Eliciting Web Site Preferences of People with Learning Disabilities

ERIC Educational Resources Information Center

Williams, Peter

2017-01-01

The Internet can be an excellent tool to help people with learning disabilities access relevant and appropriately written information. However, little work has been undertaken to ascertain web design or content preferences for this cohort. This paper examines methods to address this issue. Twenty five participants were presented with three web…

Convergent validity between a discrete choice experiment and a direct, open-ended method: comparison of preferred attribute levels and willingness to pay estimates.

PubMed

Marjon van der Pol; Shiell, Alan; Au, Flora; Johnston, David; Tough, Suzanne

2008-12-01

The Discrete Choice Experiment (DCE) has become increasingly popular as a method for eliciting patient or population preferences. If DCE estimates are to inform health policy, it is crucial that the answers they provide are valid. Convergent validity is tested in this paper by comparing the results of a DCE exercise with the answers obtained from direct, open-ended questions. The two methods are compared in terms of preferred attribute levels and willingness to pay (WTP) values. Face-to-face interviews were held with 292 women in Calgary, Canada. Similar values were found between the two methods with respect to preferred levels for two out of three of the attributes examined. The DCE predicted less well for levels outside the range than for levels inside the range reaffirming the importance of extensive piloting to ensure appropriate level range in DCEs. The mean WTP derived from the open-ended question was substantially lower than the mean derived from the DCE. However, the two sets of willingness to pay estimates were consistent with each other in that individuals who were willing to pay more in the open-ended question were also willing to pay more in the DCE. The difference in mean WTP values between the two approaches (direct versus DCE) demonstrates the importance of continuing research into the different biases present across elicitation methods.

Examining overlap in behavioral and neural representations of morals, facts, and preferences.

PubMed

Theriault, Jordan; Waytz, Adam; Heiphetz, Larisa; Young, Liane

2017-11-01

Metaethical judgments refer to judgments about the information expressed by moral claims. Moral objectivists generally believe that moral claims are akin to facts, whereas moral subjectivists generally believe that moral claims are more akin to preferences. Evidence from developmental and social psychology has generally favored an objectivist view; however, this work has typically relied on few examples, and analyses have disallowed statistical generalizations beyond these few stimuli. The present work addresses whether morals are represented as fact-like or preference-like, using behavioral and neuroimaging methods, in combination with statistical techniques that can (a) generalize beyond our sample stimuli, and (b) test whether particular item features are associated with neural activity. Behaviorally, and contrary to prior work, morals were perceived as more preference-like than fact-like. Neurally, morals and preferences elicited common magnitudes and spatial patterns of activity, particularly within the dorsal-medial prefrontal cortex (DMPFC), a critical region for social cognition. This common DMPFC activity for morals and preferences was present across whole-brain conjunctions, and in individually localized functional regions of interest (targeting the theory of mind network). By contrast, morals and facts did not elicit any neural activity in common. Follow-up item analyses suggested that the activity elicited in common by morals and preferences was explained by their shared tendency to evoke representations of mental states. We conclude that morals are represented as far more subjective than prior work has suggested. This conclusion is consistent with recent theoretical research, which has argued that morality is fundamentally about regulating social relationships. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Public Preferences of Loblolly Pine (Pinus taeda) Stands Generated by Different Site Preparation Methods

Treesearch

Jianbang Gan; Stephen H. Kolison; James H. Miller

1998-01-01

In recent decades, the public's demand for non-timber products and services from forests has dramatically increased. To meet these diverse demands, particularly from public forests, has called for the critical evaluation of non-timber as well as timber benefits of forest resources. However, it has been a challenge to elicit and quantify public preferences for non...

A comparison of analytic hierarchy process and conjoint analysis methods in assessing treatment alternatives for stroke rehabilitation.

PubMed

Ijzerman, Maarten J; van Til, Janine A; Bridges, John F P

2012-01-01

With growing emphasis on patient involvement in health technology assessment, there is a need for scientific methods that formally elicit patient preferences. Analytic hierarchy process (AHP) and conjoint analysis (CA) are two established scientific methods - albeit with very different objectives. The objective of this study was to compare the performance of AHP and CA in eliciting patient preferences for treatment alternatives for stroke rehabilitation. Five competing treatments for drop-foot impairment in stroke were identified. One survey, including the AHP and CA questions, was sent to 142 patients, resulting in 89 patients for final analysis (response rate 63%). Standard software was used to calculate attribute weights from both AHP and CA. Performance weights for the treatments were obtained from an expert panel using AHP. Subsequently, the mean predicted preference for each of the five treatments was calculated using the AHP and CA weights. Differences were tested using non-parametric tests. Furthermore, all treatments were rank ordered for each individual patient, using the AHP and CA weights. Important attributes in both AHP and CA were the clinical outcome (0.3 in AHP and 0.33 in CA) and risk of complications (about 0.2 in both AHP and CA). Main differences between the methods were found for the attributes 'impact of treatment' (0.06 for AHP and 0.28 for two combined attributes in CA) and 'cosmetics and comfort' (0.28 for two combined attributes in AHP and 0.05 for CA). On a group level, the most preferred treatments were soft tissue surgery (STS) and orthopedic shoes (OS). However, STS was most preferred using AHP weights versus OS using CA weights (p < 0.001). This difference was even more obvious when interpreting the individual treatment ranks. Nearly all patients preferred STS according to the AHP predictions, while >50% of the patients chose OS instead of STS, as most preferred treatment using CA weights. While we found differences between AHP and CA, these differences were most likely caused by the labeling of the attributes and the elicitation of performance judgments. CA scenarios are built using the level descriptions, and hence provide realistic treatment scenarios. In AHP, patients only compared less concrete attributes such as 'impact of treatment.' This led to less realistic choices, and thus overestimation of the preference for the surgical scenarios. Several recommendations are given on how to use AHP and CA in assessing patient preferences.

A comparison of two methods for expert elicitation in health technology assessments.

PubMed

Grigore, Bogdan; Peters, Jaime; Hyde, Christopher; Stein, Ken

2016-07-26

When data needed to inform parameters in decision models are lacking, formal elicitation of expert judgement can be used to characterise parameter uncertainty. Although numerous methods for eliciting expert opinion as probability distributions exist, there is little research to suggest whether one method is more useful than any other method. This study had three objectives: (i) to obtain subjective probability distributions characterising parameter uncertainty in the context of a health technology assessment; (ii) to compare two elicitation methods by eliciting the same parameters in different ways; (iii) to collect subjective preferences of the experts for the different elicitation methods used. Twenty-seven clinical experts were invited to participate in an elicitation exercise to inform a published model-based cost-effectiveness analysis of alternative treatments for prostate cancer. Participants were individually asked to express their judgements as probability distributions using two different methods - the histogram and hybrid elicitation methods - presented in a random order. Individual distributions were mathematically aggregated across experts with and without weighting. The resulting combined distributions were used in the probabilistic analysis of the decision model and mean incremental cost-effectiveness ratios and the expected values of perfect information (EVPI) were calculated for each method, and compared with the original cost-effectiveness analysis. Scores on the ease of use of the two methods and the extent to which the probability distributions obtained from each method accurately reflected the expert's opinion were also recorded. Six experts completed the task. Mean ICERs from the probabilistic analysis ranged between £162,600-£175,500 per quality-adjusted life year (QALY) depending on the elicitation and weighting methods used. Compared to having no information, use of expert opinion decreased decision uncertainty: the EVPI value at the £30,000 per QALY threshold decreased by 74-86 % from the original cost-effectiveness analysis. Experts indicated that the histogram method was easier to use, but attributed a perception of more accuracy to the hybrid method. Inclusion of expert elicitation can decrease decision uncertainty. Here, choice of method did not affect the overall cost-effectiveness conclusions, but researchers intending to use expert elicitation need to be aware of the impact different methods could have.

Eliciting preferences for priority setting in genetic testing: a pilot study comparing best-worst scaling and discrete-choice experiments.

PubMed

Severin, Franziska; Schmidtke, Jörg; Mühlbacher, Axel; Rogowski, Wolf H

2013-11-01

Given the increasing number of genetic tests available, decisions have to be made on how to allocate limited health-care resources to them. Different criteria have been proposed to guide priority setting. However, their relative importance is unclear. Discrete-choice experiments (DCEs) and best-worst scaling experiments (BWSs) are methods used to identify and weight various criteria that influence orders of priority. This study tests whether these preference eliciting techniques can be used for prioritising genetic tests and compares the empirical findings resulting from these two approaches. Pilot DCE and BWS questionnaires were developed for the same criteria: prevalence, severity, clinical utility, alternatives to genetic testing available, infrastructure for testing and care established, and urgency of care. Interview-style experiments were carried out among different genetics professionals (mainly clinical geneticists, researchers and biologists). A total of 31 respondents completed the DCE and 26 completed the BWS experiment. Weights for the levels of the six attributes were estimated by conditional logit models. Although the results derived from the DCE and BWS experiments differed in detail, we found similar valuation patterns in the DCE and BWS experiments. The respondents attached greatest value to tests with high clinical utility (defined by the availability of treatments that reduce mortality and morbidity) and to testing for highly prevalent conditions. The findings from this study exemplify how decision makers can use quantitative preference eliciting methods to measure aggregated preferences in order to prioritise alternative clinical interventions. Further research is necessary to confirm the survey results.

Eliciting consumer preferences for health plans.

PubMed

Booske, B C; Sainfort, F; Hundt, A S

1999-10-01

To examine (1) what people say is important to them in choosing a health plan; (2) the effect, if any, that giving health plan information has on what people say is important to them; and (3) the effect of preference elicitation methods on what people say is important. A random sample of 201 Wisconsin state employees who participated in a health plan choice experiment during the 1995 open enrollment period. We designed a computer system to guide subjects through the review of information about health plan options. The system began by eliciting the stated preferences of the subjects before they viewed the information, at time 0. Subjects were given an opportunity to revise their preference structures first after viewing summary information about four health plans (time 1) and then after viewing more extensive, detailed information about the same options (time 2). At time 2, these individuals were also asked to rate the relative importance of a predefined list of health plan features presented to them. Data were collected on the number of attributes listed at each point in time and the importance weightings assigned to each attribute. In addition, each item on the attribute list was content analyzed. The provision of information changes the preference structures of individuals. Costs (price) and coverage dominated the attributes cited both before and after looking at health plan information. When presented with information on costs, quality, and how plans work, many of these relatively well educated consumers revised their preference structures; yet coverage and costs remained the primary cited attributes. Although efforts to provide health plan information should continue, decisions on the information to provide and on making it available are not enough. Individuals need help in understanding, processing, and using the information to construct their preferences and make better decisions.

Comparison of two multi-criteria decision techniques for eliciting treatment preferences in people with neurological disorders.

PubMed

Ijzerman, Maarten J; van Til, Janine A; Snoek, Govert J

2008-12-01

To present and compare two multi-criteria decision techniques (analytic hierarchy process [AHP] and conjoint analysis [CA]) for eliciting preferences in patients with cervical spinal cord injury (SCI) who are eligible for surgical augmentation of hand function, either with or without implantation of a neuroprosthesis. The methods were compared in respect to attribute weights, overall preference, and practical experiences. Two previously designed and administered multi-criteria decision surveys in patients with SCI were compared and further analysed. Attributes and their weights in the AHP experiment were determined by an expert panel, followed by determination of the weights in the patient group. Attributes for the CA were selected and validated using an expert panel, piloted in six patients with SCI and subsequently administered to the same group of patients as participated in the AHP experiment. Both experiments showed the importance of non-outcome-related factors such as inpatient stay and number of surgical procedures. In particular, patients were less concerned with clinical outcomes in actual decision making. Overall preference in both the AHP and CA was in favor of tendon reconstruction (0.6 vs 0.4 for neuroprosthetic implantation). Both methods were easy to apply, but AHP was less easily explained and understood. Both the AHP and CA methods produced similar outcomes, which may have been caused by the obvious preferences of patients. CA may be preferred because of the holistic approach of considering all treatment attributes simultaneously and, hence, its power in simulating real market decisions. On the other hand, the AHP method is preferred as a hands-on, easy-to-implement task with immediate feedback to the respondent. This flexibility allows AHP to be used in shared decision making. However, the way the technique is composed results in many inconsistencies. Patients preferred CA but complained about the number of choice tasks.

MCDA swing weighting and discrete choice experiments for elicitation of patient benefit-risk preferences: a critical assessment.

PubMed

Tervonen, Tommi; Gelhorn, Heather; Sri Bhashyam, Sumitra; Poon, Jiat-Ling; Gries, Katharine S; Rentz, Anne; Marsh, Kevin

2017-12-01

Multiple criteria decision analysis swing weighting (SW) and discrete choice experiments (DCE) are appropriate methods for capturing patient preferences on treatment benefit-risk trade-offs. This paper presents a qualitative comparison of the 2 methods. We review and critically assess similarities and differences of SW and DCE based on 6 aspects: comprehension by study participants, cognitive biases, sample representativeness, ability to capture heterogeneity in preferences, reliability and validity, and robustness of the results. The SW choice task can be more difficult, but the workshop context in which SW is conducted may provide more support to patients who are unfamiliar with the end points being evaluated or who have cognitive impairments. Both methods are similarly prone to a number of biases associated with preference elicitation, and DCE is prone to simplifying heuristics, which limits its application with large number of attributes. The low cost per patient of the DCE means that it can be better at achieving a representative sample, though SW does not require such large sample sizes due to exact nature of the collected preference data. This also means that internal validity is automatically enforced with SW, while the internal validity of DCE results needs to be assessed manually. Choice between the 2 methods depends on characteristics of the benefit-risk assessment, especially on how difficult the trade-offs are for the patients to make and how many patients are available. Although there exist some empirical studies on many of the evaluation aspects, critical evidence gaps remain. Copyright © 2017 John Wiley & Sons, Ltd.

Patients' preferences for primary health care - a systematic literature review of discrete choice experiments.

PubMed

Kleij, Kim-Sarah; Tangermann, Ulla; Amelung, Volker E; Krauth, Christian

2017-07-11

Primary care is a key element of health care systems and addresses the main health problems of the population. Due to the demographic change, primary care even gains in importance. The knowledge of the patients' preferences can help policy makers as well as physicians to set priorities in their effort to make health care delivery more responsive to patients' needs. Our objective was to describe which aspects of primary care were included in preference studies and which of them were the most preferred aspects. In order to elicit the preferences for primary care, a systematic literature search was conducted. Two researchers searched three electronic databases (PubMed, Scopus, and PsycINFO) and conducted a narrative synthesis. Inclusion criteria were: focus on primary health care delivery, discrete choice experiment as elicitation method, and studies published between 2006 and 2015 in English language. We identified 18 studies that elicited either the patients' or the population's preferences for primary care based on a discrete choice experiment. Altogether the studies used 16 structure attributes, ten process attributes and four outcome attributes. The most commonly applied structure attribute was "Waiting time till appointment", the most frequently used process attribute was "Shared decision making / professional's attention paid to your views". "Receiving the 'best' treatment" was the most commonly applied outcome attribute. Process attributes were most often the ones of highest importance for patients or the population. The attributes and attribute levels used in the discrete choice experiments were identified by literature research, qualitative research, expert interviews, or the analysis of policy documents. The results of the DCE studies show different preferences for primary health care. The diversity of the results may have several reasons, such as the method of analysis, the selection procedure of the attributes and their levels or the specific research question of the study. As the results of discrete choice experiments depend on many different factors, it is important for a better comprehensibility of the studies to transparently report the steps undertaken in a study as well as the interim results regarding the identification of attributes and levels.

An enquiry into the method of paired comparison: reliability, scaling, and Thurstone's Law of Comparative Judgment

Treesearch

Thomas C. Brown; George L. Peterson

2009-01-01

The method of paired comparisons is used to measure individuals' preference orderings of items presented to them as discrete binary choices. This paper reviews the theory and application of the paired comparison method, describes a new computer program available for eliciting the choices, and presents an analysis of methods for scaling paired choice data to...

Temporal Stability of Stated Preferences: The Case of Junior Nursing Jobs.

PubMed

Doiron, Denise; Yoo, Hong Il

2017-06-01

With the growing use of discrete choice experiments (DCEs) in health workforce research, the reliability of elicited job preferences is a growing concern. We provide the first empirical evidence on the temporal stability of such preferences using a unique longitudinal survey of Australian nursing students and graduate nurses. The respondents completed DCEs on nursing positions in two survey waves. Each position is described by salary and 11 non-salary attributes, and the two waves are spaced 15months apart on average. Between the waves, most final-year students finished their degrees and started out as graduate nurses. Thus, the survey covers a long timespan that includes an important period of career transition. The relative importance of different job attributes appears stable enough to support the use of DCEs to identify key areas of policy intervention. There is virtually no change in the groupings of influential job characteristics. Conclusions regarding the stability of willingness-to-pay, however, are different because of unstable preferences for salary. The instability of preferences for salary was also found previously in the context of comparing alternative elicitation methods. This prompts us to push for further work on the reliability of stated preferences over monetary attributes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

[Patients' Priorities in the Treatment of Neuroendocrine Tumours: An Analytical Hierarchy Process].

PubMed

Mühlbacher, A C; Juhnke, C; Kaczynski, A

2016-10-01

Background: Neuroendocrine tumours (NET) are relatively rare, usually slow-growing malignant tumours. So far there are no data on the patient preferences/priorities regarding the therapy for NET. This empirical study aimed at the elicitation of patient priorities in the drug treatment of NET. Method: Qualitative patient interviews (N=9) were conducted. To elicit the patient's perspective regarding various treatment aspects of NET a self-administered questionnaire using the Analytical Hierarchy Process (AHP) was developed. The data collection was carried out using paper questionnaires supported by an item response system in a group discussion. To evaluate the patient-relevant outcomes, the eigenvector method was applied. Results: N=24 patients, experts and relatives participated in the AHP survey. In the AHP all respondents had clear priorities for all considered attributes. The attribute "overall survival" was the most significant feature of a drug therapy for all respondents. As in the qualitative interviews, "efficacy attributes" dominated the side effects in the AHP as well. The evaluation of all participants thus showed the attributes "overall survival" (Wglobal:0.418), "progression-free survival" (Wglobal:0.172) and "response to treatment" (Wglobal:0.161) to be most relevant. "Occurrence of abdominal pain" (Wglobal:0.051) was ranked sixth, with "tiredness/fatigue" and "risk of a hypoglycaemia" (Wglobal:0.034) in a shared seventh place. Conclusion: The results thus provide evidence about how much influence a treatment capacity has on therapeutic decisions. Using the AHP major aspects of drug therapy from the perspective of those affected were captured, and positive and negative therapeutic properties could be related against each other. Based on the assessment of the patient's perspective further investigation must elicit patient preferences for NET drug therapy. In the context of a discrete choice experiment or another choice-based method of preference measurement, the results obtained here can be validated and the therapeutic features weighted according to their preferability. © Georg Thieme Verlag KG Stuttgart · New York.

Assessing Option Grid® practicability and feasibility for facilitating shared decision making: An exploratory study.

PubMed

Tsulukidze, Maka; Grande, Stuart W; Gionfriddo, Michael R

2015-07-01

To assess the feasibility of Option Grids(®)for facilitating shared decision making (SDM) in simulated clinical consultations and explore clinicians' views on their practicability. We used mixed methods approach to analyze clinical consultations using the Observer OPTION instrument and thematic analysis for follow-up interviews with clinicians. Clinicians achieved high scores on information sharing and low scores on preference elicitation and integration. Four themes were identified: (1) Barriers affect practicability of Option Grids(®); (2) Option Grids(®) facilitate the SDM process; (3) Clinicians are aware of the gaps in their practice of SDM; (4) Training and ongoing feedback on the optimal use of Option Grids(®) are necessary. Use of Option Grids(®) by clinicians with background knowledge in SDM did not facilitate optimal levels of competency on the SDM core concepts of preference elicitation and integration. Future research must evaluate the impact of training on the use of Option Grids(®), and explore how best to help clinicians bridge the gap between knowledge and action. Clinicians proficiently imparting information in simulations struggled to elicit and integrate patient preferences - understanding this gap and developing strategies to close it are the next steps for implementing SDM into clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Valuing SF-6D Health States Using a Discrete Choice Experiment.

