing times. Large fat reserves and low humidity, indicative of beneficial synoptic weather patterns, favored southward departure across the Gulf. Individuals detected in the YP departed with large fat reserves and later in the fall with profitable winds, and flight durations (mean = 22.4 h) were positively related to wind profit. Age was not related to departure behavior, arrival, or travel time. However, vireos negotiated the GOM differently than thrushes, including different departure decisions, lower probability of detection in the YP, and longer crossing times. Defense of winter territories by thrushes but not vireos and species-specific foraging habits may explain the divergent migratory behaviors. Fat reserves appear extremely important to departure decisions and arrival in the YP. As habitat along the GOM is degraded, birds may be limited in their ability to acquire fat to cross the Gulf. PMID:26578793

  3. Fat, weather, and date affect migratory songbirds’ departure decisions, routes, and time it takes to cross the Gulf of Mexico

    PubMed Central

    Deppe, Jill L.; Ward, Michael P.; Bolus, Rachel T.; Diehl, Robert H.; Celis-Murillo, Antonio; Zenzal, Theodore J.; Moore, Frank R.; Benson, Thomas J.; Smolinsky, Jaclyn A.; Schofield, Lynn N.; Enstrom, David A.; Paxton, Eben H.; Bohrer, Gil; Beveroth, Tara A.; Raim, Arlo; Obringer, Renee L.; Delaney, David; Cochran, William W.

    2015-01-01

    Approximately two thirds of migratory songbirds in eastern North America negotiate the Gulf of Mexico (GOM), where inclement weather coupled with no refueling or resting opportunities can be lethal. However, decisions made when navigating such features and their consequences remain largely unknown due to technological limitations of tracking small animals over large areas. We used automated radio telemetry to track three songbird species (Red-eyed Vireo, Swainson’s Thrush, Wood Thrush) from coastal Alabama to the northern Yucatan Peninsula (YP) during fall migration. Detecting songbirds after crossing ∼1,000 km of open water allowed us to examine intrinsic (age, wing length, fat) and extrinsic (weather, date) variables shaping departure decisions, arrival at the YP, and crossing times. Large fat reserves and low humidity, indicative of beneficial synoptic weather patterns, favored southward departure across the Gulf. Individuals detected in the YP departed with large fat reserves and later in the fall with profitable winds, and flight durations (mean = 22.4 h) were positively related to wind profit. Age was not related to departure behavior, arrival, or travel time. However, vireos negotiated the GOM differently than thrushes, including different departure decisions, lower probability of detection in the YP, and longer crossing times. Defense of winter territories by thrushes but not vireos and species-specific foraging habits may explain the divergent migratory behaviors. Fat reserves appear extremely important to departure decisions and arrival in the YP. As habitat along the GOM is degraded, birds may be limited in their ability to acquire fat to cross the Gulf. PMID:26578793

  4. Prepubertal tamoxifen treatment affects development of heifer reproductive tissues and related signaling pathways.

    PubMed

    Al Naib, A; Tucker, H L M; Xie, G; Keisler, D H; Bartol, F F; Rhoads, R P; Akers, R M; Rhoads, M L

    2016-07-01

    Prepubertal exposure of the developing ovaries and reproductive tract (RT) to estrogen or xenoestrogens can have acute and long-term consequences that compromise the reproductive performance of cattle. This research examined effects of the selective estrogen receptor modulator tamoxifen (TAM) on gene and protein abundance in prepubertal ovaries and RT, with a particular focus on signaling pathways that affect morphology. Tamoxifen was administered to Holstein heifer calves (n=8) daily (0.3mg/kg subcutaneously) from 28 to 120 d of age, when tissues were collected. Control calves (n=7) received an equal volume of excipient. Weight, gross measurements, and samples of reproductive tissues were collected, and protein and mRNA were extracted from snap-frozen samples of vagina, cervix, uterus, oviduct, ovary, and liver. Neither estradiol nor insulin-like growth factor I (IGFI) concentrations in the serum were affected by TAM treatment. Tamoxifen treatment reduced ovarian weight independently from effects on antral follicle populations, as there was no difference in visible antral follicle numbers on the day of collection. Estrogen receptor α (ESR1) and β (ESR2) mRNA, ESR1 protein, IGFI, progesterone receptor, total growth hormone receptor, WNT4, WNT5A, and WNT7A mRNA, in addition to mitogen-activated protein kinase (MAPK) and phosphorylated MAPK proteins were affected differently depending on the tissue examined. However, neither IGFI receptor mRNA nor protein abundance were affected by TAM treatment. Results indicate that reproductive development in prepubertal Holstein heifer calves is TAM-sensitive, and that bovine RT and ovarian development are supported, in part, by estrogen receptor-dependent mechanisms during the period studied here. Potential long-term consequences of such developmental disruption remain to be defined. PMID:27085397

  5. The relationship between cancer patient treatment decision-making roles and quality of life

    PubMed Central

    Atherton, Pamela J.; Smith, Tenbroeck; Singh, Jasvinder A.; Huntington, Jef; Diekmann, Brent B.; Huschka, Mashele; Sloan, Jeff A.

    2013-01-01

    Background This study's objective was to explore relationships between patient role preferences during the cancer treatment decision-making process and quality of life (QOL). Methods As part of a larger survey conducted by the American Cancer Society, 1-year cancer survivors completed a survey in 2000. This paper is based upon respondents from Minnesota (response rate 37.4%). Standardized measures included the Profile of Mood States (scores converted to have a range, 0-100; 100 is the best mood), the Short Form (SF)-36 (standardized scores), and the Control Preferences Scale. Patients' actual and preferred role preference distributions and concordance between the roles were compared to QOL scores using two-sample t-test methodology. Results Survivors (n=594) actual role in cancer care was 33% active, 50% collaborative and 17% passive. Their preferred role was 35% active, 53% collaborative, and 13% passive. 88% of survivors had concordant preferred and actual roles. Survivors with concordant roles had higher SF-36 Physical Component Scores (PCS) (p<0.01), higher vitality (p=0.01), less fatigue (p<0.01), less confusion (p=0.01), less anger (p=0.046) and better overall mood (p=0.01). These results were similar in both the female and the younger (age <60) cohorts. Survivors with active actual roles had higher PCS (p<0.01), less tension (p=0.04), and higher vitality (p=0.04) than those being collaborative or passive. No differences existed in QOL scores by preferred role. Conclusions Survivors who experienced discordance between their actual role and preferred role reported substantial QOL deficits in both physical and emotional domains. These results are indicative of the need to support patient preferences. PMID:23558408

  6. Facial affect processing deficits in schizophrenia: A meta-analysis of antipsychotic treatment effects

    PubMed Central

    Kempton, Matthew J; Mehta, Mitul A

    2015-01-01

    Social cognition, including emotion processing, is a recognised deficit observed in patients with schizophrenia. It is one cognitive domain which has been emphasised as requiring further investigation, with the efficacy of antipsychotic treatment on this deficit remaining unclear. Nine studies met our criteria for entry into a meta-analysis of the effects of medication on facial affect processing, including data from 1162 patients and six antipsychotics. Overall we found a small, positive effect (Hedge’s g = 0.13, 95% CI 0.05 to 0.21, p = 0.002). In a subgroup analysis this was statistically significant for atypical, but not typical, antipsychotics. It should be noted that the pooled sample size of the typical subgroup was significantly lower than the atypical. Meta-regression analyses revealed that age, gender and changes in symptom severity were not moderating factors. For the small, positive effect on facial affect processing, the clinical significance is questionable in terms of treating deficits in emotion identification in schizophrenia. We show that antipsychotic medications are poor at improving facial affect processing compared to reducing symptoms. This highlights the need for further investigation into the neuropharmacological mechanisms associated with accurate emotion processing, to inform treatment options for these deficits in schizophrenia. PMID:25492885

  7. Antibiotic Treatment Affects Intestinal Permeability and Gut Microbial Composition in Wistar Rats Dependent on Antibiotic Class

    PubMed Central

    Tulstrup, Monica Vera-Lise; Christensen, Ellen Gerd; Carvalho, Vera; Linninge, Caroline; Ahrné, Siv; Højberg, Ole; Licht, Tine Rask; Bahl, Martin Iain

    2015-01-01

    Antibiotics are frequently administered orally to treat bacterial infections not necessarily related to the gastrointestinal system. This has adverse effects on the commensal gut microbial community, as it disrupts the intricate balance between specific bacterial groups within this ecosystem, potentially leading to dysbiosis. We hypothesized that modulation of community composition and function induced by antibiotics affects intestinal integrity depending on the antibiotic administered. To address this a total of 60 Wistar rats (housed in pairs with 6 cages per group) were dosed by oral gavage with either amoxicillin (AMX), cefotaxime (CTX), vancomycin (VAN), metronidazole (MTZ), or water (CON) daily for 10–11 days. Bacterial composition, alpha diversity and caecum short chain fatty acid levels were significantly affected by AMX, CTX and VAN, and varied among antibiotic treatments. A general decrease in diversity and an increase in the relative abundance of Proteobacteria was observed for all three antibiotics. Additionally, the relative abundance of Bifidobacteriaceae was increased in the CTX group and both Lactobacillaceae and Verrucomicrobiaceae were increased in the VAN group compared to the CON group. No changes in microbiota composition or function were observed following MTZ treatment. Intestinal permeability to 4 kDa FITC-dextran decreased after CTX and VAN treatment and increased following MTZ treatment. Plasma haptoglobin levels were increased by both AMX and CTX but no changes in expression of host tight junction genes were found in any treatment group. A strong correlation between the level of caecal succinate, the relative abundance of Clostridiaceae 1 family in the caecum, and the level of acute phase protein haptoglobin in blood plasma was observed. In conclusion, antibiotic-induced changes in microbiota may be linked to alterations in intestinal permeability, although the specific interactions remain to be elucidated as changes in permeability did

  8. Syndromic treatment of gonococcal and chlamydial infections in women seeking primary care for the genital discharge syndrome: decision-making.

    PubMed Central

    Behets, F. M.; Miller, W. C.; Cohen, M. S.

    2001-01-01

    The syndromic treatment of gonococcal and chlamydial infections in women seeking primary care in clinics where resources are scarce, as recommended by WHO and implemented in many developing countries, necessitates a balance to be struck between overtreatment and undertreatment. The present paper identifies factors that are relevant to the selection of specific strategies for syndromic treatment in the above circumstances. Among them are the general aspects of decision-making and caveats concerning the rational decision-making approach. The positive and negative implications are outlined of providing or withholding treatment following a specific algorithm with a given accuracy to detect infection, i.e. sensitivity, specificity and predictive values. Other decision-making considerations that are identified are related to implementation and include the stability of risk factors with regard to time, space and the implementer, acceptability by stakeholders, and environmental constraints. There is a need to consider empirically developed treatment algorithms as a basis for policy discourse, to be evaluated together with the evidence, alternatives and arguments by the stakeholders. PMID:11731816

  9. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology].

    PubMed

    Winkler, Eva C; Heußner, Pia

    2016-03-01

    Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment. In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions. PMID:26983109

  10. The Effect of Emotion and Physician Communication Behaviors on Surrogates’ Life-Sustaining Treatment Decisions: A Randomized Simulation Experiment

    PubMed Central

    Barnato, Amber E.; Arnold, Robert M.

    2013-01-01

    Objective Surrogate decision makers for critically ill patients experience strong negative emotional states. Emotions influence risk perception, risk preferences, and decision making. We sought to explore the effect of emotional state and physician communication behaviors on surrogates’ life-sustaining treatment (LST) decisions. Design 5×2 between-subject randomized factorial experiment. Setting Web-based simulated interactive video meeting with an intensivist to discuss code status. Subjects Community-based participants 35 and older who self-identified as the surrogate for a parent or spouse recruited from 8 US cities through public advertisements. Interventions Block random assignment to emotion arousal manipulation and each of 4 physician communication behaviors. Measurements and Main Results Surrogate’s code status decision (CPR vs. DNR/AND). 256/373 (69%) respondents logged-in and were randomized: average age 50, 70% were surrogates for a parent, 63.5% were women, 76% were white, 11% black, and 9% Asian, and 81% were college educated. When asked about code status, 56% chose CPR. The emotion arousal manipulation increased depression-dejection (β=1.76 [0.58 – 2.94]), but did not influence CPR choice. Physician emotion handling and framing the decision as the patient’s rather than the surrogate’s did not influence CPR choice. Framing no CPR as the default rather than CPR resulted in fewer surrogates choosing CPR (48% vs. 64%, OR=0.52 [0.32-0.87]), as did framing the alternative to CPR as “allow natural death” rather than DNR (49% vs. 61%, OR=0.58 [95% CI 0.35-0.96]). Conclusions Experimentally-induced emotional state did not influence code status decisions, although small changes in physician communication behaviors substantially influenced this decision. PMID:23660727

  11. Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th-grade Chinese adolescent smokers.

    PubMed

    Xiao, Lin; Bechara, Antoine; Cen, Steven; Grenard, Jerry L; Stacy, Alan W; Gallaher, Peggy; Wei, Yonglan; Jia, Yong; Anderson Johnson, C

    2008-06-01

    This study addressed the question of whether poor decision making would be associated with adolescent past 7-day smoking. We conducted a cross-sectional study of 208 10th-grade adolescents in Chengdu City, China. We used the Iowa Gambling Task (IGT) to assess decision-making, and the Self-ordered Pointing Task (SOPT) to assess working memory capacity. Paper and pencil questionnaires assessed the school academic performance (SAP) and smoking variables. The results showed that a significantly higher proportion of past 7-day smokers (91.7%) were susceptible to future smoking and cigarette offers from best friends compared to other levels of smokers (never, ever and past 30-day smokers). Consistent with these behavioral data, the neuropsychological assessments revealed that relative to never smokers, past 7-day adolescent smokers (but not ever smokers or past 30-day smokers) demonstrated significantly lower scores on the IGT. Moreover, a higher proportion of past 7-day smokers (91.7%) performed poorly (no more than an overall net score of 10) on the IGT than nonsmokers and irregular (ever or past 30-day) smokers (about 65.3%). There were no differences on working memory performance for smokers (at any level) compared to never smokers after adjusting for school-type. In addition, logistic regression showed that the IGT significantly predicted past 7-day smoking after controlling for the working memory, school academic performance and demographic variables. These results suggest that poor affective decision making might predispose some adolescents to smoking in the future or in the social situations where their peers are smoking. Intervention targeting affective decision making might hold promise for reducing adolescents' risks for substance use. PMID:18584472

  12. Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th-grade Chinese adolescent smokers

    PubMed Central

    Xiao, Lin; Bechara, Antoine; Cen, Steven; Grenard, Jerry L.; Stacy, Alan W.; Gallaher, Peggy; Wei, Yonglan; Jia, Yong; Johnson, C. Anderson

    2008-01-01

    This study addressed the question of whether poor decision making would be associated with adolescent past 7-day smoking. We conducted a cross-sectional study of 208 10th-grade adolescents in Chengdu City, China. We used the Iowa Gambling Task (IGT) to assess decision-making, and the Self-ordered Pointing Task (SOPT) to assess working memory capacity. Paper and pencil questionnaires assessed the school academic performance (SAP) and smoking variables. The results showed that a significantly higher proportion of past 7-day smokers (91.7%) were susceptible to future smoking and cigarette offers from best friends compared to other levels of smokers (never, ever and past 30-day smokers). Consistent with these behavioral data, the neuropsychological assessments revealed that relative to never smokers, past 7-day adolescent smokers (but not ever smokers or past 30-day smokers) demonstrated significantly lower scores on the IGT. Moreover, a higher proportion of past 7-day smokers (91.7%) performed poorly (no more than an overall net score of 10) on the IGT than nonsmokers and irregular (ever or past 30-day) smokers (about 65.3%). There were no differences on working memory performance for smokers (at any level) compared to never smokers after adjusting for school-type. In addition, logistic regression showed that the IGT significantly predicted past 7-day smoking after controlling for the working memory, school academic performance and demographic variables. These results suggest that poor affective decision making might predispose some adolescents to smoking in the future or in the social situations where their peers are smoking. Intervention targeting affective decision making might hold promise for reducing adolescents’ risks for substance use. PMID:18584472

  13. Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program

    PubMed Central

    Guy, David; Ghanem, Gabriella; Loblaw, Andrew; Buckley, Roger; Persaud, Beverly; Cheung, Patrick; Chung, Hans; Danjoux, Cyril; Morton, Gerard; Noakes, Jeff; Spevack, Les; Hajek, David; Flax, Stanley

    2016-01-01

    Introduction: We aimed to report on data from the multidisciplinary diagnostic assessment program (DAP) at the Gale and Graham Wright Prostate Centre (GGWPC) at North York General Hospital (NYGH). We assessed referral, diagnosis, and treatment decisions for newly diagnosed prostate cancer (PCa) patients as seen over time, risk stratification, and clinic type to establish a deeper understanding of current decision-making trends. Methods: From June 2007 to April 2012, 1277 patients who were diagnosed with PCa at the GGWPC were included in this study. Data was collected and reviewed retrospectively using electronic patient records. Results: 1031 of 1260 patients (81.8%) were seen in a multidisciplinary clinic (MDC). Over time, a decrease in low-risk (LR) diagnoses and an increase intermediate-risk (IR) diagnoses was observed (p<0.0001). With respect to overall treatment decisions 474 (37.1%) of patients received primary radiotherapy, 340 (26.6%) received surgical therapy, and 426 (33.4%) had conservative management; 57% of patients who were candidates for active surveillance were managed this way. No significant treatment trends were observed over time (p=0.8440). Significantly, different management decisions were made in those who attended the MDC compared to those who only saw a urologist (p<0.0001). Conclusions: In our DAP, the vast majority of patients presented with screen-detected disease, but there was a gradual shift from low- to intermediate-risk disease over time. Timely multidisciplinary consultation was achievable in over 80% of patients and was associated with different management decisions. We recommend that all patients at risk for prostate cancer be worked up in a multi-disciplinary DAP. PMID:27217859

  14. Treatment decisions for newborns at the threshold of viability: an ethical dilemma.

    PubMed

    Doroshow, R W; Hodgman, J E; Pomerance, J J; Ross, J W; Michel, V J; Luckett, P M; Shaw, A

    2000-09-01

    The major ethical issues involved in decision-making in the care of extremely low birth weight newborns are analyzed here. We propose a schema for assessment and management of these infants that is consistent with ethical principles broadly accepted by the pediatric community, and which takes into account mortality risk at any given institution rather than arbitrary weight limits, with a major decision-making role for the infant's parents. When possible, the decision of whether or not to resuscitate should be made before delivery; when not possible, delivery room resuscitation is recommended, and the decision to continue or withdraw care should be made subsequently based on likelihood of survival and the wishes of the parents. PMID:11002878

  15. Goal-oriented training affects decision-making processes in virtual and simulated fire and rescue environments.

    PubMed

    Cohen-Hatton, Sabrina R; Honey, R C

    2015-12-01

    Decisions made by operational commanders at emergency incidents have been characterized as involving a period of information gathering followed by courses of action that are often generated without explicit plan formulation. We examined the efficacy of goal-oriented training in engendering explicit planning that would enable better communication at emergency incidents. While standard training mirrored current operational guidance, goal-oriented training incorporated "decision controls" that highlighted the importance of evaluating goals, anticipated consequences, and risk/benefit analyses once a potential course of action has been identified. In Experiment 1, 3 scenarios (a house fire, road traffic collision, and skip fire) were presented in a virtual environment, and in Experiment 2 they were recreated on the fireground. In Experiment 3, the house fire was recreated as a "live burn," and incident commanders and their crews responded to this scenario as an emergency incident. In all experiments, groups given standard training showed the reported tendency to move directly from information gathering to action, whereas those given goal-oriented training were more likely to develop explicit plans and show anticipatory situational awareness. These results indicate that training can be readily modified to promote explicit plan formulation that could facilitate plan sharing between incident commanders and their teams. PMID:26523338

  16. Medial prefrontal serotonin in the rat is involved in goal-directed behaviour when affect guides decision making

    PubMed Central

    La Fors, Sabrina S. B. M.; Meerkerk, Dorie T. J.; Joosten, Ruud N. J. M. A.; Uylings, Harry B. M.; Feenstra, Matthijs G. P.

    2007-01-01

    Rationale Across species, serotonin (5-HT) depletion in the prefrontal cortex (PFC) has been shown to cause impaired performance on tests of cognitive flexibility and the processing of affective information (e.g. information with an ‘emotional’ content). While recent work has explored the specific role of the orbital PFC herein, the role of the medial PFC remains unclear. Objectives The aim of our current experiments was to study the role of medial PFC 5-HT in both the processing of affective information and reversal learning across stimulus modalities. Materials and methods To this end, we selectively destroyed 5-HT terminals in the medial PFC of male Wistar rats by means of local infusion of the toxin 5,7-dihydroxytryptamine. Both control and lesioned animals were tested in two reversal learning paradigms with either spatial or odour cues and an affective switch from non-preferred to preferred food rewards. Results Our results indicate that a pellet switch during reversal learning impaired performance in control animals but not in lesioned animals, independent of the stimulus modality. Conclusion These results indicate that lesioned animals are not guided in their behaviour by the affective value of the reward like intact animals and thus that medial prefrontal 5-HT is needed for affective processing in goal-directed behaviour. PMID:17874235

  17. Impact of Oncotype DX Recurrence Score on Treatment Decisions: Results of a Prospective Multicenter Study in Turkey

    PubMed Central

    Ozmen, Vahit; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikdogan, Abdurrahman; Saip, Pinar

    2016-01-01

    Introduction: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX® 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the impact of the Recurrence Score® (RS) on treatment decisions and physician perceptions in Turkey. We also studied correlations between RS and routine risk factors. Patients and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at multidisciplinary tumor conferences. The initial treatment decision was recorded before tumor blocks were sent to the central laboratory. Each case was brought back to tumor conference after receiving the RS result. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classical risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of 165 patients, 57% had low RS, 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in treatment decision was 33%. Initially, chemotherapy followed by hormonal therapy (CT+HT) was recommended to 92 (56%) of all patients, which decreased to 61 (37%) patients post-RS assay (p<0.001). Multivariate analysis indicated that progesterone receptor (PR) and Ki-67 scores were significantly related to RS. Conclusion: Oncotype DX testing may provide meaningful additional information in carefully selected patients.  PMID:27081583

  18. The double-edged sword of genetic accounts of criminality: causal attributions from genetic ascriptions affect legal decision making.

    PubMed

    Cheung, Benjamin Y; Heine, Steven J

    2015-12-01

    Much debate exists surrounding the applicability of genetic information in the courtroom, making the psychological processes underlying how people consider this information important to explore. This article addresses how people think about different kinds of causal explanations in legal decision-making contexts. Three studies involving a total of 600 Mechanical Turk and university participants found that genetic, versus environmental, explanations of criminal behavior lead people to view the applicability of various defense claims differently, perceive the perpetrator's mental state differently, and draw different causal attributions. Moreover, mediation and path analyses highlight the double-edged nature of genetic attributions-they simultaneously reduce people's perception of the perpetrator's sense of control while increasing people's tendencies to attribute the cause to internal factors and to expect the perpetrator to reoffend. These countervailing relations, in turn, predict sentencing in opposite directions, although no overall differences in sentencing or ultimate verdicts were found. PMID:26498975

  19. Social Support as a Neglected E-Learning Motivator Affecting Trainee's Decisions of Continuous Intentions of Usage

    ERIC Educational Resources Information Center

    Weng, Cathy; Tsai, Chin-Chung; Weng, Apollo

    2015-01-01

    Drawing from the social influence theory and acknowledging that the others' support within the work context affects employees' learning, values, and behaviours, an alternative framework was proposed to explain employees' learning satisfaction and future intention to participate in e-training programs in the current study. 578 survey data collected…

  20. A decision support tool for simulating the effects of alternative policies affecting water resources: an application at the European scale

    NASA Astrophysics Data System (ADS)

    Fassio, A.; Giupponi, C.; Hiederer, R.; Simota, C.

    2005-03-01

    This paper presents the methodology applied and results obtained from testing the Decision Support System 'mDSS' developed by the MULINO Project (Multi-sectoral, integrated and operational decision support system for the sustainable use of water resources at the catchment scale), for assessing alternative measures for the reduction of nitrogen pressure from agriculture on water resources at European level. The European policy background is set by the EU Nitrates Directive (91/676/EEC) and the Water Framework Directive (2000/60/EC). The nature of the research is exploratory. It is aimed in particular at testing the usefulness of available official statistics for ex ante evaluations of alternative policy measures at the European scale, and the feasibility of such operations within the newly released mDSS software. Alternative measures for reducing N-pressure and spatial targets were designed and simulated in a GIS environment based on raster maps of 1 km resolution. The geographic extent of the present work is defined as the agricultural land of EU15. Data deriving from official statistics were used to calculate a simplified nitrogen balance, in which the sources of nitrogen are separated into organic (livestock manure) and mineral fertilisers, to distinguish the potential contribution of livestock and crop productions to water pollution at the river basin scale. Spatial indicators and evaluation indices were defined within a conceptual framework. For the study the DPSIR approach (Driving force, Pressure, State, Impact, Response), proposed by the European Environmental Agency, was adopted. The approach was subsequently elaborated by means of the multi-criteria functionality provided by mDSS. The results of this application test at the regional scale highlight the potential of the tool for evaluating the effects of policy measures targeted at different spatial implementation strategies through the application of simple screening models and using available data

  1. Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women’s Choices for Mastectomy and Breast Conserving Surgery

    PubMed Central

    Bellavance, Emily Catherine; Kesmodel, Susan Beth

    2016-01-01

    One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this decision-making process. Although significant scientific and societal advances have been made in improving women’s choices for the breast cancer treatment, there are still deficits in the decision-making processes surrounding the surgical treatment of breast cancer. Further research is needed to define optimal patient education and shared decision-making practices in this area. PMID:27066455

  2. Easing the burden of surrogate decision making: the role of a do-not-escalate-treatment order.

    PubMed

    Jacobsen, Juliet; Billings, Andrew

    2015-03-01

    We present a case illustrating the common problem of a surrogate decision maker who is psychologically distressed over the medical team's recommendation to withdraw life-sustaining treatment. We suggest how a do-not-escalate-treatment (DNET) order can be helpful in such situations when the usual approaches to withholding or withdrawing care are not acceptable to the surrogate. We define a DNET order, explain when it might be useful, and discuss how it can facilitate a humane, negotiated resolution of differences. PMID:25671289

  3. A decision aid for considering indomethacin prophylaxis vs. symptomatic treatment of PDA for extreme low birth weight infants

    PubMed Central

    2011-01-01

    Background Decision Aids (DA) are well established in various fields of medicine. It can improve the quality of decision-making and reduce decisional conflict. In neonatal care, and due to scientific equipoise, neonatologists caring for extreme low birth weight (ELBW) infants are in need to elicit parents' preferences with regard to the use of indomethacin therapy in ELBW infants. We aimed to develop a DA that elicits parents' preferences with regard to indomethacin therapy in ELBW infants. Methods We developed a DA for the use of the indomethacin therapy in ELBW infants according to the Ottawa Decision Support Framework. The development process involved parents, neonatologists, DA developers and decision making experts. A pilot testing with healthy volunteers was conducted through an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale. Results The DA is a computer-based interactive tool. In the first part, the DA provides information about patent ductus arteriosus (PDA) as a disease, the different treatment options, and the benefits and downsides of using indomethacin therapy in preterm infants. In the second part, it coaches the parent in the decision making process through clarifying values and preferences. Volunteers rated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008). Conclusion We have developed a computer based DA to assess parental preferences with regard to indomethacin therapy in preterm infants. Future research will involve measurement of parental preferences to guide and augment the clinical decisions in current neonatal practice. PMID:21888665

  4. Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation

    PubMed Central

    van der Veeken, Frida C. A.