PubMed

Norman, Richard; Viney, Rosalie; Brazier, John; Burgess, Leonie; Cronin, Paula; King, Madeleine; Ratcliffe, Julie; Street, Deborah

2014-08-01

SF-6D utility weights are conventionally produced using a standard gamble (SG). SG-derived weights consistently demonstrate a floor effect not observed with other elicitation techniques. Recent advances in discrete choice methods have allowed estimation of utility weights. The objective was to produce Australian utility weights for the SF-6D and to explore the application of discrete choice experiment (DCE) methods in this context. We hypothesized that weights derived using this method would reflect the largely monotonic construction of the SF-6D. We designed an online DCE and administered it to an Australia-representative online panel (n = 1017). A range of specifications investigating nonlinear preferences with respect to additional life expectancy were estimated using a random-effects probit model. The preferred model was then used to estimate a preference index such that full health and death were valued at 1 and 0, respectively, to provide an algorithm for Australian cost-utility analyses. Physical functioning, pain, mental health, and vitality were the largest drivers of utility weights. Combining levels to remove illogical orderings did not lead to a poorer model fit. Relative to international SG-derived weights, the range of utility weights was larger with 5% of health states valued below zero. s. DCEs can be used to investigate preferences for health profiles and to estimate utility weights for multi-attribute utility instruments. Australian cost-utility analyses can now use domestic SF-6D weights. The comparability of DCE results to those using other elicitation methods for estimating utility weights for quality-adjusted life-year calculations should be further investigated. © The Author(s) 2013.

The efficiency and effectiveness of utilizing diagrams in interviews: an assessment of participatory diagramming and graphic elicitation.

PubMed

Umoquit, Muriah J; Dobrow, Mark J; Lemieux-Charles, Louise; Ritvo, Paul G; Urbach, David R; Wodchis, Walter P

2008-08-08

This paper focuses on measuring the efficiency and effectiveness of two diagramming methods employed in key informant interviews with clinicians and health care administrators. The two methods are 'participatory diagramming', where the respondent creates a diagram that assists in their communication of answers, and 'graphic elicitation', where a researcher-prepared diagram is used to stimulate data collection. These two diagramming methods were applied in key informant interviews and their value in efficiently and effectively gathering data was assessed based on quantitative measures and qualitative observations. Assessment of the two diagramming methods suggests that participatory diagramming is an efficient method for collecting data in graphic form, but may not generate the depth of verbal response that many qualitative researchers seek. In contrast, graphic elicitation was more intuitive, better understood and preferred by most respondents, and often provided more contemplative verbal responses, however this was achieved at the expense of more interview time. Diagramming methods are important for eliciting interview data that are often difficult to obtain through traditional verbal exchanges. Subject to the methodological limitations of the study, our findings suggest that while participatory diagramming and graphic elicitation have specific strengths and weaknesses, their combined use can provide complementary information that would not likely occur with the application of only one diagramming method. The methodological insights gained by examining the efficiency and effectiveness of these diagramming methods in our study should be helpful to other researchers considering their incorporation into qualitative research designs.

Healthy-years equivalent: wounded but not yet dead.

PubMed

Hauber, A Brett

2009-06-01

The quality-adjusted life-year (QALY) has become the dominant measure of health value in health technology assessment in recent decades despite some well-known and fundamental flaws in the preference-elicitation methods used to construct health-state utility weights and the strong assumptions required to construct QALYs as a measure of health value using these utility weights. The healthy-years equivalent (HYE) was proposed as an alternative measure of health value that was purported to overcome many of the limitations of the QALY. The primary argument against the HYE is that it is difficult to estimate and, therefore, impractical. After much debate in the literature, the QALY appears to have won the battle; however, the HYE is not yet dead. Empirical research and recent advances in methods continue to offer evidence of the feasibility using the HYE as a measure of health value and also addresses some of criticisms surrounding the preference-elicitation methods used to estimate the HYE. This article provides a brief review of empirical applications of the HYE and identifies recent advances in empirical estimation that may breathe new life into a valiant, but wounded, measure.

Eliciting Parents' Individual Requirements for an Inclusive Digital School System.

PubMed

Eftring, Håkan; Rassmus-Gröhn, Kirsten; Hedvall, Per-Olof

2016-01-01

Parents often have a busy time sorting out their life puzzles, including getting information about their children's activities in school. More and more communication between teachers and parents take place via digital school systems. It can be hard for parents to find the information they are looking for and the teacher decides when information is sent and what communication method to use. All parents, but especially parents with disabilities, might have individual preferences on how to receive information and how to adapt meetings at school. In this paper we present a project where we involved parents and teachers in focus groups, an idea workshop and iterative user trials of a digital prototype. The goal was to elicit parents' individual requirements for an inclusive digital school system, where they can store their individual preferences about how and when to receive information from school and what requirements they have on meetings at school. Preliminary results show that we managed to create open and focused discussions among parents and teachers. The parents reacted very positively on an onboarding page with the possibility to quickly and easily enter preferences after their first log in, but more work needs to be done on how preferences are categorized on the onboarding page. Finally, parents need to get clear feedback from teachers and school when they have entered or updated preferences, so they can trust that their preferences will be met.

Management of low-grade cervical abnormalities detected at screening: which method do women prefer?

PubMed

Whynes, D K; Woolley, C; Philips, Z

2008-12-01

To establish whether women with low-grade abnormalities detected during screening for cervical cancer prefer to be managed by cytological surveillance or by immediate colposcopy. TOMBOLA (Trial of Management of Borderline and Other Low-grade Abnormal smears) is a randomized controlled trial comparing alternative management strategies following the screen-detection of low-grade cytological abnormalities. At exit, a sample of TOMBOLA women completed a questionnaire eliciting opinions on their management, contingent valuations (CV) of the management methods and preferences. Within-trial quality of life (EQ-5D) data collected for a sample of TOMBOLA women throughout their follow-up enabled the comparison of self-reported health at various time points, by management method. Once management had been initiated, self-reported health in the colposcopy arm rose relative to that in the surveillance arm, although the effect was short-term only. For the majority of women, the satisfaction ratings and the CV indicated approval of the management method to which they had been randomized. Of the minority manifesting a preference for the method which they had not experienced, relatively more would have preferred colposcopy than would have preferred surveillance. The findings must be interpreted in the light of sample bias with respect to preferences, whereby enthusiasm for colposcopy was probably over-represented amongst trial participants. The study suggests that neither of the management methods is preferred unequivocally; rather, individual women have individual preferences, although many would be indifferent between methods.

No Association between Oxytocin Receptor (OXTR) Gene Polymorphisms and Experimentally Elicited Social Preferences

PubMed Central

Apicella, Coren L.; Cesarini, David; Johannesson, Magnus; Dawes, Christopher T.; Lichtenstein, Paul; Wallace, Björn; Beauchamp, Jonathan; Westberg, Lars

2010-01-01

Background Oxytocin (OXT) has been implicated in a suite of complex social behaviors including observed choices in economic laboratory experiments. However, actual studies of associations between oxytocin receptor (OXTR) gene variants and experimentally elicited social preferences are rare. Methodology/Principal Findings We test hypotheses of associations between social preferences, as measured by behavior in two economic games, and 9 single nucleotide polymorphisms (SNPs) of the OXTR gene in a sample of Swedish twins (n = 684). Two standard economic games, the dictator game and the trust game, both involving real monetary consequences, were used to elicit such preferences. After correction for multiple hypothesis testing, we found no significant associations between any of the 9 single nucleotide polymorphisms (SNPs) and behavior in either of the games. Conclusion We were unable to replicate the most significant association reported in previous research between the amount donated in a dictator game and an OXTR genetic variant. PMID:20585395

No association between oxytocin receptor (OXTR) gene polymorphisms and experimentally elicited social preferences.

PubMed

Apicella, Coren L; Cesarini, David; Johannesson, Magnus; Dawes, Christopher T; Lichtenstein, Paul; Wallace, Björn; Beauchamp, Jonathan; Westberg, Lars

2010-06-16

Oxytocin (OXT) has been implicated in a suite of complex social behaviors including observed choices in economic laboratory experiments. However, actual studies of associations between oxytocin receptor (OXTR) gene variants and experimentally elicited social preferences are rare. We test hypotheses of associations between social preferences, as measured by behavior in two economic games, and 9 single nucleotide polymorphisms (SNPs) of the OXTR gene in a sample of Swedish twins (n = 684). Two standard economic games, the dictator game and the trust game, both involving real monetary consequences, were used to elicit such preferences. After correction for multiple hypothesis testing, we found no significant associations between any of the 9 single nucleotide polymorphisms (SNPs) and behavior in either of the games. We were unable to replicate the most significant association reported in previous research between the amount donated in a dictator game and an OXTR genetic variant.

Analysis of skin conductance response during evaluation of preferences for cosmetic products

PubMed Central

Ohira, Hideki; Hirao, Naoyasu

2015-01-01

We analyzed skin conductance response (SCR) as a psychophysiological index to evaluate affective aspects of consumer preferences for cosmetic products. To examine the test-retest reliability of association between preferences and SCR, we asked 33 female volunteers to complete two experimental sessions approximately 1 year apart. The participants indicated their preferences in a typical paired comparison task by choosing the better option from a combination of two products among four products. We measured anticipatory SCR prior to expressions of the preferences. We found that the mean amplitude of the SCR elicited by the preferred products was significantly larger than that elicited by the non-preferred products. The participants' preferences and corresponding SCR patterns were well preserved at the second session 1 year later. Our results supported cumulating findings that SCR is a useful index of consumer preferences that has future potential, both in laboratory and marketing settings. PMID:25709593

Questioning the differences between general public vs. patient based preferences towards EQ-5D-5L defined hypothetical health states.

PubMed

Ogorevc, Marko; Murovec, Nika; Fernandez, Natacha Bolanos; Rupel, Valentina Prevolnik

2017-03-28

The purpose of this article is to explore whether any differences exist between the general population and patient based preferences towards EQ-5D-5L defined hypothetical health states. The article discusses the role of adaptation and self-interest in valuing health states and it also contributes rigorous empirical evidence to the scientific debate on the differences between the patient and general population preferences towards hypothetical health states. Patient preferences were elicited in 2015 with the EQ-5D-5L questionnaire using time trade-off and discrete choice experiment design and compared to the Spanish general population preferences, which were elicited using identical methods. Patients were chosen on a voluntary basis according to their willingness to participate in the survey. They were recruited from patient organisations and a hospital in Madrid, Spain. 282 metastatic breast cancer patients and 333 rheumatoid arthritis patients were included in the sample. The analysis revealed differences in preferences between the general population and patient groups. Based on the results of our analysis, it is suggested that the differences in preferences stem from patients being more able to accurately imagine "non-tangible" dimensions of health states (anxiety or depression, and pain or discomfort) than the general population with less experience in various health states. However, this does not mean that general public values should not be reflected in utilities derived for coverage decision making. Copyright © 2017 Elsevier B.V. All rights reserved.

The efficiency and effectiveness of utilizing diagrams in interviews: an assessment of participatory diagramming and graphic elicitation

PubMed Central

Umoquit, Muriah J; Dobrow, Mark J; Lemieux-Charles, Louise; Ritvo, Paul G; Urbach, David R; Wodchis, Walter P

2008-01-01

Background This paper focuses on measuring the efficiency and effectiveness of two diagramming methods employed in key informant interviews with clinicians and health care administrators. The two methods are 'participatory diagramming', where the respondent creates a diagram that assists in their communication of answers, and 'graphic elicitation', where a researcher-prepared diagram is used to stimulate data collection. Methods These two diagramming methods were applied in key informant interviews and their value in efficiently and effectively gathering data was assessed based on quantitative measures and qualitative observations. Results Assessment of the two diagramming methods suggests that participatory diagramming is an efficient method for collecting data in graphic form, but may not generate the depth of verbal response that many qualitative researchers seek. In contrast, graphic elicitation was more intuitive, better understood and preferred by most respondents, and often provided more contemplative verbal responses, however this was achieved at the expense of more interview time. Conclusion Diagramming methods are important for eliciting interview data that are often difficult to obtain through traditional verbal exchanges. Subject to the methodological limitations of the study, our findings suggest that while participatory diagramming and graphic elicitation have specific strengths and weaknesses, their combined use can provide complementary information that would not likely occur with the application of only one diagramming method. The methodological insights gained by examining the efficiency and effectiveness of these diagramming methods in our study should be helpful to other researchers considering their incorporation into qualitative research designs. PMID:18691410

Value-Based Assessment of New Medical Technologies: Towards a Robust Methodological Framework for the Application of Multiple Criteria Decision Analysis in the Context of Health Technology Assessment.

PubMed

Angelis, Aris; Kanavos, Panos

2016-05-01

In recent years, multiple criteria decision analysis (MCDA) has emerged as a likely alternative to address shortcomings in health technology assessment (HTA) by offering a more holistic perspective to value assessment and acting as an alternative priority setting tool. In this paper, we argue that MCDA needs to subscribe to robust methodological processes related to the selection of objectives, criteria and attributes in order to be meaningful in the context of healthcare decision making and fulfil its role in value-based assessment (VBA). We propose a methodological process, based on multi-attribute value theory (MAVT) methods comprising five distinct phases, outline the stages involved in each phase and discuss their relevance in the HTA process. Importantly, criteria and attributes need to satisfy a set of desired properties, otherwise the outcome of the analysis can produce spurious results and misleading recommendations. Assuming the methodological process we propose is adhered to, the application of MCDA presents three very distinct advantages to decision makers in the context of HTA and VBA: first, it acts as an instrument for eliciting preferences on the performance of alternative options across a wider set of explicit criteria, leading to a more complete assessment of value; second, it allows the elicitation of preferences across the criteria themselves to reflect differences in their relative importance; and, third, the entire process of preference elicitation can be informed by direct stakeholder engagement, and can therefore reflect their own preferences. All features are fully transparent and facilitate decision making.

How the manner of presentation of data influences older patients in determining their treatment preferences.

PubMed

Mazur, D J; Merz, J F

1993-03-01

To assess how the manner of presentation of graphic data to older patients influences their treatment preferences. Cross-sectional structured interviews with patients. A university-based Department of Veterans Affairs Medical Center. One hundred sixty-six consecutive patients (mean age = 64.8 years, range of ages 29-82) seen in a Department of Veterans Affairs general medicine clinic. Five pairs of 5-year survival curves were presented to patients. Each pair was composed of two survival curves for alternative unidentified treatments for an unidentified medical condition. Curve A (LT = better long-term, worse short-term survival) was fixed throughout all curve pairs. Curve B (ST = better short-term, worse long-term survival) changed in each curve pair, showing incrementally better chances of short-term survival across the five curve pairs. Patients were randomly assigned to view the curve pairs in forward (increasing short-term survival) or backward (decreasing short-term survival) order. Order is a significant predictor of patients' initial preferences for the short-term survival curve (P = 0.0004) as well as their willingness to shift preferences during presentation of the five curve pairs. Patients > or = 65 were more likely to initially choose the ST curve in forward order presentation than patients < 65. More educated patients generally were less likely to prefer the ST curve under both elicitation orders. The data indicate that the method of eliciting patients' preferences strongly influenced their expressed preferences, and that these preferences may have predictable relationships with demographic characteristics such as age.

Patients’ values and preferences of the expected efficacy of hip arthroscopy for osteoarthritis: a protocol for a multinational structured interview-based study combined with a randomised survey on the optimal amount of information to elicit preferences

PubMed Central

Zhang, Yuqing; Tikkinen, Kari A O; Agoritsas, Thomas; Ayeni, Olufemi R; Alexander, Paul; Imam, Maha; Yoo, Daniel; Tsalatsanis, Athanasios; Djulbegovic, Benjamin; Thabane, Lehana; Schünemann, Holger; Guyatt, Gordon H

2014-01-01

Introduction Symptomatic hip osteoarthritis (OA) is a disabling condition with up to a 25% cumulative lifetime risk. Total hip arthroplasty (THA) is effective in relieving patients’ symptoms and improving function. It is, however, associated with substantial risk of complications, pain and major functional limitation before patients can return to full function. In contrast, hip arthroscopy (HA) is less invasive and can postpone THA. However, there is no evidence regarding the delay in the need for THA that patients would find acceptable to undergoing HA. Knowing patients’ values and preferences (VP) on this expected delay is critical when making recommendations regarding the advisability of HA. Furthermore, little is known on the optimal amount of information regarding interventions and outcomes needed to present in order to optimally elicit patients’ VP. Methods and analysis We will perform a multinational, structured interview-based survey of preference in delay time for THA among patients with non-advanced OA who failed to respond to conservative therapy. We will combine these interviews with a randomised trial addressing the optimal amount of information regarding the interventions and outcomes required to elicit preferences. Eligible patients will be randomly assigned (1 : 1) to either a short or a long format of health scenarios of THA and HA. We will determine each patient's VP using a trade-off and anticipated regret exercises. Our primary outcomes for the combined surveys will be: (1) the minimal delay time in the need for THA surgery that patients would find acceptable to undertaking HA, (2) patients’ satisfaction with the amount of information provided in the health scenarios used to elicit their VPs. Ethics and dissemination The protocol has been approved by the Hamilton Integrated Research Ethics Board (HIREB13-506). We will disseminate our study findings through peer-reviewed publications and conference presentations, and make them available to guideline makers issuing recommendations addressing HA and THA. PMID:25326208

Using Discrete Choice Experiments to Inform the Benefit-Risk Assessment of Medicines: Are We Ready Yet?

PubMed

Vass, Caroline M; Payne, Katherine

2017-09-01

There is emerging interest in the use of discrete choice experiments as a means of quantifying the perceived balance between benefits and risks (quantitative benefit-risk assessment) of new healthcare interventions, such as medicines, under assessment by regulatory agencies. For stated preference data on benefit-risk assessment to be used in regulatory decision making, the methods to generate these data must be valid, reliable and capable of producing meaningful estimates understood by decision makers. Some reporting guidelines exist for discrete choice experiments, and for related methods such as conjoint analysis. However, existing guidelines focus on reporting standards, are general in focus and do not consider the requirements for using discrete choice experiments specifically for quantifying benefit-risk assessments in the context of regulatory decision making. This opinion piece outlines the current state of play in using discrete choice experiments for benefit-risk assessment and proposes key areas needing to be addressed to demonstrate that discrete choice experiments are an appropriate and valid stated preference elicitation method in this context. Methodological research is required to establish: how robust the results of discrete choice experiments are to formats and methods of risk communication; how information in the discrete choice experiment can be presented effectually to respondents; whose preferences should be elicited; the correct underlying utility function and analytical model; the impact of heterogeneity in preferences; and the generalisability of the results. We believe these methodological issues should be addressed, alongside developing a 'reference case', before agencies can safely and confidently use discrete choice experiments for quantitative benefit-risk assessment in the context of regulatory decision making for new medicines and healthcare products.

The Affective Impact of Financial Skewness on Neural Activity and Choice

PubMed Central

Wu, Charlene C.; Bossaerts, Peter; Knutson, Brian

2011-01-01

Few finance theories consider the influence of “skewness” (or large and asymmetric but unlikely outcomes) on financial choice. We investigated the impact of skewed gambles on subjects' neural activity, self-reported affective responses, and subsequent preferences using functional magnetic resonance imaging (FMRI). Neurally, skewed gambles elicited more anterior insula activation than symmetric gambles equated for expected value and variance, and positively skewed gambles also specifically elicited more nucleus accumbens (NAcc) activation than negatively skewed gambles. Affectively, positively skewed gambles elicited more positive arousal and negatively skewed gambles elicited more negative arousal than symmetric gambles equated for expected value and variance. Subjects also preferred positively skewed gambles more, but negatively skewed gambles less than symmetric gambles of equal expected value. Individual differences in both NAcc activity and positive arousal predicted preferences for positively skewed gambles. These findings support an anticipatory affect account in which statistical properties of gambles—including skewness—can influence neural activity, affective responses, and ultimately, choice. PMID:21347239

Ludic Elicitation: Using Games for Knowledge Elicitation

ERIC Educational Resources Information Center

Cao, Yan

2014-01-01

Knowledge elicitation from human beings is important for many fields, such as decision support systems, risk communication, and customer preference studying. Traditional approaches include observations, questionnaires, structured and semi-structured interviews, and group discussions. Many publications have been studying different techniques for a…

Data on German farmers risk preference, perception and management strategies.

PubMed

Meraner, Manuela; Finger, Robert

2017-12-01

The extent to which people are willing to take on risk, i.e. their risk preferences as well as subjective risk perception plays a major role in explaining their behavior. This is of particular relevance in agricultural production, which is inherently risky. The data presented here was collected amongst a total of 64 German farmers in 2015. It includes results of three different risk preference elicitation methods (multiple price list, business statements in four relevant domains and general self-assessment) as well as risk perception. Additionally, farm business characteristics (e.g. size, farm-level workforce, succession) and personal farmer characteristics (e.g. age, gender, risk literacy) are included.

Using Conjoint Analysis to Elicit GPs’ Preferences for Family Physician Contracts: A Case Study in Iran

PubMed Central

Ranjbar Ezatabadi, Mohammad; Rashidian, Arash; Shariati, Mohammad; Rahimi Foroushani, Abbas; Akbari Sari, Ali

2016-01-01

Background Family physician plans in Iran face several challenges, one of which is developing attractive and efficient contracts that motivate physicians to participate in the plan. Objectives This study aimed to elicit GPs’ preferences for family physician contracts. Patients and Methods In a cross-sectional study using the conjoint analysis technique, 580 GPs selected from the family physician database in Iran in 2014. Through qualitative and quantitative methods, 18 contract scenarios were developed via orthogonal design i.e., the impact of each attribute is measured independently from changes in other attributes and a questionnaire was developed. Data were collected through this questionnaire and analyzed using the ordered logistic regression (OLR) model. Results The results show that “quotas for admission to specialized courses” is the strongest preference of GPs (β = 1.123). In order of importance, the other preferences are having the right to provide services outside of the specified package (β = 0.962), increased number of covered population (β = 0.814), capitation payment + 15% bonus (β = 0.644), increased catchment area to 5 km (β = 0.349), and increased length of contract to five years (β = 0.345). Conclusions The conjoint analysis results show that GPs concerned about various factors of family physician contracts. These results can be helpful for policy-makers as they complete the process of creating family physician plans, which can help increase the motivation of GPs to participate in the plan. PMID:28191339

Discrete choice experiments of pharmacy services: a systematic review.

PubMed

Vass, Caroline; Gray, Ewan; Payne, Katherine

2016-06-01

Background Two previous systematic reviews have summarised the application of discrete choice experiments to value preferences for pharmacy services. These reviews identified a total of twelve studies and described how discrete choice experiments have been used to value pharmacy services but did not describe or discuss the application of methods used in the design or analysis. Aims (1) To update the most recent systematic review and critically appraise current discrete choice experiments of pharmacy services in line with published reporting criteria and; (2) To provide an overview of key methodological developments in the design and analysis of discrete choice experiments. Methods The review used a comprehensive strategy to identify eligible studies (published between 1990 and 2015) by searching electronic databases for key terms related to discrete choice and best-worst scaling (BWS) experiments. All healthcare choice experiments were then hand-searched for key terms relating to pharmacy. Data were extracted using a published checklist. Results A total of 17 discrete choice experiments eliciting preferences for pharmacy services were identified for inclusion in the review. No BWS studies were identified. The studies elicited preferences from a variety of populations (pharmacists, patients, students) for a range of pharmacy services. Most studies were from a United Kingdom setting, although examples from Europe, Australia and North America were also identified. Discrete choice experiments for pharmacy services tended to include more attributes than non-pharmacy choice experiments. Few studies reported the use of qualitative research methods in the design and interpretation of the experiments (n = 9) or use of new methods of analysis to identify and quantify preference and scale heterogeneity (n = 4). No studies reported the use of Bayesian methods in their experimental design. Conclusion Incorporating more sophisticated methods in the design of pharmacy-related discrete choice experiments could help researchers produce more efficient experiments which are better suited to valuing complex pharmacy services. Pharmacy-related discrete choice experiments could also benefit from more sophisticated analytical techniques such as investigations into scale and preference heterogeneity. Employing these sophisticated methods for both design and analysis could extend the usefulness of discrete choice experiments to inform health and pharmacy policy.

Willingness to pay per quality-adjusted life year: is one threshold enough for decision-making?: results from a study in patients with chronic prostatitis.

PubMed

Zhao, Fei-Li; Yue, Ming; Yang, Hua; Wang, Tian; Wu, Jiu-Hong; Li, Shu-Chuen

2011-03-01

To estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) ratio with the stated preference data and compare the results obtained between chronic prostatitis (CP) patients and general population (GP). WTP per QALY was calculated with the subjects' own health-related utility and the WTP value. Two widely used preference-based health-related quality of life instruments, EuroQol (EQ-5D) and Short Form 6D (SF-6D), were used to elicit utility for participants' own health. The monthly WTP values for moving from participants' current health to a perfect health were elicited using closed-ended iterative bidding contingent valuation method. A total of 268 CP patients and 364 participants from GP completed the questionnaire. We obtained 4 WTP/QALY ratios ranging from $4700 to $7400, which is close to the lower bound of local gross domestic product per capita, a threshold proposed by World Health Organization. Nevertheless, these values were lower than other proposed thresholds and published empirical researches on diseases with mortality risk. Furthermore, the WTP/QALY ratios from the GP were significantly lower than those from the CP patients, and different determinants were associated with the within group variation identified by multiple linear regression. Preference elicitation methods are acceptable and feasible in the socio-cultural context of an Asian environment and the calculation of WTP/QALY ratio produced meaningful answers. The necessity of considering the QALY type or disease-specific QALY in estimating WTP/QALY ratio was highlighted and 1 to 3 times of gross domestic product/capita recommended by World Health Organization could potentially serve as a benchmark for threshold in this Asian context.

Eliciting population preferences for mass colorectal cancer screening organization.

PubMed

Nayaradou, Maximilien; Berchi, Célia; Dejardin, Olivier; Launoy, Guy

2010-01-01

The implementation of mass colorectal cancer (CRC) screening is a public health priority. Population participation is fundamental for the success of CRC screening as for any cancer screening program. The preferences of the population may influence their likelihood of participation. The authors sought to elicit population preferences for CRC screening test characteristics to improve the design of CRC screening campaigns. A discrete choice experiment was used. Questionnaires were compiled with a set of pairs of hypothetical CRC screening scenarios. The survey was conducted by mail from June 2006 to October 2006 on a representative sample of 2000 inhabitants, aged 50 to 74 years from the northwest of France, who were randomly selected from electoral lists. Questionnaires were sent to 2000 individuals, each of whom made 3 or 4 discrete choices between hypothetical tests that differed in 7 attributes: how screening is offered, process, sensitivity, rate of unnecessary colonoscopy, expected mortality reduction, method of screening test result transmission, and cost. Complete responses were received from 656 individuals (32.8%). The attributes that influenced population preferences included expected mortality reduction, sensitivity, cost, and process. Participants from high social classes were particularly influenced by sensitivity. The results demonstrate that the discrete choice experiment provides information on patient preferences for CRC screening: improving screening program effectiveness, for instance, by improving test sensitivity (the most valued attribute) would increase satisfaction among the general population with regard to CRC screening programs. Additional studies are required to study how patient preferences actually affect adherence to regular screening programs.

Convergent validity between willingness to pay elicitation methods: an application to Grand Canyon whitewater boaters

USGS Publications Warehouse

Neher, Christopher; Bair, Lucas S.; Duffield, John; Patterson, David A.; Neher, Katherine

2018-01-01

We directly compare trip willingness to pay (WTP) values between dichotomous choice contingent valuation (DCCV) and discrete choice experiment (DCE) stated preference surveys of private party Grand Canyon whitewater boaters. The consistency of DCCV and DCE estimates is debated in the literature, and this study contributes to the body of work comparing the methods. Comparisons were made of mean WTP estimates for four hypothetical Colorado River flow-level scenarios. Boaters were found to most highly value mid-range flows, with very low and very high flows eliciting lower WTP estimates across both DCE and DCCV surveys. Mean WTP precision was estimated through simulation. No statistically significant differences were detected between the two methods at three of the four hypothetical flow levels.

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

PubMed Central

Donington, Jessica; Lynch, William R.; Mazzone, Peter J.; Midthun, David E.; Naidich, David P.; Wiener, Renda Soylemez

2013-01-01

Objectives: The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. Methods: We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the “Methodology for Development of Guidelines for Lung Cancer” in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed. Results: We formulated recommendations for evaluating solid pulmonary nodules that measure > 8 mm in diameter, solid nodules that measure ≤ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefits and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. Conclusions: Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management. PMID:23649456

Factors Associated with Congruence Between Preferred and Actual Place of Death

PubMed Central

Bell, Christina L.; Somogyi-Zalud, Emese; Masaki, Kamal H.

2009-01-01

Congruence between preferred and actual place of death may be an essential component in terminal care. Most patients prefer a home death, but many patients do not die in their preferred location. Specialized (physician, hospice and palliative) home care visits may increase home deaths, but factors associated with congruence have not been systematically reviewed. This study sought to review the extent of congruence reported in the literature, and examine factors that may influence congruence. In July 2009, a comprehensive literature search was performed using MEDLINE, Psych Info, CINAHL, and Web of Science. Reference lists, related articles, and the past five years of six palliative care journals were also searched. Overall congruence rates (percentage of met preferences for all locations of death) were calculated for each study using reported data to allow cross-study comparison. Eighteen articles described 30% to 91% congruence. Eight specialized home care studies reported 59% to 91% congruence. A physician-led home care program reported 91% congruence. Of the 10 studies without specialized home care for all patients, seven reported 56% to 71% congruence and most reported unique care programs. Of the remaining three studies without specialized home care for all patients, two reported 43% to 46% congruence among hospital inpatients, and one elicited patient preference “if everything were possible,” with 30% congruence. Physician support, hospice enrollment, and family support improved congruence in multiple studies. Research in this important area must consider potential sources of bias, the method of eliciting patient preference, and the absence of a single ideal place of death. PMID:20116205

Factors associated with congruence between preferred and actual place of death.

PubMed

Bell, Christina L; Somogyi-Zalud, Emese; Masaki, Kamal H

2010-03-01

Congruence between preferred and actual place of death may be an essential component in terminal care. Most patients prefer a home death, but many patients do not die in their preferred location. Specialized (physician, hospice, and palliative) home care visits may increase home deaths, but factors associated with congruence have not been systematically reviewed. This study sought to review the extent of congruence reported in the literature and examine factors that may influence congruence. In July 2009, a comprehensive literature search was performed using MEDLINE, PsychInfo, CINAHL, and Web of Science. Reference lists, related articles, and the past five years of six palliative care journals were also searched. Overall congruence rates (percentage of met preferences for all locations of death) were calculated for each study using reported data to allow cross-study comparison. Eighteen articles described 30%-91% congruence. Eight specialized home care studies reported 59%-91% congruence. A physician-led home care program reported 91% congruence. Of the 10 studies without specialized home care for all patients, seven reported 56%-71% congruence and most reported unique care programs. Of the remaining three studies without specialized home care for all patients, two reported 43%-46% congruence among hospital inpatients, and one elicited patient preference "if everything were possible," with 30% congruence. Physician support, hospice enrollment, and family support improved congruence in multiple studies. Research in this important area must consider potential sources of bias, the method of eliciting patient preference, and the absence of a single ideal place of death. (c) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Amplifying Each Patient's Voice: A Systematic Review of Multi-criteria Decision Analyses Involving Patients.

PubMed

Marsh, Kevin; Caro, J Jaime; Hamed, Alaa; Zaiser, Erica

2017-04-01

Qualitative methods tend to be used to incorporate patient preferences into healthcare decision making. However, for patient preferences to be given adequate consideration by decision makers they need to be quantified. Multi-criteria decision analysis (MCDA) is one way to quantify and capture the patient voice. The objective of this review was to report on existing MCDAs involving patients to support the future use of MCDA to capture the patient voice. MEDLINE and EMBASE were searched in June 2014 for English-language papers with no date restriction. The following search terms were used: 'multi-criteria decision*', 'multiple criteria decision*', 'MCDA', 'benefit risk assessment*', 'risk benefit assessment*', 'multicriteri* decision*', 'MCDM', 'multi-criteri* decision*'. Abstracts were included if they reported the application of MCDA to assess healthcare interventions where patients were the source of weights. Abstracts were excluded if they did not apply MCDA, such as discussions of how MCDA could be used; or did not evaluate healthcare interventions, such as MCDAs to assess the level of health need in a locality. Data were extracted on weighting method, variation in patient and expert preferences, and discussion on different weighting techniques. The review identified ten English-language studies that reported an MCDA to assess healthcare interventions and involved patients as a source of weights. These studies reported 12 applications of MCDA. Different methods of preference elicitation were employed: direct weighting in workshops; discrete choice experiment surveys; and the analytical hierarchy process using both workshops and surveys. There was significant heterogeneity in patient responses and differences between patients, who put greater weight on disease characteristics and treatment convenience, and experts, who put more weight on efficacy. The studies highlighted cognitive challenges associated with some weighting methods, though patients' views on their ability to undertake weighting tasks was positive. This review identified several recent examples of MCDA used to elicit patient preferences, which support the feasibility of using MCDA to capture the patient voice. Challenges identified included, how best to reflect the heterogeneity of patient preferences in decision making and how to manage the cognitive burden associated with some MCDA tasks.

Clinical decision-making: predictors of patient participation in nursing care.

PubMed

Florin, Jan; Ehrenberg, Anna; Ehnfors, Margareta

2008-11-01

To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care. Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity. A cross-sectional survey of 428 persons, newly discharged from inpatient care. The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation. Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision making in nursing care. Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient. Relevance to clinical practice. The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients'basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.

Lossed in translation: an off-the-shelf method to recover probabilistic beliefs from loss-averse agents.

PubMed

Offerman, Theo; Palley, Asa B

2016-01-01

Strictly proper scoring rules are designed to truthfully elicit subjective probabilistic beliefs from risk neutral agents. Previous experimental studies have identified two problems with this method: (i) risk aversion causes agents to bias their reports toward the probability of [Formula: see text], and (ii) for moderate beliefs agents simply report [Formula: see text]. Applying a prospect theory model of risk preferences, we show that loss aversion can explain both of these behavioral phenomena. Using the insights of this model, we develop a simple off-the-shelf probability assessment mechanism that encourages loss-averse agents to report true beliefs. In an experiment, we demonstrate the effectiveness of this modification in both eliminating uninformative reports and eliciting true probabilistic beliefs.

Effects of baseline risk information on social and individual choices.

PubMed

Gyrd-Hansen, Dorte; Kristiansen, Ivar Sønbø; Nexøe, Jørgen; Nielsen, Jesper Bo

2002-01-01

This article analyzes preferences for risk reductions in the context of individual and societal decision making. The effect of information on baseline risk is analyzed in both contexts. The results indicate that if individuals are to imagine that they suffer from 1 low-risk and 1 high-risk ailment, and are offered a specified identical absolute risk reduction, a majority will ceteris paribus opt for treatment of the low-risk ailment. A different preference structure is elicited when priority questions are framed as social choices. Here, a majority will prefer to treat the high-risk group of patients. The preference reversal demonstrates the extent to which baseline risk information can influence preferences in different choice settings. It is argued that presentation of baseline risk information may induce framing effects that lead to nonoptimal resource allocations. A solution to this problem may be to not present group-specific baseline risk information when eliciting preferences.

Patient preference to use a questionnaire varies according to attributes.

PubMed

Kim, Na Yae; Richardson, Lyndsay; He, Weilin; Jones, Glenn

2011-08-01

Health care professionals may assume questionnaires are burdensome to patients, and this limits their use in clinical settings and promotes simplification. However, patient adherence may improve by optimizing questionnaire attributes and contexts. This cross-sectional survey used Contingent Valuation methods to directly elicit patient preference for conventional monitoring of symptoms, versus adding a tool to monitoring. Under explicit consideration was the 10-question Edmonton Symptom Assessment System (ESAS). In the questionnaire, attributes of ESAS were sequentially altered to try and force preference reversal. A separate group of participants completed both questionnaire and interviews to explore questionnaire reliability, and extend validity. Overall, 24 of 43 participants preferred using ESAS. Most important attributes to preference were frequency, specificity, and complexity. Where preference is initially against ESAS, it may reverse by simplifying the tool and its administrative processes. Interviews in 10 additional participants supported reproducibility and validity of the questionnaire method. Preference for using tools increases when tools are made relevant and used more appropriately. Questionnaires completed by patients as screening tools or aids to communication may be under-utilized. Optimization of ESAS and similar tools may be guided by empirical findings, including those obtained from Contingent Valuation methodologies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Correction to: Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol.

PubMed

Sales, Anne E; Ersek, Mary; Intrator, Orna K; Levy, Cari; Carpenter, Joan G; Hogikyan, Robert; Kales, Helen C; Landis-Lewis, Zach; Olsan, Tobie; Miller, Susan C; Montagnini, Marcos; Periyakoil, Vyjeyanthi S; Reder, Sheri

2018-02-09

The authors would like to correct errors in the original article [1] that may have lead readers to misinterpret the scope, evidence base and target population of VHA Handbook 1004.03 "Life-Sustaining Treatment (LST) Decisions: Eliciting, Documenting, and Honoring Patients' Values, Goals, and Preferences".

Focus Groups in Elderly Ophthalmologic Patients: Setting the Stage for Quantitative Preference Elicitation.

PubMed

Danner, Marion; Vennedey, Vera; Hiligsmann, Mickaël; Fauser, Sascha; Stock, Stephanie

2016-02-01

Patients suffering from age-related macular degeneration (AMD) are rarely actively involved in decision-making, despite facing preference-sensitive treatment decisions. This paper presents a qualitative study to prepare quantitative preference elicitation in AMD patients. The aims of this study were (1) to gain familiarity with and learn about the special requirements of the AMD patient population for quantitative data collection; and (2) to select/refine patient-relevant treatment attributes and levels, and gain insights into preference structures. Semi-structured focus group interviews were performed. An interview guide including preselected categories in the form of seven potentially patient-relevant treatment attributes was followed. To identify the most patient-relevant treatment attributes, a ranking exercise was performed. Deductive content analyses were done by two independent reviewers for each attribute to derive subcategories (potential levels of attributes) and depict preference trends. The focus group interviews included 21 patients. The interviews revealed that quantitative preference surveys in this population will have to be interviewer assisted to make the survey feasible for patients. The five most patient-relevant attributes were the effect on visual function [ranking score (RS): 139], injection frequency (RS: 101), approval status (RS: 83), side effects (RS: 79), and monitoring frequency (RS: 76). Attribute and level refinement was based on patients' statements. Preference trends and dependencies between attributes informed the quantitative instrument design. This study suggests that qualitative research is a very helpful step to prepare the design and administration of quantitative preference elicitation instruments. It especially facilitated familiarization with the target population and its preferences, and it supported attribute/level refinement.

Using a multidimensional unfolding approach to assess multiple sclerosis patient preferences for disease-modifying therapy: a pilot study

PubMed Central

Sempere, Angel Perez; Vera-Lopez, Vanesa; Gimenez-Martinez, Juana; Ruiz-Beato, Elena; Cuervo, Jesús; Maurino, Jorge

2017-01-01

Purpose Multidimensional unfolding is a multivariate method to assess preferences using a small sample size, a geometric model locating individuals and alternatives as points in a joint space. The objective was to evaluate relapsing–remitting multiple sclerosis (RRMS) patient preferences toward key disease-modifying therapy (DMT) attributes using multidimensional unfolding. Patients and methods A cross-sectional pilot study in RRMS patients was conducted. Drug attributes included relapse prevention, disease progression prevention, side-effect risk and route and schedule of administration. Assessment of preferences was performed through a five-card game. Patients were asked to value attributes from 1 (most preferred) to 5 (least preferred). Results A total of 37 patients were included; the mean age was 38.6 years, and 78.4% were female. Disease progression prevention was the most important factor (51.4%), followed by relapse prevention (40.5%). The frequency of administration had the lowest preference rating for 56.8% of patients. Finally, 19.6% valued the side-effect risk attribute as having low/very low importance. Conclusion Patients’ perspective for DMT attributes may provide valuable information to facilitate shared decision-making. Efficacy attributes were the most important drug characteristics for RRMS patients. Multidimensional unfolding seems to be a feasible approach to assess preferences in multiple sclerosis patients. Further elicitation studies using multidimensional unfolding with other stated choice methods are necessary to confirm these findings. PMID:28615928

Picture book exposure elicits positive visual preferences in toddlers.

PubMed

Houston-Price, Carmel; Burton, Eliza; Hickinson, Rachel; Inett, Jade; Moore, Emma; Salmon, Katherine; Shiba, Paula

2009-09-01

Although the relationship between "mere exposure" and attitude enhancement is well established in the adult domain, there has been little similar work with children. This article examines whether toddlers' visual attention toward pictures of foods can be enhanced by repeated visual exposure to pictures of foods in a parent-administered picture book. We describe three studies that explored the number and nature of exposures required to elicit positive visual preferences for stimuli and the extent to which induced preferences generalize to other similar items. Results show that positive preferences for stimuli are easily and reliably induced in children and, importantly, that this effect of exposure is not restricted to the exposed stimulus per se but also applies to new representations of the exposed item.