    2016-01-01

    Background Rehabilitation in forensic psychiatry is achieved gradually with different leave modules, in line with the Risk Need Responsivity model. A forensic routine outcome monitoring tool should measure treatment progress based on the rehabilitation theory, and it should be predictive of important treatment outcomes in order to be usable in decision-making. Therefore, this study assesses the predictive validity for both positive (i.e., leave) and negative (i.e., inpatient incidents) treatment outcomes with the Instrument for Forensic Treatment Evaluation (IFTE). Methods Two-hundred and twenty-four patients were included in this study. ROC analyses were conducted with the IFTE factors and items for three leave modules: guided, unguided and transmural leave for the whole group of patients. Predictive validity of the IFTE for aggression in general, physical aggression specifically, and urine drug screening (UDS) violations was assessed for patients with the main diagnoses in Dutch forensic psychiatry, patients with personality disorders and the most frequently occurring co-morbid disorders: those with combined personality and substance use disorders. Results and Conclusions Results tentatively imply that the IFTE has a reasonable to good predictive validity for inpatient aggression and a marginal to reasonable predictive value for leave approvals and UDS violations. The IFTE can be used for information purposes in treatment decision-making, but reports should be interpreted with care and acknowledge patients’ personal risk factors, strengths and other information sources. PMID:27517721

  5. Metabolic syndrome - the consequence of lifelong treatment of bipolar affective disorder.

    PubMed

    Dadić-Hero, Elizabeta; Ruzić, Klementina; Grahovac, Tanja; Petranović, Duska; Graovac, Mirjana; Palijan, Tija Zarković

    2010-06-01

    Mood disturbances are characteristic and dominant feature of Mood disorders. Bipolar Affective Disorder (BAD) is a mood disorder which occurs equally in both sexes. BAD may occur in co morbidity with other mental diseases and disorders such as: Anorexia Nervosa, Bulimia Nervosa, Attention Deficit, Panic Disorder and Social Phobia. However, medical disorders (one or more) can also coexist with BAD. Metabolic syndrome is a combination of metabolic disorders that increase the risk of developing cardiovascular disease. A 61-year old female patient has been receiving continuous and systematic psychiatric treatment for Bipolar Affective Disorder for the last 39 years. The first episode was a depressive one and it occurred after a child delivery. Seventeen years ago the patient developed diabetes (diabetes type II), and twelve years ago arterial hypertension was diagnosed. High cholesterol and triglyceride levels as well as weight gain were objective findings. During the last nine years she has been treated for lower leg ulcer. Since metabolic syndrome includes abdominal obesity, hypertension, diabetes mellitus, increased cholesterol and serum triglyceride levels, the aforesaid patient can be diagnosed with Metabolic Syndrome. When treating Bipolar Affective Disorder, the antipsychotic drug choice should be careful and aware of its side-effects in order to avoid the development or aggravation of metabolic syndrome. PMID:20562789

  6. Epilepsy due to PNPO mutations: genotype, environment and treatment affect presentation and outcome

    PubMed Central

    Mills, Philippa B.; Camuzeaux, Stephane S.M.; Footitt, Emma J.; Mills, Kevin A.; Gissen, Paul; Fisher, Laura; Das, Krishna B.; Varadkar, Sophia M.; Zuberi, Sameer; McWilliam, Robert; Stödberg, Tommy; Plecko, Barbara; Baumgartner, Matthias R.; Maier, Oliver; Calvert, Sophie; Riney, Kate; Wolf, Nicole I.; Livingston, John H.; Bala, Pronab; Morel, Chantal F.; Feillet, François; Raimondi, Francesco; Del Giudice, Ennio; Chong, W. Kling; Pitt, Matthew

    2014-01-01

    The first described patients with pyridox(am)ine 5’-phosphate oxidase deficiency all had neonatal onset seizures that did not respond to treatment with pyridoxine but responded to treatment with pyridoxal 5’-phosphate. Our data suggest, however, that the clinical spectrum of pyridox(am)ine 5’-phosphate oxidase deficiency is much broader than has been reported in the literature. Sequencing of the PNPO gene was undertaken for a cohort of 82 individuals who had shown a reduction in frequency and severity of seizures in response to pyridoxine or pyridoxal 5’-phosphate. Novel sequence changes were studied using a new cell-free expression system and a mass spectrometry-based assay for pyridoxamine phosphate oxidase. Three groups of patients with PNPO mutations that had reduced enzyme activity were identified: (i) patients with neonatal onset seizures responding to pyridoxal 5’-phosphate (n = 6); (ii) a patient with infantile spasms (onset 5 months) responsive to pyridoxal 5’-phosphate (n = 1); and (iii) patients with seizures starting under 3 months of age responding to pyridoxine (n = 8). Data suggest that certain genotypes (R225H/C and D33V) are more likely to result in seizures that to respond to treatment with pyridoxine. Other mutations seem to be associated with infertility, miscarriage and prematurity. However, the situation is clearly complex with the same combination of mutations being seen in patients who responded and did not respond to pyridoxine. It is possible that pyridoxine responsiveness in PNPO deficiency is affected by prematurity and age at the time of the therapeutic trial. Other additional factors that are likely to influence treatment response and outcome include riboflavin status and how well the foetus has been supplied with vitamin B6 by the mother. For some patients there was a worsening of symptoms on changing from pyridoxine to pyridoxal 5’-phosphate. Many of the mutations in PNPO affected residues involved in binding flavin

  7. Epilepsy due to PNPO mutations: genotype, environment and treatment affect presentation and outcome.

    PubMed

    Mills, Philippa B; Camuzeaux, Stephane S M; Footitt, Emma J; Mills, Kevin A; Gissen, Paul; Fisher, Laura; Das, Krishna B; Varadkar, Sophia M; Zuberi, Sameer; McWilliam, Robert; Stödberg, Tommy; Plecko, Barbara; Baumgartner, Matthias R; Maier, Oliver; Calvert, Sophie; Riney, Kate; Wolf, Nicole I; Livingston, John H; Bala, Pronab; Morel, Chantal F; Feillet, François; Raimondi, Francesco; Del Giudice, Ennio; Chong, W Kling; Pitt, Matthew; Clayton, Peter T

    2014-05-01

    The first described patients with pyridox(am)ine 5'-phosphate oxidase deficiency all had neonatal onset seizures that did not respond to treatment with pyridoxine but responded to treatment with pyridoxal 5'-phosphate. Our data suggest, however, that the clinical spectrum of pyridox(am)ine 5'-phosphate oxidase deficiency is much broader than has been reported in the literature. Sequencing of the PNPO gene was undertaken for a cohort of 82 individuals who had shown a reduction in frequency and severity of seizures in response to pyridoxine or pyridoxal 5'-phosphate. Novel sequence changes were studied using a new cell-free expression system and a mass spectrometry-based assay for pyridoxamine phosphate oxidase. Three groups of patients with PNPO mutations that had reduced enzyme activity were identified: (i) patients with neonatal onset seizures responding to pyridoxal 5'-phosphate (n = 6); (ii) a patient with infantile spasms (onset 5 months) responsive to pyridoxal 5'-phosphate (n = 1); and (iii) patients with seizures starting under 3 months of age responding to pyridoxine (n = 8). Data suggest that certain genotypes (R225H/C and D33V) are more likely to result in seizures that to respond to treatment with pyridoxine. Other mutations seem to be associated with infertility, miscarriage and prematurity. However, the situation is clearly complex with the same combination of mutations being seen in patients who responded and did not respond to pyridoxine. It is possible that pyridoxine responsiveness in PNPO deficiency is affected by prematurity and age at the time of the therapeutic trial. Other additional factors that are likely to influence treatment response and outcome include riboflavin status and how well the foetus has been supplied with vitamin B6 by the mother. For some patients there was a worsening of symptoms on changing from pyridoxine to pyridoxal 5'-phosphate. Many of the mutations in PNPO affected residues involved in binding flavin mononucleotide or

  8. How do women trade-off benefits and risks in chemotherapy treatment decisions based on gene expression profiling for early-stage breast cancer? A discrete choice experiment

    PubMed Central

    Marshall, Deborah A; Deal, Ken; Bombard, Yvonne; Leighl, Natasha; MacDonald, Karen V; Trudeau, Maureen

    2016-01-01

    Objectives Gene expression profiling (GEP) of tumours informs baseline risk prediction, potentially affecting adjuvant chemotherapy decisions for women with early-stage breast cancer. Since only 15% will experience a recurrence, concerns have been raised about potential harms from overtreatment and high GEP costs in publicly funded healthcare systems. We aimed to estimate preferences and personal utility of GEP testing information and benefit–risk trade-offs in chemotherapy treatment decisions. Design, setting and intervention Based on literature review and findings from our qualitative research (focus groups, interviews with patients with breast cancer and medical oncologists), we developed a discrete choice experiment (DCE) survey and administered it via an internet panel. The DCE included 12 choice tasks with 5 attributes and 3 alternatives considering orthogonality, D-efficiency and level balance. Participants The DCE survey was administered to 1004 Canadian women from the general population. Main outcome measures Preferences were analysed using conditional logit and hierarchical Bayes and evaluated for goodness of fit. We conducted simulation analyses for alternative scenarios. Results GEP test score indicating likely benefit from chemotherapy was the most important attribute. Doctor's clinical estimate of the risk of cancer returning, trust in your cancer doctor and side effects of chemotherapy (temporary and permanent) were relatively less important but showed significant differences among levels. In the scenario analyses, 78% were likely to choose chemotherapy in a high-risk scenario, 55% in a moderate-risk scenario and 33% in a low-risk scenario, with the other attributes held constant. A high GEP score was more important in influencing the choice of chemotherapy for those at intermediate clinical risk. Conclusions GEP testing information influences chemotherapy treatment decisions in early-stage breast cancer and varies depending on clinical risk

  9. Prenatal Thyroxine Treatment Disparately Affects Peripheral and Amygdala Thyroid Hormone Levels

    PubMed Central

    Shukla, Pradeep K.; Sittig, Laura J.; Andrus, Brian M.; Schaffer, Daniel J.; Batra, Kanchi K.; Redei, Eva E.

    2009-01-01

    Summary A prenatal hypothyroid state is associated with behavioral abnormalities in adulthood. Wistar–Kyoto (WKY) rats exhibit hypothyroidism and increased depressive and anxiety-like behaviors. Thus, the WKY could illuminate the mechanisms by which the reversal of developmental hypothyroidism in humans and animals results in adult behavioral improvement. We examined the outcome of maternal thyroxine (T4) treatment on thyroid hormone-regulated functions and adult behavior of the WKY offspring. Pregnant WKY dams completed gestation with and without T4 administration and their adult male offspring were tested. Measures included depressive and anxiety-like behaviors, and thyroid hormone (TH) concentrations in both plasma and specific brain regions. In addition, the expression of two proteins affecting thyroid hormone trafficking and metabolism, monocarboxylate transporter 8 (MCT-8) and iodothyronine deiodinase type III (Dio3), and of several behavior-altering molecules, glucocorticoid receptor (GR), prepro-thyrotropin releasing hormone (prepro-TRH) and corticotrophin releasing hormone (CRH), were determined in the hippocampus and amygdala of the offspring. Prenatal T4 treatment of WKYs did not affect adult depressive behavior but increased anxiety-like behavior and decreased plasma levels of THs. In the hippocampus of males treated with T4 in utero, Dio3 and MCT-8 protein levels were increased, while in the amygdala, there were increases of free T4, MCT-8, GR, prepro-TRH protein and CRH mRNA levels. These results show that T4 administration in utero programs adult peripheral and amygdalar thyroid hormone levels divergently, and that the resulting upregulation of anxiety-related genes in the amygdala could be responsible for the exacerbated anxiety-like behavior seen in WKYs after prenatal T4 treatment. PMID:20005050

  10. Factors affecting the decision to hospitalise children admitted to the emergency department due to non-fatal suicide attempts by pills

    PubMed Central

    Gokalp, Gamze; Anil, Murat; Bal, Alkan; Bicilioglu, Yuksel; Kamit Can, Fulya; Anil, Ayse Berna

    2016-01-01

    Objective: Suicide attempts (SAs) in the paediatric age group represent an important cause of morbidity and mortality. Our aim was to examine the factors affecting the decision to hospitalize children with a diagnosis of non-fatal SA by pills. Methods: Children <18 years of age admitted with SA by pills during 2014 were evaluated retrospectively. Patients were divided into two groups: Group-I comprised hospitalised patients and Group-II included those who were discharged from the PED. These two groups were compared in terms of clinical and demographic characteristics recorded upon PED admission. Results: A total of 196 patients were included in the study. The number of pills taken for self-poisoning in Group-I (median: 20 pills) was higher than that in Group-II (median: 12 pills) (p < 0.001), and the rate of pathological findings during the first paediatric psychiatric consultation was higher in Group-I (91.1%) than in the Group-II (54.8%) (p < 0.001). Conclusion: Factors affecting the disposition decision in cases of children who performed non-fatal SA via pills included the amount of medication taken for the suicide attempt and the presence of psychiatric disorders, as determined by a paediatric psychiatrist during the acute phase. PMID:27375723

  11. Neuronal Dysregulation in Stroke-Associated Pseudobulbar Affect (PBA): Diagnostic Scales and Current Treatment Options

    PubMed Central

    Lapchak, Paul A

    2015-01-01

    Until recently there was little understanding of the exact pathophysiology and treatment choices for stroke patients with Pseudobulbar affect (PBA). PBA is typically characterized by outbursts or uncontrollable laughing or crying and in the majority of patients, the outbursts being involuntary and incompatible with the patients’ emotional state. PBA is a behavioral syndrome reported to be displayed in 28–52% of stroke patients with first or multiple strokes, and incidence may be higher in patients who have had prior stroke events, and higher in females. There is typically involvement of glutaminergic, serotoninergic and dopaminergic neuronal circuits of the corticolimbic-subcorticothalamic-pontocerebellar network. PBA is now understood to be a disinhibition syndrome in which specific pathways involving serotonin and glutamate are disrupted or modulated causing reduced cortical inhibition of a cerebellar/brainstem-situated “emotional” laughing or crying focal center. Stroke-induced disruption of one or more neuronal pathway circuits may “disinhibit” voluntary laughing and crying making the process involuntary. With a “new” treatment currently being marketed to treat PBA patients, this article will delve into the neurological and physiological basis for PBA in stroke, and review progress with the diagnosis and treatment of PBA. PMID:26693049

  12. Assessment of post-contamination treatments affecting different bonding stages to dentin

    PubMed Central

    Elkassas, Dina; Arafa, Abla

    2016-01-01

    Objectives: To assess the effect of cleansing treatments following saliva and blood contamination at different bonding stages to dentin. Materials and Methods: Labial surfaces of 168 permanent maxillary central incisors were ground flat exposing superficial dentin. Specimens were divided into: uncontaminated control (A), contamination after etching (B), contamination after adhesive application (C), contamination after adhesive polymerization (D). Groups were further subdivided according to cleansing treatments into: rinsing (B1, C1, D1), re-etching (B2, D3), sodium hypochlorite application (B3), ethyl alcohol application (C2), acetone application (C3), rinsing and rebonding (D2), re-etching and rebonding (D4). Composite microcylinders were bonded to treated substrates and shear loaded micro-shear bond strength (μSBS) until failure and treated surfaces were examined with scanning electron microscope. Debonded surfaces were classified as adhesive, cohesive or mixed failure. The data were analyzed using one-way ANOVA and Tukey's post hoc test. Results: The μSBS values were ranked as follow; Group B: A > B3 > B2 > B1 > B, Group C: A > C3 > C2 > C1 > C, Group D: A > D4 > D1 = D2 ≥ D3. Debonded surfaces showed adhesive failure in Group B while cohesive failure in Groups C and D. Conclusions: Cleansing treatments differ according to bonding step; re-etching then rebonding suggested if etched substrate or polymerized adhesive were contaminated while acetone application decontaminated affected unpolymerized adhesive. PMID:27403048

  13. Effective NSAID treatment indicates that hyperprostaglandinism is affecting the clinical severity of childhood hypophosphatasia

    PubMed Central

    Girschick, HJ; Schneider, P; Haubitz, I; Hiort, O; Collmann, H; Beer, M; Shin, YS; Seyberth, HW

    2006-01-01

    Background Hypophosphatasia (HP) is an inborn error of bone metabolism characterized by a genetic defect in the gene encoding the tissue-nonspecific alkaline phosphatase (TNSALP). There is a lack of knowledge as to how the variability and clinical severity of the HP phenotype (especially pain and walking impairment) are related to metabolic disturbances or impairments, subsequent to the molecular defect. Methods We analyzed the changes in clinical symptoms and the prostaglandin (PG) metabolism in response to treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in six children affected by childhood HP. In addition, by exposing HP fibroblasts to pyridoxal phosphate and/or calcium pyrophosphate in vitro, we analyzed whether the alterations in PG levels are sequelae related to the metabolic defect. Results Childhood HP patients, who often complain about pain in the lower limbs without evident fractures, have systemic hyperprostaglandinism. Symptomatic anti-inflammatory treatment with NSAIDs significantly improved pain-associated physical impairment. Calcium pyrophosphate, but not pyridoxal phosphate, induced cyclooxygenase-2 (COX-2) gene expression and PG production in HP and normal fibroblasts in vitro. Conclusion Clinical features of childhood HP related to pain in the lower legs may be, at least in part, sequelae related to elevated PG levels, secondary to the primary metabolic defect. Consequently, NSAID treatment does improve the clinical features of childhood HP. PMID:16803637

  14. Does labelling a rare cancer diagnosis 'good' affect the patient's experience of treatment and recovery?

    PubMed

    Ridgway, E; Grose, J; Charles, A; Hewett, J; Jarvis, M; Benjamin, S

    2016-05-01

    Doctors sometimes tell patients with rare but highly treatable cancers that they have 'good' cancer which some patients have found unhelpful, but this has been little explored. The aim of this study was to explore how patients reacted to being told they had a 'good' cancer. Qualitative interviews were carried out with 25 people with rare but prognostically favourable cancers who had received treatment at two hospitals within a cancer network. Results showed that despite good treatment outcomes, patients are still very shocked to hear the word cancer and react in similar ways to those with other forms of cancer. The potential effects of treatment should be recognised as having a detrimental effect on patient well-being whatever the prognosis. We should therefore avoid using 'good' and 'cancer' in the same sentence. In addition, the impact on all family members should not be underestimated. The data can be used to improve clinical practice and improve support for people affected by cancer. PMID:25335904

  15. Success and Failure in Dynamic Decision Environments: Understanding Treatment Strategies for Patients with a Chronic Disease

    ERIC Educational Resources Information Center

    Ramsey, Gregory W.

    2010-01-01

    This dissertation proposes and tests a theory explaining how people make decisions to achieve a goal in a specific task environment. The theory is represented as a computational model and implemented as a computer program. The task studied was primary care physicians treating patients with type 2 diabetes. Some physicians succeed in achieving…

  16. Perceived need for information among patients with a haematological malignancy: associations with information satisfaction and treatment decision-making preferences.

    PubMed

    Rood, Janneke A J; van Zuuren, Florence J; Stam, Frank; van der Ploeg, Tjeerd; Eeltink, Corien; Verdonck-de Leeuw, Irma M; Huijgens, Peter C

    2015-06-01

    For patients with haematological malignancies, information on disease, prognosis, treatment and impact on quality of life is of the utmost importance. To gain insight into the perceived need for information in relation to sociodemographic and clinical parameters, comorbidity, quality of life (QoL) and information satisfaction, we compiled a questionnaire based on existing validated questionnaires. A total of 458 patients diagnosed with a haematological malignancy participated. The perceived need for information was moderate to high (40-70%). Multivariate regression analyses showed that a higher need for information was related to younger age, worse QoL, being member of a patient society and moderate comorbidity. The need for disease and treatment-related information was higher than the need for psychosocial information. A higher need for disease and treatment-related information was associated to being diagnosed with multiple myeloma. A higher need for psychosocial information was related to a lower educational level. The information provision could be improved according to 41% of the patients. Higher satisfaction with provided information was associated with better QoL. Most patients (62%) reported that they wanted to be fully informed about their illness and actively involved in treatment decision-making. The results contribute to improving patient-tailored information provision and shared decision-making in clinical practice. PMID:24811073

  17. Sperm treatment affects capacitation parameters and penetration ability of ejaculated and epididymal boar spermatozoa.

    PubMed

    Matás, C; Sansegundo, M; Ruiz, S; García-Vázquez, F A; Gadea, J; Romar, R; Coy, P

    2010-11-01

    This work was designed to study how this ability is affected by different sperm treatments routinely used for in vitro fertilization (IVF) assay. In this study, boar sperm samples from epididymal or ejaculated origin were processed by three different methods: left unwashed (NW group), washed in Dulbecco's phosphate-buffered saline supplemented with 0.1% BSA (BSA group), and washed on a Percoll(®) gradient (PERCOLL group). After preparation of semen samples, changes in motility patterns were studied by CASA, calcium uptake by spectrofluorimetry, and ROS generation, spontaneous acrosome reaction, and lipid disorder by means of flow cytometry. Finally IVF assays were also performed with the different semen samples and penetrability results evaluated at 2 and 4 h post insemination (hpi). Independently of the sperm treatment, epididymal spermatozoa showed higher values of progressive motility, percentage of live cells with low lipid disorder, and penetration ability at 4 hpi than the corresponding ejaculated spermatozoa. Ejaculated spermatozoa showed higher levels of calcium uptake, ROS generation and percentage of spontaneous acrosome reaction than epididymal sperm. Regarding sperm treatments, PERCOLL group showed the highest values for some motility parameters (linearity of the curvilinear trajectory, straightness, and average path velocity/curvilinear velocity), ROS generation and penetration ability at 2 and 4 hpi; however this same group showed the lowest values for sperm curvilinear velocity and lateral head displacement. From all experimental groups, ejaculated-PERCOLL-treated spermatozoa showed the highest fertilization ability after 2 hpi. Results suggest that capacitation pathways can be regulated by suitable treatments making the ejaculated sperm able to reach capacitation and fertilize oocytes in similar levels than epididymal spermatozoa, although most of the studied capacitation-associated changes do not correlate with this ability. PMID:20688369

  18. Fascioliasis and Intestinal Parasitoses Affecting Schoolchildren in Atlixco, Puebla State, Mexico: Epidemiology and Treatment with Nitazoxanide

    PubMed Central

    Zumaquero-Ríos, José Lino; Sarracent-Pérez, Jorge; Rojas-García, Raúl; Rojas-Rivero, Lázara; Martínez-Tovilla, Yaneth; Valero, María Adela; Mas-Coma, Santiago

    2013-01-01

    Background The Atlixco municipality, Puebla State, at a mean altitude of 1840 m, was selected for a study of Fasciola hepatica infection in schoolchildren in Mexico. This area presents permanent water collections continuously receiving thaw water from Popocatepetl volcano (5426 m altitude) through the community supply channels, conforming an epidemiological scenario similar to those known in hyperendemic areas of Andean countries. Methodology and Findings A total of 865 6–14 year-old schoolchildren were analyzed with FasciDIG coproantigen test and Lumbreras rapid sedimentation technique, and quantitatively assessed with Kato-Katz. Fascioliasis prevalences ranged 2.94–13.33% according to localities (mean 5.78%). Intensities were however low (24–384 epg). The association between fascioliasis and the habit of eating raw vegetables was identified, including watercress and radish with pronouncedly higher relative risk than lettuce, corncob, spinach, alfalfa juice, and broccoli. Many F. hepatica-infected children were coinfected by other parasites. Entamoeba histolytica/dispar, Giardia intestinalis, Blastocystis hominis, Hymenolepis nana and Ascaris lumbricoides infection resulted in risk factors for F. hepatica infection. Nitazoxanide efficacy against fascioliasis was 94.0% and 100% after first and second treatment courses, respectively. The few children, for whom a second treatment course was needed, were concomitantly infected by moderate ascariasis burdens. Its efficacy was also very high in the treatment of E. histolytica/E. dispar, G. intestinalis, B. hominis, H. nana, A. lumbricoides, Trichuris trichiura, and Enterobius vermicularis. A second treatment course was needed for all children affected by ancylostomatids. Conclusions Fascioliasis prevalences indicate this area to be mesoendemic, with isolated hyperendemic foci. This is the first time that a human fascioliasis endemic area is described in North America. Nitazoxanide appears as an appropriate

  19. Investigation of patient, tumour and treatment variables affecting residual motion for respiratory-gated radiotherapy

    NASA Astrophysics Data System (ADS)

    George, R.; Ramakrishnan, V.; Siebers, J. V.; Chung, T. D.; Keall, P. J.

    2006-10-01

    Respiratory gating can reduce the apparent respiratory motion during imaging and treatment; however, residual motion within the gating window remains. Respiratory training can improve respiratory reproducibility and, therefore, the efficacy of respiratory-gated radiotherapy. This study was conducted to determine whether residual motion during respiratory gating is affected by patient, tumour or treatment characteristics. The specific aims of this study were to: (1) identify significant characteristics affecting residual motion, (2) investigate time trends of residual motion over a period of days (inter-session) and (3) investigate time trends of residual motion within the same day (intra-session). Twenty-four lung cancer patients were enrolled in an Institutional Review Board (IRB)-approved protocol. For approximately five sessions, 331 four-minute, respiratory motion traces were acquired with free breathing, audio instructions and audio-visual biofeedback for each patient. The residual motion was quantified by the standard deviation of the displacement within the gating window. The generalized linear model was used to obtain coefficients for each variable within the model and to evaluate the clinical and statistical significance. The statistical significance was determined by a p-value <0.05, while effect sizes of >=0.1 cm (one standard deviation) were considered clinically significant. This data analysis was applied to patient, tumour and treatment variables. Inter- and intra-session variations were also investigated. The only variable that was significant for both inhale- and exhale-based gating was disease type. In addition, visual-training displacement, breathing type and Karnofsky performance status (KPS) values were significant for inhale-based gating, and dose-per-fraction was significant for exhale-based gating. Temporal respiratory variations within and between sessions were observed for individual patients. However inter- and intra-session analyses did

  20. Factors affecting treatment efficacy in social phobia: the use of video feedback and individual vs. group formats.

    PubMed

    Aderka, Idan M

    2009-01-01

    This meta-analysis assessed two potential moderators of treatment efficacy in social phobia: video feedback, and treatment format (i.e., individual vs. group). Eighteen recent (2000-2006) trials including a total of 511 participants were sampled. Effect sizes (Cohen's d's) were calculated for each trial while correcting for measurement error. The Q statistic was used to test (a) heterogeneity across trials and (b) potential moderators. Results indicated that use of video feedback was not a moderator of treatment efficacy and did not significantly affect effect sizes. In contrast, treatment format was a moderator of treatment efficacy such that individual treatments reported larger effect sizes and lower attrition rates compared with group treatments. The results suggest that individual treatments in social phobia may be superior to group treatments irrespective of treatment type. PMID:18599263

  1. Effects of Viewing an Evidence-Based Video Decision Aid on Patients’ Treatment Preferences for Spine Surgery

    PubMed Central

    Lurie, Jon D.; Spratt, Kevin F.; Blood, Emily A.; Tosteson, Tor D.; Tosteson, Anna N. A.; Weinstein, James N.

    2011-01-01

    Study Design Secondary analysis within a large clinical trial Objective To evaluate the changes in treatment preference before and after watching a video decision aid as part of an informed consent process. Summary of Background Data A randomized trial with a similar decision aid in herniated disc patients had shown decreased rate of surgery in the video group, but the effect of the video on expressed preferences is not known. Methods Subjects enrolling in the Spine Patient Outcomes Research Trial (SPORT) with intervertebral disc herniation (IDH), spinal stenosis (SPS), or degenerative spondylolisthesis (DS) at thirteen multidisciplinary spine centers across the US were given an evidence-based videotape decision aid viewed prior to enrollment as part of informed consent. Results Of the 2505 patients, 86% (n=2151) watched the video and 14% (n=354) did not. Watchers shifted their preference more often than non-watchers(37.9% vs. 20.8%, p < 0.0001) and more often demonstrated a strengthened preference (26.2% vs. 11.1%, p < 0.0001). Among the 806 patients whose preference shifted after watching the video, 55% shifted toward surgery (p=0.003). Among the 617 who started with no preference, after the video 27% preferred non-operative care, 22% preferred surgery, and 51% remained uncertain. Conclusion After watching the evidence-based patient decision aid (video) used in SPORT, patients with specific lumbar spine disorders formed and/or strengthened their treatment preferences in a balanced way that did not appear biased toward or away from surgery. PMID:21358485

  2. Aging Prisoners' Treatment Selection: Does Prospect Theory Enhance Understanding of End-of-Life Medical Decisions?

    ERIC Educational Resources Information Center

    Phillips, Laura L.; Allen, Rebecca S.; Harris, Grant M.; Presnell, Andrew H.; DeCoster, Jamie; Cavanaugh, Ronald

    2011-01-01

    Purpose: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated…

  3. Myo-Inositol in the Treatment of Teenagers Affected by PCOS

    PubMed Central

    Barbakadze, Ludmila; Kvashilava, Nana

    2016-01-01

    Objective. To compare the effectiveness of myo-inositol (MI) and oral contraceptive pills (OCPs) in monotherapy and MI in combination with OCPs in the treatment of teenagers affected by polycystic ovary syndrome (PCOS). Methods. 61 adolescent girls aged 13–19 years, with PCOS, were involved in the prospective, open-label study. Patients were randomized into three groups: I group, 20 patients receiving drospirenone 3 mg/ethinyl estradiol 30 μg; II group, 20 patients receiving 4 g myo-inositol plus 400 mg folic acid; III group, 21 patients receiving both medications. Results. After receiving MI significant reduction in weight, BMI, glucose, C-peptide, insulin, HOMA-IR, FT, and LH was detected. The levels of SHBG, TT, FAI, DHEA-S, and AMH did not change statistically significantly. After receiving OCPs weight and BMI slightly increased, but metabolic parameters did not change. Combination of MI and OCPs did not change weight and BMI, but reduction in C-peptide, insulin, and HOMA-IR was detected. TT, FT, FAI, DHEA-S, LH, and AMH levels decreased and SHBG increased. Conclusions. Administration of MI is a safe and effective method to prevent and correct metabolic disorders in teenagers affected by PCOS. With combination of MI and OCPs antiandrogenic effects are enhanced, negative impact of OCPs on weight gain is balanced, and metabolic profile is improved.