Identifying and measuring stakeholder preferences for disease prioritisation: A case study of the pig industry in Australia.

PubMed

Brookes, V J; Hernández-Jover, M; Neslo, R; Cowled, B; Holyoake, P; Ward, M P

2014-01-01

We describe stakeholder preference modelling using a combination of new and recently developed techniques to elicit criterion weights to incorporate into a multi-criteria decision analysis framework to prioritise exotic diseases for the pig industry in Australia. Australian pig producers were requested to rank disease scenarios comprising nine criteria in an online questionnaire. Parallel coordinate plots were used to visualise stakeholder preferences, which aided identification of two diverse groups of stakeholders - one group prioritised diseases with impacts on livestock, and the other group placed more importance on diseases with zoonotic impacts. Probabilistic inversion was used to derive weights for the criteria to reflect the values of each of these groups, modelling their choice using a weighted sum value function. Validation of weights against stakeholders' rankings for scenarios based on real diseases showed that the elicited criterion weights for the group who prioritised diseases with livestock impacts were a good reflection of their values, indicating that the producers were able to consistently infer impacts from the disease information in the scenarios presented to them. The highest weighted criteria for this group were attack rate and length of clinical disease in pigs, and market loss to the pig industry. The values of the stakeholders who prioritised zoonotic diseases were less well reflected by validation, indicating either that the criteria were inadequate to consistently describe zoonotic impacts, the weighted sum model did not describe stakeholder choice, or that preference modelling for zoonotic diseases should be undertaken separately from livestock diseases. Limitations of this study included sampling bias, as the group participating were not necessarily representative of all pig producers in Australia, and response bias within this group. The method used to elicit criterion weights in this study ensured value trade-offs between a range of potential impacts, and that the weights were implicitly related to the scale of measurement of disease criteria. Validation of the results of the criterion weights against real diseases - a step rarely used in MCDA - added scientific rigour to the process. The study demonstrated that these are useful techniques for elicitation of criterion weights for disease prioritisation by stakeholders who are not disease experts. Preference modelling for zoonotic diseases needs further characterisation in this context. Copyright © 2013 Elsevier B.V. All rights reserved.

Eliciting patients’ values by use of ‘willingness to pay’: letting the theory drive the method

PubMed Central

Donaldson, Cam

2001-01-01

Objective To describe the three different ways in which ‘willingness to pay’ (WTP) has been used to elicit patients’ values of alternative interventions. Design For each of the three approaches a survey of patients or the public was undertaken. Setting, participants and interventions studied For two surveys, the setting was Aberdeen Maternity Hospital, where pregnant women were asked about their WTP for different methods of prenatal screening for cystic fibrosis. In the third survey, parents of primary and secondary schoolchildren were asked about their WTP for different ways of providing child health services. Main outcome measures Ability of WTP to discriminate between options (i.e. to say whether one option is ‘better’ than another) and the consistency of WTP with stated preferences. Results Experience with some methods shows that, despite the apparent logic of the technique, it is difficult to elicit consistent responses whereby WTP values derived match the rankings of interventions compared. The most promising technique, the ‘marginal approach’, happens to conform more with economic theory than other approaches. Potential limitations of WTP, such as its association with ability to pay, are discussed, as are approaches to dealing with such problems. Finally, if patients prefer an intervention that is more costly than the status quo, logic dictates that those extra resources will have to be obtained from another health‐care programme. In such contexts, to aid decision‐making, values derived from members of the community for different programmes may be more relevant than values derived from patients. Initial studies in the use of WTP in this broader context of eliciting community values are also outlined. Conclusions WTP has potential, but its application, and interpretation, are not straightforward. More testing of the ‘marginal approach’ is required and greater use of qualitative research, to assess the validity of the approach, should be made in this area. PMID:11493324

Nicotine behavioral pharmacology: clues from planarians

PubMed Central

Rawls, Scott M.; Patil, Tanvi; Tallarida, Christopher S.; Baron, Steven; Kim, Myongji; Song, Kevin; Ward, Sara; Raffa, Robert B.

2011-01-01

Background Nicotine is one of the world’s most addictive substances and the primary reason that humans inhale tobacco smoke. The pharmacological effects of nicotine can be investigated in planarians, aquatic flatworms that possess an integrated neural network including cephalic ganglia that some consider the earliest “brain” and spinal cord. Here, we tested the hypothesis that nicotine exposure elicits mammalian-like behaviors in planarians. Methods Planarian motility and stereotypy (C-shape hyperkinesias) were quantified following acute nicotine exposure. During repeated nicotine exposure, we investigated the presence of withdrawal, tolerance, behavioral sensitization, and environmental place conditioning. Results Acute nicotine exposure increased stereotypical activity and elicited biphasic effects on motility. A low concentration (0.01 mM) increased motility whereas higher concentrations (0.3 – 10 mM) elicited the opposite effect. Planarians exposed to nicotine (0.03 mM) for 60 min and then tested in water displayed reduced motility that was not observed during exposure to water, acute nicotine, or continuous nicotine. Nicotine-treated planarians withdrawn from the drug for 3 days before being challenged with nicotine displayed behavioral sensitization at low concentrations (0.1, 0.3 mM) but tolerance at higher concentrations (1, 3 mM). Planarians conditioned with nicotine in the ambient light (non-preferred environment) displayed a reduction in their natural preference for a dark environment. Conclusions The present results suggest nicotine elicits mammalian-like effects in planarians, including decreased motility and increased stereotypy following acute administration and abstinence-induced withdrawal, behavioral sensitization, tolerance, and place conditioning during repeated exposure. PMID:21530106

Involving Patients in Weighting Benefits and Harms of Treatment in Parkinson's Disease

PubMed Central

Weernink, Marieke G. M.; van Til, Janine A.; van Vugt, Jeroen P. P.; Movig, Kris L. L.; Groothuis-Oudshoorn, Catharina G. M.; IJzerman, Maarten J.

2016-01-01

Introduction Little is known about how patients weigh benefits and harms of available treatments for Parkinson’s Disease (oral medication, deep brain stimulation, infusion therapy). In this study we have (1) elicited patient preferences for benefits, side effects and process characteristics of treatments and (2) measured patients’ preferred and perceived involvement in decision-making about treatment. Methods Preferences were elicited using a best-worst scaling case 2 experiment. Attributes were selected based on 18 patient-interviews: treatment modality, tremor, slowness of movement, posture and balance problems, drowsiness, dizziness, and dyskinesia. Subsequently, a questionnaire was distributed in which patients were asked to indicate the most and least desirable attribute in nine possible treatment scenarios. Conditional logistic analysis and latent class analysis were used to estimate preference weights and identify subgroups. Patients also indicated their preferred and perceived degree of involvement in treatment decision-making (ranging from active to collaborative to passive). Results Two preference patterns were found in the patient sample (N = 192). One class of patients focused largely on optimising the process of care, while the other class focused more on controlling motor-symptoms. Patients who had experienced advanced treatments, had a shorter disease duration, or were still employed were more likely to belong to the latter class. For both classes, the benefits of treatment were more influential than the described side effects. Furthermore, many patients (45%) preferred to take the lead in treatment decisions, however 10.8% perceived a more passive or collaborative role instead. Discussion Patients weighted the benefits and side effects of treatment differently, indicating there is no “one-size-fits-all” approach to choosing treatments. Moreover, many patients preferred an active role in decision-making about treatment. Both results stress the need for physicians to know what is important to patients and to share treatment decisions to ensure that patients receive the treatment that aligns with their preferences. PMID:27575744

Experience theory, or How desserts are like losses.

PubMed

Martin, Jolie M; Reimann, Martin; Norton, Michael I

2016-11-01

Although many experiments have explored risk preferences for money, few have systematically assessed risk preferences for everyday experiences. We propose a conceptual model and provide convergent evidence from 7 experiments to suggest that, in contrast to a typical "zero" reference point for choices on money, reference points for choices of experiences are set at more extreme outcomes, leading to concave utility for negative experiences but convex utility for positive experiences. As a result, people are more risk-averse for negative experiences such as disgusting foods-as for monetary gains-but more risk-seeking for positive experiences such as desserts-as for monetary losses. These risk preferences for experiences are robust to different methods of elicitation. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Concert hall acoustics: Repertoire, listening position, and individual taste of the listeners influence the qualitative attributes and preferences.

PubMed

Lokki, Tapio; Pätynen, Jukka; Kuusinen, Antti; Tervo, Sakari

2016-07-01

Some studies of concert hall acoustics consider the acoustics in a hall as a single entity. Here, it is shown that the acoustics vary between different seats, and the choice of music also influences the perceived acoustics. The presented study compared the acoustics of six unoccupied concert halls with extensive listening tests, applying two different music excerpts on three different seats. Twenty eight assessors rated the halls according to the subjective preference of the assesors and individual attributes with a paired comparison method. Results show that assessors can be classified into two preference groups, which prioritize different perceptual factors. In addition, the individual attributes elicited by assessors were clustered into three latent classes.

'I love Rock 'n' Roll'--music genre preference modulates brain responses to music.

PubMed

Istók, Eva; Brattico, Elvira; Jacobsen, Thomas; Ritter, Aileen; Tervaniemi, M

2013-02-01

The present study examined the effect of participants' music genre preference on the neural processes underlying evaluative and cognitive judgements of music using the event-related potential technique. To this aim, two participant groups differing in their preference for Latin American and Heavy Metal music performed a liking judgement and a genre classification task on a variety of excerpts of either music genre. A late positive potential (LPP) was elicited in all conditions between 600 and 900 ms after stimulus onset. During the genre classification task, an early negativity was elicited by the preferred compared to the non-preferred music at around 230-370 ms whereas the non-preferred genre was characterized by a larger LPP. The findings suggest that evaluative and cognitive judgements of music are accompanied by affective responses and that the valence of music may spontaneously modulate early processes of music categorization even when no overt liking judgement is required. Copyright © 2012 Elsevier B.V. All rights reserved.

Client Preferences for STD/HIV Prevention Programs.

ERIC Educational Resources Information Center

Hennessy, Michael; Mercier, Michele M.; Williams, Samantha P.; Arno, Janet N.

2002-01-01

Conducted a formative research study designed to elicit preferences for sexually transmitted disease (STD)/HIV prevention programs from clients at a midwestern STD clinic. Responses of 126 participants show preferences for mixed group or individual meetings with counselors, with extensive intervention less favored than single sessions. Discusses…

Preferences for family involvement in care among consumers with serious mental illness.

PubMed

Cohen, Amy N; Drapalski, Amy L; Glynn, Shirley M; Medoff, Deborah; Fang, Li Juan; Dixon, Lisa B

2013-03-01

Despite robust evidence of efficacy, family services for individuals diagnosed as having serious mental illness are of limited availability and drastically underutilized. This underutilization may be due to a mismatch between consumer and family preferences and the services offered. This study is the first systematic report on preferences expressed by consumers with serious mental illness for family involvement. The study enrolled 232 mental health consumers with serious mental illness who had contact with family but did not have any family regularly involved in their mental health care. Consumers were recruited from outpatient mental health clinics at three large medical centers in two Veterans Integrated Service Networks. Interviews elicited demographic characteristics, treatment preferences regarding family involvement, and perceived benefits and barriers to involvement. Chart diagnoses and measures of symptom severity, family functioning, and contact were collected. Seventy-eight percent (171 of 219) of the consumers wanted family members to be involved in their care, and many desired involvement through several methods. Consumers were concerned with the impact of involvement on both themselves and their family member. The consumer's degree of perceived benefit of family involvement significantly predicted the degree of desire for family involvement after analyses controlled for service need (family conflict, family-related quality of life, and symptom severity), enabling factors (family contact and family capacity), demographic variables (age, gender, race, living with family, and marital status), and barriers perceived by the consumer. The extent of overall support for family involvement in care coupled with the heterogeneity of preferred modes and concerns and anticipated benefits underscore the imperative to offer diverse family services and to elicit consumers' preferences regarding whether and how to involve their families.

Attenuation of Cocaine-Induced Conditioned Place Preference and Motor Activity via Cannabinoid CB2 Receptor Agonism and CB1 Receptor Antagonism in Rats

PubMed Central

Delis, Foteini; Polissidis, Alexia; Poulia, Nafsika; Justinova, Zuzana; Nomikos, George G.; Goldberg, Steven R.

2017-01-01

Abstract Background: Studies have shown the involvement of cannabinoid (CB) receptors in the behavioral and neurobiological effects of psychostimulants. Most of these studies have focused on the role of CB1 receptors in the psychostimulant effects of cocaine, while very few have investigated the respective role of CB2 receptors. Further studies are warranted to elucidate the extent of CB receptor involvement in the expression of cocaine-induced effects. Methods: The role of CB1 and CB2 receptors in the rewarding and motor properties of cocaine was assessed in conditioned place preference, conditioned motor activity, and open field activity in rats. Results: The CB1 receptor antagonist rimonabant (3 mg/kg) decreased the acquisition and the expression of conditioned place preference induced by cocaine (20 mg/kg). Rimonabant inhibited cocaine-elicited conditioned motor activity when administered during the expression of cocaine-induced conditioned place preference. Rimonabant decreased ambulatory and vertical activity induced by cocaine. The CB2 receptor agonist JWH-133 (10 mg/kg) decreased the acquisition and the expression of cocaine-induced conditioned place preference. JWH-133 inhibited cocaine-elicited conditioned motor activity when administered during the acquisition and the expression of cocaine-induced conditioned place preference. JWH-133 decreased ambulatory activity and abolished vertical activity induced by cocaine. The effects of JWH-133 on cocaine conditioned and stimulated responses were abolished when the CB2 receptor antagonist/inverse agonist AM630 (5 mg/kg) was preadministered. Conclusions: Cannabinoid CB1 and CB2 receptors modulate cocaine-induced rewarding behavior and appear to have opposite roles in the regulation of cocaine’s reinforcing and psychomotor effects. PMID:27994006

Stated Preference Survey Estimating the Willingness to Pay ...

EPA Pesticide Factsheets

A national stated preference survey designed to elicit household willingness to pay for reductions in impinged and entrained fish at cooling water intake structures. To improve estimation of environmental benefits estimation

Prospect theory in the valuation of health.

PubMed

Moffett, Maurice L; Suarez-Almazor, Maria E

2005-08-01

Prospect theory is the prominent nonexpected utility theory in the estimation of health state preference scores for quality-adjusted life year calculation. Until recently, the theory was not considered to be developed to the point of implementation in economic analysis. This review focuses on the research and evidence that tests the implementation of prospect theory into health state valuation. The typical application of expected utility theory assumes that a decision maker has stable preferences under conditions of risk and uncertainty. Under prospect theory, preferences are dependent on whether the decision maker regards the outcome of a choice as a gain or loss, relative to a reference point. The conceptual preference for standard gamble utilities in the valuation of health states has led to the development of elicitation techniques. Empirical evidence using these techniques indicates that when individual preferences are elicited, a prospect theory consistent framework appears to be necessary for adequate representation of individual health utilities. The relevance of prospect theory to policy making and resource allocation remains to be established. Societal preferences may not need the same attitudes towards risks as individual preferences, and may remain largely risk neutral.

Fuzzy rationality and parameter elicitation in decision analysis

NASA Astrophysics Data System (ADS)

Nikolova, Natalia D.; Tenekedjiev, Kiril I.

2010-07-01

It is widely recognised by decision analysts that real decision-makers always make estimates in an interval form. An overview of techniques to find an optimal alternative among such with imprecise and interval probabilities is presented. Scalarisation methods are outlined as most appropriate. A proper continuation of such techniques is fuzzy rational (FR) decision analysis. A detailed representation of the elicitation process influenced by fuzzy rationality is given. The interval character of probabilities leads to the introduction of ribbon functions, whose general form and special cases are compared with the p-boxes. As demonstrated, approximation of utilities in FR decision analysis does not depend on the probabilities, but the approximation of probabilities is dependent on preferences.

Counseling women with early pregnancy failure: utilizing evidence, preserving preference.

PubMed

Wallace, Robin R; Goodman, Suzan; Freedman, Lori R; Dalton, Vanessa K; Harris, Lisa H

2010-12-01

To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management. Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice. Women have strong and diverse preferences for EPF management and report higher satisfaction when treated according to these preferences. However, estimates of actual treatment patterns suggest that current practice does not reflect the evidence for safety and acceptability of all options, or patient preferences. Multiple practice barriers and biases exist that may be influencing provider counseling about options for EPF management. Choosing management for EPF is a preference-sensitive decision. A patient-centered approach to EPF management should incorporate counseling about all treatment options. Providers can integrate a counseling model into EPF management practice that utilizes principles of shared decision-making and an organized method for eliciting patient preferences, priorities, and concerns about treatment options. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

The Effect of Gender Stereotypes on Explicit and Implicit Career Preferences

ERIC Educational Resources Information Center

Gadassi, Reuma; Gati, Itamar

2009-01-01

The present study compared gender differences in directly reported and indirectly derived career preferences and tested the hypothesis that individuals' implicit preferences would show less gender-biased occupational choices than their directly elicited ones. Two hundred sixty-six visitors to a career-related Internet site were asked to (a) list 5…

Can a Circular Payment Card Format Effectively Elicit Preferences? Evidence From a Survey on a Mandatory Health Insurance Scheme in Tunisia.

PubMed

Chanel, Olivier; Makhloufi, Khaled; Abu-Zaineh, Mohammad

2017-06-01

The choice of elicitation format is a crucial but tricky aspect of stated preferences surveys. It affects not only the quantity and quality of the information collected on respondents' willingness to pay (WTP) but also the potential errors/biases that prevent their true WTP from being observed. We propose a new elicitation mechanism, the circular payment card (CPC), and show that it helps overcome the drawbacks of the standard payment card (PC) format. It uses a visual pie chart representation without start or end points: respondents spin the circular card in any direction until they find the section that best matches their true WTP. We performed a contingent valuation survey regarding a mandatory health insurance scheme in Tunisia, a middle-income country. Respondents were randomly allocated into one of three subgroups and their WTP was elicited using one of three formats: open-ended (OE), standard PC and the new CPC. We compared the elicited WTP. We found significant differences in unconditional and conditional analyses. Our empirical results consistently indicated that the OE and standard PC formats led to significantly lower WTP than the CPC format. Overall, our results are encouraging and suggest CPC could be an effective alternative format to elicit 'true' WTP.

Preference elicitation approach for measuring the willingness to pay for liver cancer treatment in Korea.

PubMed

Cho, Donghun; Jo, Changik

2015-09-01

The Korean government has expanded the coverage of the national insurance scheme for four major diseases: cancers, cardiovascular diseases, cerebrovascular diseases, and rare diseases. This policy may have a detrimental effect on the budget of the national health insurance agency. Like taxes, national insurance premiums are levied on the basis of the income or wealth of the insured. Using a preference elicitation method, we attempted to estimate how much people are willing to pay for insurance premiums that would expand their coverage for liver cancer treatment. We calculated the marginal willingness to pay (MWTP) through the marginal rate of substitution between the two attributes of the insurance premium and the total annual treatment cost by adopting conditional logit and mixed logit models. The effects of various other terms that could interact with socioeconomic status were also estimated, such as gender, income level, educational attainment, age, employment status, and marital status. The estimated MWTP values of the monthly insurance premium for liver cancer treatment range from 4,130 KRW to 9,090 KRW.

Saudi mothers' preferences about breaking bad news concerning newborns: a structured verbal questionnaire

PubMed Central

2011-01-01

Background Breaking bad news (BBN) to parents whose newborn has a major disease is an ethical dilemma. In Saudi Arabia, BBN about newborns is performed according to the parental preferences that have been reported from non-Arabic/non-Islamic countries. Saudi mothers' preferences about BBN have not yet been studied. Therefore, we aimed to elicit the preferences of Saudi mothers about BBN concerning newborns. Methods We selected a convenience sample of 402 Saudi mothers, aged 18-50 years, who had no previous experience with BBN. We selected them via a simple number-randomization scheme from the premises of a level III Saudi hospital between October of 2009 and January of 2011. We used a hypothetical situation (BBN about trisomy 21) to elicit their preferences about BBN concerning newborns via a structured verbal questionnaire composed of 12 multiple-choice questions. We expressed their preferences as percentages (95% confidence interval), and we used the Kendall's W test (W) to assess the degree of agreement in preferences. Results The Saudi mothers preferred that BBN be conducted with both parents together (64% [60-69]), albeit with weak levels of agreement (W = 0.29). They showed moderate agreement in their preferences that BBN should be conducted early (79% [75-83], W = 0.48), in detail (81% [77-85], W = 0.52), in person (88% [85-91], W = 0.58), and in a quiet setting (86% [83-90], W = 0.53). With extremely weak agreement, they preferred to have a known person present for support during BBN (56% [51-61], W = 0.01), to have close bodily contact with their babies (66% [61-70], W = 0.10), and to have no another patients present (64% [59-68], W = 0.08). They showed moderate levels of agreement in their desires to detail, in advance, their preferences about process of BBN by giving a reversible, written informed consent that could be utilized for guidance, if needed (80% [76-84], W = 0.36). Conclusions In our experience, Saudi mothers' preferences about BBN concerning newborns are varied, suggesting that a "one-size-fits-all" approach is inappropriate. A reversible, written informed consent detailing their preferences about BBN that would be kept in their medical records and utilized for guidance, if needed, may be the best solution, given this level of diversity. These findings merit further study. PMID:21861876

Conducting a Discrete-Choice Experiment Study Following Recommendations for Good Research Practices: An Application for Eliciting Patient Preferences for Diabetes Treatments.

PubMed

Janssen, Ellen M; Hauber, A Brett; Bridges, John F P

2018-01-01

To consolidate and illustrate good research practices in health care to the application and reporting of a study measuring patient preferences for type 2 diabetes mellitus medications, given recent methodological advances in stated-preference methods. The International Society for Pharmacoeconomics and Outcomes Research good research practices and other recommendations were used to conduct a discrete-choice experiment. Members of a US online panel with type 2 diabetes mellitus completed a Web-enabled, self-administered survey that elicited choices between treatment pairs with six attributes at three possible levels each. A D-efficient experimental design blocked 48 choice tasks into three 16-task surveys. Preference estimates were obtained using mixed logit estimation and were used to calculate choice probabilities. A total of 552 participants (51% males) completed the survey. Avoiding 90 minutes of nausea was valued the highest (mean -10.00; 95% confidence interval [CI] -10.53 to -9.47). Participants wanted to avoid low blood glucose during the day and/or night (mean -3.87; 95% CI -4.32 to -3.42) or one pill and one injection per day (mean -7.04; 95% CI -7.63 to -6.45). Participants preferred stable blood glucose 6 d/wk (mean 4.63; 95% CI 4.15 to 5.12) and a 1% decrease in glycated hemoglobin (mean 5.74; 95% CI 5.22 to 6.25). If cost increased by $1, the probability that a treatment profile would be chosen decreased by 1%. These results are consistent with the idea that people have strong preferences for immediate consequences of medication. Despite efforts to produce recommendations, ambiguity surrounding good practices remains and various judgments need to be made when conducting stated-preference studies. To ensure transparency, these judgments should be described and justified. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Learning preferences and learning styles: a study of Wessex general practice registrars.

PubMed Central

Lesmes-Anel, J; Robinson, G; Moody, S

2001-01-01

BACKGROUND: Experienced trainers know that individual registrars react very differently to identical learning experiences generated during the year in practice. This divergence reflects differences in registrars' learning styles. Only one study of United Kingdom (UK) general practitioners' learning styles has been undertaken. Learning style theory predicts that matching learning preference with learning style will enhance learning. This paper researches for the first time the evidence in the setting of UK general practice. AIM: To determine, for the general practice registrars within the Wessex Region, the nature of their learning preferences and learning styles and correlations between them. DESIGN OF STUDY: A descriptive confidential postal questionnaire survey. SETTING: Fifty-seven registrars identified in the Wessex Region with a minimum experience of six months in general practice. METHOD: The questionnaire gathered demographic data (sex, age, experience in general practice, years post-registration, and postgraduate qualifications). Learning preferences were elicited using a six-point Likert scale for learning experiences. The Honey and Mumford Learning Style Questionnaire (LSQ) elicited the registrars' learning styles. A second questionnaire was sent to non-responders. RESULTS: The response rate was 74%. Registrars report that interactive learning with feedback is preferred, but more passive learning formats remain valued. A wide range of learning style scores was found. The Honey and Mumford LSQ mean scores fell within the reflector-theorist quadrant. Evidence for correlations between learning preferences and learning styles was also found, in particular for the multiple choice question and audit components of summative assessment. CONCLUSION: A wide range of registrar learning styles exists in Wessex, and initial correlations are described between learning preferences and learning styles as predicted by style theory. This work sets the stage for a shared understanding and use of learning style theory to enhance professional learning throughout a GP's career. More research is needed in this domain. PMID:11462316

PATIENT-CENTERED DECISION MAKING: LESSONS FROM MULTI-CRITERIA DECISION ANALYSIS FOR QUANTIFYING PATIENT PREFERENCES.

PubMed

Marsh, Kevin; Caro, J Jaime; Zaiser, Erica; Heywood, James; Hamed, Alaa

2018-01-01

Patient preferences should be a central consideration in healthcare decision making. However, stories of patients challenging regulatory and reimbursement decisions has led to questions on whether patient voices are being considered sufficiently during those decision making processes. This has led some to argue that it is necessary to quantify patient preferences before they can be adequately considered. This study considers the lessons from the use of multi-criteria decision analysis (MCDA) for efforts to quantify patient preferences. It defines MCDA and summarizes the benefits it can provide to decision makers, identifies examples of MCDAs that have involved patients, and summarizes good practice guidelines as they relate to quantifying patient preferences. The guidance developed to support the use of MCDA in healthcare provide some useful considerations for the quantification of patient preferences, namely that researchers should give appropriate consideration to: the heterogeneity of patient preferences, and its relevance to decision makers; the cognitive challenges posed by different elicitation methods; and validity of the results they produce. Furthermore, it is important to consider how the relevance of these considerations varies with the decision being supported. The MCDA literature holds important lessons for how patient preferences should be quantified to support healthcare decision making.

The double identity of linguistic doubling.

PubMed

Berent, Iris; Bat-El, Outi; Brentari, Diane; Dupuis, Amanda; Vaknin-Nusbaum, Vered

2016-11-29

Does knowledge of language consist of abstract principles, or is it fully embodied in the sensorimotor system? To address this question, we investigate the double identity of doubling (e.g., slaflaf, or generally, XX; where X stands for a phonological constituent). Across languages, doubling is known to elicit conflicting preferences at different levels of linguistic analysis (phonology vs. morphology). Here, we show that these preferences are active in the brains of individual speakers, and they are demonstrably distinct from sensorimotor pressures. We first demonstrate that doubling in novel English words elicits divergent percepts: Viewed as meaningless (phonological) forms, doubling is disliked (e.g., slaflaf < slafmak), but once doubling in form is systematically linked to meaning (e.g., slaf = ball, slaflaf = balls), the doubling aversion shifts into a reliable (morphological) preference. We next show that sign-naive speakers spontaneously project these principles to novel signs in American Sign Language, and their capacity to do so depends on the structure of their spoken language (English vs. Hebrew). These results demonstrate that linguistic preferences doubly dissociate from sensorimotor demands: A single stimulus can elicit diverse percepts, yet these percepts are invariant across stimulus modality--for speech and signs. These conclusions are in line with the possibility that some linguistic principles are abstract, and they apply broadly across language modality.

Patient preferences versus physicians' judgement: does it make a difference in healthcare decision making?

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2013-06-01

Clinicians and public health experts make evidence-based decisions for individual patients, patient groups and even whole populations. In addition to the principles of internal and external validity (evidence), patient preferences must also influence decision making. Great Britain, Australia and Germany are currently discussing methods and procedures for valuing patient preferences in regulatory (authorization and pricing) and in health policy decision making. However, many questions remain on how to best balance patient and public preferences with physicians' judgement in healthcare and health policy decision making. For example, how to define evaluation criteria regarding the perceived value from a patient's perspective? How do physicians' fact-based opinions also reflect patients' preferences based on personal values? Can empirically grounded theories explain differences between patients and experts-and, if so, how? This article aims to identify and compare studies that used different preference elicitation methods and to highlight differences between patient and physician preferences. Therefore, studies comparing patient preferences and physician judgements were analysed in a review. This review shows a limited amount of literature analysing and comparing patient and physician preferences for healthcare interventions and outcomes. Moreover, it shows that methodology used to compare preferences is diverse. A total of 46 studies used the following methods-discrete-choice experiments, conjoint analyses, standard gamble, time trade-offs and paired comparisons-to compare patient preferences with doctor judgements. All studies were published between 1985 and 2011. Most studies reveal a disparity between the preferences of actual patients and those of physicians. For most conditions, physicians underestimated the impact of intervention characteristics on patients' decision making. Differentiated perceptions may reflect ineffective communication between the provider and the patient. This in turn may keep physicians from fully appreciating the impact of certain medical conditions on patient preferences. Because differences exist between physicians' judgement and patient preferences, it is important to incorporate the needs and wants of the patient into treatment decisions.

Choice Experiments to Quantify Preferences for Health and Healthcare: State of the Practice.

PubMed

Mühlbacher, Axel; Johnson, F Reed

2016-06-01

Stated-preference methods increasingly are used to quantify preferences in health economics, health technology assessment, benefit-risk analysis and health services research. The objective of stated-preference studies is to acquire information about trade-off preferences among treatment outcomes, prioritization of clinical decision criteria, likely uptake or adherence to healthcare products and acceptability of healthcare services or policies. A widely accepted approach to eliciting preferences is discrete-choice experiments. Patient, physician, insurant or general-public respondents choose among constructed, experimentally controlled alternatives described by decision-relevant features or attributes. Attributes can represent complete health states, sets of treatment outcomes or characteristics of a healthcare system. The observed pattern of choice reveals how different respondents or groups of respondents implicitly weigh, value and assess different characteristics of treatments, products or services. An important advantage of choice experiments is their foundation in microeconomic utility theory. This conceptual framework provides tests of internal validity, guidance for statistical analysis of latent preference structures, and testable behavioural hypotheses. Choice experiments require expertise in survey-research methods, random-utility theory, experimental design and advanced statistical analysis. This paper should be understood as an introduction to setting up a basic experiment rather than an exhaustive critique of the latest findings and procedures. Where appropriate, we have identified topics of active research where a broad consensus has not yet been established.

Valuing Individuals' Preferences and Health Choices of Physical Exercise.

PubMed

Aboagye, Emmanuel

2017-06-01

The efficacy of physical exercise for the prevention and treatment of non-specific low back pain (LBP) is well documented, but little is known about how individuals value specific components of physical exercise, such as the type and design or the intensity and frequency of exercise. Other factors that influence individual differences in health choices and adherence are associated with individuals' attitudes toward and likelihood of performing recommended exercise regimens. Current evidence shows that efficacy is similar among exercise interventions, but their features vary widely. Thus it may be difficult for clinicians to discriminate between available options in clinical practice. Considering the many challenges in determining the form of exercise best suited to the individual patient, this commentary discusses some of the practical methods that could be used to elicit individual preference for recommended health care interventions. Such methods have the advantage of providing more information for health care decision making, particularly with regard to exercise interventions for LBP. This commentary also advocates for the use of patient preference in health care decisions.

A comparison of methods for converting DCE values onto the full health-dead QALY scale.

PubMed

Rowen, Donna; Brazier, John; Van Hout, Ben

2015-04-01

Preference elicitation techniques such as time trade-off (TTO) and standard gamble (SG) receive criticism for their complexity and difficulties of use. Ordinal techniques such as discrete choice experiment (DCE) are arguably easier to understand but generate values that are not anchored onto the full health-dead 1-0 quality-adjusted life-year (QALY) scale required for use in economic evaluation. This article compares existing methods for converting modeled DCE latent values onto the full health-dead QALY scale: 1) anchoring DCE values using dead as valued in the DCE and 2) anchoring DCE values using TTO value for worst state to 2 new methods: 3) mapping DCE values onto TTO and 4) combining DCE and TTO data in a hybrid model. Models are compared using their ability to predict mean TTO health state values. We use postal DCE data (n = 263) and TTO data (n = 307) collected by interview in a general population valuation study of an asthma condition-specific measure (AQL-5D). New methods 3 and 4 using mapping and hybrid models are better able to predict mean TTO health state values (mean absolute difference [MAD], 0.052-0.084) than the anchor-based methods (MAD, 0.075-0.093) and were better able to predict mean TTO health state values even when using in their estimation a subsample of the available TTO data. These new mapping and hybrid methods have a potentially useful role for producing values on the QALY scale from data elicited using ordinal techniques such as DCE for use in economic evaluation that makes best use of the desirable properties of each elicitation technique and elicited data. Further research is encouraged. © The Author(s) 2014.

Patient preferences and willingness to pay for different options of anticoagulant therapy.

PubMed

Moia, Marco; Mantovani, Lorenzo Giovanni; Carpenedo, Monica; Scalone, Luciana; Monzini, Mara Silvia; Cesana, Giancarlo; Mannucci, Pier Mannuccio

2013-04-01

New anticoagulant drugs alternative to vitamin K antagonists are currently under clinical evaluation. Patient's preferences should be considered in the development of new therapeutic strategies. Our study aim was to elicit patient preferences, and estimate their willingness to pay for the different treatment options. A Discrete Choice Experiment was administered to patients consecutively attending an anticoagulation clinic, either on stable oral anticoagulant therapy, or during their first visit at the time of starting therapy. Six treatment characteristics were analysed: route and number of medication administrations, frequency of monitoring, risk of some minor bleeding, the amount of attention required for drug/food interactions, requirement for dose adjustment, and out-of-pocket treatment cost. Relationships between patient's preferences and their characteristics were analysed. 255 patients participated (55 % men, with a mean age 64 years; 35.7 % on stable therapy). A statistically significant importance was attributed to all but two characteristics (the amount of attention required for interaction with other drugs/food and for dose adjustment.) Monthly patient willingness to pay was 79 for tablets versus injections; 41 for once-daily versus twice-daily tablets, 25 for drugs without risk of minor bleeding events and 20 for once-monthly versus twice-monthly monitoring. Patients on stable therapy considered more important the amount of attention required for drug/food interactions than did the starters. Younger or working patients considered the reduction of monitoring frequency more important than did the older or not working patients (retired, housewives). This study elicited preferences from patients on oral anticoagulant therapy with a simple and well established method, which allows to obtain information warranted for planning optimal healthcare.

Reviewing and piloting methods for decreasing discount rates; someone, somewhere in time.

PubMed

Parouty, Mehraj B Y; Krooshof, Daan G M; Westra, Tjalke A; Pechlivanoglou, Petros; Postma, Maarten J

2013-08-01

There has been substantial debate on the need for decreasing discounting for monetary and health gains in economic evaluations. Next to the discussion on differential discounting, a way to identify the need for such discounting strategies is through eliciting the time preferences for monetary and health outcomes. In this article, the authors investigate the perceived time preference for money and health gains through a pilot survey on Dutch university students using methods on functional forms previously suggested. Formal objectives of the study were to review such existing methods and to pilot them on a convenience sample using a questionnaire designed for this specific purpose. Indeed, a negative relation between the time of delay and the variance of the discounting rate for all models was observed. This study was intended as a pilot for a large-scale population-based investigation using the findings from this pilot on wording of the questionnaire, interpretation, scope and analytic framework.

Laterality of Grooming and Tool Use in a Group of Captive Bonobos (Pan paniscus).

PubMed

Brand, Colin M; Marchant, Linda F; Boose, Klaree J; White, Frances J; Rood, Tabatha M; Meinelt, Audra

2017-01-01

Humans exhibit population level handedness for the right hand; however, the evolution of this behavioral phenotype is poorly understood. Here, we compared the laterality of a simple task (grooming) and a complex task (tool use) to investigate whether increasing task difficulty elicited individual hand preference among a group of captive bonobos (Pan paniscus). Subjects were 17 bonobos housed at the Columbus Zoo and Aquarium. Laterality of grooming was recorded using group scans; tool use was recorded using all-occurrence sampling. Grooming was characterized as unimanual or bimanual, and both tasks were scored as right-handed or left-handed. Most individuals did not exhibit significant hand preference for unimanual or bimanual (asymmetrical hand use) grooming, although 1 individual was lateralized for each. For the 8 subjects who engaged in termite fishing enough for statistical testing, 7 individuals exhibited significant laterality and strong individual hand preference. Four subjects preferred their left hand, 3 preferred their right, and 1 had no preference. Grooming, a simple behavior, was not lateralized in this group, yet a more complex behavior revealed a strong individual hand preference, and these results are congruent with other recent findings that demonstrate complex tasks elicit hand preference in bonobos. © 2017 S. Karger AG, Basel.

Willingness to pay for improved respiratory and cardiovascular health: a multiple-format, stated-preference approach.

PubMed

Johnson, F R; Banzhaf, M R; Desvousges, W H

2000-06-01

This study uses stated-preference (SP) analysis to measure willingness to pay (WTP) to reduce acute episodes of respiratory and cardiovascular ill health. The SP survey employs a modified version of the health state descriptions used in the Quality of Well Being (QWB) Index. The four health state attributes are symptom, episode duration, activity restrictions and cost. Preferences are elicited using two different SP formats: graded-pair and discrete-choice. The different formats cause subjects to focus on different evaluation strategies. Combining two elicitation formats yields more valid and robust estimates than using only one approach. Estimates of indirect utility function parameters are obtained using advanced panel econometrics for each format separately and jointly. Socio-economic differences in health preferences are modelled by allowing the marginal utility of money relative to health attributes to vary across respondents. Because the joint model captures the combined preference information provided by both elicitation formats, these model estimates are used to calculate WTP. The results demonstrate the feasibility of estimating meaningful WTP values for policy-relevant respiratory and cardiac symptoms, even from subjects who never have personally experienced these conditions. Furthermore, because WTP estimates are for individual components of health improvements, estimates can be aggregated in various ways depending upon policy needs. Thus, using generic health attributes facilitates transferring WTP estimates for benefit-cost analysis of a variety of potential health interventions. Copyright 2000 John Wiley & Sons, Ltd.

Quantifying women's stated benefit-risk trade-off preferences for IBS treatment outcomes.

PubMed

Johnson, F Reed; Hauber, A Brett; Ozdemir, Semra; Lynd, Larry

2010-01-01

The Food and Drug Administration, currently, is exploring quantitative benefit-risk methods to support regulatory decision-making. A scientifically valid method for assessing patients' benefit-risk trade-off preferences is needed to compare risks and benefits in a common metric. The study aims to quantify the maximum acceptable risk (MAR) of treatment-related adverse events (AEs) that women with diarrhea-predominant irritable bowel syndrome (IBS) are willing to accept in exchange for symptom relief. A stated-choice survey was used to elicit trade-off preferences among constructed treatment profiles, each defined by symptom severity and treatment-related AEs. Symptom attributes included frequency of abdominal pain and discomfort, frequency of diarrhea, and frequency of urgency. AE attributes included frequency of mild-to-moderate constipation and the risk of four possible serious AEs. A Web-enabled survey was administered to 589 female US residents at least 18 years of age with a self-reported diagnosis of diarrhea-predominant IBS. Preference weights and MAR were estimated using mixed-logit methods. SUBJECTS were willing to accept higher risks of serious AEs in return for treatments offering better symptom control. For an improvement from the lowest to the highest of four benefit levels, subjects were willing to tolerate a 2.65% increase in impacted-bowel risk, but only a 1.34% increase in perforated-bowel risk. Variation in MARs across AE types is consistent with the relative seriousness of the AEs. Stated-preference methods offer a scientifically valid approach to quantifying benefit-risk trade-off preferences that can be used to inform regulatory decision-making.

Influenza immunization elicits antibodies specific for an egg-adapted vaccine strain.

PubMed

Raymond, Donald D; Stewart, Shaun M; Lee, Jiwon; Ferdman, Jack; Bajic, Goran; Do, Khoi T; Ernandes, Michael J; Suphaphiphat, Pirada; Settembre, Ethan C; Dormitzer, Philip R; Del Giudice, Giuseppe; Finco, Oretta; Kang, Tae Hyun; Ippolito, Gregory C; Georgiou, George; Kepler, Thomas B; Haynes, Barton F; Moody, M Anthony; Liao, Hua-Xin; Schmidt, Aaron G; Harrison, Stephen C

2016-12-01

For broad protection against infection by viruses such as influenza or HIV, vaccines should elicit antibodies that bind conserved viral epitopes, such as the receptor-binding site (RBS). RBS-directed antibodies have been described for both HIV and influenza virus, and the design of immunogens to elicit them is a goal of vaccine research in both fields. Residues in the RBS of influenza virus hemagglutinin (HA) determine a preference for the avian or human receptor, α-2,3-linked sialic acid and α-2,6-linked sialic acid, respectively. Transmission of an avian-origin virus between humans generally requires one or more mutations in the sequences encoding the influenza virus RBS to change the preferred receptor from avian to human, but passage of a human-derived vaccine candidate in chicken eggs can select for reversion to avian receptor preference. For example, the X-181 strain of the 2009 new pandemic H1N1 influenza virus, derived from the A/California/07/2009 isolate and used in essentially all vaccines since 2009, has arginine at position 226, a residue known to confer preference for an α-2,3 linkage in H1 subtype viruses; the wild-type A/California/07/2009 isolate, like most circulating human H1N1 viruses, has glutamine at position 226. We describe, from three different individuals, RBS-directed antibodies that recognize the avian-adapted H1 strain in current influenza vaccines but not the circulating new pandemic 2009 virus; Arg226 in the vaccine-strain RBS accounts for the restriction. The polyclonal sera of the three donors also reflect this preference. Therefore, when vaccines produced from strains that are never passaged in avian cells become widely available, they may prove more capable of eliciting RBS-directed, broadly neutralizing antibodies than those produced from egg-adapted viruses, extending the established benefits of current seasonal influenza immunizations.