  4. Treatment of human-computer interface in a decision support system

    SciTech Connect

    Heger, A.S.; Duran, F.A.; Frysinger, S.; Cox, R.G.

    1992-11-01

    One of the most challenging applications facing the computer community is development of effective adaptive human-computer interface. This challenge stems from the complex nature of the human part of this symbiosis. The application of this discipline to the environmental restoration and waste management is further complicated due to the nature of environmental data. The information that is required to manage environmental impacts of human activity is fundamentally complex. This paper will discuss the efforts at Sandia National Laboratories in developing the adaptive conceptual model manager within the constraint of the environmental decision-making. A computer workstation, that hosts the Conceptual Model Manager and the Sandia Environmental Decision Support System will also be discussed.

  5. Aggressive experience affects the sensitivity of neurons towards pharmacological treatment in the hypothalamic attack area.

    PubMed

    Haller, J; Abrahám, I; Zelena, D; Juhász, G; Makara, G B; Kruk, M R

    1998-09-01

    Early investigators of brain stimulation-evoked complex behaviours (attack, escape, feeding, self-grooming, sexual behaviour) reported that experience may affect the behavioural outcome of brain stimulation. This intriguing example of functional neuronal plasticity was later totally neglected. The present experiment investigated the behavioural outcome of in vivo microdialysis perfusion of the glutamate agonist kainate and/or the GABAA antagonist bicuculline into the hypothalamic attack area (HAA) of (1) animals naive to dyadic encounters; (2) animals with a recent aggressive experience (the probe being implanted 6-24 h after the last of a series of dyadic encounters); and (3) animals with an earlier aggressive experience (probe being implanted 2 weeks after the last aggressive experience). On the experimental day, rats received two 5-min infusions during a dyadic encounter lasting 35 min with an unknown opponent. Flow rate was 1.5-2 microliters/min, drug concentrations were 1.8 x 10(-5) and 1.5 x 10(-5) M for kainate and bicuculline, respectively. Behaviour was analysed before, during and after perfusions. Only the combined kainate + bicuculline treatment had significant effects on behaviour at the doses studied. A significant increase in aggressive behaviour was elicited only in animals with a recent aggressive experience, while naive animals and with an earlier experience responded to the treatments by grooming. These results appear to support early observations indicating that one important aspect of brain stimulation effects is previous experience. PMID:9832932

  6. Chronic fatigue syndrome and seasonal affective disorder: comorbidity, diagnostic overlap, and implications for treatment.

    PubMed

    Terman, M; Levine, S M; Terman, J S; Doherty, S

    1998-09-28

    This study aimed to determine symptom patterns in patients with chronic fatigue syndrome (CFS), in summer and winter. Comparison data for patients with seasonal affective disorder (SAD) were used to evaluate seasonal variation in mood and behavior, atypical neurovegetative symptoms characteristic of SAD, and somatic symptoms characteristic of CFS. Rating scale questionnaires were mailed to patients previously diagnosed with CFS. Instruments included the Personal Inventory for Depression and SAD (PIDS) and the Systematic Assessment for Treatment Emergent Effects (SAFTEE), which catalogs the current severity of a wide range of somatic, behavioral, and affective symptoms. Data sets from 110 CFS patients matched across seasons were entered into the analysis. Symptoms that conform with the Centers for Disease Control and Prevention (CDC) case definition of CFS were rated as moderate to very severe during the winter months by varying proportions of patients (from 43% for lymph node pain or enlargement, to 79% for muscle, joint, or bone pain). Fatigue was reported by 92%. Prominent affective symptoms included irritability (55%), depressed mood (52%), and anxiety (51%). Retrospective monthly ratings of mood, social activity, energy, sleep duration, amount eaten, and weight change showed a coherent pattern of winter worsening. Of patients with consistent summer and winter ratings (n = 73), 37% showed high global seasonality scores (GSS) > or = 10. About half this group reported symptoms indicative of major depressive disorder, which was strongly associated with high seasonality. Hierarchical cluster analysis of wintertime symptoms revealed 2 distinct clinical profiles among CFS patients: (a) those with high seasonality, for whom depressed mood clustered with atypical neurovegetative symptoms of hypersomnia and hyperphagia, as is seen in SAD; and (b) those with low seasonality, who showed a primary clustering of classic CFS symptoms (fatigue, aches, cognitive disturbance

  7. Wastewater treatment in tsunami affected areas of Thailand by constructed wetlands.

    PubMed

    Brix, H; Koottatep, T; Laugesen, C H

    2007-01-01

    The tsunami of December 2004 destroyed infrastructure in many coastal areas in South-East Asia. In January 2005, the Danish Government gave a tsunami relief grant to Thailand to re-establish the wastewater management services in some of the areas affected by the tsunami. This paper describes the systems which have been built at three locations: (a) Baan Pru Teau: A newly-built township for tsunami victims which was constructed with the contribution of the Thai Red Cross. Conventional septic tanks were installed for the treatment of blackwater from each household and its effluent and grey water (40 m3/day) are collected and treated at a 220 m2 subsurface flow constructed wetland. (b) Koh Phi Phi Don island: A wastewater collection system for the main business and hotel area of the island, a pumping station and a pressure pipe to the treatment facility, a multi-stage constructed wetland system and a system for reuse of treated wastewater. The constructed wetland system (capacity 400 m3/day) consists of vertical flow, horizontal subsurface flow, free water surface flow and pond units. Because the treatment plant is surrounded by resorts, restaurants and shops, the constructed wetland systems are designed with terrains as scenic landscaping. (c) Patong: A 5,000 m2 constructed wetland system has been established to treat polluted water from drainage canals which collect overflow from septic tanks and grey water from residential areas. It is envisaged that these three systems will serve as prototype demonstration systems for appropriate wastewater management in Thailand and other tropical countries. PMID:17802840

  8. Factors Affecting Distribution of Estrogenicity in the Influents, Effluents, and Biosolids of Canadian Wastewater Treatment Plants.

    PubMed

    Shieh, Ben H H; Louie, Alvin; Law, Francis C P

    2016-05-01

    Canadian wastewater treatment plants (WWTPs) release significant amounts of estrogenic chemicals to nearby surface waters. Environmental estrogens have been implicated as the causative agents of many developmental and reproductive problems in animals, including fish. The goals of this study were to assess the estrogenic activity in the influents, effluents, and biosolids of thirteen Canadian WWTPs using the yeast estrogen screen (YES) bioassay and to investigate whether factors, such as wastewater treatment method, sample storage, extraction efficiency, population, and summer/winter temperature had any effects on the distribution of estrogenicity in the WWTPs. Results of the study showed that estrogenicity from the influent to the effluent decreased in seven WWTPs, increased in two WWTPs, and did not change in four WWTPs during the winter. Estrogenic concentrations generally decreased in the order of biosolids > influents > effluents and ranged from 1.57 to 24.6, 1.25E-02 to 3.84E-01, and 9.46E-03 to 3.90E-01 ng estradiol equivalents/g or ml, respectively. The estrogenicity in the final effluents, but not those in the influents and biosolids, was significantly higher in the summer than the winter. Among the WWTP treatment methods, advanced, biological nutrient removal appeared to be the most effective method to remove estrogenic chemicals from wastewaters in Canada. Our studies help to identify factors or mechanisms that affect the distribution of estrogenicity in WWTPs, providing a better understanding on the discharges of estrogenic chemicals from WWTPs. PMID:26433808

  9. Developing a model based decision support tool for the identification of sustainable treatment options for domestic wastewater.

    PubMed

    Balkema, A J; Preisig, H A; Otterpohl, R; Lambert, A J; Weijers, S R

    2001-01-01

    To enable decision makers to select sustainable wastewater treatment systems, insight into the sustainability of a wide variety of systems should be provided in a transparent way leaving room for adaptation and interpretation according to the local situation. To provide this insight a structured methodology comparing wastewater treatment systems with respect to sustainability is defined. Similar to life cycle assessment (LCA) three phases can be distinguished: (1) goal and scope definition, (2) inventory analysis, and (3) optimisation and results. In the goal and scope definition we set the system boundaries to include most of the water cycle and part of the food cycle. Furthermore, we defined a multi-disciplinary set of sustainability indicators including technical, economic, environmental, and socio-cultural aspects. In the inventory analysis these sustainability indicators are quantified using simple static models of wastewater unit operations. Selection of unit operations results in a model of a complete wastewater treatment system. In the optimisation phase the decision maker can weigh the different sustainability indicators and select sustainable options through integer programming. PMID:11385856

  10. Decisions at the Brink: Locomotor Experience Affects Infants’ Use of Social Information on an Adjustable Drop-off

    PubMed Central

    Karasik, Lana B.; Tamis-LeMonda, Catherine S.; Adolph, Karen E.

    2016-01-01

    How do infants decide what to do at the brink of a precipice? Infants could use two sources of information to guide their actions: perceptual information generated by their own exploratory activity and social information offered by their caregivers. The current study investigated the role of locomotor experience in using social information—both encouragement and discouragement—for descending drop-offs. Mothers of 30 infants (experienced 12-month-old crawlers, novice 12-month-old walkers, and experienced 18-month-old walkers) encouraged and discouraged descent on a gradation of drop-offs (safe “steps” and risky “cliffs”). Novice walkers descended more frequently than experienced crawlers and walkers and fell while attempting to walk over impossibly high cliffs. All infants showed evidence of integrating perceptual and social information, but locomotor experience affected infants’ use of social messages, especially on risky drop-offs. Experienced crawlers and walkers selectively deferred to social information when perceptual information is ambiguous. In contrast, novice walkers took mothers’ advice inconsistently and only at extreme drop-offs. PMID:27375507

  11. She Left, He Left: How Employment and Satisfaction Affect Men’s and Women’s Decisions to Leave Marriages

    PubMed Central

    Sayer, Liana C.; England, Paula; Allison, Paul; Kangas, Nicole

    2012-01-01

    Most past studies examining determinants of divorce have ignored differences between the factors that elevate wives’ and husbands’ initiation of divorce. We use three waves of the National Survey of Families and Households and a latent class model embedded in a competing-risks event history model to assess distinct predictors of wives and husbands leaving marriages. We assess who left using each ex-spouse’s answer to a question that asked who had wanted the breakup more. We find that when men are not employed, either husbands or wives are more likely to leave. When wives report better than average marital satisfaction, their employment affects neither their nor their husbands’ exits. However, when wives report below average marital satisfaction, their employment makes it more likely that they will leave. We compare findings to predictions from two theories: an institutional perspective that sees divorce to result from a violation of gender-specific norms, and exchange/bargaining theory, which posits that resources allow a spouse to leave if exchange and bargaining fail to provide a satisfactory marriage. To amend the theories to better fit the data, we foreground the asymmetric nature of gender change in recent decades, with women changing more than men. PMID:21932472

  12. The perception of attractiveness and trustworthiness in male faces affects hypothetical voting decisions differently in wartime and peacetime scenarios.

    PubMed

    Little, Anthony C; Roberts, S Craig; Jones, Benedict C; Debruine, Lisa M

    2012-01-01

    Facial appearance of candidates has been linked to real election outcomes. Here we extend these findings by examining the contributions of attractiveness and trustworthiness in male faces to perceived votability. We first use real faces to show that attractiveness and trustworthiness are positively and independently related to perceptions of good leadership (rating study). We then show that computer graphic manipulations of attractiveness and trustworthiness influence choice of leader (experiments 1 and 2). Finally, we show that changing context from wartime to peacetime can affect which face receives the most votes. Attractive faces were relatively more valued for wartime and trustworthy faces relatively more valued for peacetime (experiments 1 and 2). This pattern suggests that attractiveness, which may indicate health and fitness, is perceived to be a useful attribute in wartime leaders, whereas trustworthiness, which may indicate prosocial traits, is perceived to be more important during peacetime. Our studies highlight the possible role of facial appearance in voting behaviour and the role of attributions of attractiveness and trust. We also show that there may be no general characteristics of faces that make them perceived as the best choice of leader; leaders may be chosen because of characteristics that are perceived as the best for leaders to possess in particular situations. PMID:22650610

  13. MORTALITY DURING TREATMENT: FACTORS AFFECTING THE SURVIVAL OF OILED, REHABILITATED COMMON MURRES (URIA AALGE).

    PubMed

    Duerr, Rebecca S; Ziccardi, Michael H; Massey, J Gregory

    2016-07-01

    After major oil spills, hundreds to thousands of live stranded birds enter rehabilitative care. To target aspects of rehabilitative efforts for improvement and to evaluate which initial physical examination and biomedical parameters most effectively predict survival to release, medical records were examined from 913 Common Murres ( Uria aalge ; COMUs) oiled during the November 2001-January 2003 oil spill associated with the sunken S.S. Jacob Luckenbach off San Francisco, California, US. Results showed that 52% of all deaths occurred during the first 2 days of treatment. Birds stranding closest to the wreck had greater amounts of oil on their bodies than birds stranding farther away. More heavily oiled birds were in better clinical condition than birds with lesser amounts of oil, as shown by higher body mass (BM), packed cell volumes (PCV), total plasma protein (TP), and higher survival proportions. Additionally, BM, PCV, TP, and body temperature were positively correlated. For comparison, medical records from all nonoiled COMUs admitted for rehabilitation at the same facility during 2007-09 (n=468) were examined, and these variables were also found to be positively correlated. Oiled birds with BM under 750 g had approximately 5% lower PCV than BM-matched nonoiled COMUs. More heavily oiled COMUs may be in better condition than less oiled birds because heavily oiled birds must beach themselves immediately to avoid drowning and hypothermia, whereas lightly oiled birds may postpone beaching until exhausted due to extreme body catabolism. The strong relationship of PCV to BM regardless of oiling provides evidence that anemia commonly encountered in oiled seabirds may be a sequela to overall loss of body condition rather than solely due to toxic effects of oiling. Clinical information garnered in this study provides guidance for triage decisions during oil spills. PMID:27187030

  14. Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th grade Chinese adolescent binge drinkers.

    PubMed

    Johnson, C Anderson; Xiao, Lin; Palmer, Paula; Sun, Ping; Wang, Qiong; Wei, Yonglan; Jia, Yong; Grenard, Jerry L; Stacy, Alan W; Bechara, Antoine

    2008-01-31

    The primary aim of this study was to test the hypothesis that adolescent binge drinkers, but not lighter drinkers, would show signs of impairment on tasks of affective decision-making as measured by the Iowa Gambling Test (IGT), when compared to adolescents who never drank. We tested 207 10th grade adolescents in Chengdu City, China, using two versions of the IGT, the original and a variant, in which the reward/punishment contingencies were reversed. This enables one to distinguish among different possibilities of impaired decision-making, such as insensitivity to long-term consequences, or hypersensitivity to reward. Furthermore, we tested working memory capacity using the Self-ordered Pointing Test (SOPT). Paper and pencil questionnaires were used to assess drinking behaviors and school academic performance. Results indicated that relative to never-drinkers, adolescent binge drinkers, but not other (ever, past 30-day) drinkers, showed significantly lower net scores on the original version of the IGT especially in the latter trials. Furthermore, the profiles of behavioral performance from the original and variant versions of the IGT were consistent with a decision-making impairment attributed to hypersensitivity to reward. In addition, working memory and school academic performance revealed no differences between drinkers (at all levels) and never-drinkers. Logistic regression analysis showed that after controlling for demographic variables, working memory, and school academic performance, the IGT significantly predicted binge-drinking. These findings suggest that a "myopia" for future consequences linked to hypersensitivity to reward is a key characteristic of adolescents with binge-drinking behavior, and that underlying neural mechanisms for this "myopia" for future consequences may serve as a predisposing factor that renders some adolescents more susceptible to future addictive behaviors. PMID:17996909

  15. Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems?

    PubMed

    Garland, Ann F; Taylor, Robin; Brookman-Frazee, Lauren; Baker-Ericzen, Mary; Haine-Schlagel, Rachel; Liu, Yi Hui; Wong, Sarina

    2015-06-01

    Race/ethnic disparities in utilization of children's mental health care have been well documented and are particularly concerning given the long-term risks of untreated mental health problems (Institute of Medicine, 2003; Kessler et al. Am J Psychiatry 152:10026-1032, 1995). Research investigating the higher rates of unmet need among race/ethnic minority youths has focused primarily on policy, fiscal, and individual child or family factors that can influence service access and use. Alternatively, this study examines provider behavior as a potential influence on race/ethnic disparities in mental health care. The goal of the study was to examine whether patient (family) race/ethnicity influences physician diagnostic and treatment decision-making for childhood disruptive behavior problems. The study utilized an internet-based video vignette with corresponding survey of 371 randomly selected physicians from across the USA representing specialties likely to treat these patients (pediatricians, family physicians, general and child psychiatrists). Participants viewed a video vignette in which only race/ethnicity of the mother randomly varied (non-Hispanic White, Hispanic, and African American) and then responded to questions about diagnosis and recommended treatments. Physicians assigned diagnoses such as oppositional defiant disorder (48 %) and attention deficit disorder (63 %) to the child, but there were no differences in diagnosis based on race/ethnicity. The majority of respondents recommended psychosocial treatment (98 %) and/or psychoactive medication treatment (60 %), but there were no significant differences based on race/ethnicity. Thus, in this study using mock patient stimuli and controlling for other factors, such as insurance coverage, we did not find major differences in physician diagnostic or treatment decision-making based on patient race/ethnicity. PMID:26863339

  16. Chronic Treatment with Ivabradine Does Not Affect Cardiovascular Autonomic Control in Rats.

    PubMed

    Silva, Fernanda C; Paiva, Franciny A; Müller-Ribeiro, Flávia C; Caldeira, Henrique M A; Fontes, Marco A P; de Menezes, Rodrigo C A; Casali, Karina R; Fortes, Gláucia H; Tobaldini, Eleonora; Solbiati, Monica; Montano, Nicola; Dias Da Silva, Valdo J; Chianca, Deoclécio A

    2016-01-01

    A low resting heart rate (HR) would be of great benefit in cardiovascular diseases. Ivabradine-a novel selective inhibitor of hyperpolarization-activated cyclic nucleotide gated (HCN) channels- has emerged as a promising HR lowering drug. Its effects on the autonomic HR control are little known. This study assessed the effects of chronic treatment with ivabradine on the modulatory, reflex and tonic cardiovascular autonomic control and on the renal sympathetic nerve activity (RSNA). Male Wistar rats were divided in 2 groups, receiving intraperitoneal injections of vehicle (VEH) or ivabradine (IVA) during 7 or 8 consecutive days. Rats were submitted to vessels cannulation to perform arterial blood pressure (AP) and HR recordings in freely moving rats. Time series of resting pulse interval and systolic AP were used to measure cardiovascular variability parameters. We also assessed the baroreflex, chemoreflex and the Bezold-Jarish reflex sensitivities. To better evaluate the effects of ivabradine on the autonomic control of the heart, we performed sympathetic and vagal autonomic blockade. As expected, ivabradine-treated rats showed a lower resting (VEH: 362 ± 16 bpm vs. IVA: 260 ± 14 bpm, p = 0.0005) and intrinsic HR (VEH: 369 ± 9 bpm vs. IVA: 326 ± 11 bpm, p = 0.0146). However, the chronic treatment with ivabradine did not change normalized HR spectral parameters LF (nu) (VEH: 24.2 ± 4.6 vs. IVA: 29.8 ± 6.4; p > 0.05); HF (nu) (VEH: 75.1 ± 3.7 vs. IVA: 69.2 ± 5.8; p > 0.05), any cardiovascular reflexes, neither the tonic autonomic control of the HR (tonic sympathovagal index; VEH: 0.91± 0.02 vs. IVA: 0.88 ± 0.03, p = 0.3494). We performed the AP, HR and RSNA recordings in urethane-anesthetized rats. The chronic treatment with ivabradine reduced the resting HR (VEH: 364 ± 12 bpm vs. IVA: 207 ± 11 bpm, p < 0.0001), without affecting RSNA (VEH: 117 ± 16 vs. IVA: 120 ± 9 spikes/s, p = 0.9100) and mean arterial pressure (VEH: 70 ± 4 vs. IVA: 77 ± 6 mmHg, p

  17. Chronic Treatment with Ivabradine Does Not Affect Cardiovascular Autonomic Control in Rats

    PubMed Central

    Silva, Fernanda C.; Paiva, Franciny A.; Müller-Ribeiro, Flávia C.; Caldeira, Henrique M. A.; Fontes, Marco A. P.; de Menezes, Rodrigo C. A.; Casali, Karina R.; Fortes, Gláucia H.; Tobaldini, Eleonora; Solbiati, Monica; Montano, Nicola; Dias Da Silva, Valdo J.; Chianca, Deoclécio A.

    2016-01-01

    A low resting heart rate (HR) would be of great benefit in cardiovascular diseases. Ivabradine—a novel selective inhibitor of hyperpolarization-activated cyclic nucleotide gated (HCN) channels- has emerged as a promising HR lowering drug. Its effects on the autonomic HR control are little known. This study assessed the effects of chronic treatment with ivabradine on the modulatory, reflex and tonic cardiovascular autonomic control and on the renal sympathetic nerve activity (RSNA). Male Wistar rats were divided in 2 groups, receiving intraperitoneal injections of vehicle (VEH) or ivabradine (IVA) during 7 or 8 consecutive days. Rats were submitted to vessels cannulation to perform arterial blood pressure (AP) and HR recordings in freely moving rats. Time series of resting pulse interval and systolic AP were used to measure cardiovascular variability parameters. We also assessed the baroreflex, chemoreflex and the Bezold-Jarish reflex sensitivities. To better evaluate the effects of ivabradine on the autonomic control of the heart, we performed sympathetic and vagal autonomic blockade. As expected, ivabradine-treated rats showed a lower resting (VEH: 362 ± 16 bpm vs. IVA: 260 ± 14 bpm, p = 0.0005) and intrinsic HR (VEH: 369 ± 9 bpm vs. IVA: 326 ± 11 bpm, p = 0.0146). However, the chronic treatment with ivabradine did not change normalized HR spectral parameters LF (nu) (VEH: 24.2 ± 4.6 vs. IVA: 29.8 ± 6.4; p > 0.05); HF (nu) (VEH: 75.1 ± 3.7 vs. IVA: 69.2 ± 5.8; p > 0.05), any cardiovascular reflexes, neither the tonic autonomic control of the HR (tonic sympathovagal index; VEH: 0.91± 0.02 vs. IVA: 0.88 ± 0.03, p = 0.3494). We performed the AP, HR and RSNA recordings in urethane-anesthetized rats. The chronic treatment with ivabradine reduced the resting HR (VEH: 364 ± 12 bpm vs. IVA: 207 ± 11 bpm, p < 0.0001), without affecting RSNA (VEH: 117 ± 16 vs. IVA: 120 ± 9 spikes/s, p = 0.9100) and mean arterial pressure (VEH: 70 ± 4 vs. IVA: 77 ± 6 mm

  18. Treatment of uncertainties associated with PRAs in risk-informed decision making (NUREG1855).

    SciTech Connect

    Wheeler, Timothy A.

    2010-06-01

    This document provides guidance on how to treat uncertainties associated with probabilistic risk assessment (PRA) in risk-informed decisionmaking. The objectives of this guidance include fostering an understanding of the uncertainties associated with PRA and their impact on the results of PRA and providing a pragmatic approach to addressing these uncertainties in the context of the decisionmaking. In implementing risk-informed decisionmaking, the U.S. Nuclear Regulatory Commission expects that appropriate consideration of uncertainty will be given in the analyses used to support the decision and in the interpretation of the findings of those analyses. To meet the objective of this document, it is necessary to understand the role that PRA results play in the context of the decision process. To define this context, this document provides an overview of the risk-informed decisionmaking process itself. With the context defined, this document describes the characteristics of a risk model and, in particular, a PRA. This description includes recognition that a PRA, being a probabilistic model, characterizes aleatory uncertainty that results from randomness associated with the events of the model. Because the focus of this document is epistemic uncertainty (i.e., uncertainties in the formulation of the PRA model), it provides guidance on identifying and describing the different types of sources of epistemic uncertainty and the different ways that they are treated. The different types of epistemic uncertainty are parameter, model, and completeness uncertainties. The final part of the guidance addresses the uncertainty in PRA results in the context of riskinformed decisionmaking and, in particular, the interpretation of the results of the uncertainty analysis when comparing PRA results with the acceptance criteria established for a specified application. In addition, guidance is provided for addressing completeness uncertainty in risk-informed decision making. Such

  19. Attitudes towards informed consent, confidentiality, and substitute treatment decisions in southern African medical students: a case study from Zimbabwe.

    PubMed

    Hipshman, L

    1999-08-01

    This study explored the attitudes of biomedical science students (medical students) in a non-Western setting towards three medical ethics concepts that are based on fundamental Western culture ethical principles. A dichotomous (agree/disagree) response questionnaire was constructed using Western ethnocentric culture (WEC) based perspectives of informed consent, confidentiality, and substitute decision-making. Hypothesized WEC-Biased responses were assigned to the questionnaire's questions or propositions. A number of useful responses (169) were obtained from a large, cross-sectional, convenience sample of the MBChB students at the University of Zimbabwe Medical School. Statistical analysis described the differences in response patterns between the student's responses compared to the hypothesized WEC-Biased response. The effect of the nine independent variables on selected dependent variables (responses to certain questionnaire questions) was analyzed by stepwise logistic regression. Students concurred with the hypothesized WEC-Biased responses for two-thirds of the questionnaire items. This agreement included support for the role of legal advocacy in the substitute decision-making process. The students disagreed with the hypothesized WEC-Biased responses in several important medical ethics aspects. Most notably, the students indicated that persons with mental dysfunctions, as a class, were properly considered incompetent to make treatment decisions. None of the studied independent variables was often associated with students' responses, but training year was more frequently implicated than either ethnicity or gender. In order to develop internationally and culturally relevant medical ethics standards, non-Western perspectives ought to be acknowledged and incorporated. Two main areas for further efforts include: curriculum development in ethics reasoning and related clinical (medico-legal) decision-making processes that would be relevant to medical students from

  20. Exposure to hot and cold environmental conditions does not affect the decision making ability of soccer referees following an intermittent sprint protocol

    PubMed Central

    Taylor, Lee; Fitch, Natalie; Castle, Paul; Watkins, Samuel; Aldous, Jeffrey; Sculthorpe, Nicholas; Midgely, Adrian; Brewer, John; Mauger, Alexis

    2014-01-01

    Soccer referees enforce the laws of the game and the decisions they make can directly affect match results. Fixtures within European competitions take place in climatic conditions that are often challenging (e.g., Moscow ~ −5°C, Madrid ~30°C). Effects of these temperatures on player performance are well-documented; however, little is known how this environmental stress may impair cognitive performance of soccer referees and if so, whether exercise exasperates this. The present study aims to investigate the effect of cold [COLD; −5°C, 40% relative humidity (RH)], hot (HOT; 30°C, 40% RH) and temperate (CONT; 18°C, 40% RH) conditions on decision making during soccer specific exercise. On separate occasions within each condition, 13 physically active males; either semi-professional referees or semi-professional soccer players completed three 90 min intermittent treadmill protocols that simulated match play, interspersed with 4 computer delivered cognitive tests to measure vigilance and dual task capacity. Core and skin temperature, heart rate, rating of perceived exertion (RPE) and thermal sensation (TS) were recorded throughout the protocol. There was no significant difference between conditions for decision making in either the dual task (interaction effects: FALSE p = 0.46; MISSED p = 0.72; TRACKING p = 0.22) or vigilance assessments (interaction effects: FALSE p = 0.31; HIT p = 0.15; MISSED p = 0.17) despite significant differences in measured physiological variables (skin temperature: HOT vs. CONT 95% CI = 2.6 to 3.9, p < 0.001; HOT vs. COLD 95% CI = 6.6 to 9.0, p < 0.001; CONT vs. COLD 95% CI = 3.4 to 5.7, p < 0.01). It is hypothesized that the lack of difference observed in decision making ability between conditions was due to the exercise protocol used, as it may not have elicited an appropriate and valid soccer specific internal load to alter cognitive functioning. PMID:24904425

  1. Exposure to hot and cold environmental conditions does not affect the decision making ability of soccer referees following an intermittent sprint protocol.

    PubMed

    Taylor, Lee; Fitch, Natalie; Castle, Paul; Watkins, Samuel; Aldous, Jeffrey; Sculthorpe, Nicholas; Midgely, Adrian; Brewer, John; Mauger, Alexis

    2014-01-01

    Soccer referees enforce the laws of the game and the decisions they make can directly affect match results. Fixtures within European competitions take place in climatic conditions that are often challenging (e.g., Moscow ~ -5°C, Madrid ~30°C). Effects of these temperatures on player performance are well-documented; however, little is known how this environmental stress may impair cognitive performance of soccer referees and if so, whether exercise exasperates this. The present study aims to investigate the effect of cold [COLD; -5°C, 40% relative humidity (RH)], hot (HOT; 30°C, 40% RH) and temperate (CONT; 18°C, 40% RH) conditions on decision making during soccer specific exercise. On separate occasions within each condition, 13 physically active males; either semi-professional referees or semi-professional soccer players completed three 90 min intermittent treadmill protocols that simulated match play, interspersed with 4 computer delivered cognitive tests to measure vigilance and dual task capacity. Core and skin temperature, heart rate, rating of perceived exertion (RPE) and thermal sensation (TS) were recorded throughout the protocol. There was no significant difference between conditions for decision making in either the dual task (interaction effects: FALSE p = 0.46; MISSED p = 0.72; TRACKING p = 0.22) or vigilance assessments (interaction effects: FALSE p = 0.31; HIT p = 0.15; MISSED p = 0.17) despite significant differences in measured physiological variables (skin temperature: HOT vs. CONT 95% CI = 2.6 to 3.9, p < 0.001; HOT vs. COLD 95% CI = 6.6 to 9.0, p < 0.001; CONT vs. COLD 95% CI = 3.4 to 5.7, p < 0.01). It is hypothesized that the lack of difference observed in decision making ability between conditions was due to the exercise protocol used, as it may not have elicited an appropriate and valid soccer specific internal load to alter cognitive functioning. PMID:24904425

  2. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions.

    PubMed

    Johns, Claire; Seav, Susan M; Dominick, Sally A; Gorman, Jessica R; Li, Hongying; Natarajan, Loki; Mao, Jun James; Su, H Irene

    2016-04-01

    Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions. PMID:27015968

  3. Comparison of Cone-Beam Computed Tomography and Periapical Radiography in Predicting Treatment Decision for Periapical Lesions: A Clinical Study

    PubMed Central

    Balasundaram, Ashok; Shah, Punit; Hoen, Michael M.; Wheater, Michelle A.; Bringas, Josef S.; Gartner, Arnold; Geist, James R.

    2012-01-01

    Objectives. To compare the ability of endodontists to determine the size of apical pathological lesions and select the most appropriate choice of treatment based on lesions' projected image characteristics using 2 D and 3 D images. Study Design. Twenty-four subjects were selected. Radiographic examination of symptomatic study teeth with an intraoral periapical radiograph revealed periapical lesions equal to or greater than 3 mm in the greatest diameter. Cone-beam Computed tomography (CBCT) images were made of the involved teeth after the intraoral periapical radiograph confirmed the size of lesion to be equal to greater than 3 mm. Six observers (endodontists) viewed both the periapical and CBCT images. Upon viewing each of the images from the two imaging modalities, observers (1) measured lesion size and (2) made decisions on treatment based on each radiograph. Chi-square test was used to look for differences in the choice of treatment among observers. Results. No significant difference was noted in the treatment plan selected by observers using the two modalities (χ2(3) = .036, P > 0.05). Conclusion. Lesion size and choice of treatment of periapical lesions based on CBCT radiographs do not change significantly from those made on the basis of 2 D radiographs. PMID:23056050

  4. Income received during treatment does not affect response to contingency management treatments in cocaine-dependent outpatients

    PubMed Central

    Andrade, Leonardo F.; Petry, Nancy M.

    2013-01-01

    Background Prior studies find no effect of baseline income on response to contingency management (CM) interventions. However, income among substance disordered patients is variable, particularly at treatment entry. This study investigated the impact of during-treatment income, a more proximal estimate of economic resources at the time that CM is in effect, on response to standard treatment or the standard treatment plus CM. Method These secondary analyses included 418 cocaine dependent participants initiating community intensive outpatient treatment. We examined whether differences were present in pretreatment and during-treatment overall income, as well as specific income sources. We then conducted a series of regression models to investigate the impact of during-treatment income on treatment outcome. Results Participants’ during-treatment income was significantly lower compared to pretreatment income, and this difference was largely attributable to decreases in earned income, illegal income, and support from friends and family. Neither the main effect of income, nor the interaction of income and treatment condition, was significantly associated with treatment outcome. CM, however, was a significant predictor of improved treatment outcome relative to standard treatment. Income sources and some demographic characteristics were also significant predictors of outcomes; public assistance income was associated with improved outcomes and illegal income was associated with poorer outcomes. Conclusions These results suggest that substance abusers benefit from CM regardless of their income level, and these data add to the growing literature supporting the generalizability of CM across a variety of patient characteristics. PMID:23631869

  5. Are more endodontic consultations needed in dental school clinic settings? A study of treatment decisions at one school.

    PubMed

    Aminoshariae, Anita; Tulunoglu, Ibrahim; Demko, Catherine; Galsterer, Mark; Montagnese, Thomas A; Mickel, Andre

    2015-04-01

    With no previous studies of the occurrence of interdisciplinary consultations for tooth extraction in a dental school clinic setting, the aim of this cross-sectional descriptive investigation was to measure and compare the consultation process that occurred among departments at one U.S. dental school for making treatment decisions on tooth extraction. A comprehensive computerized retrieval (Crystal Reports) was used to identify and gather data from patient records from July 1, 2007, to July 1, 2011. Treatment plans and progress notes were analyzed to determine why each tooth had been extracted and which department had recommended the extraction. Results showed that the clinical departments involved in treatment planning decisions were the DMD dental student clinic, Department of Periodontics, and Department of Endodontics. The narrative records of 227 patients who had 516 teeth extracted were examined. About three-fourths (73.26%) of the extracted teeth were extracted based on the recommendation of only one department. Of these extracted teeth, 22.0% (n=114) were previously endodontically treated, and only four were recommended for endodontic consultation prior to extraction. The study found that most extractions were performed without specialty consultations and that the Department of Endodontics was consulted the least of all departments. To foster interdisciplinary collaboration in dental school clinics and help students develop expertise in such collaborations, more specialty consultations are needed for teeth that are treatment planned for extraction in order to preclude needless extraction of potentially salvageable teeth. Doing so will provide benefits for both patient care and students' education. PMID:25838010

  6. Decision support system for the optimal location of electrical and electronic waste treatment plants: A case study in Greece

    SciTech Connect

    Achillas, Ch.; Vlachokostas, Ch.; Moussiopoulos, N.; Banias, G.

    2010-05-15

    Environmentally sound end-of-life management of Electrical and Electronic Equipment has been realised as a top priority issue internationally, both due to the waste stream's continuously increasing quantities, as well as its content in valuable and also hazardous materials. In an effort to manage Waste Electrical and Electronic Equipment (WEEE), adequate infrastructure in treatment and recycling facilities is considered a prerequisite. A critical number of such plants are mandatory to be installed in order: (i) to accommodate legislative needs, (ii) decrease transportation cost, and (iii) expand reverse logistics network and cover more areas. However, WEEE recycling infrastructures require high expenditures and therefore the decision maker need to be most precautious. In this context, special care should be given on the viability of infrastructure which is heavily dependent on facilities' location. To this end, a methodology aiming towards optimal location of Units of Treatment and Recycling is developed, taking into consideration economical together with social criteria, in an effort to interlace local acceptance and financial viability. For the decision support system's needs, ELECTRE III is adopted as a multicriteria analysis technique. The methodology's applicability is demonstrated with a real-world case study in Greece.

  7. Industrial experience of process identification and set-point decision algorithm in a full-scale treatment plant.

    PubMed

    Yoo, Changkyoo; Kim, Min Han

    2009-06-01

    This paper presents industrial experience of process identification, monitoring, and control in a full-scale wastewater treatment plant. The objectives of this study were (1) to apply and compare different process-identification methods of proportional-integral-derivative (PID) autotuning for stable dissolved oxygen (DO) control, (2) to implement a process monitoring method that estimates the respiration rate simultaneously during the process-identification step, and (3) to propose a simple set-point decision algorithm for determining the appropriate set point of the DO controller for optimal operation of the aeration basin. The proposed method was evaluated in the industrial wastewater treatment facility of an iron- and steel-making plant. Among the process-identification methods, the control signal of the controller's set-point change was best for identifying low-frequency information and enhancing the robustness to low-frequency disturbances. Combined automatic control and set-point decision method reduced the total electricity consumption by 5% and the electricity cost by 15% compared to the fixed gain PID controller, when considering only the surface aerators. Moreover, as a result of improved control performance, the fluctuation of effluent quality decreased and overall effluent water quality was better. PMID:19428173

  8. Decision support system for the optimal location of electrical and electronic waste treatment plants: a case study in greece.

    PubMed

    Achillas, Ch; Vlachokostas, Ch; Moussiopoulos, Nu; Banias, G

    2010-05-01

    Environmentally sound end-of-life management of Electrical and Electronic Equipment has been realised as a top priority issue internationally, both due to the waste stream's continuously increasing quantities, as well as its content in valuable and also hazardous materials. In an effort to manage Waste Electrical and Electronic Equipment (WEEE), adequate infrastructure in treatment and recycling facilities is considered a prerequisite. A critical number of such plants are mandatory to be installed in order: (i) to accommodate legislative needs, (ii) decrease transportation cost, and (iii) expand reverse logistics network and cover more areas. However, WEEE recycling infrastructures require high expenditures and therefore the decision maker need to be most precautious. In this context, special care should be given on the viability of infrastructure which is heavily dependent on facilities' location. To this end, a methodology aiming towards optimal location of Units of Treatment and Recycling is developed, taking into consideration economical together with social criteria, in an effort to interlace local acceptance and financial viability. For the decision support system's needs, ELECTRE III is adopted as a multicriteria analysis technique. The methodology's applicability is demonstrated with a real-world case study in Greece. PMID:20031385

  9. Treatment of affective illness in the elderly with drugs and electroconvulsive therapy.

    PubMed

    Jenike, M A

    1989-01-01

    Affective illness is common, frequently debilitating, and sometimes life-threatening in the elderly. Considerations pertaining to treatment with heterocyclic drugs, MAOIs, lithium, psychostimulants and thyroid hormone, as well as ECT, have been reviewed. Amitriptyline and imipramine cause significant orthostatic hypotension and probably should be avoided in the elderly. In addition, amitriptyline is extremely anticholinergic. Amoxapine is essentially a neuroleptic sequelae, including tardive dyskinesia. If a patient has had a prior positive response or has a relative who had a good outcome from a particular drug, it may be best to begin treatment with that drug. Initial choice of antidepressant can be based largely on the clinical picture. For example, if a depressed patient is sleeping much more than usual, try a potentially activating agent like desipramine or protriptyline. if, on the other hand, the patient is unable to sleep, a more sedating agent like nortriptyline, maprotiline, trimipramine, or trazodone should be tried. Risks and side effects of these drugs, as well as their use in cardiac patients, have been reviewed in detail. Many clinicians avoid MAOIs in elderly patients because of fear of adverse reactions. This fear is largely unfounded. Precautions, side effects, and specific recommendations have been outlined. Using lithium in the elderly requires special precautions because of decreased GFR and potential interactions with concomitantly used drugs. This paper has discussed possible side effects and toxicity. The usage of psychostimulants, such as methylphenidate and amphetamine, to treat medically ill depressed patients is reviewed. These agents are also sometimes useful in demented individuals or in patients with abulic frontal lobe syndromes. Poststroke depressions are common, and recent evidence indicates that they can be adequately treated. Stroke patients have many difficulties dealing with rehabilitation and should not be forced to suffer

  10. Foraging at wastewater treatment works affects brown adipose tissue fatty acid profiles in banana bats

    PubMed Central

    Hill, Kate; van Aswegen, Sunet; Schoeman, M. Corrie; Claassens, Sarina; Jansen van Rensburg, Peet; Naidoo, Samantha; Vosloo, Dalene

    2016-01-01

    ABSTRACT In this study we tested the hypothesis that the decrease in habitat quality at wastewater treatment works (WWTW), such as limited prey diversity and exposure to the toxic cocktail of pollutants, affect fatty acid profiles of interscapular brown adipose tissue (iBrAT) in bats. Further, the antioxidant capacity of oxidative tissues such as pectoral and cardiac muscle may not be adequate to protect those tissues against reactive molecules resulting from polyunsaturated fatty acid auto-oxidation in the WWTW bats. Bats were sampled at two urban WWTW, and two unpolluted reference sites in KwaZulu-Natal, South Africa. Brown adipose tissue (BrAT) mass was lower in WWTW bats than in reference site bats. We found lower levels of saturated phospholipid fatty acids and higher levels of mono- and polyunsaturated fatty acids in WWTW bats than in reference site bats, while C18 desaturation and n-6 to n-3 ratios were higher in the WWTW bats. This was not associated with high lipid peroxidation levels in pectoral and cardiac muscle. Combined, these results indicate that WWTW bats rely on iBrAT as an energy source, and opportunistic foraging on abundant, pollutant-tolerant prey may change fatty acid profiles in their tissue, with possible effects on mitochondrial functioning, torpor and energy usage. PMID:26740572

  11. Therapeutic use of dextromethorphan: key learnings from treatment of pseudobulbar affect.

    PubMed

    Miller, Ariel; Panitch, Hillel

    2007-08-15

    A variety of neurological conditions and disease states are accompanied by pseudobulbar affect (PBA), an emotional disorder characterized by uncontrollable outbursts of laughing and crying. The causes of PBA are unclear but may involve lesions in neural circuits regulating the motor output of emotional expression. Several agents used in treating other psychiatric disorders have been applied in the treatment of PBA with some success but data are limited and these agents are associated with unpleasant side effects due to nonspecific activity in diffuse neural networks. Dextromethorphan (DM), a widely used cough suppressant, acts at receptors in the brainstem and cerebellum, brain regions implicated in the regulation of emotional output. The combination of DM and quinidine (Q), an enzyme inhibitor that blocks DM metabolism, has recently been tested in phase III clinical trials in patients with multiple sclerosis and amyotrophic lateral sclerosis and was both safe and effective in palliating PBA symptoms. In addition, clinical studies pertaining to the safety and efficacy of DM/Q in a variety of neurological disease states are ongoing. PMID:17433820

  12. Factors affecting discontinuation of initial treatment with paroxetine in panic disorder and major depressive disorder

    PubMed Central

    Aoki, Akiko; Ishiguro, Shin; Watanabe, Takashi; Ueda, Mikito; Hayashi, Yuki; Akiyama, Kazufumi; Kato, Kazuko; Inoue, Yoshimasa; Tsuchimine, Shoko; Yasui-Furukori, Norio; Shimoda, Kazutaka

    2014-01-01

    Objective The aims of the present study were to analyze the association between discontinuation of paroxetine (PAX) and the genetic variants of the polymorphism in the serotonin transporter gene-linked polymorphic region (5-HTTLPR) in Japanese patients with panic disorder (PD) and major depressive disorder (MDD). Methods The 5-HTTLPR genotype was determined by polymerase chain reaction method. PAX plasma concentration was measured by high-performance liquid chromatography to confirm adherence. Results When comparing between the PD and MDD patients with the chi-square test and Fisher’s exact test, the PD patients had a significant and higher discontinuation rate due to non-adherence than did the MDD patients (13.5% [7/52] versus 0% [0/88], respectively; P<0.001). MDD patients had a significant and higher discontinuation rate due to untraceability than PD patients (12.5% [11/88] versus 1.9% [1/52]; P=0.032). Multilogistic regression revealed a tendency for the long/short and short/short genotypes to affect discontinuation due to adverse effects in PD patients (25.0% versus 6.3%, respectively; P=0.054). Conclusion The results indicate that the 5-HTTLPR genotype might contribute to the discontinuation of initial PAX treatment due to adverse effects in PD patients. PMID:25258536

  13. Psychiatric Morbidity and Other Factors Affecting Treatment Adherence in Pulmonary Tuberculosis Patients

    PubMed Central

    Pachi, Argiro; Bratis, Dionisios; Moussas, Georgios; Tselebis, Athanasios

    2013-01-01

    As the overall prevalence of TB remains high among certain population groups, there is growing awareness of psychiatric comorbidity, especially depression and its role in the outcome of the disease. The paper attempts a holistic approach to the effects of psychiatric comorbidity to the natural history of tuberculosis. In order to investigate factors associated with medication nonadherence among patients suffering from tuberculosis, with emphasis on psychopathology as a major barrier to treatment adherence, we performed a systematic review of the literature on epidemiological data and past medical reviews from an historical perspective, followed by theoretical considerations upon the relationship between psychiatric disorders and tuberculosis. Studies reporting high prevalence rates of psychiatric comorbidity, especially depression, as well as specific psychological reactions and disease perceptions and reviews indicating psychiatric complications as adverse effects of anti-TB medication were included. In sum, data concerning factors affecting medication nonadherence among TB patients suggested that better management of comorbid conditions, especially depression, could improve the adherence rates, serving as a framework for the effective control of tuberculosis, but further studies are necessary to identify the optimal way to address such issues among these patients. PMID:23691305

  14. Challenges in Measuring a New Construct: Perception of Voluntariness for Research and Treatment Decision Making

    PubMed Central

    Miller, Victoria A.; Reynolds, William W.; Ittenbach, Richard F.; Luce, Mary Frances; Beauchamp, Tom L.; Nelson, Robert M.

    2010-01-01

    RELIABLE AND VALID MEASURES OF RELEVANT constructs are critical in the developing field of the empirical study of research ethics. The early phases of scale development for such constructs can be complex. We describe the methodological challenges of construct definition and operationalization and how we addressed them in our study to develop a measure of perception of voluntariness. We also briefly present our conceptual approach to the construct of voluntariness, which we defined as the perception of control over decision making. Our multifaceted approach to scale development ensured that we would develop a construct definition of sufficient breadth and depth, that our new measure of voluntariness would be applicable across disciplines, and that there was a clear link between our construct definition and items. The strategies discussed here can be adapted by other researchers who are considering a scale development study related to the empirical study of ethics. PMID:19754231

  15. [Cataracts in dogs--overview and guideline for decision making in treatment].

    PubMed

    Fischer, M-C; Meyer-Lindenberg, A

    2014-01-01

    Cataract is the leading cause of impaired vision and vision loss in dogs. Because of the considerable progress in cataract surgery in recent decades, lens opacities can now be operated on with very good short-term success (90-95%), taking into account that proper patient selection is essential to maximize the probability of a successful surgical outcome. Following a description of anatomical and physiological lens characteristics, the etiology and complications of untreated cataracts are discussed. Furthermore, specific criteria for patient selection are addressed while delineating essential steps of the examination. This article aims to aid decision making in cataract therapy on the basis of diagnostic guidance and to facilitate the selection of an appropriate point of time for surgery. PMID:25422865

  16. Decision Making about Children with Psychotic Symptoms: Using the Best Evidence in Choosing a Treatment

    ERIC Educational Resources Information Center

    Shaw, Philip; Rapoport, Judith L.

    2006-01-01

    This paper presents Peter, an 11-year-old boy, with brief self-limited hallucinations and persecutory ideation (if not frank delusions) on a background of a gradual deterioration in overall functioning. Affective symptoms are not prominent, and there is little to suggest an organic contribution. This raises the possibility that he has, or is on…

  17. Cognitive and Affective Predictors of Treatment Outcome in Cognitive Processing Therapy and Prolonged Exposure for Posttraumatic Stress Disorder

    PubMed Central

    Rizvi, Shireen L.; Vogt, Dawne S.; Resick, Patricia A.

    2009-01-01

    This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n=145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to drop out of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols. PMID:19595295

  18. Cognitive and affective predictors of treatment outcome in Cognitive Processing Therapy and Prolonged Exposure for posttraumatic stress disorder.

    PubMed

    Rizvi, Shireen L; Vogt, Dawne S; Resick, Patricia A

    2009-09-01

    This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n = 145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to dropout of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols. PMID:19595295

  19. Decision-making algorithm in treatment of the atrophic mandible fractures*

    PubMed Central

    DE FEUDIS, F.; DE BENEDITTIS, M.; ANTONICELLI, V.; VITTORE, P.; CORTELAZZI, R.

    2014-01-01

    Aim Closed treatment of atrophic mandible fractures often results in malunion, pseudoarthrosis and pain. Open reduction and rigid internal fixation (ORIF) is still indicated for displaced atrophic mandible fractures. The Authors report a treatment protocol that allows to gain the best results using reconstruction plates, autologous bone grafting and free fibula flap reconstruction when necessary. Methods Retrospective analysis of 15 patients with atrophic mandible fractures who underwent treatment between 2007 and 2011. 7 cases did not receive any treatment because of their general condition, while the others 8 were surgically managed by external approach. In all cases load-bearing osteosynthesis plates with locking screws were used; in 2 of them contextual bone grafts were performed; in 1 case mandible reconstruction needed harvesting a free fibula flap. Results In 6 out of 8 cases complete functional and morphological restoration were obtained without any major complication. In 1 case suppurative infection and necrosis of the bone graft occurred, which made necessary its removing, leaving in situ only the reconstruction plate. In another case, during the first year after surgical treatment, atrophic mandible resorption occurred from one angle to the other, resulting in loss of the anchoring reconstruction plate. Conclusions ORIF is the gold standard procedure for the of atrophic mandible fractures, because it guarantees best morpho-functional outcomes and predictability. Nevertheless the Authors suggest contextual bone grafting in case of substance loss, or a poor quality bone or for dental implant surgery and free fibula flap in selected cases. PMID:24841687

  20. Dynamic Association between Negative Affect and Alcohol Lapses following Alcohol Treatment

    ERIC Educational Resources Information Center

    Witkiewitz, Katie; Villarroel, Nadia Aracelliz

    2009-01-01

    Clinical research has found a strong association between negative affect and returning to alcohol use after a period of abstinence. Yet little is known about the probability of a lapse given a particular level of negative affect or whether there is a reciprocal relationship between negative affect and alcohol use across time. The goal of the…

  1. Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C

    PubMed Central

    Tsochatzis, Emmanuel A; Crossan, Catriona; Longworth, Louise; Gurusamy, Kurinchi; Rodriguez-Peralvarez, Manolo; Mantzoukis, Konstantinos; O'Brien, Julia; Thalassinos, Evangelos; Papastergiou, Vassilios; Noel-Storr, Anna; Davidson, Brian; Burroughs, Andrew K

    2014-01-01

    The cost-effectiveness of noninvasive tests (NITs) as alternatives to liver biopsy is unknown. We compared the cost-effectiveness of using NITs to inform treatment decisions in adult patients with chronic hepatitis C (CHC). We conducted a systematic review and meta-analysis to calculate the diagnostic accuracy of various NITs using a bivariate random-effects model. We constructed a probabilistic decision analytical model to estimate health care costs and outcomes (quality-adjusted life-years; QALYs) using data from the meta-analysis, literature, and national UK data. We compared the cost-effectiveness of four treatment strategies: testing with NITs and treating patients with fibrosis stage ≥F2; testing with liver biopsy and treating patients with ≥F2; treat none; and treat all irrespective of fibrosis. We compared all NITs and tested the cost-effectiveness using current triple therapy with boceprevir or telaprevir, but also modeled new, more-potent antivirals. Treating all patients without any previous NIT was the most effective strategy and had an incremental cost-effectiveness ratio (ICER) of £9,204 per additional QALY gained. The exploratory analysis of currently licensed sofosbuvir treatment regimens found that treat all was cost-effective, compared to using an NIT to decide on treatment, with an ICER of £16,028 per QALY gained. The exploratory analysis to assess the possible effect on results of new treatments, found that if SVR rates increased to >90% for genotypes 1-4, the incremental treatment cost threshold for the “treat all” strategy to remain the most cost-effective strategy would be £37,500. Above this threshold, the most cost-effective option would be noninvasive testing with magnetic resonance elastography (ICER = £9,189). Conclusions: Treating all adult patients with CHC, irrespective of fibrosis stage, is the most cost-effective strategy with currently available drugs in developed countries. (Hepatology 2014;60:832–843) PMID

  2. Loving-kindness in the treatment of traumatized refugees and minority groups: a typology of mindfulness and the nodal network model of affect and affect regulation.

    PubMed

    Hinton, Devon E; Ojserkis, Rebecca A; Jalal, Baland; Peou, Sonith; Hofmann, Stefan G

    2013-08-01

    This article discusses how loving-kindness can be used to treat traumatized refugees and minority groups, focusing on examples from our treatment, culturally adapted cognitive-behavioral therapy (CA-CBT). To show how we integrate loving-kindness with other mindfulness interventions and why loving-kindness should be an effective therapeutic technique, we present a typology of mindfulness states and the Nodal Network Model (NNM) of Affect and Affect Regulation. We argue that mindfulness techniques such as loving-kindness are therapeutic for refugees and minority populations because of their potential for increasing emotional flexibility, decreasing rumination, serving as emotional regulation techniques, and forming part of a new adaptive processing mode centered on psychological flexibility. We present a case to illustrate the clinical use of loving-kindness within the context of CA-CBT. PMID:23784718

  3. Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians with and without Training in Evidence-Based Treatment

    ERIC Educational Resources Information Center

    Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.

    2015-01-01

    Background: Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective: The present study explored the role of prior training in evidence-based treatments (EBTs) on clinicians' assessment and treatment formulations using…

  4. Developmental and Contextual Correlates of Elders' Anticipated End-of-Life Treatment Decisions

    ERIC Educational Resources Information Center

    Decker, Ilene M.; Reed, Pamela G.

    2005-01-01

    The purpose of this study was to gain insight into developmental and contextual correlates of the aggressiveness in treatment that community-based elders anticipate they will desire at the end of life. Elders completed questionnaires to measure 4 developmental factors (integrated moral reasoning, self-transcendence, past experience with…

  5. The use of circulating tumor cells in guiding treatment decisions for patients with metastatic castration-resistant prostate cancer.

    PubMed

    Onstenk, Wendy; de Klaver, Willemijn; de Wit, Ronald; Lolkema, Martijn; Foekens, John; Sleijfer, Stefan

    2016-05-01

    The therapeutic landscape of metastatic castration-resistant prostate cancer (mCRPC) has drastically changed over the past decade with the advent of several new anti-tumor agents. Oncologists increasingly face dilemmas concerning the best treatment sequence for individual patients since most of the novel compounds have been investigated and subsequently positioned either pre- or post-docetaxel. A currently unmet need exists for biomarkers able to guide treatment decisions and to capture treatment resistance at an early stage thereby allowing for an early change to an alternative strategy. Circulating tumor cells (CTCs) have in this context intensively been investigated over the last years. The CTC count, as determined by the CellSearch System (Janssen Diagnostics LLC, Raritan, NJ), is a strong, independent prognostic factor for overall survival in patients with mCRPC at various time points during treatment and, as an early response marker, outperforms traditional response evaluations using serum prostate specific antigen (PSA) levels, scintigraphy as well as radiography. The focus of research is now shifting toward the predictive value of CTCs and the use of the characterization of CTCs to guide the selection of treatments with the highest chance of success for individual patients. Recently, the presence of the androgen receptor splice variant 7 (AR-V7) has been shown to be a promising predictive factor. In this review, we have explored the clinical value of the enumeration and characterization of CTCs for the treatment of mCRPC and have put the results obtained from recent studies investigating the prognostic and predictive value of CTCs into clinical perspective. PMID:27107266

  6. How does the context and design of participatory decision-making processes affect their outcomes? Evidence from sustainable land management in global drylands.