Picturing commuting: photovoice and seeking well-being in everyday travel

PubMed Central

Ogilvie, David

2015-01-01

We used participant-produced photography to investigate everyday commuting practices in Cambridge, UK. Photovoice served as an observational method for producing ethnographically rich data. A total of 19 participants produced over 500 photos about their journeys to and from work and took part in photo-elicitation interviews. Three themes emerged. First, many images depicted ‘well-being’ in commuting, for example, beautiful landscapes. Second, during elicitation interviews, participants described positive images that they intended but failed to capture in photos. Third, those participants who did not depict well-being described a lack of choice in their commuting, while those who acknowledged well-being seemed to do so in order to make practices of commuting meaningful and habitable. While our interpretations of photos of well-being could be subject to a methodological fallacy relating to a preference for positive over negative images in lay photography, we nonetheless suggest that the rich visual and oral narratives indicate a ‘real’ experience, albeit elicited through the photovoice. PMID:25972763

Applying Disruptive Preference Test Protocols to Increase the Number of "No Preference" Responses in the Placebo Pair, Using Chinese Consumers.

PubMed

Xia, Yixun; Zhong, Fang; O'Mahony, Michael

2016-09-01

One form of paired preference test protocol requires consumers to assess 2 pairs of products. One is the target pair under consideration, while the other is a putatively identical pair named the "placebo pair" which is also presented as a control. Counterintuitively, the majority of consumers report preferences when presented with the placebo pair. Their response frequencies are hypothesized to be those of consumers having "no preference" and are compared with the response frequencies elicited by a target pair, to determine whether the target pair elicits significant preferences. The primary goal of this paper was to study the robustness of 2 new so called disruptive protocols that reduced the proportion of consumers, who reported preferences when assessing a putatively identical pair of products. For this task, the tests were performed in a different language, in a different country, using different products from before. The results showed that the proportion of consumers reporting preferences for the placebo pair was reduced, confirming earlier work. Also, comparison of d' values showed a lack of significant overall differences between the placebo and target pairs, while chi-squared analyses indicated significant differences in the response frequencies. This indicated that the sample was segmented into 2 balanced groups with opposing preferences. © 2016 Institute of Food Technologists®

The person trade-off method and the transitivity principle: an example from preferences over age weighting.

PubMed

Dolan, Paul; Tsuchiya, Aki

2003-06-01

The person trade-off (PTO) is increasingly being used to elicit preferences in health. This paper explores the measurement properties of the PTO method in the context of a study about how members of the public prioritise between patients of different ages. In particular, it considers whether PTO responses satisfy the transitivity principle; that is, whether one PTO response can be inferred from two other PTO responses. The results suggest that very few responses to PTO questions satisfy cardinal transitivity condition. However, this study has produced results that suggest that cardinal transitivity will hold, on average, when respondents who fail to satisfy the ordinal transitivity condition have been excluded from the analysis. This suggests that future PTO studies should build in checks for ordinal transitivity. Copyright 2002 John Wiley & Sons, Ltd.

Farmers' Risk Preferences in Rural China: Measurements and Determinants.

PubMed

Jin, Jianjun; He, Rui; Gong, Haozhou; Xu, Xia; He, Chunyang

2017-06-30

This study measures farmers' risk attitudes in rural China using a survey instrument and a complementary experiment conducted in the field with the same sample of subjects. Using a question asking people about their willingness to take risks "in general", we found that the average response of our sample is slightly risk averse. Farmers' exogenous factors (age, gender, and height) and self-reported happiness have a significant impact on farmers' willingness to take risks. The experiment results show that approximately 44% of farmers in the study area are risk averse. We compare farmers' self-reported measures of risk preferences derived from the survey instrument to preferences elicited through the experimental task. Results show that answers to the general risk attitude question in the survey can predict farmers' behaviors in the experiment to a statistically significant degree. This paper can contribute to the empirical literature on comparing local farmers' risk attitudes across different risk preference measurement methods in the developing world.

Eliciting and Analyzing Male Mouse Ultrasonic Vocalization (USV) Songs

PubMed Central

Chabout, Jonathan; Jones-Macopson, Joshua; Jarvis, Erich D.

2017-01-01

Mice produce ultrasonic vocalizations (USVs) in a variety of social contexts throughout development and adulthood. These USVs are used for mother-pup retrieval1, juvenile interactions2, opposite and same sex interactions345, and territorial interactions6. For decades, the USVs have been used by investigators as proxies to study neuropsychiatric and developmental or behavioral disorders789, and more recently to understand mechanisms and evolution of vocal communication among vertebrates10. Within the sexual interactions, adult male mice produce USV songs, which have some features similar to courtship songs of songbirds11. The use of such multisyllabic repertoires can increase potential flexibility and information they carry, as they can be varied in how elements are organized and recombined, namely syntax. In this protocol a reliable method to elicit USV songs from male mice in various social contexts, such as exposure to fresh female urine, anesthetized animals, and estrus females is described. This includes conditions to induce a large amount of syllables from the mice. We reduce recording of ambient noises with inexpensive sound chambers, and present a quantification method to automatically detect, classify and analyze the USVs. The latter includes evaluation of call-rate, vocal repertoire, acoustic parameters, and syntax. Various approaches and insight on using playbacks to study an animal's preference for specific song types are described. These methods were used to describe acoustic and syntax changes across different contexts in male mice, and song preferences in female mice. PMID:28518074

Discrete choice experiments in pharmacy: a review of the literature.

PubMed

Naik-Panvelkar, Pradnya; Armour, Carol; Saini, Bandana

2013-02-01

Discrete choice experiments (DCEs) have been widely used to elicit patient preferences for various healthcare services and interventions. The aim of our study was to conduct an in-depth scoping review of the literature and provide a current overview of the progressive application of DCEs within the field of pharmacy. Electronic databases (MEDLINE, EMBASE, SCOPUS, ECONLIT) were searched (January 1990-August 2011) to identify published English language studies using DCEs within the pharmacy context. Data were abstracted with respect to DCE methodology and application to pharmacy. Our search identified 12 studies. The DCE methodology was utilised to elicit preferences for different aspects of pharmacy products, therapy or services. Preferences were elicited from either patients or pharmacists, with just two studies incorporating the views of both. Most reviewed studies examined preferences for process-related or provider-related aspects with a lesser focus on health outcomes. Monetary attributes were considered to be important by most patients and pharmacists in the studies reviewed. Logit, probit or multinomial logit models were most commonly employed for estimation. Our study showed that the pharmacy profession has adopted the DCE methodology consistent with the general health DCEs although the number of studies is quite limited. Future studies need to examine preferences of both patients and providers for particular products or disease-state management services. Incorporation of health outcome attributes in the design, testing for external validity and the incorporation of DCE results in economic evaluation framework to inform pharmacy policy remain important areas for future research. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

Factors affecting direction and strength of patient preferences for treatment of molar teeth with nonvital pulps.

PubMed

Vernazza, C R; Steele, J G; Whitworth, J M; Wildman, J R; Donaldson, C

2015-12-01

To elicit the factors affecting willingness to pay (WTP) values for the preferred options of participants for dealing with a molar tooth with a nonvital pulp, a common but difficult problem. A total of 503 patients were recruited from dental practices in the North East of England and interviewed. Their preferred treatment option for a molar tooth with a nonvital pulp (endodontics, extraction and various prosthetic restorative options) and WTP for this preferred option were elicited. Factors affecting preferred option and WTP were analysed using econometric modelling. Overall, 53% of the sample wished to save the tooth with a mean WTP of £373. The variance in WTP was high. Of those opting for extraction, the majority chose to leave a gap or have an implant. The preferred option was influenced by previous treatment experience. WTP was only influenced by having a low income. The high level of variance in WTP and its relatively unpredictable nature pose difficult questions for policy makers trying to ensure the delivery of an equitable service. For dentists, it is important not to make assumptions about patient preference and strength of preference when making decisions. Ideally, WTP values should be considered alongside effectiveness data, and those on costs, in policy making. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

An Exploratory Study of the Language-Learning Style Preferences of Iranian EFL High School Students

ERIC Educational Resources Information Center

Ramezani, Afsaneh Effatdokht; Dehgahi, Meysam; Hashemi, Hanie

2015-01-01

This study explored the learning style preferences of 40 Iranian students at Marefat Iranian high school in Kuala Lumpur of which, 20 are females and 20 are males. To this end, this study used structured interview to elicit in-depth information from the students. The results of the study showed that learning style preferences of Iranian students…

Work Adjustment Theory: An Empirical Test Using a Fuzzy Rating Scale.

ERIC Educational Resources Information Center

Hesketh, Beryl; And Others

1992-01-01

A fuzzy graphic rating scale elicited work preferences and job perceptions of 166 (of 170) Australian bank employees. Correspondence between preferences and perceptions correlated significantly with job satisfaction. Satisfaction and performance related to tenure intentions; this relation was higher for poorer performers. (SK)

A Framework Incorporating Community Preferences in Use ...

EPA Pesticide Factsheets

The report is intended to assist water quality officials, watershed managers, members of stakeholder groups, and other interested individuals in fully evaluating ecological and socioeconomic objectives and the gains and losses that often are involved in use attainment decisions. In addition, this report enables local, state, and tribal managers to better understand the benefits, as well as the costs, of attaining high water quality, and to incorporate community preferences in decision-making. Specific objectives are (1) to provide an introduction to the CWA and WQS regulation and analyses related to setting or changing designated uses; (2) create a basis for understanding the relationship between use-attainment decisions and the effects on ecosystems, ecosystem services, and ecological benefits; (3) serve as reference for methods that elicit or infer preferences for benefits and costs related to attaining uses and (4) present process for incorporating new approaches in water quality decisions.

Factors affecting patient valuations of caries prevention: Using and validating the willingness to pay method.

PubMed

Vernazza, Christopher R; Wildman, John R; Steele, Jimmy G; Whitworth, John M; Walls, Angus W G; Perry, Ross; Matthews, Roger; Hahn, Petra; Donaldson, Cam

2015-08-01

Determining the value of, or strength of preference for health care interventions is useful for policy makers in planning health care services. Willingness to pay (WTP) is an established economic technique to determine the strength of preferences for interventions by eliciting monetary valuations from individuals in hypothetical situations. The objective of this study was to elicit WTP values for a dental preventive intervention and to analyze the factors affecting these as well as investigating the validity of the WTP method. Patients aged 40 years plus attending dental practices in the UK and Germany were recruited on a consecutive basis over one month. Participants received information about a novel root caries prevention intervention. They then completed a questionnaire including a WTP task. Where the coating was indicated, patients were offered this for a payment and acceptance was recorded. Analysis included econometric modelling and comparison of expected (based on stated WTP) versus actual behaviour. The mean WTP for the coating was £96.41 (standard deviation 60.61). Econometric models showed that no demographic or dental history factors were significant predictors of WTP. 63% of the sample behaved as expected when using stated WTP to predict whether they would buy the coating. The remainder were split almost equally between those expected to pay but who did not and those who were expected to refuse but paid. Values for a caries preventive intervention had a large and unpredictable variance. In comparing hypothetical versus real preferences both under- and over-valuation occurs. Wide and unpredictable variation in valuations for prevention may mean that there are difficult policy questions around what resource should be allocated to dental prevention and how to target this resource. Copyright © 2015 Elsevier Ltd. All rights reserved.

Promoting Parent and Child Physical Activity Together: Elicitation of Potential Intervention Targets and Preferences

ERIC Educational Resources Information Center

Rhodes, Ryan E.; Lim, Clarise

2018-01-01

Promoting physical activities that involve both parents and their children would be very useful to the improved health and well-being of families, yet coactivity interventions have been particularly unsuccessful in past research. The purpose of this study was to elicit the salient parental beliefs about coactivity framed through theory of planned…

Impact of discussion on preferences elicited in a group setting.

PubMed

Stein, Ken; Ratcliffe, Julie; Round, Ali; Milne, Ruairidh; Brazier, John E

2006-03-29

The completeness of preferences is assumed as one of the axioms of expected utility theory but has been subject to little empirical study. Fifteen non-health professionals was recruited and familiarised with the standard gamble technique. The group then met five times over six months and preferences were elicited independently on 41 scenarios. After individual valuation, the group discussed the scenarios, following which preferences could be changed. Changes made were described and summary measures (mean and median) before and after discussion compared using paired t test and Wilcoxon Signed Rank Test. Semi-structured telephone interviews were carried out to explore attitudes to discussing preferences. These were transcribed, read by two investigators and emergent themes described. Sixteen changes (3.6%) were made to preferences by seven (47%) of the fifteen members. The difference between individual preference values before and after discussion ranged from -0.025 to 0.45. The average effect on the group mean was 0.0053. No differences before and after discussion were statistically significant. The group valued discussion highly and suggested it brought four main benefits: reassurance; improved procedural performance; increased group cohesion; satisfying curiosity. The hypothesis that preferences are incomplete cannot be rejected for a proportion of respondents. However, brief discussion did not result in substantial number of changes to preferences and these did not have significant impact on summary values for the group, suggesting that incompleteness, if present, may not have an important effect on cost-utility analyses.

Patient preferences for diabetes-related complications in Taiwan.

PubMed

Lin, Yi-Ju; Wang, Chin-Yuan; Cheng, Ssu-Wei; Ko, Yu

2018-05-25

As the prevalence of diabetes mellitus (DM) continues to increase rapidly, there has been a rising need not only to assess the clinical outcomes but also the impact of DM on the health-related quality of life (HRQoL) of affected individuals. Most previous studies have found that having complications is strongly associated with decreased HRQoL in DM patients. As such, it is crucial to measure individuals' preferences for DM-related complications in order to assess the magnitude of complications' effect on overall HRQoL. In addition, preference scores are an essential component of cost-utility analyses (CUAs), which studies can incorporate healthcare costs, HRQoL and clinical outcomes of DM into one analysis. The aims of this study were to assess the preference scores of DM-related complications using both the standard gamble (SG), a choice-based method, and visual analogue scale (VAS), a scaling method. We also aimed to assess several possible factors that might be associated with the preference scores of the complications. This is a cross-sectional interview-administered survey, and 213 patients with type 2 DM were interviewed. The respondents' preference scores of eleven DM-related complications were obtained using VAS and SG techniques. Demographic information, clinical characteristics and risk attitudes were also collected to explore factors that may affect patients' preference scores. Nearly one quarter of participants in Taiwan ranked at least one of the complications worse than death. The mean VAS scores ranged from 0.004 (amputation) to 0.47 (nocturnal hypoglycemia) while the mean adjusted SG scores ranged from 0.30 (blindness) to 0.66 (nocturnal hypoglycemia). There were significant differences in all of the complications' preference scores depending on risk attitudes. Both the VAS and SG methods were used to elicit the preference scores of DM-related complications, and the preference scores derived could be useful for future cost utility analyses.

Risky Business: An Analysis of Teacher Risk Preferences

ERIC Educational Resources Information Center

Bowen, Daniel H.; Buck, Stuart; Deck, Cary; Mills, Jonathan N.; Shuls, James V.

2015-01-01

A range of proposals aim to reform teacher compensation, recruitment, and retention. Teachers have generally not embraced these policies. One potential explanation for their objections is that teachers are relatively risk averse. We examine this hypothesis using a risk-elicitation task common to experimental economics. By comparing preferences of…

Making effective referrals: a knowledge-management approach.

PubMed Central

Einbinder, J. S.; Klein, D. A.; Safran, C. S.

1997-01-01

Patients and physicians often choose specially consultants with only limited knowledge of the available options. Access to information about specialists that was directly relevant to patient and clinician preferences could improve the effectiveness of the referral process. We have developed a prescriptive representation of the process of selecting consultants. This "referral map," based on decision theory, uses patient and provider preferences elicited through a literature review and interviews with physicians and provides a formal framework for representing referral knowledge and for evaluating referral options. Our method suggests that the goals and processes of selecting consultants can be managed more systematically using explicit repositories. Such systematic management promises to have a beneficial impact on the delivery of health care, as well as on patient satisfaction. PMID:9357642

Sustainability assessment in forest management based on individual preferences.

PubMed

Martín-Fernández, Susana; Martinez-Falero, Eugenio

2018-01-15

This paper presents a methodology to elicit the preferences of any individual in the assessment of sustainable forest management at the stand level. The elicitation procedure was based on the comparison of the sustainability of pairs of forest locations. A sustainability map of the whole territory was obtained according to the individual's preferences. Three forest sustainability indicators were pre-calculated for each point in a study area in a Scots pine forest in the National Park of Sierra de Guadarrama in the Madrid Region in Spain to obtain the best management plan with the sustainability map. We followed a participatory process involving fifty people to assess the sustainability of the forest management and the methodology. The results highlighted the demand for conservative forest management, the usefulness of the methodology for managers, and the importance and necessity of incorporating stakeholders into forestry decision-making processes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment.

PubMed

Honda, Ayako; Ryan, Mandy; van Niekerk, Robert; McIntyre, Diane

2015-06-01

The introduction of national health insurance (NHI), aimed at achieving universal coverage, is the most important issue currently on the South African health policy agenda. Improvement in public sector health-care provision is crucial for the successful implementation of NHI as, regardless of whether health-care services become more affordable and available, if the quality of the services provided is not acceptable, people will not use the services. Although there has been criticism of the quality of public sector health services, limited research is available to identify what communities regard as the greatest problems with the services. A discrete choice experiment (DCE) was undertaken to elicit public preferences on key dimensions of quality of care when selecting public health facilities in South Africa. Qualitative methods were applied to establish attributes and levels for the DCE. To elicit preferences, interviews with community members were held in two South African provinces: 491 in Western Cape and 499 in Eastern Cape. The availability of necessary medicine at health facilities has the greatest impact on the probability of attending public health facilities. Other clinical quality attributes (i.e. provision of expert advice and provision of a thorough examination) are more valued than non-clinical quality of care attributes (i.e. staff attitude, treatment by doctors or nurses, and waiting time). Treatment by a doctor was less valued than all other attributes. Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritize issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Promoting Parent and Child Physical Activity Together: Elicitation of Potential Intervention Targets and Preferences.

PubMed

Rhodes, Ryan E; Lim, Clarise

2018-02-01

Promoting physical activities that involve both parents and their children would be very useful to the improved health and well-being of families, yet coactivity interventions have been particularly unsuccessful in past research. The purpose of this study was to elicit the salient parental beliefs about coactivity framed through theory of planned behavior in order to inform future intervention content. A representative sample of Canadian parents ( N = 483) with children aged 6 to 14 years completed belief elicitation measures of theory of planned behavior, as well as coactivity and program preferences. Analyses included content theming by physical activity belief and preference through tallies of the percentages of parents endorsing each belief. Exploratory analyses of differences in endorsed themes were conducted by parent (mother, father), age of child (6-10 years, 11-14 years), and sex of the child. The results showed that behavioral beliefs about health, interpersonal and educational/learning opportunities and control beliefs about lack of time, various incompatible parent/child factors, parental health, and bad weather were dominant themes. Most of these themes did not vary in endorsement by parent and child characteristics. By contrast, preferences for various activities varied by parent and child characteristics, yet parents overwhelmingly desired the activities to be outdoors, close to home, after work, and originally delivered from community health professionals via Internet or face-to face means. Overall, the findings provide several considerations for specific targets to improve future physical activity intervention approaches among parents and their children.

Shared decision-making – transferring research into practice: the Analytic Hierarchy Process (AHP)

PubMed Central

Dolan, James G.