    NASA Astrophysics Data System (ADS)

    de Vente, Joris; Reed, Mark; Stringer, Lindsay; Valente, Sandra; Newig, Jens

    2014-05-01

    It is widely accepted that the design of participatory processes in environmental management needs to be adapted to local contexts. Yet, it is not clear which elements of process design are universal, making it difficult to design processes that deliver beneficial outcomes across different contexts. We used empirical evidence to analyse the extent to which context and process design can enable or impede stakeholder participation and facilitate beneficial environmental and social outcomes in a range of decision-making contexts where stakeholders are engaged in environmental management. To explore the role of national-scale context on the outcomes of participatory processes, we interviewed facilitators from a process that was replicated across 13 dryland study sites around the world, which focussed on selecting Sustainable Land Management (SLM) options in close collaboration with stakeholders. To explore the role of process design and local context, we interviewed participants and facilitators in 11 case studies in Spain and Portugal in which different process designs were used. Interview data were analysed using a combination of quantitative and qualitative approaches to characterise relationships between process design, context and process outcomes. The similarity of outcomes across the 13 international study sites suggested that the national socio-cultural context in which a participatory process is conducted has little impact on its outcomes. However, analysis of cases from Spain and Portugal showed that some aspects of local context may affect outcomes. Having said this, factors associated with process design and participant selection played a more significant role in influencing outcomes in both countries. Processes that led to more beneficial outcomes for the environment and/or participants were likely to include: the legitimate representation of stakeholders; professional facilitation including structured methods for eliciting and aggregating information and

  7. EGFRvIII does not affect radiosensitivity with or without gefitinib treatment in glioblastoma cells

    PubMed Central

    Struve, Nina; Riedel, Matthias; Schulte, Alexander; Rieckmann, Thorsten; Grob, Tobias J.; Gal, Andreas; Rothkamm, Kai; Lamszus, Katrin; Petersen, Cordula; Dikomey, Ekkehard; Kriegs, Malte

    2015-01-01

    Background Glioblastomas (GBM) are often characterized by an elevated expression of the epidermal growth factor receptor variant III (EGFRvIII). We used GBM cell lines with native EGFRvIII expression to determine whether this EGFR variant affects radiosensitivity with or without EGFR targeting. Methods Experiments were performed with GBM cell lines lacking (LN229, U87MG, U251, CAS-1) or endogenously expressing EGFRvIII (BS153, DKMG). The two latter cell lines were also used to establish sublines with a low (−) or a high proportion (+) of cells expressing EGFRvIII. EGFR signaling and the cell cycle were analyzed using Western blot and flow cytometry; cell survival was assessed by colony forming assay and double-strand break repair capacity by immunofluorescence. Results DKMG and BS153 parental cells with heterogeneous EGFRvIII expression were clearly more radiosensitive compared to other GBM cell lines without EGFRvIII expression. However, no significant difference was observed in cell proliferation, clonogenicity or radiosensitivity between the EGFRvIII− and + sublines derived from DKMG and BS153 parental cells. Expression of EGFRvIII was associated with decreased DSB repair capacity for BS153 but not for DKMG cells. The effects of EGFR targeting by gefitinib alone or in combination with irradiation were also found not to depend on EGFRvIII expression. Gefitinib was only observed to influence the proliferation of EGFRvIII− BS153 cells. Conclusion The data indicate that EGFRvIII does not alter radiosensitivity with or without anti-EGFR treatment. PMID:26418954

  8. Bioaccessibility of Pb from Ammunition in Game Meat Is Affected by Cooking Treatment

    PubMed Central

    Mateo, Rafael; Baos, Ana R.; Vidal, Dolors; Camarero, Pablo R.; Martinez-Haro, Monica; Taggart, Mark A.

    2011-01-01

    Background The presence of lead (Pb) ammunition residues in game meat has been widely documented, yet little information exists regarding the bioaccessibility of this Pb contamination. We study how cooking treatment (recipe) can affect Pb bioaccessibility in meat of animals hunted with Pb ammunition. Methodology/Principal Findings We used an in vitro gastrointestinal simulation to study bioaccessibility. The simulation was applied to meat from red-legged partridge (Alectoris rufa) hunted with Pb shot pellets and cooked using various traditional Spanish game recipes involving wine or vinegar. Total Pb concentrations in the meat were higher in samples with visible Pb ammunition by X-ray (mean±SE: 3.29±1.12 µg/g w.w.) than in samples without this evidence (1.28±0.61 µg/g). The percentage of Pb that was bioaccessible within the simulated intestine phase was far higher in meat cooked with vinegar (6.75%) and wine (4.51%) than in uncooked meat (0.7%). Risk assessment simulations using our results transformed to bioavailability and the Integrated Exposure Uptake Biokinetic model (IEUBK; US EPA) show that the use of wine instead of vinegar in cooking recipes may reduce the percentage of children that would be expected to have >10 µg/dl of Pb in blood from 2.08% to 0.26% when game meat represents 50% of the meat in diet. Conclusions/Significance Lead from ammunition in game meat is more bioaccessible after cooking, especially when using highly acidic recipes. These results are important because existing theoretical models regarding Pb uptake and subsequent risk in humans should take such factors into account. PMID:21264290

  9. 'Consumers are patients!' shared decision-making and treatment non-compliance as business opportunity.

    PubMed

    Applbaum, Kalman

    2009-03-01

    This article describes an aspect of the progressive insertion of commercial interests into the relationship between patients and their clinicians, with particular reference to psychiatry. Treatment noncompliance, a long-standing problem for healthcare professionals, has lately drawn the attention of the pharmaceutical and allied industries as a site at which to improve return on investment (ROI). Newly founded corporate ;compliance departments' and specialized consultancies that regard noncompliance as a form of marketing failure are seeking to rectify it with reinvigorated models and strategies. This intervention stands to impact patients' experience of illness as well as the participation of those formally (physicians, case managers, etc.) and informally (family, friends, etc.) involved in treatment. My analysis draws upon observation at compliance conferences to demonstrate the contrasting models of patient empowerment underlying the marketing vs. medical approaches. I propose a research agenda for measuring the effects of industry compliance programs. PMID:19293282

  10. Can access limits on sales representatives to physicians affect clinical prescription decisions? A study of recent events with diabetes and lipid drugs.

    PubMed

    Chressanthis, George A; Khedkar, Pratap; Jain, Nitin; Poddar, Prashant; Seiders, Michael G

    2012-07-01

    The authors explored to what extent important medical decisions by practitioners can be influenced by pharmaceutical representatives and, in particular, whether restricting such access could delay appropriate changes in clinical practice. Medical practices were divided into four categories based on the degree of sales representative access to clinicians: very low, low, medium, and high from a database compiled by ZS Associates called AccessMonitor (Evanston, IL) used extensively by many pharmaceutical companies. Clinical decisions of 58,647 to 72,114 physicians were statistically analyzed using prescription data from IMS Health (Danbury, CT) in three critical areas: an innovative drug for type 2 diabetes (sitagliptin), an older diabetes drug with a new Food and Drug Administration-required black box warning for cardiovascular safety (rosiglitazone), and a combination lipid therapy that had reported negative outcomes in a clinical trial (simvastatin+ezetimbe). For the uptake of the new diabetes agent, the authors found that physicians with very low access to representatives had the lowest adoption of this new therapy and took 1.4 and 4.6 times longer to adopt than physicians in the low- and medium-access restriction categories, respectively. In responding to the black box warning for rosiglitazone, the authors found that physicians with very low access were 4.0 times slower to reduce their use of this treatment than those with low access. Likewise, there was significantly less response in terms of changing prescribing to the negative news with the lipid therapy for physicians in more access-restricted offices. Overall, cardiologists were the most responsive to information changes relative to primary care physicians. These findings emphasize that limiting access to pharmaceutical representatives can have the unintended effect of reducing appropriate responses to negative information about drugs just as much as responses to positive information about innovative

  11. Benefits and risks of emerging technologies: integrating life cycle assessment and decision analysis to assess lumber treatment alternatives.

    PubMed

    Tsang, Michael P; Bates, Matthew E; Madison, Marcus; Linkov, Igor

    2014-10-01

    Assessing the best options among emerging technologies (e.g., new chemicals, nanotechnologies) is complicated because of trade-offs across benefits and risks that are difficult to quantify given limited and fragmented availability of information. This study demonstrates the integration of multicriteria decision analysis (MCDA) and life cycle assessment (LCA) to address technology alternative selection decisions. As a case study, prioritization of six lumber treatment alternatives [micronized copper quaternary (MCQ); alkaline copper quaternary (ACQ); water-borne copper naphthenate (CN); oil-borne copper naphthenate (CNo); water-borne copper quinolate (CQ); and water-borne zinc naphthenate (ZN)] for military use are considered. Multiattribute value theory (MAVT) is used to derive risk and benefit scores. Risk scores are calculated using a cradle-to-gate LCA. Benefit scores are calculated by scoring of cost, durability, and corrosiveness criteria. Three weighting schemes are used, representing Environmental, Military and Balanced stakeholder perspectives. Aggregated scores from all three perspectives show CQ to be the least favorable alterative. MCQ is identified as the most favorable alternative from the Environmental stakeholder perspective. From the Military stakeholder perspective, ZN is determined to be the most favorable alternative, followed closely by MCQ. This type of scoring and ranking of multiple heterogeneous criteria in a systematic and transparent way facilitates better justification of technology selection and regulation. PMID:25209330

  12. Minors' decision-making capacity to refuse life-saving and life-sustaining treatment: legal and psychiatric perspectives.

    PubMed

    Mendelson, Danuta; Haywood, Ian

    2014-06-01

    Laws in Belgium and The Netherlands permit euthanasia and assisted suicide for seriously ill children who experience "constant and unbearable suffering"--they have the capacity to request death by lethal injection if they convey a "reasonable understanding of the consequences" of that request. The child's capacity to understand death is therefore a prerequisite to the implementation of the request. However, modern neuro-psychological and fMRI (functional Magnetic Resonance Imaging) studies of the relationship between the neuro-anatomical development of the brain in human beings and their emotional and experiential capacity demonstrates that both are not fully developed until the early 20s for girls and mid-20s for boys. Unlike Belgium and The Netherlands, the clinical and legal implications of the immaturity of the brain on medical decision-making of minors, in particular life and death decisions, have been implicit in the Australian courts' approach to the refusal of life-saving and life-sustaining treatment by minors. This approach is exemplified by X v Sydney Children's Hospitals Network [2013] NSWCA 320 (and a series of earlier cases). PMID:25087358

  13. Gender differences in factors associated with patients' decisions to seek treatment for urinary incontinence in Alexandria, Egypt.

    PubMed

    Mohamed, A M; Hassouna, M S; Kassem, M S

    2010-11-01

    The objective of this descriptive, hospital-based comparative cross-sectional survey was to determine gender differences in factors associated with patients' decisions to seek treatment for urinary incontinence (Ul). Using an interview questionnaire, data were collected from 353 patients attending clinics at hospitals in Alexandria, Egypt. There were differences between males and females regarding specific psychosocial factors motivating health care seeking behaviour. Women had fewer hospital admissions and hospital days and less use of diagnostic procedures and surgery. More women suffered from at least one negative impact on their social lives compared to men. The impact of symptoms on quality of life appeared to be the main trigger for seeking help for UI in both men and women. PMID:21218742

  14. SU-E-J-04: A Data-Driven, Response-Based, Multi-Criteria Decision Support System for Personalized Lung Radiation Treatment Planning

    SciTech Connect

    Luo, Y; McShan, D; Schipper, M; Matuszak, M; Ten Haken, R; Kong, F

    2014-06-01

    Purpose: To develop a decision support tool to predict a patient's potential overall survival (OS) and radiation induced toxicity (RIT) based on clinical factors and responses during the course of radiotherapy, and suggest appropriate radiation dose adjustments to improve therapeutic effect. Methods: Important relationships between a patient's basic information and their clinical features before and during the radiation treatment are identified from historical clinical data by using statistical learning and data mining approaches. During each treatment period, a data analysis (DA) module predicts radiotherapy features such as time to local progression (TTLP), time to distant metastases (TTDM), radiation toxicity to different organs, etc., under possible future treatment plans based on patient specifics or responses. An information fusion (IF) module estimates intervals for a patient's OS and the probabilities of RIT from a treatment plan by integrating the outcomes of module DA. A decision making (DM) module calculates “satisfaction” with the predicted radiation outcome based on trade-offs between OS and RIT, and finds the best treatment plan for the next time period via multi-criteria optimization. Results: Using physical and biological data from 130 lung cancer patients as our test bed, we were able to train and implement the 3 modules of our decision support tool. Examples demonstrate how it can help predict a new patient's potential OS and RIT with different radiation dose plans along with how these combinations change with dose, thus presenting a range of satisfaction/utility for use in individualized decision support. Conclusion: Although the decision support tool is currently developed from a small patient sample size, it shows the potential for the improvement of each patient's satisfaction in personalized radiation therapy. The radiation treatment outcome prediction and decision making model needs to be evaluated with more patients and demonstrated for

  15. Treatment decision based on the biological behavior of pulmonary benign metastasizing leiomyoma

    PubMed Central

    Borda, Bernadett; Lazar, Gyorgy; Tiszlavicz, Laszlo; Furak, Jozsef

    2016-01-01

    Benign metastasizing leiomyoma (BML) is a rare disease in women undergoing surgery for uterine leiomyoma. About 100 cases have been reported in the literature, none of which describe the biological behavior of lesions. The authors present the case of a 36-year-old, asymptomatic woman who had undergone uterus extirpation seven years earlier for leiomyoma of the uterus. Routine chest radiography revealed multiple nodules in both lungs. Biopsy verified metastases from the original uterine leiomyoma. During a 41-month interval, 87 lesions were removed in seven operations, through mini-thoracotomy [four left-sided (42 lesions); and three right-sided (45 lesions)] by cautery resection and suturing of the parenchyma (n=83), or by wedge resection (n=4). In between the procedures, the patient received continuous oncological treatment (VIP protocol: etoposide, ifosfamide, cisplatin). Mean hospital stay was 5.14 days. Respiratory function tests performed after the last surgery showed near-normal results (FVC: 77%, FEV1: 64%, FEV1/FVC: 0.83). Over time, a decrease in number of newly developed BML nodules was observed. Mean surgical sensitivity [rate of lesions appearing on computerized tomography (CT) and removed during each surgery] of the seven metastasectomies was 95% (range: 40–150%). Pathological examination of the nodules proved that, despite continuous oncological treatment, there were no signs of necrosis, thrombosis, or fibrosis. The number of mitoses within the nodules did not change. According to our surgical results and the fact that oncological treatment did not have a significant effect on the course of the disease, we conclude that in the management of multiple BML lesions, surgically removing as many lesions as possible is advised.

  16. Treatment decision based on the biological behavior of pulmonary benign metastasizing leiomyoma.

    PubMed

    Ottlakan, Aurel; Borda, Bernadett; Lazar, Gyorgy; Tiszlavicz, Laszlo; Furak, Jozsef

    2016-08-01

    Benign metastasizing leiomyoma (BML) is a rare disease in women undergoing surgery for uterine leiomyoma. About 100 cases have been reported in the literature, none of which describe the biological behavior of lesions. The authors present the case of a 36-year-old, asymptomatic woman who had undergone uterus extirpation seven years earlier for leiomyoma of the uterus. Routine chest radiography revealed multiple nodules in both lungs. Biopsy verified metastases from the original uterine leiomyoma. During a 41-month interval, 87 lesions were removed in seven operations, through mini-thoracotomy [four left-sided (42 lesions); and three right-sided (45 lesions)] by cautery resection and suturing of the parenchyma (n=83), or by wedge resection (n=4). In between the procedures, the patient received continuous oncological treatment (VIP protocol: etoposide, ifosfamide, cisplatin). Mean hospital stay was 5.14 days. Respiratory function tests performed after the last surgery showed near-normal results (FVC: 77%, FEV1: 64%, FEV1/FVC: 0.83). Over time, a decrease in number of newly developed BML nodules was observed. Mean surgical sensitivity [rate of lesions appearing on computerized tomography (CT) and removed during each surgery] of the seven metastasectomies was 95% (range: 40-150%). Pathological examination of the nodules proved that, despite continuous oncological treatment, there were no signs of necrosis, thrombosis, or fibrosis. The number of mitoses within the nodules did not change. According to our surgical results and the fact that oncological treatment did not have a significant effect on the course of the disease, we conclude that in the management of multiple BML lesions, surgically removing as many lesions as possible is advised. PMID:27621897

  17. Genomic Profiling in Gastrointestinal Cancer: Are We Ready To Use These Data to Make Treatment Decisions?

    PubMed Central

    2015-01-01

    Remarkable strides have been made in the past 10–15 years in identifying the molecular events that drive cancer. With an enormous amount of new data, including those from The Cancer Genome Atlas Project, therapies are increasingly being developed and tested in clinical trials specifically designed to target some of these molecular events. Often, molecular signatures have become more important than the histologic features in making treatment choices. The success rate of these therapies depends on many factors but, perhaps most importantly, on patient selection according to the genetic analysis results of their individual tumors. PMID:26512044

  18. [PREDICTING FACTORS OF THE LIFE SPAN IN PATIENTS, SUFFERING METASTATIC COLORECTAL CANCER AND SYNCHRONOUS HEPATIC AFFECTION AFTER SURGICAL TREATMENT].

    PubMed

    Kolesnik, O O; Burlaka, A A; Lukashenko, A V; Pryimak, V V; Zhukov, Yu O; Makhmudov, D E; Volk, M O; Shchepotin, I B

    2015-05-01

    The results of treatment of 125 patients, suffering metastatic hepatic affection in colorectal cancer (pT1--4N0--2M1--in colonic cancer and pT1--3N0--2M1--in cancer recti), to whom in 2008-2015 yrs a one-staged (Group 1) or two-staged (Group II) surgical treatment was done. In affection of 4 regional lymph nodes and more (pN2) late results were less favorable, than in pN1 or pN0, not depending from surgical approach choosed. In 48 (38.4%) patients with one syndromal hepatic metastatic focus, the indices of general three-year and five-year cumulative survival were the best, than in other groups--82 and 63% (p = 0.001) accordingly; in monolobar affection--68 and 49%, and in bilobar--23 and 0%, not depending from method of surgical treatment (p < 0.001) choosed. Predictive factors were established, which impact negatively the indices of general survival in patients, suffering metastatic hepatic affection in colorectal cancer: hepatic metastatic foci number 4 and more, bilobar hepatic metastatic affection. PMID:26419027

  19. Water treatment residuals and biosolids co-applications affect phosphatases in a semi-arid rangeland soil

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Biosolids and water treatment residuals (WTR) land co-application has not been extensively studied, but may be beneficial by sorbing excess biosolids-borne or soil P onto WTR, reducing the likelihood of off-site movement. Reduction of excess soil P may affect the role of specific P-cleaving enzymes...

  20. Incorporating financial protection into decision rules for publicly financed healthcare treatments.

    PubMed

    Smith, Peter C

    2013-02-01

    Almost all health systems seek to offer some form of publicly financed healthcare insurance, and governments must therefore choose the size of the benefit package and the types of treatments to cover. Conventionally, the usual approach of economists has been to recommend choices on the basis of cost effectiveness of treatments, using metrics such as the 'cost per quality adjusted life year'. However, this approach is based on the assumption of health maximization subject to a budget constraint and ignores the potential impact of any additional concern with protecting individuals from the financial consequences of a health shock. Furthermore, it does not take account of the possible availability of complementary privately funded health care. This paper develops a model in which risk-averse individuals care about health but also place a value on protection from the financial consequences of rare but costly events. The paper shows how conventional cost-effectiveness analysis can readily be augmented to take account of financial protection objectives. The results depend on whether or not there exists a market in complementary privately funded health care. They have important implications for the methodology adopted by health technology assessment agencies and for the broader design of publicly funded health systems. PMID:22241688

  1. [Forgoing treatments: a kind of euthanasia? A scientific approach to the debate about end of life decisions].

    PubMed

    Riccioni, Luigi; Busca, Maria Teresa; Busatta, Lucia; Orsi, Luciano; Gristina, Giuseppe R

    2016-03-01

    In the last decade an extensive debate on the topic of end of life decisions has developed in western countries, obtaining a worldwide media relevance. Philosophers, theologians, legal experts and doctors, focus their attention on the three thorny issues of the topic: forgoing treatments, euthanasia and assisted suicide. A thorough and respectful discussion on these issues should include all stakeholders - above all palliative care physicians - and should be encouraged in order to understand the views in favor or against the three practices, checking the different moral positions, and analyzing the cultural, social and legal aspects in the background on one hand, and, on the other, their impact on the health care systems. At present, in the fields of communications and politics, the debate related to the topic of these end of life practices is characterized by a confusion of terms and meanings. As an outcome, the term "euthanasia" is misused as a "container" including forgoing treatments, euthanasia and assisted suicide, while palliative sedation is wrongly considered as a procedure to cause death. This confusing approach does not permit to understand the real issues at the stake, keeping the debate at the tabloid level. Conversely, sharing the precise meaning of the words is the only way to provide tools to make rational, autonomous and responsible decisions, allowing individual informed choices in compliance with the principle of autonomy. This article is not aimed to take a moral stand in favor or against forgoing treatments, euthanasia and assisted suicide. Through an analysis based on scientific criteria, the authors firstly review the definitions of these three practices, examining the concepts enclosed in each term; secondly, they offer a glance on the legal approach to end of life issues in western countries; lastly, they investigate the relationship between these practices and palliative care culture in light of the medical societies official statements

  2. Chronic urinary retention in men: how we define it, and how does it affect treatment outcome.

    PubMed

    Negro, Carlo L A; Muir, Gordon H

    2012-12-01

    What's known on the subject? and What does the study add? Chronic urinary retention (CUR) is a poorly defined entity, as the key element of definition, significant postvoid residual urine volume (PVR), has not a worldwide and moreover evidenced-based definition. There is no agreement on which is the threshold value to define a significant PVR and different society produced guidelines with different thresholds ranging from 300 mL to 1000 mL. Diagnosis is difficult, and management has not been defined yet. There is a lack of studies on the best management of these patients, as this group of patients has always been considered at high risk of failure. Only one study compares conservative with the surgical management but it is not a randomised controlled trail. This review offers a systematic appraisal of the most recent publications on CUR. It indicates the absence of a real worldwide agreed definition, as the two keys element of it are not satisfactorily defined yet: significant PVR, is suffering from a lack of evidenced-based definition, and percussable or palpable bladder is a very nebulous concept as it is not a criteria of certainty as different individual variables affect it. This has an important effect on management which is not structured. Most of the trials involving benign prostatic hyperplasia treatments (either medical or surgical) tend to exclude this group of patients, which is a clinically important group, comprising up to a quarter of men undergoing TURP in the UK. Urinary retention describes a bladder that does not empty completely or does not empty at all. Historically, urinary retention has been classified as either acute or chronic the latter is generally classified as high pressure or low pressure according to the bladder filling pressure on urodynamic. A MEDLINE® search for articles written in English and published before January 2010 was done using a list of terms related to urinary retention: 'urinary retention', 'chronic urinary retention

  3. A pilot study to evaluate the role of the Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) in clinical decisions for pressure ulcer treatment.

    PubMed

    Thomason, Susan S; Graves, Barbara Ann; Madaris, Linda

    2014-12-01

    The Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) was designed to assess pressure ulcer (PrU) healing in the spinal cord impaired (SCI) population. The tool contains 7 variables: wound surface area, depth, edges, tunneling, undermining, exudate type, and necrotic tissue amount. A 2-phased, quantitative pilot study based on the Theory of Reasoned Action and Theory of Planned Behavior was conducted at a large SCI/Disorders Center in the Department of Veterans Affairs (VA). In the first phase of the study, a convenience sample of 5 physicians, 3 advanced practice registered nurses, and 3 certified wound care nurses (CWCN) was surveyed using a 2-part questionnaire to assess use of the SCI-PUMT instrument, its anticipated improvement in PrU assessment, and intent to use the SCI-PUMT in clinical practice. Attitudes, subjective norms, perceived behavioral controls, and barriers related to the intent to use the SCI-PUMT were evaluated using a 5-point Likert scale (range: 1= extremely likely, 5 = extremely unlikely). In the second phase of the study, the electronic health records (EHR) of 24 veterans (with 30 PrUs) who had at least 2 completed SCI-PUMT scores during a 4-week period were used to evaluate whether an association existed between magnitudes of change of total SCI-PUMT scores and ordered changes in PrU treatment. The overall mean score for intent to use SCI-PUMT was 1.80 (SD 0.75). The least favorable scores were for convenience and motivation to use the SCI-PUMT. Analysis of EHR data showed no significant difference in magnitudes of change in the SCI-PUMT score and changes in PrU treatment recommendations made by the CWCNs. The significance was not affected regardless of an increase or no change in the score (χ2 with 1 degree of freedom = 1.158, P = 0.282) or for a decrease in the score (χ2 with 1 degree of freedom = 0.5, P = 0.478). In this pilot study, the expressed intent to use the SCI-PUMT in making clinical decisions was generally

  4. Influence of a Dissection Video Clip on Anxiety, Affect, and Self-Efficacy in Educational Dissection: A Treatment Study.

    PubMed

    Randler, Christoph; Demirhan, Eda; Wüst-Ackermann, Peter; Desch, Inga H

    2016-01-01

    In science education, dissections of animals are an integral part of teaching, but they often evoke negative emotions. We aimed at reducing negative emotions (anxiety, negative affect [NA]) and increasing positive affect (PA) and self-efficacy by an experimental intervention using a predissection video to instruct students about fish dissection. We compared this treatment with another group that watched a life history video about the fish. The participants were 135 students studying to become biology teachers. Seventy received the treatment with the dissection video, and 65 viewed the life history video. We applied a pre/posttest treatment-comparison design and used the Positive and Negative Affect Schedule (PANAS), the State-Trait-Anxiety Inventory for State (STAI-S), and a self-efficacy measure three times: before the lesson (pretest), after the film treatment (posttest 1), and after the dissection (posttest 2). The dissection film group scored higher in PA, NA, and state anxiety (STAI-S) after the dissection video treatment and higher in self-efficacy after the dissection. The life history group showed no differences between the pretest and posttest 1. The dissection film has clear benefits - increasing PA and self-efficacy - that come at the cost of higher NA and higher STAI-S. PMID:27290738

  5. Influence of a Dissection Video Clip on Anxiety, Affect, and Self-Efficacy in Educational Dissection: A Treatment Study

    PubMed Central

    Randler, Christoph; Demirhan, Eda; Wüst-Ackermann, Peter; Desch, Inga H.

    2016-01-01

    In science education, dissections of animals are an integral part of teaching, but they often evoke negative emotions. We aimed at reducing negative emotions (anxiety, negative affect [NA]) and increasing positive affect (PA) and self-efficacy by an experimental intervention using a predissection video to instruct students about fish dissection. We compared this treatment with another group that watched a life history video about the fish. The participants were 135 students studying to become biology teachers. Seventy received the treatment with the dissection video, and 65 viewed the life history video. We applied a pre/posttest treatment-comparison design and used the Positive and Negative Affect Schedule (PANAS), the State–Trait–Anxiety Inventory for State (STAI-S), and a self-efficacy measure three times: before the lesson (pretest), after the film treatment (posttest 1), and after the dissection (posttest 2). The dissection film group scored higher in PA, NA, and state anxiety (STAI-S) after the dissection video treatment and higher in self-efficacy after the dissection. The life history group showed no differences between the pretest and posttest 1. The dissection film has clear benefits—increasing PA and self-efficacy—that come at the cost of higher NA and higher STAI-S. PMID:27290738

  6. Chemotherapy treatment decision making by professionals and older patients with cancer: a narrative review of the literature.

    PubMed

    Johnson, M

    2012-01-01

    This narrative review of the literature examines the issues influencing chemotherapy treatment of older patients with cancer. Increasing age is associated with physical, social and psychological changes, but the rate of change differs widely between people, such that chronological age is not a good determinant of fitness for treatment. Changes in old age can affect disease processes and treatments that are offered. Clinical trials suggest that older patients gain benefits from chemotherapy, but with increased toxicity profile. Dose reductions may be required, but the effect on outcome is not known. Adjuvant chemotherapy is likely to benefit patients with a life expectancy over 5 years, although mortality benefits become less pronounced with increasing age. Older patients want chemotherapy, as long as side effects do not reduce quality of life or ability to function independently. Older patients face barriers to communication with professionals, including sensory and memory problems and poorer health literacy. Patients should be assessed covering functional, physiological and socio-economic domains that identify significant comorbid disease and frailty, to ensure that planned chemotherapy is appropriate. Successful treatment of older patients with chemotherapy may require interventions to support them to ensure all patients who may derive benefit can undergo treatment, if they so wish. PMID:21955060

  7. Molecular features assisting in diagnosis, surgery, and treatment decision making in low-grade gliomas.

    PubMed

    Chen, Ricky; Ravindra, Vijay M; Cohen, Adam L; Jensen, Randy L; Salzman, Karen L; Prescot, Andrew P; Colman, Howard

    2015-03-01

    The preferred management of suspected low-grade gliomas (LGGs) has been disputed, and the implications of molecular changes for medical and surgical management of LGGs are important to consider. Current strategies that make use of molecular markers and imaging techniques and therapeutic considerations offer additional options for management of LGGs. Mutations in the isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) genes suggest a role for this abnormal metabolic pathway in the pathogenesis and progression of these primary brain tumors. Use of magnetic resonance spectroscopy can provide preoperative detection of IDH-mutated gliomas and affect surgical planning. In addition, IDH1 and IDH2 mutation status may have an effect on surgical resectability of gliomas. The IDH-mutated tumors exhibit better prognosis throughout every grade of glioma, and mutation may be an early genetic event, preceding lineage-specific secondary and tertiary alterations that transform LGGs into secondary glioblastomas. The O6-methylguanine-DNAmethyltransferase (MGMT) promoter methylation and 1p19q codeletion status can predict sensitivity to chemotherapy and radiation in low- and intermediate-grade gliomas. Thus, these recent advances, which have led to a better understanding of how molecular, genetic, and epigenetic alterations influence the pathogenicity of the different histological grades of gliomas, can lead to better prognostication and may lead to specific targeted surgical interventions and medical therapies. PMID:25727224

  8. Does Alcohol Consumption during Multidrug-resistant Tuberculosis Treatment Affect Outcome?

    PubMed Central

    Duraisamy, Karthickeyan; Mrithyunjayan, Sunilkumar; Ghosh, Smita; Nair, Sreenivas Achuthan; Balakrishnan, Shibu; Subramoniapillai, Jayasankar; Oeltmann, John E.; Moonan, Patrick K.; Kumar, Ajay M. V.