2008-01-01

Objective To illustrate how the Analytic Hierarchy Process (AHP) can be used to promote shared decision-making and enhance clinician-patient communication. Methods Tutorial review. Results The AHP promotes shared decision making by creating a framework that is used to define the decision, summarize the information available, prioritize information needs, elicit preferences and values, and foster meaningful communication among decision stakeholders. Conclusions The AHP and related multi-criteria methods have the potential for improving the quality of clinical decisions and overcoming current barriers to implementing shared decision making in busy clinical settings. Further research is needed to determine the best way to implement these tools and to determine their effectiveness. Practice Implications Many clinical decisions involve preference-based trade-offs between competing risks and benefits. The AHP is a well-developed method that provides a practical approach for improving patient-provider communication, clinical decision-making, and the quality of patient care in these situations. PMID:18760559

Patients' values and preferences of the expected efficacy of hip arthroscopy for osteoarthritis: a protocol for a multinational structured interview-based study combined with a randomised survey on the optimal amount of information to elicit preferences.

PubMed

Zhang, Yuqing; Tikkinen, Kari A O; Agoritsas, Thomas; Ayeni, Olufemi R; Alexander, Paul; Imam, Maha; Yoo, Daniel; Tsalatsanis, Athanasios; Djulbegovic, Benjamin; Thabane, Lehana; Schünemann, Holger; Guyatt, Gordon H

2014-10-17

Symptomatic hip osteoarthritis (OA) is a disabling condition with up to a 25% cumulative lifetime risk. Total hip arthroplasty (THA) is effective in relieving patients' symptoms and improving function. It is, however, associated with substantial risk of complications, pain and major functional limitation before patients can return to full function. In contrast, hip arthroscopy (HA) is less invasive and can postpone THA. However, there is no evidence regarding the delay in the need for THA that patients would find acceptable to undergoing HA. Knowing patients' values and preferences (VP) on this expected delay is critical when making recommendations regarding the advisability of HA. Furthermore, little is known on the optimal amount of information regarding interventions and outcomes needed to present in order to optimally elicit patients' VP. We will perform a multinational, structured interview-based survey of preference in delay time for THA among patients with non-advanced OA who failed to respond to conservative therapy. We will combine these interviews with a randomised trial addressing the optimal amount of information regarding the interventions and outcomes required to elicit preferences. Eligible patients will be randomly assigned (1 : 1) to either a short or a long format of health scenarios of THA and HA. We will determine each patient's VP using a trade-off and anticipated regret exercises. Our primary outcomes for the combined surveys will be: (1) the minimal delay time in the need for THA surgery that patients would find acceptable to undertaking HA, (2) patients' satisfaction with the amount of information provided in the health scenarios used to elicit their VPs. The protocol has been approved by the Hamilton Integrated Research Ethics Board (HIREB13-506). We will disseminate our study findings through peer-reviewed publications and conference presentations, and make them available to guideline makers issuing recommendations addressing HA and THA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Patient preferences for medicine administration for acute agitation: results from an internet-based survey of patients diagnosed with bipolar disorder or schizophrenia in two Nordic countries.

PubMed

Jørgensen, Tine Rikke; Emborg, Charlotte; Dahlen, Karianne; Bøgelund, Mette; Carlborg, Andreas

2018-01-01

The objective was to elicit patient preferences for medicine administration method in the management of acute agitation episodes among patients diagnosed with bipolar disorder or schizophrenia. The patients' experiences of acute agitation episodes and their management of episodes were also explored. Data were collected via an anonymous, internet-based survey of residents in Denmark or Sweden with schizophrenia or bipolar disorder (October 2014 to December 2014). Inclusion criteria were having a diagnosis of schizophrenia or bipolar disorder, and being above 18 years of age. The questionnaire included questions about preferences for medication attributes, experiences with pharmacological treatment for agitation and involvement in treatment plans. A total of 237 diagnosed patients (61 with schizophrenia; 176 with bipolar disorder) completed the questionnaire. Agitation episodes were experienced by 90% of the respondents. In total, 83% of the respondents reported having received treatment with tablets. When patients were presented with the attributes of an inhalation method, respondents stated that the fast onset of action, low risk of adverse reactions and least invasive form of drug delivery were positive attributes of treatment with inhalation. Inhalation is a new delivery route for treatment of acute agitation in patients diagnosed with bipolar disorder or schizophrenia. Inhalation is the preferred treatment method for acute agitation among Danish and Swedish patients with bipolar disorder or schizophrenia.

Is Constructivism Risky? Social Anxiety, Classroom Participation, Competitive Game Play and Constructivist Preferences in Teacher Development

ERIC Educational Resources Information Center

Hills, Thomas

2007-01-01

Constructivism in practice is a challenging endeavor that invites teachers and students to engage in problems that elicit uncertainty. This article investigates the relationship between preferences for constructivist approaches and other classroom behaviors that influence the development of future teachers. The theoretical premise for this…

The N400 reveals how personal semantics is processed: Insights into the nature and organization of self-knowledge

PubMed Central

Federmeier, Kara D.

2017-01-01

There is growing recognition that some important forms of long-term memory are difficult to classify into one of the well-studied memory subtypes. One example is personal semantics. Like the episodes that are stored as part of one’s autobiography, personal semantics is linked to an individual, yet, like general semantic memory, it is detached from a specific encoding context. Access to general semantics elicits an electrophysiological response known as the N400, which has been characterized across three decades of research; surprisingly, this response has not been fully examined in the context of personal semantics. In this study, we assessed responses to congruent and incongruent statements about people’s own, personal preferences. We found that access to personal preferences elicited N400 responses, with congruency effects that were similar in latency and distribution to those for general semantic statements elicited from the same participants. These results suggest that the processing of personal and general semantics share important functional and neurobiological features. PMID:26825011

Predicting the preferences for involvement in medical decision making among patients with mental disorders

PubMed Central

Michaelis, Svea; Kriston, Levente; Härter, Martin; Watzke, Birgit; Schulz, Holger; Melchior, Hanne

2017-01-01

Background The involvement of patients in medical decision making has been investigated widely in somatic diseases. However, little is known about the preferences for involvement and variables that could predict these preferences in patients with mental disorders. Objective This study aims to determine what roles mentally ill patients actually want to assume when making medical decisions and to identify the variables that could predict this role, including patients’ self-efficacy. Method Demographic and clinical data of 798 patients with mental disorders from three psychotherapeutic units in Germany were elicited using self-report questionnaires. Control preference was measured using the Control Preferences Scale, and patients’ perceived self-efficacy was assessed using the Self-Efficacy Scale. Bivariate and multivariate regression analyses were conducted to investigate the associations between patient variables and control preference. Results Most patients preferred a collaborative role (57.5%), followed by a semi passive (21.2%), a partly autonomous (16.2%), an autonomous (2.8%) and a fully passive (2.3%) role when making medical decisions. Age, sex, diagnosis, employment status, medical pretreatment and perceived self-efficacy were associated with the preference for involvement in the multivariate logistic model. Conclusion Our results confirm the preferences for involvement in medical decisions of mentally ill patients. We reconfirmed previous findings that older patients prefer a shared role over an autonomous role and that subjects with a high qualification prefer a more autonomous role over a shared role. The knowledge about predictors may help strengthen treatment effectiveness because matching the preferred and actual role preferences has been shown to improve clinical outcome. PMID:28837621

Do women and providers value the same features of contraceptive products? Results of a best-worst stated preference experiment.

PubMed

Weisberg, Edith; Bateson, Deborah; Knox, Stephanie; Haas, Marion; Viney, Rosalie; Street, Deborah; Fiebig, Denzil

2013-06-01

To determine how women and physicians rate individual characteristics of contraceptives. Discrete choice experiments are used in health economics to elicit preferences for healthcare products. A choice experiment uses hypothetical scenarios to determine which individual factors influence choice. Women and general practitioners (GPs) were shown individual characteristics of contraceptives, not always matching existing methods, and chose the best and worst features. Two hundred women, mean age 36, 71% using contraception, were presented with descriptions of 16 possible methods and asked to indicate their preference for individual characteristics. One hundred and sixty-two GPs, mostly women, also completed 16 descriptions. Longer duration of action was most favoured by both, followed by lighter periods with less pain or amenorrhoea. The least attractive features for women were heavier and more painful periods, high cost, irregular periods, low efficacy (10% failure) and weight gain of 3 kg. GPs ranked a 10% pregnancy rate as least attractive followed by heavy painful periods and a 5% failure rate. Women and GPs differed in their ranking of contraceptive characteristics. Long duration of use, high efficacy, minimal or no bleeding without pain, were preferred by both. Very undesirable were heavy periods especially with pain, and low efficacy.

A Bayesian hierarchical model for discrete choice data in health care.

PubMed

Antonio, Anna Liza M; Weiss, Robert E; Saigal, Christopher S; Dahan, Ely; Crespi, Catherine M

2017-01-01

In discrete choice experiments, patients are presented with sets of health states described by various attributes and asked to make choices from among them. Discrete choice experiments allow health care researchers to study the preferences of individual patients by eliciting trade-offs between different aspects of health-related quality of life. However, many discrete choice experiments yield data with incomplete ranking information and sparsity due to the limited number of choice sets presented to each patient, making it challenging to estimate patient preferences. Moreover, methods to identify outliers in discrete choice data are lacking. We develop a Bayesian hierarchical random effects rank-ordered multinomial logit model for discrete choice data. Missing ranks are accounted for by marginalizing over all possible permutations of unranked alternatives to estimate individual patient preferences, which are modeled as a function of patient covariates. We provide a Bayesian version of relative attribute importance, and adapt the use of the conditional predictive ordinate to identify outlying choice sets and outlying individuals with unusual preferences compared to the population. The model is applied to data from a study using a discrete choice experiment to estimate individual patient preferences for health states related to prostate cancer treatment.

Estimating the willingness to pay for a quality-adjusted life year in Thailand: does the context of health gain matter?

PubMed Central

Thavorncharoensap, Montarat; Teerawattananon, Yot; Natanant, Sirin; Kulpeng, Wantanee; Yothasamut, Jomkwan; Werayingyong, Pitsaphun

2013-01-01

Background This study aims to elicit the value of the willingness to pay (WTP) for a quality-adjusted life year (QALY) and to examine the factors associated with the WTP for a QALY (WTP/QALY) value under the Thai health care setting. Methods A community-based survey was conducted among 1191 randomly selected respondents. Each respondent was interviewed face-to-face to elicit his/her health state preference in each of three pairs of health conditions: (1) unilateral and bilateral blindness, (2) paraplegia and quadriplegia, and (3) mild and moderate allergies. A visual analog scale (VAS) and time trade off (TTO) were used as the eliciting methods. Subsequently, the respondents were asked about their WTP for the treatment and prevention of each pair of health conditions by using a bidding-game technique. Results With regards to treatment, the mean WTP for a QALY value (WTP/QALYtreatment) estimated by the TTO method ranged from 59,000 to 285,000 baht (16.49 baht = US$1 purchasing power parity [PPP]). In contrast, the mean WTP for a QALY value in terms of prevention (WTP/QALYprevention) was significantly lower, ranging from 26,000 to 137,000 baht. Gender, household income, and hypothetical scenarios were also significant factors associated with the WTP/QALY values. Conclusion The WTP/QALY values elicited in this study were approximately 0.4 to 2 times Thailand’s 2008 GDP per capita. These values were in line with previous studies conducted in several different settings. This study’s findings clearly support the opinion that a single ceiling threshold should not be used for the resource allocation of all types of interventions. PMID:23345984

Collaborative environmental planning in river management: An application of multicriteria decision analysis in the White River Watershed in Vermont

USGS Publications Warehouse

Hermans, C.; Erickson, J.; Noordewier, T.; Sheldon, A.; Kline, M.

2007-01-01

Multicriteria decision analysis (MCDA) provides a well-established family of decision tools to aid stakeholder groups in arriving at collective decisions. MCDA can also function as a framework for the social learning process, serving as an educational aid in decision problems characterized by a high level of public participation. In this paper, the framework and results of a structured decision process using the outranking MCDA methodology preference ranking organization method of enrichment evaluation (PROMETHEE) are presented. PROMETHEE is used to frame multi-stakeholder discussions of river management alternatives for the Upper White River of Central Vermont, in the northeastern United States. Stakeholders met over 10 months to create a shared vision of an ideal river and its services to communities, develop a list of criteria by which to evaluate river management alternatives, and elicit preferences to rank and compare individual and group preferences. The MCDA procedure helped to frame a group process that made stakeholder preferences explicit and substantive discussions about long-term river management possible. ?? 2006 Elsevier Ltd. All rights reserved.

Collaborative environmental planning in river management: an application of multicriteria decision analysis in the White River Watershed in Vermont.

PubMed

Hermans, Caroline; Erickson, Jon; Noordewier, Tom; Sheldon, Amy; Kline, Mike

2007-09-01

Multicriteria decision analysis (MCDA) provides a well-established family of decision tools to aid stakeholder groups in arriving at collective decisions. MCDA can also function as a framework for the social learning process, serving as an educational aid in decision problems characterized by a high level of public participation. In this paper, the framework and results of a structured decision process using the outranking MCDA methodology preference ranking organization method of enrichment evaluation (PROMETHEE) are presented. PROMETHEE is used to frame multi-stakeholder discussions of river management alternatives for the Upper White River of Central Vermont, in the northeastern United States. Stakeholders met over 10 months to create a shared vision of an ideal river and its services to communities, develop a list of criteria by which to evaluate river management alternatives, and elicit preferences to rank and compare individual and group preferences. The MCDA procedure helped to frame a group process that made stakeholder preferences explicit and substantive discussions about long-term river management possible.

Does technique matter; a pilot study exploring weighting techniques for a multi-criteria decision support framework.

PubMed

van Til, Janine; Groothuis-Oudshoorn, Catharina; Lieferink, Marijke; Dolan, James; Goetghebeur, Mireille

2014-01-01

There is an increased interest in the use of multi-criteria decision analysis (MCDA) to support regulatory and reimbursement decision making. The EVIDEM framework was developed to provide pragmatic multi-criteria decision support in health care, to estimate the value of healthcare interventions, and to aid in priority-setting. The objectives of this study were to test 1) the influence of different weighting techniques on the overall outcome of an MCDA exercise, 2) the discriminative power in weighting different criteria of such techniques, and 3) whether different techniques result in similar weights in weighting the criteria set proposed by the EVIDEM framework. A sample of 60 Dutch and Canadian students participated in the study. Each student used an online survey to provide weights for 14 criteria with two different techniques: a five-point rating scale and one of the following techniques selected randomly: ranking, point allocation, pairwise comparison and best worst scaling. The results of this study indicate that there is no effect of differences in weights on value estimates at the group level. On an individual level, considerable differences in criteria weights and rank order occur as a result of the weight elicitation method used, and the ability of different techniques to discriminate in criteria importance. Of the five techniques tested, the pair-wise comparison of criteria has the highest ability to discriminate in weights when fourteen criteria are compared. When weights are intended to support group decisions, the choice of elicitation technique has negligible impact on criteria weights and the overall value of an innovation. However, when weights are used to support individual decisions, the choice of elicitation technique influences outcome and studies that use dissimilar techniques cannot be easily compared. Weight elicitation through pairwise comparison of criteria is preferred when taking into account its superior ability to discriminate between criteria and respondents' preferences.

Promoting advance planning for health care and research among older adults: A randomized controlled trial

PubMed Central

2012-01-01

Background Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/Design Dyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments. Discussion This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system. Trial Registration ISRCTN89993391 PMID:22221980

Differentiating the influence of incidental anger and fear on risk decision-making.

PubMed

Yang, Qiwei; Zhao, Ding; Wu, Yan; Tang, Ping; Gu, Ruolei; Luo, Yue-Jia

2018-02-01

Previous research has revealed that incidental emotions of different valence (positive/negative/neutral) produce distinct impacts on risk decision-making. This study went on to compare the effects of different emotions of which the valence are identical. We focused on anger and fear, both of which are negative emotions but differ in motivational and appraisal dimensions. Participants finished a forced-choice gambling task, during which incidental emotions (anger/fear/happy) were elicited by facial stimuli selected from the Chinese Facial Affective Picture System. Behavioral and event-related potential (ERP) data were recorded in the experiment, which showed that anger and fear were different in their influence on behavioral risk preference and the relationship between outcome processing and subsequent risk decisions. Regarding the behavioral results, risk preference in the anger condition was higher than the fear condition, but lower than the happy condition. Regarding the ERP results elicited by outcome feedback (gain/loss), in the fear condition, the feedback-related negativity (FRN) was positively correlated with risk preference; in the anger condition, the gain-related P3 component was positively correlated with risk preference; in the happy condition, both the FRN and the loss-related P3 was negatively correlated with risk preference. The current findings provide novel insight into distinguishing the effect of different incidental emotions on risk preference. Copyright © 2017 Elsevier Inc. All rights reserved.

Characterizing spatial uncertainty when integrating social data in conservation planning.

PubMed

Lechner, A M; Raymond, C M; Adams, V M; Polyakov, M; Gordon, A; Rhodes, J R; Mills, M; Stein, A; Ives, C D; Lefroy, E C

2014-12-01

Recent conservation planning studies have presented approaches for integrating spatially referenced social (SRS) data with a view to improving the feasibility of conservation action. We reviewed the growing conservation literature on SRS data, focusing on elicited or stated preferences derived through social survey methods such as choice experiments and public participation geographic information systems. Elicited SRS data includes the spatial distribution of willingness to sell, willingness to pay, willingness to act, and assessments of social and cultural values. We developed a typology for assessing elicited SRS data uncertainty which describes how social survey uncertainty propagates when projected spatially and the importance of accounting for spatial uncertainty such as scale effects and data quality. These uncertainties will propagate when elicited SRS data is integrated with biophysical data for conservation planning and may have important consequences for assessing the feasibility of conservation actions. To explore this issue further, we conducted a systematic review of the elicited SRS data literature. We found that social survey uncertainty was commonly tested for, but that these uncertainties were ignored when projected spatially. Based on these results we developed a framework which will help researchers and practitioners estimate social survey uncertainty and use these quantitative estimates to systematically address uncertainty within an analysis. This is important when using SRS data in conservation applications because decisions need to be made irrespective of data quality and well characterized uncertainty can be incorporated into decision theoretic approaches. © 2014 Society for Conservation Biology.

Weighing Clinical Evidence Using Patient Preferences: An Application of Probabilistic Multi-Criteria Decision Analysis.

PubMed

Broekhuizen, Henk; IJzerman, Maarten J; Hauber, A Brett; Groothuis-Oudshoorn, Catharina G M

2017-03-01

The need for patient engagement has been recognized by regulatory agencies, but there is no consensus about how to operationalize this. One approach is the formal elicitation and use of patient preferences for weighing clinical outcomes. The aim of this study was to demonstrate how patient preferences can be used to weigh clinical outcomes when both preferences and clinical outcomes are uncertain by applying a probabilistic value-based multi-criteria decision analysis (MCDA) method. Probability distributions were used to model random variation and parameter uncertainty in preferences, and parameter uncertainty in clinical outcomes. The posterior value distributions and rank probabilities for each treatment were obtained using Monte-Carlo simulations. The probability of achieving the first rank is the probability that a treatment represents the highest value to patients. We illustrated our methodology for a simplified case on six HIV treatments. Preferences were modeled with normal distributions and clinical outcomes were modeled with beta distributions. The treatment value distributions showed the rank order of treatments according to patients and illustrate the remaining decision uncertainty. This study demonstrated how patient preference data can be used to weigh clinical evidence using MCDA. The model takes into account uncertainty in preferences and clinical outcomes. The model can support decision makers during the aggregation step of the MCDA process and provides a first step toward preference-based personalized medicine, yet requires further testing regarding its appropriate use in real-world settings.

A regret theory approach to decision curve analysis: A novel method for eliciting decision makers' preferences and decision-making

PubMed Central

2010-01-01

Background Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA. Methods First, we analysed a classic decision tree describing three decision alternatives: treat, do not treat, and treat or no treat based on a predictive model. We then computed the expected regret for each of these alternatives as the difference between the utility of the action taken and the utility of the action that, in retrospect, should have been taken. For any pair of strategies, we measure the difference in net expected regret. Finally, we employ the concept of acceptable regret to identify the circumstances under which a potentially wrong strategy is tolerable to a decision-maker. Results We developed a novel dual visual analog scale to describe the relationship between regret associated with "omissions" (e.g. failure to treat) vs. "commissions" (e.g. treating unnecessary) and decision maker's preferences as expressed in terms of threshold probability. We then proved that the Net Expected Regret Difference, first presented in this paper, is equivalent to net benefits as described in the original DCA. Based on the concept of acceptable regret we identified the circumstances under which a decision maker tolerates a potentially wrong decision and expressed it in terms of probability of disease. Conclusions We present a novel method for eliciting decision maker's preferences and an alternative derivation of DCA based on regret theory. Our approach may be intuitively more appealing to a decision-maker, particularly in those clinical situations when the best management option is the one associated with the least amount of regret (e.g. diagnosis and treatment of advanced cancer, etc). PMID:20846413

WHAT IS THE ROLE OF COMMUNITY PREFERENCE INFORMATION IN HEALTH TECHNOLOGY ASSESSMENT DECISION MAKING? A CASE STUDY OF COLORECTAL CANCER SCREENING.