    2015-01-01

    Rationale India reports the largest number of multidrug-resistant tuberculosis cases in the world; yet, no longitudinal study has assessed factors related to treatment outcomes under programmatic conditions in the public sector. Objectives To describe demographic, clinical, and risk characteristics associated with treatment outcomes for all patients with multidrug-resistant tuberculosis registered in the Revised National Tuberculosis Control Programme, Kerala State, India from January 1, 2009 to June 30, 2010. Methods Cox regression methods were used to calculate adjusted hazard ratios with 95% confidence intervals (CIs) to assess factors associated with an unsuccessful treatment outcome. Measurements and Main Results Of 179 patients with multidrug-resistant tuberculosis registered, 112 (63%) had successful treatment outcomes (77 bacteriologically cured, 35 treatment completed) and 67 (37%) had unsuccessful treatment outcomes (30 died, 26 defaulted, 9 failed treatment, 1 stopped treatment because of drug-related adverse events, and 1 developed extensively drug-resistant tuberculosis). The hazard for unsuccessful outcome was significantly higher among patients who consumed alcohol during treatment (adjusted hazard ratio, 4.3; 95% CI, 1.1–17.6) than those who did not. Persons who consumed alcohol during treatment, on average, missed 18 more intensive-phase doses (95% CI, 13–22) than those who did not. Although many patients had diabetes (33%), were ever smokers (39%), or had low body mass index (47%), these factors were not associated with outcome. Conclusion Overall treatment success was greater than global and national averages; however, outcomes among patients consuming alcohol remained poor. Integration of care for multidrug-resistant tuberculosis and alcoholism should be considered to improve treatment adherence and outcomes. PMID:24735096

  9. Do postfire mulching treatments affect plant community recovery in California coastal sage scrub lands?

    PubMed

    McCullough, Sarah A; Endress, Bryan A

    2012-01-01

    In recent years, the use of postfire mulch treatments to stabilize slopes and reduce soil erosion in shrubland ecosystems has increased; however, the potential effects on plant recovery have not been examined. To evaluate the effects of mulching treatments on postfire plant recovery in southern California coastal sage scrub, we conducted a field experiment with three experimental treatments, consisting of two hydromulch products and an erosion control blanket, plus a control treatment. The area burned in 2007, and treatments were applied to six plot blocks before the 2008 growing season. Treatment effects on plant community recovery were analyzed with a mixed effects ANOVA analysis using a univariate repeated measures approach. Absolute plant cover increased from 13 to 90% by the end of the second growing season, and the mean relative cover of exotic species was 32%. The two hydromulch treatments had no effect on any plant community recovery response variable measured. For the erosion control blanket treatment, the amount of bare ground cover at the end of the second growing season was significantly lower (P = 0.01), and greater shrub height was observed (P < 0.01). We conclude that postfire mulch treatments did not provide either a major benefit or negative impact to coastal sage scrub recovery on the study area. PMID:22042409

  10. A Primer on Bayesian Decision Analysis With an Application to a Personalized Kidney Transplant Decision

    PubMed Central

    Neapolitan, Richard; Jiang, Xia; Ladner, Daniela P.; Kaplan, Bruce

    2016-01-01

    To provide personalized medicine, we not only must determine the treatments and other decisions most likely to be effective for a patient, but also consider the patient’s tradeoff between possible benefits of therapy versus possible loss of quality of life. There are numerous studies indicating that various treatments can negatively affect quality of life. Even if we have all information available for a given patient, it is an arduous task to amass the information to reach a decision that maximizes the utility of the decision to the patient. A clinical decision support system (CDSS) is a computer program, which is designed to assist healthcare professionals with decision making tasks. By utilizing emerging large datasets, we hold promise for developing CDSSs that can predict how treatments and other decisions can affect outcomes. However, we need to go beyond that; namely our CDSS needs to account for the extent to which these decisions can affect quality of life. This manuscript provides an introduction to developing CDSSs using Bayesian networks and influence diagrams. Such CDSSs are able to recommend decisions that maximize the expected utility of the predicted outcomes to the patient. By way of comparison, we examine the benefit and challenges of the Kidney Donor Risk Index (KDRI) as a decision support tool, and we discuss several difficulties with this index. Most importantly, the KDRI does not provide a measure of the expected quality of life if the kidney is accepted versus the expected quality of life if the patient stays on dialysis. Finally, we develop a schema for an influence diagram that models the kidney transplant decision, and show how the influence diagram approach can resolve these difficulties and provide the clinician and the potential transplant recipient with a valuable decision support tool. PMID:26900809

  11. Breast Cancer Treatment Decision Making among Latinas and non-Latina Whites: A Communication Model Predicting Decisional Outcomes and Quality of Life

    PubMed Central

    Yanez, Betina; Stanton, Annette L.; Maly, Rose C.

    2014-01-01

    Objective Deciding among medical treatment options is a pivotal event following cancer diagnosis, a task that can be particularly daunting for individuals uncomfortable with communication in a medical context. Few studies have explored the surgical decision-making process and associated outcomes among Latinas. We propose a model to elucidate pathways though which acculturation (indicated by language use) and reports of communication effectiveness specific to medical decision making contribute to decisional outcomes (i.e., congruency between preferred and actual involvement in decision making, treatment satisfaction) and quality of life among Latinas and non-Latina White women with breast cancer. Methods Latinas (N = 326) and non-Latina Whites (N = 168) completed measures six months after breast cancer diagnosis, and quality of life was assessed 18 months after diagnosis. Structural equation modeling was used to examine relationships between language use, communication effectiveness, and outcomes. Results Among Latinas, 63% reported congruency in decision making, whereas 76% of non-Latina Whites reported congruency. In Latinas, greater use of English was related to better reported communication effectiveness. Effectiveness in communication was not related to congruency in decision making, but several indicators of effectiveness in communication were related to greater treatment satisfaction, as was greater congruency in decision making. Greater treatment satisfaction predicted more favorable quality of life. The final model fit the data well only for Latinas. Differences in quality of life and effectiveness in communication were observed between racial/ethnic groups. Conclusions Findings underscore the importance of developing targeted interventions for physicians and Latinas with breast cancer to enhance communication in decision making. PMID:22746263

  12. Parental refusal of life-saving treatments for adolescents: Chinese familism in medical decision-making re-visited.

    PubMed

    Hui, Edwin

    2008-06-01

    This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession. PMID:18447864

  13. Enhancing Medical Decision-Making Evaluations: Introduction of Normative Data for the Capacity to Consent to Treatment Instrument.

    PubMed

    Gerstenecker, Adam; Niccolai, Lindsay; Marson, Daniel; Triebel, Kristen L

    2016-04-01

    A number of measures have been developed to assess medical decision-making capacity (MDC) in adults. However, their clinical utility is limited by a lack of available normative data. In the current study, we introduce age-independent and age-adjusted normative data for a measure of MDC: the Capacity to Consent to Treatment Instrument. The sample consisted of 308 cognitively normal, community-dwelling adults ranging in age from 19 to 86 years. For age-adjusted norms, individual raw scores were first converted to age-corrected scaled scores based on position within a cumulative frequency distribution and then grouped according to empirically supported age ranges. For age-independent norms, the same method was utilized but without age-corrections being applied or participants being grouped into age ranges. This study has the potential to enhance MDC evaluations by allowing clinicians to compare a patient's performance on the Capacity to Consent to Treatment Instrument with that of adults regardless of age as well as to same age peers. Tables containing normative corrections are supplementary material available online at http://asm.sagepub.com/supplemental. PMID:26282778

  14. Predicting stone composition before treatment – can it really drive clinical decisions?

    PubMed Central

    Bres–Niewada, Ewa; Radziszewski, Piotr

    2014-01-01

    Introduction Determination of stone composition is considered to be crucial for the choice of an optimal treatment algorithm. It is especially important for uric acid stones, which can be dissolved by oral chemolysis and for renal stones smaller than 2 cm, which can be treated with extracorporeal shockwave lithotripsy (ESWL). Material and methods This short review identifies the latest papers on radiological assessment of stone composition and presents a comprehensive evaluation of current scientific findings. Results Stone chemical composition is difficult to predict using standard CT imaging, however, attenuation index measured in Hounsfield units (HU) is related to ESWL outcome. Stone density >1000 HU can be considered predictive for ESWL failure. It seems that stone composition is meaningless in determining the outcome of ureterolithotripsy and percutaneous surgery. Alternative imaging techniques such as Dual–Energy CT or analysis of shape, density and homogeneity of stones on plain X–rays are used as promising methods of predicting stone composition and ESWL outcome. Conclusions New imaging techniques facilitate the identification of uric acid stones and ESWL–resistant stones. Therefore, they may help in selecting the best therapeutic option. PMID:25667761

  15. How Outpatient Substance Abuse Treatment Unit Director Activities May Affect Provision of Community Outreach Services

    ERIC Educational Resources Information Center

    Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey; Green, Sherri

    2013-01-01

    Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services,…

  16. Treatment Preferences Affect the Therapeutic Alliance: Implications for Randomized Controlled Trials

    ERIC Educational Resources Information Center

    Iacoviello, Brian M.; McCarthy, Kevin Scott; Barrett, Marna S.; Rynn, Moira; Gallop, Robert; Barber, Jacques P.

    2007-01-01

    The influence of treatment preferences on the development of the therapeutic alliance was investigated. Seventy-five patients were followed while participating in a randomized controlled trial comparing supportive-expressive psychotherapy with sertraline or pill placebo in the treatment of major depressive disorder. Therapeutic alliance was…

  17. P-glycoprotein activity in the blood-brain barrier is affected by virus-induced neuroinflammation and antipsychotic treatment.

    PubMed

    Doorduin, Janine; de Vries, Erik F J; Dierckx, Rudi A; Klein, Hans C

    2014-10-01

    A large percentage of schizophrenic patients respond poorly to antipsychotic treatment. This could be explained by inefficient drug transport across the blood-brain barrier due to P-glycoprotein mediated efflux. P-glycoprotein activity and expression in the blood-brain barrier can be affected by inflammation and pharmacotherapy. We therefore investigated the effect of herpes simplex virus type-1 (HSV-1) induced neuroinflammation and antipsychotic treatment on P-glycoprotein activity. Rats were inoculated with HSV-1 or PBS (control) on day 0 and treated with saline, clozapine or risperidone from day 0 up until day 4 post-inoculation. Positron emission tomography with the P-glycoprotein substrate [11C]verapamil was used to assess P-glycoprotein activity at day 6 post-inoculation. Disease symptoms in HSV-1 inoculated rats increased over time and were not significantly affected by treatment. The volume of distribution (VT) of [11C]verapamil was significantly lower (10-22%) in HSV-1 inoculated rats than in control rats. In addition, antipsychotic treatment significantly affected the VT of [11C]verapamil in all brain regions, although this effect was drug dependent. In fact, VT of [11C]verapamil was significantly increased (22-39%) in risperidone treated rats in most brain regions when compared to clozapine treated rats and in midbrain when compared to saline treated rats. No interaction between HSV-1 inoculation and antipsychotic treatment on VT of [11C]verapamil was found. In this study we demonstrated that HSV-1 induced neuroinflammation increased and risperidone treatment decreased P-glycoprotein activity. This finding is of importance for the understanding of treatment resistance in schizophrenia, and warrants further investigation of the underlying mechanism and the importance in clinical practice. PMID:24973705

  18. Alkaline peroxide treatment induces acquired unruly hair by apparently affecting distinct macrofibrils.

    PubMed

    Nawa, Teppei; Kawaguchi, Aiko; Kitano, Hiroki; Yamamoto, Toshihiko; Fujinami, So; Asao, Naoki; Nakajima, Ken

    2013-01-01

    Individual hairs can be inherently curly; however, bleach treatment can cause damaged hairs to acquire a curl, a phenomenon we term acquired unintentional unruly hair. Because there have been no reports concerning acquired unintentional unruly hair, the influence of bleach treatment with alkaline peroxide that produce this phenomenon was investigated. First, it was validated that the radius of curvature in many curly hairs is reduced upon bleach treatment. Next, the influence of bleach treatment on the mechanical properties of inner components was studied by the force curve method using atomic force microscopy. This measurement revealed four types of macrofibrils-on the orthocortex- or the paracortex-like structure, and on the concave or the convex side-have different mechanical properties. Macrofibrils on the orthocortex-like structure on the convex side were especially influenced by alkaline peroxide treatment, and may be particularly important to acquired unintentional unruly hair. PMID:23931089

  19. Pharmacologic Evidence to Support Clinical Decision Making for Peripartum Methadone Treatment

    PubMed Central

    Bogen, D. L.; Perel, J. M.; Helsel, J. C.; Hanusa, B. H.; Romkes, M.; Nukui, T.; Friedman, C. R.; Wisner, K. L.

    2012-01-01

    Rationale Limited pharmacological data are available to guide methadone treatment during pregnancy and postpartum. Objectives Study goals were to: 1) Characterize changes in methadone dose across childbearing, 2) Determine enantiomer-specific methadone withdrawal kinetics from steady-state during late pregnancy, 3) Assess enantiomer-specific changes in methadone level/dose (L/D) ratios across childbearing, and 4) Explore relationships between CYP2B6, CYP2C19 and CYP3A4 single nucleotide polymorphisms and maternal dose, plasma concentration and L/D. Methods Methadone dose changes and timed plasma samples were obtained for women on methadone (n=25) followed prospectively from third trimester of pregnancy to three months postpartum. Results Participants were primarily white, Medicaid insured and multiparous. All women increased their dose from first to end of second trimester (mean peak increase=23 mg/day); 71% of women increased from second trimester to delivery (mean peak increase=19 mg/day). Half took a higher dose 3 months postpartum than at delivery despite significantly larger clearance during late pregnancy. Third trimester enantiomer-specific methadone half-lives (range R-methadone 14.7-24.9 hours; S-methadone 8.02-18.9 hours) were about half of those reported in non-pregnant populations. In 3 women with weekly 24-hour methadone levels after delivery, L/D increased within 1-2 weeks after delivery. Women with the CYP2B6 Q172 variant GT genotype have consistently higher L/D values for S-methadone across both pregnancy and postpartum. Conclusions Most women require increases in methadone dose across pregnancy. Given the shorter half-life and larger clearances during pregnancy, many pregnant women may benefit from split methadone dosing. L/D increases quickly after delivery and doses should be lowered rapidly after delivery. PMID:22926004

  20. GIDEON (Global Investigation of therapeutic DEcisions in hepatocellular carcinoma and Of its treatment with sorafeNib): second interim analysis

    PubMed Central

    Lencioni, R; Kudo, M; Ye, S-L; Bronowicki, J-P; Chen, X-P; Dagher, L; Furuse, J; Geschwind, J F; de Guevara, L Ladrón; Papandreou, C; Takayama, T; Yoon, S K; Nakajima, K; Lehr, R; Heldner, S; Sanyal, A J

    2014-01-01

    Background GIDEON (Global Investigation of therapeutic DEcisions in hepatocellular carcinoma [HCC] and Of its treatment with sorafeNib) is a global, prospective, non-interventional study undertaken to evaluate the safety of sorafenib in patients with unresectable HCC in real-life practice, including Child-Pugh B patients who were excluded from clinical trials. Methods Patients with unresectable HCC, for whom the decision to treat with sorafenib, based on the approved label and prescribing guidelines, had been taken by their physician, were eligible for inclusion. Demographic data and disease/medical history were recorded at entry. Sorafenib dosing and adverse events (AEs) were collected at follow-up visits. The second interim analysis was undertaken when ∼1500 treated patients were followed up for ≥ 4 months. Results Of the 1571 patients evaluable for safety, 61% had Child-Pugh A status and 23% Child-Pugh B. The majority of patients (74%) received the approved 800 mg initial sorafenib dose, regardless of Child-Pugh status; however, median duration of therapy was shorter in Child-Pugh B patients. The majority of drug-related AEs were grade 1 or 2, and the most commonly reported were consistent with previous reports. The incidence and nature of drug-related AEs were broadly similar across Child-Pugh, Barcelona Clinic Liver Cancer (BCLC) and initial dosing subgroups, and consistent with the overall population. Conclusions Consistent with the first interim analysis, overall safety profile and dosing strategy are similar across Child-Pugh subgroups. Safety findings also appear comparable irrespective of initial sorafenib dose or BCLC stage. Final analyses in > 3000 patients are ongoing. PMID:24283303

  1. Low Temperature Treatment Affects Concentration and Distribution of Chrysanthemum Stunt Viroid in Argyranthemum.

    PubMed

    Zhang, Zhibo; Lee, YeonKyeong; Sivertsen, Astrid; Skjeseth, Gry; Haugslien, Sissel; Clarke, Jihong Liu; Wang, Qiao-Chun; Blystad, Dag-Ragnar

    2016-01-01

    Chrysanthemum stunt viroid (CSVd) can infect Argyranthemum and cause serious economic loss. Low temperature treatment combined with meristem culture has been applied to eradicate viroids from their hosts, but without success in eliminating CSVd from diseased Argyranthemum. The objectives of this work were to investigate (1) the effect of low temperature treatment combined with meristem culture on elimination of CSVd, (2) the effect of low temperature treatment on CSVd distribution pattern in shoot apical meristem (SAM), and (3) CSVd distribution in flowers and stems of two infected Argyranthemum cultivars. After treatment with low temperature combined with meristem tip culture, two CSVd-free plants were found in 'Border Dark Red', but none in 'Yellow Empire'. With the help of in situ hybridization, we found that CSVd distribution patterns in the SAM showed no changes in diseased 'Yellow Empire' following 5°C treatment, compared with non-treated plants. However, the CSVd-free area in SAM was enlarged in diseased 'Border Dark Red' following prolonged 5°C treatment. Localization of CSVd in the flowers and stems of infected 'Border Dark Red' and 'Yellow Empire' indicated that seeds could not transmit CSVd in these two cultivars, and CSVd existed in phloem. Results obtained in the study contributed to better understanding of the distribution of CSVd in systemically infected plants and the combination of low temperature treatment and meristem tip culture for production of viroid-free plants. PMID:26973607

  2. Low Temperature Treatment Affects Concentration and Distribution of Chrysanthemum Stunt Viroid in Argyranthemum

    PubMed Central

    Zhang, Zhibo; Lee, YeonKyeong; Sivertsen, Astrid; Skjeseth, Gry; Haugslien, Sissel; Clarke, Jihong Liu; Wang, Qiao-Chun; Blystad, Dag-Ragnar

    2016-01-01

    Chrysanthemum stunt viroid (CSVd) can infect Argyranthemum and cause serious economic loss. Low temperature treatment combined with meristem culture has been applied to eradicate viroids from their hosts, but without success in eliminating CSVd from diseased Argyranthemum. The objectives of this work were to investigate (1) the effect of low temperature treatment combined with meristem culture on elimination of CSVd, (2) the effect of low temperature treatment on CSVd distribution pattern in shoot apical meristem (SAM), and (3) CSVd distribution in flowers and stems of two infected Argyranthemum cultivars. After treatment with low temperature combined with meristem tip culture, two CSVd-free plants were found in ‘Border Dark Red’, but none in ‘Yellow Empire’. With the help of in situ hybridization, we found that CSVd distribution patterns in the SAM showed no changes in diseased ‘Yellow Empire’ following 5°C treatment, compared with non-treated plants. However, the CSVd-free area in SAM was enlarged in diseased ‘Border Dark Red’ following prolonged 5°C treatment. Localization of CSVd in the flowers and stems of infected ‘Border Dark Red’ and ‘Yellow Empire’ indicated that seeds could not transmit CSVd in these two cultivars, and CSVd existed in phloem. Results obtained in the study contributed to better understanding of the distribution of CSVd in systemically infected plants and the combination of low temperature treatment and meristem tip culture for production of viroid-free plants. PMID:26973607

  3. Access and completion of a Web-based treatment in a population-based sample of tornado-affected adolescents.

    PubMed

    Price, Matthew; Yuen, Erica K; Davidson, Tatiana M; Hubel, Grace; Ruggiero, Kenneth J

    2015-08-01

    Although Web-based treatments have significant potential to assess and treat difficult-to-reach populations, such as trauma-exposed adolescents, the extent that such treatments are accessed and used is unclear. The present study evaluated the proportion of adolescents who accessed and completed a Web-based treatment for postdisaster mental health symptoms. Correlates of access and completion were examined. A sample of 2,000 adolescents living in tornado-affected communities was assessed via structured telephone interview and invited to a Web-based treatment. The modular treatment addressed symptoms of posttraumatic stress disorder, depression, and alcohol and tobacco use. Participants were randomized to experimental or control conditions after accessing the site. Overall access for the intervention was 35.8%. Module completion for those who accessed ranged from 52.8% to 85.6%. Adolescents with parents who used the Internet to obtain health-related information were more likely to access the treatment. Adolescent males were less likely to access the treatment. Future work is needed to identify strategies to further increase the reach of Web-based treatments to provide clinical services in a postdisaster context. PMID:25622071

  4. Access and Completion of a Web-Based Treatment in a Population-Based Sample of Tornado-Affected Adolescents

    PubMed Central

    Price, Matthew; Yuen, Erica; Davidson, Tatiana M.; Hubel, Grace; Ruggiero, Kenneth J.

    2015-01-01

    Although web-based treatments have significant potential to assess and treat difficult to reach populations, such as trauma-exposed adolescents, the extent that such treatments are accessed and used is unclear. The present study evaluated the proportion of adolescents who accessed and completed a web-based treatment for post-disaster mental health symptoms. Correlates of access and completion were examined. A sample of 2,000 adolescents living in tornado-affected communities was assessed via structured telephone interview and invited to a web-based treatment. The modular treatment addressed symptoms of PTSD, depression, and alcohol and tobacco use. Participants were randomized to experimental or control conditions after accessing the site. Overall access for the intervention was 35.8%. Module completion for those who accessed ranged from 52.8% to 85.6%. Adolescents with parents who used the Internet to obtain health-related information were more likely to access the treatment. Adolescent males were less likely to access the treatment. Future work is needed to identify strategies to further increase the reach of web-based treatments to provide clinical services in a post-disaster context. PMID:25622071

  5. Psychosocial co-morbidity affects treatment outcome in children with fecal incontinence.

    PubMed

    van Everdingen-Faasen, Els Q; Gerritsen, Bert J; Mulder, Paul G H; Fliers, Ellen A; Groeneweg, Michael

    2008-09-01

    Fecal incontinence is a common disorder in children. Many children with fecal incontinence have psychosocial co-morbidity. In this study, the effect of psychosocial co-morbidity on the treatment outcome of children with fecal incontinence was evaluated. One hundred and fifty children with fecal incontinence were treated in a multidisciplinary program. All children had been treated unsuccessfully for at least one year before entering the program. The treatment consisted of laxative treatment, psychosocial interventions, and biofeedback training. Psychosocial co-morbidity was classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). One hundred and forty-one children were completely analyzed (102 boys, mean age 9.6 (range 6.5-16.5) years). Of these, 31 (22%) children had fecal incontinence without constipation and 110 (78%) children had fecal incontinence associated with constipation. In 95% of children, at least one psychosocial co-morbidity was present. Treatment was successful at 12 months in 69% of patients. Treatment was less successful in children with attention deficit hyperactivity disorder (ADHD), in children with parent-child relational problems, and in mentally retarded children. The results indicate that the early assessment and treatment of psychosocial co-morbidity might improve treatment response in children with fecal incontinence. Children with fecal incontinence are treated less successfully in the first year if they have ADHD, parent-child relational problems, or mental retardation. Psychosocial evaluation and the early assessment and treatment of psychosocial co-morbidity is indicated in order to improve response rate. Family counseling--aimed at improving parent-child relations--should be an integral part of a multidisciplinary treatment program for fecal incontinence. PMID:17952465

  6. Treatment of multidrug-resistant tuberculosis in a remote, conflict-affected area of the Democratic Republic of Congo.

    PubMed

    Shanks, L; Masumbuko, E W; Ngoy, N M; Maneno, M; Bartlett, S; Thi, S S; Shah, T

    2012-08-01

    The Democratic Republic of Congo is a high-burden country for multidrug-resistant tuberculosis. Médecins Sans Frontières has supported the Ministry of Health in the conflict-affected region of Shabunda since 1997. In 2006, three patients were diagnosed with drug-resistant TB (DR-TB) and had no options for further treatment. An innovative model was developed to treat these patients despite the remote setting. Key innovations were the devolving of responsibility for treatment to non-TB clinicians remotely supported by a TB specialist, use of simplified monitoring protocols, and a strong focus on addressing stigma to support adherence. Treatment was successfully completed after a median of 24 months. This pilot programme demonstrates that successful treatment for DR-TB is possible on a small scale in remote settings. PMID:22565108

  7. EFFECT OF POSITIVE AND NEGATIVE AFFECTIVE STIMULI AND BEVERAGE CUES ON MEASURES OF CRAVING IN NON TREATMENT-SEEKING ALCOHOLICS

    PubMed Central

    Mason, Barbara J.; Light, John M.; Escher, Tobie; Drobes, David J.

    2009-01-01

    Rationale Laboratory paradigms are useful for investigating mechanisms of human alcohol cue reactivity in a highly controlled environment. A number of studies have examined the effects of beverage exposure or negative affective stimuli on cue reactivity independently, but only a few have reported on interaction effects between beverage cue and affective stimuli, and none have evaluated the effects of positive stimuli on beverage cue reactivity. Objectives To assess independent and interactive effects of both positive and negative affective stimuli and beverage cue on psychophysiological and subjective measures of reactivity in alcohol dependence. Methods A total of 47 non treatment-seeking paid volunteers with current alcohol dependence participated in a within-subjects trial where each was exposed to a standardized set of pleasant, neutral, or unpleasant visual stimuli followed by alcohol or water cues. Psychophysiological cue reactivity measures were obtained during beverage presentation, and subjective reactivity measures were taken directly following beverage presentation. Results Mixed-effect models revealed a significant main effect of beverage and positive (but not negative) affective stimuli on subjective strength of craving, and significant main effects of both positive and negative affective stimuli on ratings of emotionality. Despite the power to detect relatively small interaction effects, no significant interactions were observed between affect and beverage conditions on any reactivity measure. A key finding of this study is that positive affective stimuli commonly associated with drinking situations can induce craving in the absence of alcohol cues. Conclusions Main effects of beverage cue replicated results from previous studies. In addition, positive affective stimuli influenced craving strength. Beverage and affective cues showed no interaction effects. PMID:18604601

  8. Impact assessment and recommendation of alternative conjunctive water use strategies for salt affected agricultural lands through a field scale decision support system - a case study.

    PubMed

    Kaur, Ravinder; Paul, Madhumita; Malik, Rashmi

    2007-06-01

    Conjunctive use of saline/non-saline irrigation waters is generally aimed at minimizing yield losses and enhancing flexibility of cropping, without much alteration in farming operations. Recommendation of location-specific suitable conjunctive water use plans requires assessment of their long-term impacts on soil salinization/sodification and crop yield reductions. This is conventionally achieved through long-term field experiments. However such impact evaluations are site specific, expensive and time consuming. Appropriate decision support systems (DSS) can be time-efficient and cost-effective means for such long-term impact evaluations. This study demonstrates the application of one such (indigenously developed) DSS for recommending best conjunctive water use plans for a, rice-wheat growing, salt affected farmer's field in Gurgaon district of Haryana (India). Before application, the DSS was extensively validated on several farmers and controlled experimental fields in Gurgaon and Karnal districts of Haryana (India). Validation of DSS showed its potential to give realistic estimates of root zone soil salinity (with R = 0.76-0.94; AMRE = 0.03-0.06; RMSPD = 0.51-0.90); sodicity (with R = 0.99; AMRE = 0.02; RMSPD = 0.84) and relative crop yield reductions (AMRE = 0.24), under existing (local) resource management practices. Long term (10 years) root zone salt build ups and associated rice/wheat crop yield reductions, in a salt affected farmer's field, under varied conjunctive water use scenarios were evaluated with the validated DSS. It was observed that long-term applications of canal (CW) and tube well (TW) waters in a cycle and in 1:1 mixed mode, during Kharif season, predicted higher average root zone salt reductions (2-9%) and lower rice crop yield reductions (4-5%) than the existing practice of 3-CW, 3-TW, 3-CW. Besides this, long-term application of 75% CW mixed with 25% TW, during Rabi season, predicted about 17% lower average root-zone salt reductions than

  9. Quality and antioxidant properties on sweet cherries as affected by preharvest salicylic and acetylsalicylic acids treatments.

    PubMed

    Giménez, María José; Valverde, Juan Miguel; Valero, Daniel; Guillén, Fabián; Martínez-Romero, Domingo; Serrano, María; Castillo, Salvador

    2014-10-01

    The effects of salicylic acid (SA) or acetylsalicylic acid (ASA) treatments during on-tree cherry growth and ripening on fruit quality attributes, especially those related with the content on bioactive compounds and antioxidant activity were analysed in this research. For this purpose, two sweet cherry cultivars, 'Sweet Heart' and 'Sweet Late', were used and SA or ASA treatments, at 0.5, 1.0 and 2.0mM concentrations, were applied at three key points of fruit development (pit hardening, initial colour changes and onset of ripening). These treatments increased fruit weight and ameliorated quality attributes at commercial harvest, and led to cherries with higher concentration in total phenolics and in total anthocyanins, as well as higher antioxidant activity, in both hydrophilic and lipophilic fractions. Thus, preharvest treatments with SA or ASA could be promising tools to improve sweet cherry quality and health beneficial effects for consumers. PMID:24799232

  10. Repeated treatment with oxytocin promotes hippocampal cell proliferation, dendritic maturation and affects socio-emotional behavior.

    PubMed

    Sánchez-Vidaña, Dalinda Isabel; Chan, Ngai-Man Jackie; Chan, Alan H L; Hui, Katy K Y; Lee, Sylvia; Chan, Hoi-Yi; Law, Yuen Shan; Sze, Mei Yi; Tsui, Wai-Ching Sarah; Fung, Timothy K H; Lau, Benson Wui-Man; Lai, Cynthia Y Y

    2016-10-01

    Rewarding social behaviors including positive social interactions and sexual behaviors are shown to regulate adult neurogenesis, but the underlying biological mechanisms remain elusive. Oxytocin, a neurohypophysial hormone secreted after exposure to social interaction or sexual behaviors, has a profound role in the formation of social bonding and regulation of emotional distress. While the acute effect of oxytocin was usually studied, relatively scarce evidence showed the behavioral consequence of repeated oxytocin treatment. The purpose of the current study was to investigate the effect of repeated oxytocin treatment on hippocampal cell proliferation, dendritic maturation of new born neurons and social/emotional behaviors. Adult male Sprague-Dawley rats received treatment with either vehicle or oxytocin (1mg/kg) daily for two weeks. Behavioral tests revealed that oxytocin increased social behaviors and reduced the anxiety- and depression-like behaviors. Cell proliferation, differentiation and the dendritic complexity of new born neurons in the hippocampus were promoted by oxytocin treatment. Depression- and anxiety-like behaviors were induced by repeated treatment of corticosterone (40mg/kg) for two weeks while oxytocin treatment reversed the behavioral disturbances. Suppression of cell proliferation caused by corticosterone was reverted by oxytocin treatment in which cell proliferation, cell differentiation, and dendritic complexity increased. The present findings reveal that oxytocin not only enhances cell proliferation, but also promotes the development of the new neurons which is associated with the induction of positive emotional and social behaviors. The results also suggest that oxytocin may be a potential therapeutic agent for treatment of emotional and social dysfunction. PMID:27418343

  11. Investigation of parameters affecting treatment time in MRI-guided transurethral ultrasound therapy

    NASA Astrophysics Data System (ADS)

    N'Djin, W. A.; Burtnyk, M.; Chopra, R.; Bronskill, M. J.

    2010-03-01

    MRI-guided transurethral ultrasound therapy shows promise for minimally invasive treatment of localized prostate cancer. Real-time MR temperature feedback enables the 3D control of thermal therapy to define an accurate region within the prostate. Previous in-vivo canine studies showed the feasibility of this method using transurethral planar transducers. The aim of this simulation study was to reduce the procedure time, while maintaining treatment accuracy by investigating new combinations of treatment parameters. A numerical model was used to simulate a multi-element heating applicator rotating inside the urethra in 10 human prostates. Acoustic power and rotation rate were varied based on the feedback of the temperature in the prostate. Several parameters were investigated for improving the treatment time. Maximum acoustic power and rotation rate were optimized interdependently as a function of prostate radius and transducer operating frequency, while avoiding temperatures >90° C in the prostate. Other trials were performed on each parameter separately, with the other parameter fixed. The concept of using dual-frequency transducers was studied, using the fundamental frequency or the 3rd harmonic component depending on the prostate radius. The maximum acoustic power which could be used decreased as a function of the prostate radius and the frequency. Decreasing the frequency (9.7-3.0 MHz) or increasing the power (10-20 W.cm-2) led to treatment times shorter by up to 50% under appropriate conditions. Dual-frequency configurations, while helpful, tended to have less impact on treatment times. Treatment accuracy was maintained and critical adjacent tissues like the rectal wall remained protected. The interdependence between power and frequency may require integrating multi-parametric functions inside the controller for future optimizations. As a first approach, however, even slight modifications of key parameters can be sufficient to reduce treatment time.

  12. Antidepressants and Suicide Risk: How Did Specific Information in FDA Safety Warnings Affect Treatment Patterns?

    PubMed Central

    Busch, Susan H.; Frank, Richard G.; Leslie, Doug; Martin, Andres; Martin, Erika; Rosenheck, Robert; Barry, Colleen L.

    2009-01-01

    Objective From June 2003 through October 2004, the Food and Drug Administration (FDA) released five safety warnings related to antidepressant use and increased suicide risk in children. While researchers have documented a decline in antidepressant use in children over this time period, less is known about whether specific safety information conveyed in individual warnings was reflected in treatment patterns. Methods Thomson Marketscan claims data (2001–2005) for a national sample of privately insured children were used to construct treatment episodes (N=23,529). For each new episode of major depressive disorder, it was determined whether children’s treatment followed specific recommendations included in warnings released by the FDA. Treatment recommendations pertained to the use of the antidepressants paroxetine and fluoxetine and to patient monitoring. Treatment patterns were expected to change as the nature of risk information conveyed by the FDA changed over time. Results The timing of FDA recommendations was associated with trends in the use of paroxetine and fluoxetine by children with major depressive disorder newly initiating antidepressant treatment. However, no evidence of increases in outpatient visits (i.e., monitoring) among depressed children initiating antidepressants was found. Conclusions Release of specific risk and benefit information by the FDA was associated with changes in prescribing, but not outpatient follow-up. These results suggest the FDA plays an important role in communicating information to the public and providers, but while public health safety warnings were associated with changes in some practice patterns, not all recommendations conveyed in warnings were followed. PMID:20044412

  13. Comparing a Cognitive Model and Phototherapy in the Treatment of Seasonal Affective Disorder.

    ERIC Educational Resources Information Center

    Krantz, Sandra

    Seasonal affective disorder (SAD) is characterized by recurrent major depression or bipolar disorder that occurs annually, usually later in fall as the daylight hours decrease, and that alternates with euthymic or hypomanic moods in the spring and summer. Pioneering research by Dr. Norman Rosenthal and associates has found phototherapy to be…

  14. Factors affecting the response to the specific treatment of several forms of clinical anestrus in high producing dairy cows.

    PubMed

    López-Gatius, F; Mirzaei, A; Santolaria, P; Bech-Sàbat, G; Nogareda, C; García-Ispierto, I; Hanzen, Ch; Yániz, J L

    2008-06-01

    This study was designed to examine estrous response rates to the therapeutic treatment of clinical anestrus in high producing dairy cows and to identify the factors that could affect these rates. Cows with silent ovulation (Subestrus group), cystic ovarian disease (Cyst group) or ovarian hypofunction (OH group) were given specific treatment for their disorder. Data were derived from 1764 treatments in cows producing a mean of 45.4 kg of milk upon treatment including: 889 subestrous cows, 367 cystic cows and 508 cows with ovarian hypofunction. Cows showing estrus following treatment exhibited a similar pregnancy rate to cows attaining natural estrus used as reference: 33% (337/1006) and 35% (626/1796), respectively. No significant differences in pregnancy rates were observed among the Subestrus, Cyst and OH groups (34% (196/571), 34% (44/130), 32% (97/305), respectively. Based on the odds ratio, an estrous response for all groups was less likely to occur in cows that had suffered previous anestrus, compared to cows that were anestrous for the first time, whereas the likelihood of an estrous response increased in cows treated after 90 days in milk. Our results indicate that previous anestrus and a late stage of lactation can have a negative and positive effect, respectively, on the estrous response to the specific treatment of clinical anestrus shown by high producing dairy cows. Treatment targeted at each type of clinical anestrus can render similar pregnancy rates to those shown by cows in natural estrus. PMID:18359070

  15. The decision to repair or replace a defective restoration is affected by who placed the original restoration: findings from the National Dental PBRN

    PubMed Central

    Gordan, Valeria V; Riley, Joseph; Geraldeli, Saulo; Williams, O. Dale; Spoto, Joseph C; Gilbert, Gregg H

    2014-01-01

    Objectives To evaluate how restoration characteristics are associated with the decision to repair or replace an existing restoration. The following hypotheses were studied: Dentists who placed the original restoration are more likely to repair instead of replace restorations (H1) that are in molar teeth; (H2) that are in the upper arch; (H3) that have amalgam restorative material; (H4) if a fracture is not the primary reason for the defect; and (H5) when the restoration comprises more than one surface. Methods This cross-sectional study used a consecutive patient/restoration recruitment design. 194 dentists members of a dental practice-based research network recorded data on restorations in permanent teeth that needed repair or replacement. Results For 6,623 of the 8,770 defective restorations in 6,643 patients, the treatment was provided by the dentist who had not placed the original restoration (75%). The 2-way interaction revealed that dentists who had placed the original restoration often chose to repair when the defective restoration was in a molar, relative to premolar or anterior teeth (OR = 2.2, p < .001); and chose to replace when the restoration had amalgam (OR = 0.5, p < .001), and when it was a fracture compared to another reason (OR = 0.8, p = 001). Conclusion Most dentists are not conservative when they revisit a restoration that they originally placed regardless of type of failure, number of surfaces or material used. However, dentists who had placed the original restoration were significantly more likely to repair it when the defective restoration was in a molar tooth. PMID:25223822

  16. Parameters affecting the occurrence and removal of polybrominated diphenyl ethers in twenty Canadian wastewater treatment plants.

    PubMed

    Kim, M; Guerra, P; Theocharides, M; Barclay, K; Smyth, S A; Alaee, M

    2013-05-01

    This study determined PBDE levels in influent, primary effluent, and final effluent collected from diverse treatment processes including four aerated lagoons, two facultative lagoons, four primary treatments, eight secondary biological treatments and two advanced treatments. Parameters examined for correlation included seasonal temperature, community sizes, industrial inputs, and operational conditions. PBDE levels in influent were 21-1000 ng/L (median 190 ng/L). Higher concentrations in influent samples were found during summer, and in WWTPs which treated leachate and higher proportions of industrial wastewater vs. residential wastewater. Final effluent levels ranged between 3 and 270 ng/L (median 12 ng/L). Among all congeners, the sum of BDE-209, -47 and -99 accounted for 79 and 71% of total PBDEs in influent and final effluent, respectively, with BDE-209 having the highest proportion. Median removal efficiencies for all process types exceeded 90% except primary treatment at 70%. PBDE levels and removals were correlated to the levels and removals of conventional parameters that represent wastewater strength, such as chemical oxygen demand and total suspended solids. The role of the primary clarifier was significant (∼82% removal) and removal was associated with hydraulic retention time (HRT) and surface loading rate. Best removal of PBDEs was achieved at greater than 2000 mg/L mixed liquor suspended solids (MLSS), longer than 10 h of HRT, and 9 days of solids retention time. PMID:23466032

  17. The Treatment Decision-Making Process: Age Differences in a Sample of Women Recently Diagnosed with Nonrecurrent Early-Stage Breast Cancer.

    ERIC Educational Resources Information Center

    Petrisek, Ann C.; Laliberte, Linda L.; Allen, Susan M.; Mor, Vincent

    1997-01-01

    Using retrospective, self-report data collected from women recently diagnosed with breast cancer (N=179), examines the influence of age differences in the treatment decision-making process. Findings indicate that older women were less likely than their younger counterparts to have desired participation in therapy selection or sought out medical…

  18. The duration of gastrin treatment affects global gene expression and molecular responses involved in ER stress and anti-apoptosis

    PubMed Central

    2013-01-01

    Background How cells decipher the duration of an external signal into different transcriptional outcomes is poorly understood. The hormone gastrin can promote a variety of cellular responses including proliferation, differentiation, migration and anti-apoptosis. While gastrin in normal concentrations has important physiological functions in the gastrointestine, prolonged high levels of gastrin (hypergastrinemia) is related to pathophysiological processes. Results We have used genome-wide microarray time series analysis and molecular studies to identify genes that are affected by the duration of gastrin treatment in adenocarcinoma cells. Among 403 genes differentially regulated in transiently (gastrin removed after 1 h) versus sustained (gastrin present for 14 h) treated cells, 259 genes upregulated by sustained gastrin treatment compared to untreated controls were expressed at lower levels in the transient mode. The difference was subtle for early genes like Junb and c-Fos, but substantial for delayed and late genes. Inhibition of protein synthesis by cycloheximide was used to distinguish between primary and secondary gastrin regulated genes. The majority of gastrin upregulated genes lower expressed in transiently treated cells were primary genes induced independently of de novo protein synthesis. This indicates that the duration effect of gastrin treatment is mainly mediated via post-translational signalling events, while a smaller fraction of the differentially expressed genes are regulated downstream of primary transcriptional events. Indeed, sustained gastrin treatment specifically induced prolonged ERK1/2 activation and elevated levels of the AP-1 subunit protein JUNB. Enrichment analyses of the differentially expressed genes suggested that endoplasmic reticulum (ER) stress and survival is affected by the duration of gastrin treatment. Sustained treatment exerted an anti-apoptotic effect on serum starvation-induced apoptosis via a PKC-dependent mechanism. In

  19. Shade treatment affects structure and recovery of invasive C4 African grass Echinochloa pyramidalis.

    PubMed

    López Rosas, Hugo; Moreno-Casasola, Patricia; Espejel González, Verónica E

    2015-03-01

    Echinochloa pyramidalis (Lam.) Hitchc. & Chase is an African grass with C4 photosynthesis, high biomass production, and high vegetative propagation that is tolerant to grazing and able to grow in flooded and dry conditions. Thus, it is highly invasive in tropical freshwater marshes where it is intentionally planted by ranchers to increase cattle production. This invasion is reducing plant biodiversity by increasing the invader's aerial coverage, changing wetland hydrology and causing soil physicochemical changes such as vertical accretion. Reducing the dominance of this species and increasing the density of native wetland species is a difficult, expensive, and time-consuming process. We applied a series of disturbance treatments aimed at eliminating E. pyramidalis and recovering the native vegetation of a partially invaded freshwater marsh. Treatments included physical (cutting, soil disking, transplanting individuals of the key native species Sagittaria lancifolia subsp. media (Micheli) Bogin, and/or reducing light with shade mesh) and/or chemical (spraying Round-Up™ herbicide) disturbances. At the end of the experiment, four of the five treatments used were effective in increasing the cover and biomass of native species and reducing that of E. pyramidalis. The combination of these treatments should be used to generate a proposal for the restoration of tropical wetlands invaded by non-native grasses. A promising treatment is using soil disked to soften the soil and destroy belowground structures such as roots and rhizomes. This treatment would be more promising if combined with the use of shade cloth. If it is desirable not to impact the soil or if there is not enough budget to make an effort to include active restoration disking soil, the use of shade cloth will suffice, although the recovery of native vegetation will be slower. PMID:25859337

  20. Shade treatment affects structure and recovery of invasive C4 African grass Echinochloa pyramidalis

    PubMed Central

    López Rosas, Hugo; Moreno-Casasola, Patricia; Espejel González, Verónica E

    2015-01-01

    Echinochloa pyramidalis (Lam.) Hitchc. & Chase is an African grass with C4 photosynthesis, high biomass production, and high vegetative propagation that is tolerant to grazing and able to grow in flooded and dry conditions. Thus, it is highly invasive in tropical freshwater marshes where it is intentionally planted by ranchers to increase cattle production. This invasion is reducing plant biodiversity by increasing the invader's aerial coverage, changing wetland hydrology and causing soil physicochemical changes such as vertical accretion. Reducing the dominance of this species and increasing the density of native wetland species is a difficult, expensive, and time-consuming process. We applied a series of disturbance treatments aimed at eliminating E. pyramidalis and recovering the native vegetation of a partially invaded freshwater marsh. Treatments included physical (cutting, soil disking, transplanting individuals of the key native species Sagittaria lancifolia subsp. media (Micheli) Bogin, and/or reducing light with shade mesh) and/or chemical (spraying Round-Up™ herbicide) disturbances. At the end of the experiment, four of the five treatments used were effective in increasing the cover and biomass of native species and reducing that of E. pyramidalis. The combination of these treatments should be used to generate a proposal for the restoration of tropical wetlands invaded by non-native grasses. A promising treatment is using soil disked to soften the soil and destroy belowground structures such as roots and rhizomes. This treatment would be more promising if combined with the use of shade cloth. If it is desirable not to impact the soil or if there is not enough budget to make an effort to include active restoration disking soil, the use of shade cloth will suffice, although the recovery of native vegetation will be slower. PMID:25859337

  1. [Treatment errors involving diagnosis using prostate specific antigen. Decisions of the commission of experts for medical mistakes of treatment of the state medical board of North Rhine].

    PubMed

    Lent, V; Baumbusch, F; Weber, G

    2005-12-01

    Advances in prostate specific antigen (PSA) diagnosis are accompanied by deficits in realization. The justification of claims by affected patients against their doctors are reviewed by commissions of experts and mediation by medical councils out of court, impartial and free of charge. The objectivity of the review is ensured by the independence of the commission and its members as well as the determination of facts and their assessment. Criteria are professional standards and required care. Since 1995, 21 requests by affected patients have been reviewed. In 15 cases (71.4%), treatment errors were ascertained. This involved either a delayed or an insufficient diagnosis (prostatic biopsy). In ten of the patients, a mostly early prostate cancer would have be diagnosed and treated at the time of the first finding of PSA values between 3.3 and 10.4 ng/ml. In ten of 13 patients, the tumor was diagnosed late, having PSA values between 6.8 and 1251 ng/ml with no chance of curative therapy. As in other life threatening diseases, time of recognition is most important for the diagnosis and treatment of patients with prostate cancer. Particularly for early recognition, PSA is much more sensitive then digital rectal examination, and in cases without a digital finding is the only parameter for early diagnoses. In men with suspicious PSA values (>4.0 ng/ml) suitable a diagnostic test (prostate biopsy) is required early, until cancer is detected or excluded. PMID:16142454

  2. Acceptance and Commitment Therapy in the Treatment of Alcohol Use Disorder and Comorbid Affective Disorder: A Pilot Matched Control Trial.

    PubMed

    Thekiso, Thekiso B; Murphy, Philip; Milnes, Jennie; Lambe, Kathryn; Curtin, Aisling; Farren, Conor K

    2015-11-01

    This study examined whether acceptance and commitment therapy (ACT) enhances treatment as usual (TAU) in improving treatment outcomes in patients with alcohol use disorder (AUD) and comorbid affective disorder. Fifty-two participants were included in the study, of whom 26 were patients with AUD and either depression or bipolar disorder treated with ACT group therapy in parallel with TAU (inpatient integrated treatment) and 26 were matched controls who had received TAU alone. Drinking and craving outcomes were total alcohol abstinence, cumulative abstinence duration (CAD) and Obsessive Compulsive Drinking Scale (OCDS) scores at 3 and 6 months postintervention. Affective and anxiety outcomes were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Young Mania Rating Scale (YMRS) scores at these follow-ups. Baseline demographic and clinical characteristics were similar in both groups. Retention rates were high: 100% of the ACT group were followed up at 3 and 6 months; 92.3% and 84.6% of the TAU alone group were followed up at 3 and 6 months, respectively. Patients in the ACT group reported significantly higher CAD at 3 and 6 months, significantly lower BDI and BAI scores at 3 and 6 months, and significantly lower OCDS scores at 3 months, than those who received only TAU. No other significant differences in treatment outcomes were found between the groups. ACT provides added benefit to TAU in improving drinking, craving, depression and anxiety outcomes in patients with AUD and comorbid affective disorder. Most treatment improvements were sustained over a 6-month follow-up period. PMID:26520216

  3. LCA as a decision support tool for the environmental improvement of the operation of a municipal wastewater treatment plant.

    PubMed

    Pasqualino, Jorgelina C; Meneses, Montse; Abella, Montserrat; Castells, Francesc

    2009-05-01

    Life cycle assessment (LCA) methodology is used to evaluate the environmental profile of a product or process from its origin to its final destination. In this paper we used LCA to evaluate the current situation of a wastewater treatment plant and identify improvement alternatives. Currently, the highest environmental impacts are caused by the stages of the plant with the highest energy consumption, the use of biogas from anaerobic digestion (95% burned in torch) and the final destination of the sludge (98.6% for agricultural use and 1.4% for compost). We propose four alternatives for biogas applications and five alternatives for sludge applications and compare them to the current situation. The alternatives were incorporated in a decision support system to identify and prioritize the most positive environmental option. Using biogas to produce electricity or a combination of electricity and heat provided the best environmental options since the energy produced would be enough to supply all the stages of the plant, thus reducing their environmental impact. The best environmental option for the final destination of the sludge is to combine the current situation (fertilizer replacement) with use of the sludge in a cement plant (as a replacement for fuel and raw material). PMID:19534150

  4. Water treatment residuals and biosolids coapplications affect semiarid rangeland phosphorus cycling

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Land co-application of water treatment residuals (WTR) with biosolids has not been extensively researched, but the limited studies performed suggest that WTR sorb excess biosolids-borne P. To understand the long-term effects of a single co-application and the short-term impacts of a repeated co-app...

  5. Preharvest herbicide treatments affect black bean desiccation, yield, and canned bean color

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A field trial was conducted near Richville, Michigan in 2013 and 2014 to evaluate the effects of preharvest herbicide treatments on desiccation, yield, and canned black bean quality and color. Three Type II black bean varieties, Zorro, Eclipse, and Zenith, were planted on two different dates in each...

  6. Do Pharmacological and Behavioral Interventions Differentially Affect Treatment Outcome for Children with Social Phobia?

    ERIC Educational Resources Information Center

    Scharfstein, Lindsay A.; Beidel, Deborah C.; Rendon Finnell, Laura; Distler, Aaron; Carter, Nathan T.

    2011-01-01

    In a randomized trial for children with social phobia (SP), Social Effectiveness Therapy for Children (SET-C; a treatment consisting of exposure and social skills training) and fluoxetine were more effective than pill placebo in reducing social distress and behavioral avoidance, but only SET-C demonstrated significantly improved overall social…

  7. Water treatment residuals and biosolids co-applications affect semi-arid rangeland phosphorus cycling

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Land co-application of water treatment residuals (WTR) with biosolids has not been extensively researched, but the limited studies performed suggest that WTR sorb excess biosolids-borne P. To understand the long-term effects of a single co-application and the short-term impacts of a repeated co-app...

  8. How Attendance and Quality of Participation Affect Treatment Response to Parent Management Training

    ERIC Educational Resources Information Center

    Nix, Robert L.; Bierman, Karen L.; McMahon, Robert J.

    2009-01-01

    This study examined whether attendance and quality of participation in parent management training predicted treatment response. Data were from 445 parents (55% minority, 62% single; almost all of low socioeconomic status) who had 1st-grade children with severe conduct problems. Quality of participation in weekly parent groups was based on group…

  9. Timing and rate of Chaparral treatment affects tall fescue seedhead development and pasture plant densities

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The herbicide Chaparral™ has been shown to suppress seedhead development in tall fescue (Neotyphodium coenophialum) pastures and reduce the symptoms of tall fescue toxicosis in cattle. However, little is known about the logistics of herbicide treatment on tall fescue pastures. The objective of thi...

  10. Ruby laser for treatment of tattoos: technical considerations affecting clinical use

    NASA Astrophysics Data System (ADS)

    Grove, Robert E.

    1990-06-01

    Recent clinical research on the use of ruby lasers for the treatment of tattoos and FIlk approval of a commercial system have renewed interest in this device. In this paper the principles of Q-switched ruby laser operation are reviewed, and potential sources of error in the estimation of delivered fluence are discussed.

  11. Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011

    PubMed Central

    Shahrezaei, Marzieh; Maracy, Mohammad Reza; Farid, Fariba

    2015-01-01

    Background: Regarding cases of infectious diseases tuberculosis (TB) is the most important cause of death and according to the DALY criteria, this disease has the seventh position in global disease ranking. In this study, we aim to determine the risk factors, which have a significant effect on the treatment completion and mortality of TB patients. Methods: This study is a retrospective cohort study. The sample is made up of registered TB patients in the Isfahan Province from 2006 to 2011. Information of the patients was collected from their files in health centers in the Isfahan Province. Variables such as age, sex, weight, nationality, residence, type of TB, imprisonment, human immunodeficiency virus, TB case were measured. Descriptive statistics (including frequency, percentage, mean and standard deviation) and statistical analysis (including Cox proportional hazard model) were used. Results: The result showed that imprisonment (hazard ratio [HR] = 4.76, P = 0.019), age (HR = 4.44, P = 0.001) and the TB case (HR = 2.73, P = 0.037) of pulmonary TB had significant impacts on mortality of the patients, also in the case of treatment completion, the TB case (HR = 0.34, P < 0.001) proved to have a significant impact on completion of the treatment. Type of extra-pulmonary TB in extra-pulmonary TB patients also had an effect on treatment completion. Conclusions: We can conclude that factors such as age, imprisonment, TB case and type of extra-pulmonary TB are effective on the treatment completion and mortality of the patients. It may be useful for policy makers to make more control of high-risk patients. PMID:26445638

  12. Making Decisions about Treatment

    MedlinePlus

    Project Inform Information, inspiration and advocacy for people with HIV/AIDS and hepatitis C Skip to content ... Health care reform CONTRIBUTORS Search for: Twitter Feed Project Inform ProjectInform ProjectInform Easy to use #PrEP cards ...

  13. An ontology for factors affecting tuberculosis treatment adherence behavior in sub-Saharan Africa

    PubMed Central

    Ogundele, Olukunle Ayodeji; Moodley, Deshendran; Pillay, Anban W; Seebregts, Christopher J

    2016-01-01

    Purpose Adherence behavior is a complex phenomenon influenced by diverse personal, cultural, and socioeconomic factors that may vary between communities in different regions. Understanding the factors that influence adherence behavior is essential in predicting which individuals and communities are at risk of nonadherence. This is necessary for supporting resource allocation and intervention planning in disease control programs. Currently, there is no known concrete and unambiguous computational representation of factors that influence tuberculosis (TB) treatment adherence behavior that is useful for prediction. This study developed a computer-based conceptual model for capturing and structuring knowledge about the factors that influence TB treatment adherence behavior in sub-Saharan Africa (SSA). Methods An extensive review of existing categorization systems in the literature was used to develop a conceptual model that captured scientific knowledge about TB adherence behavior in SSA. The model was formalized as an ontology using the web ontology language. The ontology was then evaluated for its comprehensiveness and applicability in building predictive models. Conclusion The outcome of the study is a novel ontology-based approach for curating and structuring scientific knowledge of adherence behavior in patients with TB in SSA. The ontology takes an evidence-based approach by explicitly linking factors to published clinical studies. Factors are structured around five dimensions: factor type, type of effect, regional variation, cross-dependencies between factors, and treatment phase. The ontology is flexible and extendable and provides new insights into the nature of and interrelationship between factors that influence TB adherence. PMID:27175067

  14. Cytapheresis in the treatment of cell-affected blood disorders and abnormalities.

    PubMed

    Balint, Bela; Ostojic, Gordana; Pavlovic, Mirjana; Hrvacevic, Rajko; Pavlovic, Miodrag; Tukic, Ljiljana; Radovic, Milan

    2006-08-01

    This report presents our experience with cytaphereses performed in treatment of 476 patients. Leukapheresis was used in management of 68 patients with hyperleukocytosis leukostasis (WBC > or = 150 x 10(9)L(-1)). Average decrease in cell count after treatment was 73.3%. Plateletapheresis for 32 patients (platelets > or = 1500 x 10(9)L(-1)) was applied in order to prevent the thrombotic-hemorrhagic syndrome and resulted in a moderate platelet count reduction (84.3%). Erythrocytaphereses performed in treatment of 376 patients by manual or automated technique resulted in a rapid blood viscosity drop (42.4+/-7.1%). Patients with red blood cell exchanges (severe malaria and autoimmune hemolytic crisis) were in life-threatening situations and resulted in a prompt reduction of parasitized or antibody-coated RBCs and anemia correction. This study indicates that "conventional" TCs resulted in considerable cytoreduction only in patients with especially high cell count. This effect was not associated with bone marrow remission. The best clinical effect and long-term benefits were obtained using RBCX and antimalarial drugs in malaria patients who have had high-level parasitized-RBCs with multiorgan dysfunction. PMID:16935563

  15. Advanced sludge treatment affects extracellular polymeric substances to improve activated sludge dewatering.

    PubMed

    Neyens, Elisabeth; Baeyens, Jan; Dewil, Raf; De heyder, Bart

    2004-01-30

    The management of wastewater sludge, now often referred to as biosolids, accounts for a major portion of the cost of the wastewater treatment process and represents significant technical challenges. In many wastewater treatment facilities, the bottleneck of the sludge handling system is the dewatering operation. Advanced sludge treatment (AST) processes have been developed in order to improve sludge dewatering and to facilitate handling and ultimate disposal. The authors have extensively reported lab-scale, semi-pilot and pilot investigations on either thermal and thermochemical processes, or chemical oxidation using hydrogen peroxide. To understand the action of these advanced sludge technologies, the essential role played by extracellular polymeric substances (EPS) needs to be understood. EPS form a highly hydrated biofilm matrix, in which the micro-organisms are embedded. Hence they are of considerable importance in the removal of pollutants from wastewater, in bioflocculation, in settling and in dewatering of activated sludge. The present paper reviews the characteristics of EPS and the influence of thermochemical and oxidation mechanisms on degradation and flocculation of EPS. Experimental investigations on waste activated sludge are conducted by the authors to evaluate the various literature findings. From the experiments, it is concluded that AST methods enhance cake dewaterability in two ways: (i) they degrade EPS proteins and polysaccharides reducing the EPS water retention properties; and (ii) they promote flocculation which reduces the amount of fine flocs. PMID:15177096

  16. Do Menopausal Status and Use of Hormone Therapy Affect Antidepressant Treatment Response? Findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study

    PubMed Central

    Toups, Marisa; Rush, A. John; Wisniewski, Stephen R.; Thase, Michael E.; Luther, James; Warden, Diane; Fava, Maurizio; Trivedi, Madhukar H.

    2013-01-01

    Abstract Background Menopausal status and use of hormonal contraception or menopausal hormone therapy (HT) may affect treatment response to selective serotonin reuptake inhibitors (SSRIs). This report evaluates whether menopausal status and use of hormonal contraceptives or menopausal HT affect outcome in women treated with citalopram. Methods In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, 896 premenopausal and 544 postmenopausal women were treated with citalopram for 12–14 weeks. Baseline demographic and clinical characteristics were used in adjusted analysis of the effect of menopausal status and use of hormonal contraceptives or menopausal HT on outcomes. Remission was defined as final Hamilton Rating Scale for Depression-17 (HRSD17) ≤7 or Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) score ≤5 and response as ≥50% decrease from the baseline QIDS-SR16 score. Results Premenopausal and postmenopausal women differed in multiple clinical and demographic baseline variables but did not differ in response or remission rates. Premenopausal women taking hormonal contraceptives had significantly greater unadjusted remission rates on the HRSD17 and the QIDS-SR16 than women not taking contraception. Response and remission rates were not different between postmenopausal women taking vs. not taking HT. Adjusted results showed no significant difference in any outcome measure across menopause status in women who were not taking contraception/HT. There were no significant differences in adjusted results across HT status in premenopausal or postmenopausal women. Conclusions In this study, citalopram treatment outcome was not affected by menopausal status. Hormonal contraceptives and HT also did not affect probability of good outcome. PMID:23398127

  17. Analysis of soybean root proteins affected by gibberellic acid treatment under flooding stress.

    PubMed

    Oh, Myeong Won; Nanjo, Yohei; Komatsu, Setsuko

    2014-01-01

    Flooding is a serious abiotic stress for soybean because it restricts growth and reduces grain yields. To investigate the effect of gibberellic acid (GA) on soybean under flooding stress, root proteins were analyzed using a gel-free proteomic technique. Proteins were extracted from the roots of 4-days-old soybean seedlings exposed to flooding stress in the presence and absence of exogenous GA3 for 2 days. A total of 307, 324, and 250 proteins were identified from untreated, and flooding-treated soybean seedlings without or with GA3, respectively. Secondary metabolism- and cell-related proteins, and proteins involved in protein degradation/synthesis were decreased by flooding stress; however, the levels of these proteins were restored by GA3 supplementation under flooding. Fermentation- and cell wall-related proteins were not affected by GA3 supplementation. Furthermore, putative GA-responsive proteins, which were identified by the presence of a GA-responsive element in the promoter region, were less abundant by flooding stress; however, these proteins were more abundant by GA3 supplementation under flooding. Taken together, these results suggest that GA3 affects the abundance of proteins involved in secondary metabolism, cell cycle, and protein degradation/synthesis in soybeans under flooding stress. PMID:24702262

  18. Do Alzheimer's Disease Patients Want to Participate in a Treatment Decision, and Would Their Caregivers Let Them?

    ERIC Educational Resources Information Center

    Hirschman, Karen B.; Joyce, Colette M.; James, Bryan D.; Xie, Sharon X.; Karlawish, Jason H.T.

    2005-01-01

    Purpose: This study was designed to examine the factors associated with the preferences of Alzheimer's disease patients to participate in a decision to use an Alzheimer's disease-slowing medication and how involved their caregivers would let them be in this decision. Design and Methods: Interviews were conducted with 48 patients in the…

  19. Overland flow generation mechanisms affected by topsoil treatment: Application to soil conservation

    NASA Astrophysics Data System (ADS)

    González Paloma, Hueso; Juan Francisco, Martinez-Murillo; Damian, Ruiz-Sinoga Jose; Hanoch, Lavee

    2015-04-01

    Hortonian overland-flow is responsible for significant amounts of soil loss in Mediterranean geomorphological systems. Restoring the native vegetation is the most effective way to control runoff and sediment yield. During the seeding and plant establishment, vegetation cover may be better sustained if soil is amended with an external source. Four amendments were applied in an experimental set of plots: straw mulching (SM); mulch with chipped branches of Aleppo Pine (Pinus halepensis L.) (PM); TerraCotten hydroabsobent polymers (HP); sewage sludge (RU); and control (C). Plots were afforested following the same spatial pattern, and amendments were mixed with the soil at the rate 10 Mg ha-1. This research demonstrates the role played by the treatments in overland flow generation mechanism (runoff, overland flow and soil moisture along the soil profile). The general overland flow characteristics showed that in the C plots the average overland flow was 8.0 ± 22.0 l per event, and the HP plots produced a similar mean value (8.1 ± 20.1 l). The average overland flow per event was significantly less for soil amended with SM, PM or RU (2.7 ± 8.3 l; 1.3 ± 3.5 l and 2.2 ± 5.9 l, respectively). There was a similar trend with respect to the maximum overland flow. The mean sediment yield per event was relatively high in the C and HP plots (8.6 ± 27.8 kg and 14.8 ± 43.4 kg, respectively), while significantly lower values were registered in the SM, PM and RU plots (0.4 ± 1.0 kg; 0.2 ± 0.3 kg and 0.2 ± 0.3 kg, respectively). Very similar trends were found for the maximum sediment yield. Regarding to the soil moisture values, there was a difference in the trends between the C and HP plots and the SM, PM and RU plots. In the C and HP plots the general trend was for a decrease in soil moisture downward through the soil profile, while in the SM, PM and RU plots the soil moisture remained relatively constant or increased, except for the RU treatment in which the soil moisture

  20. Factors affecting treatment outcome in congenital nasolacrimal duct obstruction: A retrospective analysis from South India

    PubMed Central

    Bhandari, Sahil; Sengupta, Sabyasachi; Yadalla, Dayakar; Rajagopalan, Jayagayathri; Velis, Girish Bharat; Talele, Deepti; Kushwaha, Sameer

    2015-01-01

    Purpose: To investigate outcomes for different treatment modalities in congenital nasolacrimal duct obstruction (CNLDO) in an Indian population. Design: Retrospective, interventional, case series. Materials and Methods: In an institutional setting, case records of patients with CNLDO from January 2008 to 2012, were reviewed, and data on patient demographics, clinical presentation, and treatment details (sac massage, probing, and/or dacryocystorhinostomy) were recorded. Success of treatment was defined as complete resolution of symptoms and negative regurgitation on pressure over lacrimal sac (ROPLAS) area. Results: Two hundred and ninety-eight eyes of 240 patients with a mean age of 22.2 ± 26.14 months (median = 12 months, interquartile range = 17) were analyzed. Sac massage (n = 226) was successful in 67 eyes (30%). Multivariable logistic regression analyses showed that children with mucoid ROPLAS were almost 6 times more likely (odds ratio [OR] = 5.55 vs. clear ROPLAS, 95% confidence interval [CI] = 2.35–13.09, P < 0.001) to experience failure of sac massage. Overall probing (n = 193) was successful for 143 (74%) eyes. Multivariable logistic regression showed that older children were 25% more likely to experience probing failure (OR = 1.25 for every 6 months increment in age, 95%, CI = 1.09–1.42, P = 0.001). Conclusion: Sac massage is successful in only a third of our patients and those with mucoid ROPLAS are more likely to experience failure. Probing is successful in three-quarter of our subjects, and its success declines with a progressive increase in age. Lower socioeconomic status, poor general health, and recurrent respiratory infections are unique to our population and may influence outcomes. PMID:26654998

  1. N2O emission from organic barley cultivation as affected by green manure treatment

    NASA Astrophysics Data System (ADS)

    Nadeem, S.; Hansen, S.; Bleken, M.; Dörsch, P.

    2012-04-01

    Legumes are an important source of nitrogen in stockless organic cereal production. However, substantial amounts of N can be lost from legume-grass leys prior to or after incorporation as green manure (GM). Here we report N2O emissions from a field experiment in SE Norway exploring different green manure management strategies: mulching versus removal of grass-clover herbage during a whole growing season and replacement as biogas residue to a subsequent barley crop. Grass-clover ley had significantly higher N2O emissions as compared with a non fertilized cereal reference during the GM year (2009). Mulching of herbage induced significantly more N2O emission (+ 0.37 kg N2O-N ha-1) throughout the growing season than removing herbage. In spring 2010, all plots were ploughed (with and without GM) resulting in generally higher N2O emissions during barley production. Addition of biogas residue (80 kg N ha-1) in 2010 to previously non mulched GM and unfertilized cereal plots (2009) had no significant effect on cumulative N2O emissions relative to a treatment receiving the same amount of N in form of mulched aboveground GM. Ley management (mulching vs. removing biomass in 2009) had no effect on N2O emissions during barley production in 2010. In general, organic amendments (previously mulched or harvested GM, biorest) increased N2O emissions relative to a reference treatment with low mineral N fertilisation (80 kg N ha-1). Organic cereal production emitted 95 g N2O-N kg-1 N yield in barley grain, which was substantially higher than in the reference treatment with 80 kg mineral N fertilization in 2010 (47 g N2O-N kg-1 N yield in barley grain).

  2. Clinical and Pharmacogenetic Factors Affecting Neonatal Bilirubinemia Following Atazanavir Treatment of Mothers During Pregnancy

    PubMed Central

    Huang, Shu-Pang; Conradie, Francesca; Zorrilla, Carmen D.; Josipovic, Deirdre; Botes, Mariëtte; Osiyemi, Olayemi; Hardy, Hélène; Bertz, Richard; McGrath, Donnie

    2013-01-01

    Abstract A theoretical concern exists that atazanavir (ATV) use during pregnancy may exacerbate physiologic neonatal hyperbilirubinemia. The aim of this substudy was to evaluate patterns of neonatal bilirubin following ATV/ritonavir (RTV) treatment of pregnant mothers and clinical and pharmacogenetic factors that may correlate. The design involved a subanalysis of study AI424182, a multicenter, open-label, prospective, single-arm Phase I study. The study had two treatment arms: (1) ATV/RTV 300/100 mg once daily or (2) ATV/RTV 400/100 mg once daily, both in combination with zidovudine/lamivudine 300/150 mg twice daily. Total bilirubin was assessed at baseline, each visit, and delivery day for mothers and on days 1 (delivery day), 3, 5, and 7 and weeks 2 and 6 for neonates. Blood samples were obtained for UGT1A1 genotyping and ATV cord blood concentration. Bilirubin elevation of any grade occurred in 14/40 neonates (35%). All Grade 3 to 4 bilirubin abnormalities (n=7) occurred after day 14. The pattern of neonatal bilirubin levels reported was consistent with neonatal physiologic elevations of bilirubin. Little correlation was observed between either maternal bilirubin levels over the last 4 weeks of pregnancy (including delivery) or ATV cord concentration and neonatal bilirubin. There was a significant association between UGT1A1 genotype and bilirubin grade in the maternal population (p=0.0006) but not neonates (p=0.49). Neither neonatal UGT1A1 genotype nor cord blood ATV concentration is a good predictor of neonatal hyperbilirubinemia. ATV/RTV treatment of mothers does not appear to exacerbate neonatal physiologic hyperbilirubinemia. PMID:23782005

  3. Clinical and pharmacogenetic factors affecting neonatal bilirubinemia following atazanavir treatment of mothers during pregnancy.

    PubMed

    Eley, Timothy; Huang, Shu-Pang; Conradie, Francesca; Zorrilla, Carmen D; Josipovic, Deirdre; Botes, Mariëtte; Osiyemi, Olayemi; Hardy, Hélène; Bertz, Richard; McGrath, Donnie

    2013-10-01

    A theoretical concern exists that atazanavir (ATV) use during pregnancy may exacerbate physiologic neonatal hyperbilirubinemia. The aim of this substudy was to evaluate patterns of neonatal bilirubin following ATV/ritonavir (RTV) treatment of pregnant mothers and clinical and pharmacogenetic factors that may correlate. The design involved a subanalysis of study AI424182, a multicenter, open-label, prospective, single-arm Phase I study. The study had two treatment arms: (1) ATV/RTV 300/100 mg once daily or (2) ATV/RTV 400/100 mg once daily, both in combination with zidovudine/lamivudine 300/150 mg twice daily. Total bilirubin was assessed at baseline, each visit, and delivery day for mothers and on days 1 (delivery day), 3, 5, and 7 and weeks 2 and 6 for neonates. Blood samples were obtained for UGT1A1 genotyping and ATV cord blood concentration. Bilirubin elevation of any grade occurred in 14/40 neonates (35%). All Grade 3 to 4 bilirubin abnormalities (n=7) occurred after day 14. The pattern of neonatal bilirubin levels reported was consistent with neonatal physiologic elevations of bilirubin. Little correlation was observed between either maternal bilirubin levels over the last 4 weeks of pregnancy (including delivery) or ATV cord concentration and neonatal bilirubin. There was a significant association between UGT1A1 genotype and bilirubin grade in the maternal population (p=0.0006) but not neonates (p=0.49). Neither neonatal UGT1A1 genotype nor cord blood ATV concentration is a good predictor of neonatal hyperbilirubinemia. ATV/RTV treatment of mothers does not appear to exacerbate neonatal physiologic hyperbilirubinemia. PMID:23782005

  4. Creep properties of PWC-11 base metal and weldments as affected by heat treatment

    NASA Technical Reports Server (NTRS)

    Titran, R. H.; Moore, T. J.; Grobstein, T. L.

    1986-01-01

    In a preliminary study using single specimens for each condition, PWC-11 (a niobium-base alloy with a nominal composition of Nb-1%Zr-0.1%C) was creep tested at 1350 K and 40 MPa. Base metal specimens and specimens with transverse electron beam welds were tested with and without a 1000 hr, 1350 K aging treatment prior to testing. In the annealed condition (1 hr at 1755 K + 2 hr at 1475 K), the base metal exhibited superior creep strength compared to the nonaged condition, reaching 1 percent strain in 3480 hr. A 1000 hr, 1350 K aging treatment prior to creep testing had a severe detrimental effect on creep strength of the base metal and transverse electron beam weldments, reducing the time to attain 1 percent strain by an order of magnitude. Extrapolated temperature compensated creep rates indicate that the present heat of PWC-11 may be four times as creep resistant as similarly tested Nb-1%Zr. The extrapolated stress to achieve 1 percent creep strain in 7 yr at 1350 K is 2.7 MPa for annealed Nb-1%Zr and 12 MPa for annealed and aged PWC-11 base metal with and without a transverse electron beam weld.

  5. Do pharmacological and behavioral interventions differentially affect treatment outcome for children with social phobia?

    PubMed

    Scharfstein, Lindsay A; Beidel, Deborah C; Finnell, Laura Rendon; Distler, Aaron; Carter, Nathan T

    2011-09-01

    In a randomized trial for children with social phobia (SP), Social Effectiveness Therapy for Children (SET-C; a treatment consisting of exposure and social skills training) and fluoxetine were more effective than pill placebo in reducing social distress and behavioral avoidance, but only SET-C demonstrated significantly improved overall social skill and social competence. In the current study, the authors examined the specific social skills enhanced by SET-C using a recently developed coding schema. At posttreatment, children treated with SET-C displayed a more effective ability to manage the conversational topic (pragmatic social behaviors) and more appropriate motor movement, facial orientation, and posture (paralinguistic social behaviors) than children treated with fluoxetine or placebo. In contrast, children treated with fluoxetine displayed no more pragmatic or paralinguistic skill than children given a pill placebo. There were no group differences on ratings of voice volume and vocal inflection (speech and prosodic social behaviors). Furthermore, only children treated with SET-C improved from pre- to posttreatment on all three skill variables. Findings suggest that pharmacological interventions that only target reduction in anxious arousal may not have an impact on social skill deficits and may not be adequate to optimally treat SP. The relationship of social skill to social avoidance and the importance of social skills training to enhance social competence in the treatment of childhood SP are discussed. PMID:21586501

  6. How does family drug treatment court participation affect child welfare outcomes?

    PubMed

    Gifford, Elizabeth Joanne; Eldred, Lindsey Morgan; Vernerey, Allison; Sloan, Frank Allen

    2014-10-01

    Parental substance use is a risk factor for child maltreatment. Family drug treatment courts (FDTCs) have emerged in the United States as a policy option to treat the underlying condition and promote family preservation. This study examines the effectiveness of FDTCs in North Carolina on child welfare outcomes. Data come from North Carolina records from child protection services, court system, and birth records. Three types of parental participation in a FDTC are considered: referral, enrolling, and completing an FDTC. The sample includes 566 children who were placed into foster care and whose parents participated in a FDTC program. Findings indicate that children of parents who were referred but did not enroll or who enrolled but did not complete had longer stays in foster care than children of completers. Reunification rates for children of completers were also higher. Outcomes for children in the referred and enrolled groups did not differ in the multivariate analyses. While effective substance use treatment services for parents may help preserve families, future research should examine factors for improving participation and completion rates as well as factors involved in scaling programs so that more families are served. PMID:24736039

  7. In vitro gastrointestinal digestion of glabrous canaryseed proteins as affected by variety and thermal treatment.

    PubMed

    Rajamohamed, Sahul H; Aryee, Alberta N A; Hucl, Pierre; Patterson, Carol Ann; Boye, Joyce I

    2013-09-01

    Glabrous or hairless canaryseed is a nutritional grain that could be a good addition to the diet if approved as a novel food. To assess the impact of thermal treatment on its digestibility; raw, roasted or boiled flours prepared from three different varieties of glabrous canaryseed were subjected to in vitro gastrointestinal digestion conditions and the effect on protein electrophoretic profiles was examined using sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Roasting was done by dry-heat in an oven at 176 °C for 12 min whereas boiling was done in water at 98 °C for 12 min. SDS-PAGE showed approximately twenty-five protein bands in the undigested raw flour with molecular masses (MM) ranging from <14 kDa to >97 kDa. The dominant proteins had low MM, between the ranges of ~57 to 12 kDa. Roasting markedly altered the protein electrophoretic profile with the appearance of large molecular weight aggregates. Canaryseed proteins were more easily digested after thermal treatment and under sequential gastric-duodenal conditions than under gastric or duodenal conditions alone. Furthermore, roasting appeared to have a greater impact on in vitro protein digestibility than boiling. PMID:23912803

  8. Agonistic Anti-TIGIT Treatment Inhibits T Cell Responses in LDLr Deficient Mice without Affecting Atherosclerotic Lesion Development

    PubMed Central

    Foks, Amanda C.; Ran, Ingrid A.; Frodermann, Vanessa; Bot, Ilze; van Santbrink, Peter J.; Kuiper, Johan; van Puijvelde, Gijs H. M.

    2013-01-01

    Objective Co-stimulatory and co-inhibitory molecules are mainly expressed on T cells and antigen presenting cells and strongly orchestrate adaptive immune responses. Whereas co-stimulatory molecules enhance immune responses, signaling via co-inhibitory molecules dampens the immune system, thereby showing great therapeutic potential to prevent cardiovascular diseases. Signaling via co-inhibitory T cell immunoglobulin and ITIM domain (TIGIT) directly inhibits T cell activation and proliferation, and therefore represents a novel therapeutic candidate to specifically dampen pro-atherogenic T cell reactivity. In the present study, we used an agonistic anti-TIGIT antibody to determine the effect of excessive TIGIT-signaling on atherosclerosis. Methods and Results TIGIT was upregulated on CD4+ T cells isolated from mice fed a Western-type diet in comparison with mice fed a chow diet. Agonistic anti-TIGIT suppressed T cell activation and proliferation both in vitro and in vivo. However, agonistic anti-TIGIT treatment of LDLr−/− mice fed a Western-type diet for 4 or 8 weeks did not affect atherosclerotic lesion development in comparison with PBS and Armenian Hamster IgG treatment. Furthermore, elevated percentages of dendritic cells were observed in the blood and spleen of agonistic anti-TIGIT-treated mice. Additionally, these cells showed an increased activation status but decreased IL-10 production. Conclusions Despite the inhibition of splenic T cell responses, agonistic anti-TIGIT treatment does not affect initial atherosclerosis development, possibly due to increased activity of dendritic cells. PMID:24376654

  9. Mechanical biological treatment of organic fraction of MSW affected dissolved organic matter evolution in simulated landfill.

    PubMed

    Salati, Silvia; Scaglia, Barbara; di Gregorio, Alessandra; Carrera, Alberto; Adani, Fabrizio

    2013-08-01

    The aim of this paper was to study the evolution of DOM during 1 year of observation in simulated landfill, of aerobically treated vs. untreated organic fraction of MSW. Results obtained indicated that aerobic treatment of organic fraction of MSW permitted getting good biological stability so that, successive incubation under anaerobic condition in landfill allowed biological process to continue getting a strong reduction of soluble organic matter (DOM) that showed, also, an aromatic character. Incubation of untreated waste gave similar trend, but in this case DOM decreasing was only apparent as inhibition of biological process in landfill did not allow replacing degraded/leached DOM with new material coming from hydrolysis of fresh OM. PMID:23743423

  10. Experimentally studied dynamic dose interplay does not meaningfully affect target dose in VMAT SBRT lung treatments

    SciTech Connect

    Stambaugh, Cassandra; Nelms, Benjamin E.; Dilling, Thomas; Stevens, Craig; Latifi, Kujtim; Zhang, Geoffrey; Moros, Eduardo; Feygelman, Vladimir

    2013-09-15

    Purpose: The effects of respiratory motion on the tumor dose can be divided into the gradient and interplay effects. While the interplay effect is likely to average out over a large number of fractions, it may play a role in hypofractionated [stereotactic body radiation therapy (SBRT)] treatments. This subject has been extensively studied for intensity modulated radiation therapy but less so for volumetric modulated arc therapy (VMAT), particularly in application to hypofractionated regimens. Also, no experimental study has provided full four-dimensional (4D) dose reconstruction in this scenario. The authors demonstrate how a recently described motion perturbation method, with full 4D dose reconstruction, is applied to describe the gradient and interplay effects during VMAT lung SBRT treatments.Methods: VMAT dose delivered to a moving target in a patient can be reconstructed by applying perturbations to the treatment planning system-calculated static 3D dose. Ten SBRT patients treated with 6 MV VMAT beams in five fractions were selected. The target motion (motion kernel) was approximated by 3D rigid body translation, with the tumor centroids defined on the ten phases of the 4DCT. The motion was assumed to be periodic, with the period T being an average from the empirical 4DCT respiratory trace. The real observed tumor motion (total displacement ≤8 mm) was evaluated first. Then, the motion range was artificially increased to 2 or 3 cm. Finally, T was increased to 60 s. While not realistic, making T comparable to the delivery time elucidates if the interplay effect can be observed. For a single fraction, the authors quantified the interplay effect as the maximum difference in the target dosimetric indices, most importantly the near-minimum dose (D{sub 99%}), between all possible starting phases. For the three- and five-fractions, statistical simulations were performed when substantial interplay was found.Results: For the motion amplitudes and periods obtained from

  11. How attendance and quality of participation affect treatment response to parent management training.

    PubMed

    Nix, Robert L; Bierman, Karen L; McMahon, Robert J

    2009-06-01

    This study examined whether attendance and quality of participation in parent management training predicted treatment response. Data were from 445 parents (55% minority, 62% single; almost all of low socioeconomic status) who had 1st-grade children with severe conduct problems. Quality of participation in weekly parent groups was based on group leader ratings. Parent outcomes were based on interviewer ratings, behavioral observations, parent reports, and teacher ratings. Results of hierarchical linear models suggested that few family characteristics predicted attendance in this efficacy trial and that attendance was not related to changes in parenting over the year. However, several family characteristics predicted quality of participation in parent management training, and this in turn predicted changes in parental perceptions, warmth, physical punishment, and school involvement. From a clinical perspective, these findings suggest that it is not enough to get parents to attend sessions; it is also necessary to facilitate their active engagement in the therapeutic process. PMID:19485585

  12. Factors affecting the treatment of reject water by the anammox process.

    PubMed

    Li, Zhigang; Ma, Yongguang; Hira, Daisuke; Fujii, Takao; Furukawa, Kenji

    2011-05-01

    Reject water from a municipal wastewater treatment plant was treated using a stirred tank anammox reactor after being treated by a partial nitrification reactor. The results indicated the variations in the influent NO(2)(-)-N to NH(4)(+)-N ratio had a negative effect on reactor performance, especially when the T-N concentrations were high. Influent total organic carbon concentrations greater than 50mg/L were proven to have a serious effect on the nitrogen removal efficiencies of the anammox reactor. Observations by scanning electron microscope showed that the surface of the anammox granular sludge was covered by some materials, possibly the effluent SS contained in the partial nitrified reject water. Furthermore, the study of the bacterial composition of the anammox granular sludge showed that the anammox bacterium, Planctomycete KSU-1, was dominant, even during the inhibition phase. PMID:21435859

  13. Left ventricular concentric geometry during treatment adversely affects cardiovascular prognosis in hypertensive patients.

    PubMed

    Muiesan, Maria Lorenza; Salvetti, Massimo; Monteduro, Cristina; Bonzi, Bianca; Paini, Anna; Viola, Sara; Poisa, Paolo; Rizzoni, Damiano; Castellano, Maurizio; Agabiti-Rosei, Enrico

    2004-04-01

    Left ventricular (LV) mass and geometry predict risk for cardiovascular events in hypertension. Regression of LV hypertrophy (LVH) may imply an important prognostic significance. The relation between changes in LV geometry during antihypertensive treatment and subsequent prognosis has not yet been determined. A total of 436 prospectively identified uncomplicated hypertensive subjects with a baseline and follow-up echocardiogram (last examination 72+/-38 months apart) were followed for an additional 42+/-16 months. Their family doctor gave antihypertensive treatment. After the last follow-up echocardiogram, a first cardiovascular event occurred in 71 patients. Persistence of LVH from baseline to follow-up was confirmed as an independent predictor of cardiovascular events. Cardiovascular morbidity and mortality were significantly greater in patients with concentric (relative wall thickness > or =0.44) than in those with eccentric geometry (relative wall thickness <0.44) in patients presenting with LVH (P=0.002) and in those without LVH (P=0.002) at the follow-up echocardiogram. The incidence of cardiovascular events progressively increased from the first to the third tertile of LV mass index at follow-up (partition values 91 and 117 g/m2), but for a similar value of LV mass index it was significantly greater in those with concentric geometry (OR: 4.07; 95% CI: 1.49 to 11.14; P=0.004 in the second tertile; OR: 3.45; 95% CI: 1.62 to 7.32; P=0.001 in the third tertile; P<0.0001 in concentric versus eccentric geometry). Persistence or development of concentric geometry during follow-up may have additional prognostic significance in hypertensive patients with and without LVH. PMID:15007041

  14. Treatment Modality Affects Allograft-Derived Schwann Cell Phenotype and Myelinating Capacity

    PubMed Central

    Hayashi, Ayato; Moradzadeh, Arash; Tong, Alice; Wei, Cindy; Tuffaha, Sami H.; Hunter, Daniel A.; Tung, Thomas H.; Parsadanian, Alexander; Mackinnon, Susan E.; Myckatyn, Terence M.

    2009-01-01

    We used peripheral nerve allografts, already employed clinically to reconstruct devastating peripheral nerve injuries, to study Schwann cell (SC) plasticity in adult mice. By modulating the allograft treatment modality we were able to study migratory, denervated, rejecting, and reinnervated phenotypes in transgenic mice whose SCs expressed GFP under regulatory elements of either the S100β (S100-GFP) or nestin (Nestin-GFP) promoters. Well-differentiated SCs strongly expressed S100-GFP, while Nestin-GFP expression was stimulated by denervation, and i