PubMed

Wortley, Sally; Flitcroft, Kathy; Howard, Kirsten

2015-01-01

The aim of this study was to determine the role of community preference information from discrete choice studies of colorectal cancer (CRC) screening in health technology assessment (HTA) reports and subsequent policy decisions. We undertook a systematic review of discrete choice studies of CRC screening. Included studies were reviewed to assess the policy context of the research. For those studies that cited a recent or pending review of CRC screening, further searches were undertaken to determine the extent to which community preference information was incorporated into the HTA decision-making process. Eight discrete choice studies that evaluated preferences for CRC screening were identified. Four of these studies referred to a national or local review of CRC screening in three countries: Australia, Canada, and the Netherlands. Our review of subsequently released health policy documents showed that while consideration was given to community views on CRC, policy was not informed by discrete choice evidence. Preferences and values of patients are increasingly being considered "evidence" to be incorporated into HTA reports. Discrete choice methodology is a rigorous quantitative method for eliciting preferences and while as a methodology it is growing in profile, it would appear that the results of such research are not being systematically translated or integrated into HTA reports. A formalized approach is needed to incorporate preference literature into the HTA decision-making process.

Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil.

PubMed

Campolina, Alessandro G; Rozman, Luciana M; Decimoni, Tassia C; Leandro, Roseli; Novaes, Hillegonda M D; De Soárez, Patrícia Coelho

2017-04-01

Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil. The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil. We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment) Database, Web of Science, Scopus, Bireme (Biblioteca Regional de Medicina), BVS ECOS (Health Economics database of the Brazilian Virtual Library of Health), and SISREBRATS (Sistema de Informação da Rede Brasileira de Avaliação de Tecnologias em Saúde [Brazilian Network for the Evaluation of Health Technologies]) from 1980 to 2013. Articles were included if they were CUAs according to the classification devised by Drummond et al. Two independent reviewers screened articles for relevance and carried out data extraction. Disagreements were resolved through discussion or through consultation with a third reviewer. We performed a qualitative narrative synthesis. Of the 535 health economic evaluations (HEEs) relating to Brazil, only 40 were CUAs and therefore included in the analysis. Most studies adhered to methodological guidelines for quality of reporting and 77.5% used quality-adjusted life-years (QALYs) as the health outcome. Of these studies, 51.6% did not report the population used to elicit preferences for outcomes and 45.2% used a specific population such as expert opinion. The preference elicitation method was not reported in 58.1% of these studies. The majority (80.6%) of studies did not report the instrument used to derive health state valuations and no publication reported whether tariffs (or preference weights) were national or international. No study mentioned the methodology used to estimate QALYs. Many published Brazilian cost-utility studies adhere to key recommended general methods for HEE; however, the use of QALY calculations is far from being the current international standard. Development of health preferences research can contribute to quality improvement of health technology assessment reports in Brazil.

A comparison of alternative variants of the lead and lag time TTO.

PubMed

Devlin, Nancy; Buckingham, Ken; Shah, Koonal; Tsuchiya, Aki; Tilling, Carl; Wilkinson, Grahame; van Hout, Ben

2013-05-01

'Lead Time' TTO improves upon conventional TTO by providing a uniform method for eliciting positive and negative values. This research investigates (i) the values generated from different combinations of time in poor health and in full health; and the order in which these appear (lead vs. lag); (ii) whether values concur with participants' views about states; (iii) methods for handling extreme preferences. n = 208 participants valued five EQ-5D states, using two of four variants. Combinations of lead time and health state duration were: 10 years and 20 years; 5 years and 1 year; 5 years and 10 years; and a health state duration of 5 years with a lag time of 10 years. Longer lead times capture more preferences, but may involve a framing effect. Lag time results in less non-trading for mild states, and less time being traded for severe states. Negative values broadly agree with participants' stated opinion that the state is worse than dead. The values are sensitive to the ratio of lead time to duration of poor health, and the order in which these appear (lead vs. lag). It is feasible to handle extreme preferences though challenges remain. Copyright © 2012 John Wiley & Sons, Ltd.

Estimating Preferences for Treatments in Patients With Localized Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ávila, Mónica; CIBER en Epidemiología y Salud Pública; Universitat Pompeu Fabra, Barcelona

Purpose: Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. Methods and Materials: This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003more » to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. Results: Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. Conclusions: Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical prostatectomy. These time trade-off and standard gamble preference assessments as well as the willingness-to-pay estimation could be useful to perform respectively cost-utility or cost-benefit analyses, which can guide health policy decisions.« less

Infants prefer the faces of strangers or mothers to morphed faces: an uncanny valley between social novelty and familiarity.

PubMed

Matsuda, Yoshi-Taka; Okamoto, Yoko; Ida, Misako; Okanoya, Kazuo; Myowa-Yamakoshi, Masako

2012-10-23

The 'uncanny valley' response is a phenomenon involving the elicitation of a negative feeling and subsequent avoidant behaviour in human adults and infants as a result of viewing very realistic human-like robots or computer avatars. It is hypothesized that this uncanny feeling occurs because the realistic synthetic characters elicit the concept of 'human' but fail to satisfy it. Such violations of our normal expectations regarding social signals generate a feeling of unease. This conflict-induced uncanny valley between mutually exclusive categories (human and synthetic agent) raises a new question: could an uncanny feeling be elicited by other mutually exclusive categories, such as familiarity and novelty? Given that infants prefer both familiarity and novelty in social objects, we address this question as well as the associated developmental profile. Using the morphing technique and a preferential-looking paradigm, we demonstrated uncanny valley responses of infants to faces of mothers (i.e. familiarity) and strangers (i.e. novelty). Furthermore, this effect strengthened with the infant's age. We excluded the possibility that infants detect and avoid traces of morphing. This conclusion follows from our finding that the infants equally preferred strangers' faces and the morphed faces of two strangers. These results indicate that an uncanny valley between familiarity and novelty may accentuate the categorical perception of familiar and novel objects.

Craving, Cue Reactivity, and Stimulus Control Among Early-Stage Young Smokers: Effects of Smoking Intensity and Gender

PubMed Central

2014-01-01

Introduction: Smoking initiation usually begins in adolescence, but how and for whom nicotine dependence emerges during this period is unclear. The cue-reactivity paradigm is well suited to examine one marker of dependence: craving-related stimulus control, i.e., the ability of environmental cues to elicit craving to smoke. This study examined the effects of both level of smoking involvement (daily vs. occasional smoking) and gender on reactivity to both smoking and alcohol cues. Methods: Young (age range 16–20; 42% female) daily (n = 55) and occasional (n = 52) smokers were exposed to each of three counterbalanced cues: (a) in vivo smoking (e.g., sight, smell, lighting of cigarette), (b) alcohol (e.g., opening, pouring, and smell of preferred beverage), and (c) neutral cue. Results: Daily smokers exhibited higher levels of tonic (i.e., noncue-elicited) craving than did occasional smokers. Both groups showed significant increases in craving in response to cues (i.e., cue-elicited craving), with little evidence that cue-elicited craving differed between groups. Females were more cue reactive to both the alcohol and smoking cues than males, particularly for the positively reinforced aspects of smoking (i.e., hedonic craving). There were no gender × group interaction effects in response to either the alcohol or the smoking cue. Conclusions: Findings show the presence of cue-elicited craving even among occasional smokers and are consistent with literature demonstrating heightened sensitivity to environmental cues among females. Cue-elicited craving may be one mechanism that contributes to the maintenance of smoking behavior and perhaps to the development of nicotine dependence within early stage smokers. PMID:24042699

The N400 reveals how personal semantics is processed: Insights into the nature and organization of self-knowledge.

PubMed

Coronel, Jason C; Federmeier, Kara D

2016-04-01

There is growing recognition that some important forms of long-term memory are difficult to classify into one of the well-studied memory subtypes. One example is personal semantics. Like the episodes that are stored as part of one's autobiography, personal semantics is linked to an individual, yet, like general semantic memory, it is detached from a specific encoding context. Access to general semantics elicits an electrophysiological response known as the N400, which has been characterized across three decades of research; surprisingly, this response has not been fully examined in the context of personal semantics. In this study, we assessed responses to congruent and incongruent statements about people's own, personal preferences. We found that access to personal preferences elicited N400 responses, with congruency effects that were similar in latency and distribution to those for general semantic statements elicited from the same participants. These results suggest that the processing of personal and general semantics share important functional and neurobiological features. Copyright © 2016 Elsevier Ltd. All rights reserved.

An assessment of the nonmarket benefits of the Water Framework Directive for households in England and Wales

NASA Astrophysics Data System (ADS)

Metcalfe, Paul J.; Baker, William; Andrews, Kevin; Atkinson, Giles; Bateman, Ian J.; Butler, Sarah; Carson, Richard T.; East, Jo; Gueron, Yves; Sheldon, Rob; Train, Kenneth

2012-03-01

Results are presented from a large-scale stated preference study designed to estimate the nonmarket benefits for households in England and Wales arising from the European Union Water Framework Directive (WFD). Multiple elicitation methods (a discrete choice experiment and two forms of contingent valuation) are employed, with the order in which they are asked randomly varied across respondents, to obtain a robust model for valuing specified WFD implementation programs applied to all of the lakes, reservoirs, rivers, canals, transitional, and coastal waters of England and Wales. The potential for subsequent policy incorporation and value transfer was enhanced by generating area-based values. These were found to vary from £2,263 to £39,168 per km2 depending on the population density around the location of the improvement, the ecological scope of that improvement, and the value elicitation method employed. While the former factors are consistent with expectations, the latter suggests that decision makers need to be aware of such methodological effects when employing derived values.

Discrete choice experiments to measure consumer preferences for health and healthcare.

PubMed

Viney, Rosalie; Lancsar, Emily; Louviere, Jordan

2002-08-01

To investigate the impact of health policies on individual well-being, estimate the value to society of new interventions or policies, or predict demand for healthcare, we need information about individuals' preferences. Economists usually use market-based data to analyze preferences, but such data are limited in the healthcare context. Discrete choice experiments are a potentially valuable tool for elicitation and analysis of preferences and thus, for economic analysis of health and health programs. This paper reviews the use of discrete choice experiments to measure consumers' preferences for health and healthcare. The paper provides an overview of the approach and discusses issues that arise when using discrete choice experiments to assess individuals' preferences for health and healthcare.

Optimising web site designs for people with learning disabilities

PubMed Central

Williams, Peter; Hennig, Christian

2015-01-01

Much relevant internet-mediated information is inaccessible to people with learning disabilities because of difficulties in navigating the web. This paper reports on the methods undertaken to determine how information can be optimally presented for this cohort. Qualitative work is outlined where attributes relating to site layout affecting usability were elicited. A study comparing web sites of different design layouts exhibiting these attributes is discussed, with the emphasis on methodology. Eight interfaces were compared using various combinations of menu position (vertical or horizontal), text size and the absence or presence of images to determine which attributes of a site have the greatest performance impact. Study participants were also asked for their preferences, via a ‘smiley-face’ rating scale and simple interviews. ‘Acquiescence bias’ was minimised by avoiding polar (‘yes/no’) interrogatives, achieved by asking participants to compare layouts (such as horizontal versus vertical menu), with reasons coaxed from those able to articulate them. Preferred designs were for large text and images. This was the reverse of those facilitating fastest retrieval times, a discrepancy due to preferences being judged on aesthetic considerations. Design recommendations that reconcile preference and performance findings are offered. These include using a horizontal menu, juxtaposing images and text, and reducing text from sentences to phrases, thus facilitating preferred large text without increasing task times. PMID:26097431

Preferences for physician services in Ukraine: a discrete choice experiment.

PubMed

Danyliv, Andriy; Pavlova, Milena; Gryga, Irena; Groot, Wim

2015-01-01

Evidence on preferences of Ukrainian consumers for healthcare improvements can help to design reforms that correspond to societal priorities. This study aims to elicit and to place monetary values on public preferences for out-patient physician services in Ukraine. The method of discrete choice experiment is used on a sample of 303 respondents, representative of the adult Ukrainian population. The random effect logit model with interactions provides the best fit for the data and is used to calculate the marginal willingness to pay (MWTP) for quality and access improvements. At a sample level, there is no clear preference to pay formally rather than informally or vice versa. We also do not find that visiting a general practitioner is preferred over direct access to a medical specialist. However, there are differences between population groups. Quality-related attributes of physician services appear important to respondents, especially the attitude of medical staff. Thus, interpersonal aspects of out-patient care should be given priority in decisions about investments in quality improvements. Other aspects, that is social quality and access, are important as well but their improvement brings fewer social gains. Measures should be taken to eradicate the informal payment channels and to strengthen the gate-keeping role of primary care. Copyright © 2014 John Wiley & Sons, Ltd.

Assessing Women’s Preferences and Preference Modeling for Breast Reconstruction Decision Making

PubMed Central

Sun, Clement S.; Cantor, Scott B.; Reece, Gregory P.; Crosby, Melissa A.; Fingeret, Michelle C.

2014-01-01

Background: Women considering breast reconstruction must make challenging trade-offs among issues that often conflict. It may be useful to quantify possible outcomes using a single summary measure to aid a breast cancer patient in choosing a form of breast reconstruction. Methods: In this study, we used multiattribute utility theory to combine multiple objectives to yield a summary value using 9 different preference models. We elicited the preferences of 36 women, aged 32 or older with no history of breast cancer, for the patient-reported outcome measures of breast satisfaction, psychosocial well-being, chest well-being, abdominal well-being, and sexual well-being as measured by the BREAST-Q in addition to time lost to reconstruction and out-of-pocket cost. Participants ranked hypothetical breast reconstruction outcomes. We examined each multiattribute utility preference model and assessed how often each model agreed with participants’ rankings. Results: The median amount of time required to assess preferences was 34 minutes. Agreement among the 9 preference models with the participants ranged from 75.9% to 78.9%. None of the preference models performed significantly worse than the best-performing risk-averse multiplicative model. We hypothesize an average theoretical agreement of 94.6% for this model if participant error is included. There was a statistically significant positive correlation with more unequal distribution of weight given to the 7 attributes. Conclusions: We recommend the risk-averse multiplicative model for modeling the preferences of patients considering different forms of breast reconstruction because it agreed most often with the participants in this study. PMID:25105083

A Child's Space: Personal Space Preferences of Preschool Children as a Function of Material and Tactile Stimuli.

ERIC Educational Resources Information Center

Angoli, Marilyn; Hensley, Wayne E.

In the context of reciprocity theory (in which disclosure by one person elicits self-disclosure by another person), personal space preferences of three-, four-, and five-year-old children were examined. Equal numbers of each age group and sex (N=120) were either given or not given material rewards and were either touched or not touched by the…

The Importance of Measuring Strength-of-Preference Scores for Health Care Options in Preference-Sensitive Care

PubMed Central

Crump, R. Trafford; Llewellyn-Thomas, Hilary A.

2012-01-01

Objective The objective was to determine whether a paired-comparison/leaning scale method: a) could feasibly be used to elicit strength-of-preference scores for elective health care options in large community-based survey settings; and b) could reveal preferential sub-groups that would have been overlooked if only a categorical-response format had been used. Study Design Medicare beneficiaries in four different regions of the United States were interviewed in person. Participants considered 8 clinical scenarios, each with 2 to 3 different health care options. For each scenario, participants categorically selected their favored option, then indicated how strongly they favored that option relative to the alternative on a paired-comparison bi-directional Leaning Scale. Results Two hundred and two participants were interviewed. For 7 of the 8 scenarios, a clear majority (> 50%) indicated that, overall, they categorically favored one option over the alternative(s). However, the bi-directional strength-of-preference Leaning Scale scores revealed that, in 4 scenarios, for half of those participants, their preference for the favored option was actually “weak” or “neutral”. Conclusion Investigators aiming to assess population-wide preferential attitudes towards different elective health care scenarios should consider gathering ordinal-level strength-of-preference scores and could feasibly use the paired-comparison/bi-directional Leaning Scale to do so. PMID:22494579

The Interplay of Preference, Familiarity and Psychophysical Properties in Defining Relaxation Music.

PubMed

Tan, Xueli; Yowler, Charles J; Super, Dennis M; Fratianne, Richard B

2012-01-01

The stress response has been well documented in past music therapy literature. However, hypometabolism, or the relaxation response, has received much less attention. Music therapists have long utilized various music-assisted relaxation techniques with both live and recorded music to elicit such a response. The ongoing proliferations of relaxation music through commercial media and the dire lack of evidence to support such claims warrant attention from healthcare professionals and music therapists. The purpose of these 3 studies was to investigate the correlational relationships between 12 psychophysical properties of music, preference, familiarity, and degree of perceived relaxation in music. Fourteen music therapists recommended and analyzed 30 selections of relaxation music. A group of 80 healthy adults then rated their familiarity, preference, and degree of perceived relaxation in the music. The analysis provided a detailed description of the intrinsic properties in music that were perceived to be relaxing by listeners. These properties included tempo, mode, harmonic, rhythmic, instrumental, and melodic complexities, timbre, vocalization/lyrics, pitch range, dynamic variations, and contour. In addition, music preference was highly correlated with listeners' perception of relaxation in music for both music therapists and healthy adults. The correlation between familiarity and degree of relaxation reached significance in the healthy adult group. Results from this study provided an in-depth operational definition of the intrinsic parameters in relaxation music and also highlighted the importance of preference and familiarity in eliciting the relaxation response.

Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study.

PubMed

Kok, Marlies M; Weernink, Marieke G M; von Birgelen, Clemens; Fens, Anneloes; van der Heijden, Liefke C; van Til, Janine A

2018-01-01

To explore patient preference for vascular access site in percutaneous coronary procedures, the perceived importance of benefits and risks of transradial access (TRA) and transfemoral access (TFA) were assessed. In addition, direct preference for vascular access and preference for shared decision making (SDM) were evaluated. TRA has gained significant ground on TFA during the last decades. Surveys on patient preference have mostly been performed in dedicated TRA trials. In the PREVAS study (Clinicaltrials.gov: NCT02625493) a stated preference elicitation method best-worst scaling (BWS) was used to determine patient preference for six treatment attributes: bleeding, switch of access-site, postprocedural vessel quality, mobilization and comfort, and over-night stay. Based on software-generated treatment scenarios, 142 patients indicated which characteristics they perceived most and least important in treatment choice. Best-minus-Worst scores and attribute importance were calculated. Bleeding risk was considered most important (attribute importance 31.3%), followed by length of hospitalization (22.6%), and mobilization(20.2%). Most patients preferred the approach of their current procedure (85.9%); however, 71.1% of patients with experience with both access routes favored TRA (P < 0.001). Most patients (38.0%) appreciated SDM, balanced between patient and cardiologist. Patients appreciate lower bleeding risk and early ambulation, factors favoring TRA. Previous experience with a single access route has a major impact on preference, while experience with both routes generally resulted in preference for TRA. Most patients prefer balanced SDM. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

The role of taste in alcohol preference, consumption and risk behavior.

PubMed

Thibodeau, Margaret; Pickering, Gary J

2017-10-05

Alcohol consumption is widespread, and high levels of use are associated with increased risk of developing an alcohol use disorder. Thus, understanding the factors that influence alcohol intake is important for disease prevention and management. Additionally, elucidating the factors that associate with alcohol preference and intake in non-clinical populations allows for product development and optimisation opportunities for the alcoholic beverage industry. The literature on how taste (orosensation) influences alcohol behavior is critically appraised in this review. Ethanol, the compound common to all alcoholic beverages, is generally aversive as it primarily elicits bitterness and irritation when ingested. Individuals who experience orosensations (both taste and chemesthetic) more intensely tend to report lower liking and consumption of alcoholic beverages. Additionally, a preference for sweetness is likely associated with a paternal history of alcohol use disorders. However, conflicting findings in the literature are common and may be partially attributable to differences in the methods used to access orosensory responsiveness and taste phenotypes. We conclude that while taste is a key driver in alcohol preference, intake and use disorder, no single taste-related factor can adequately predict alcohol behaviour. Areas for further research and suggestions for improved methodological and analytical approaches are highlighted.

Preferences of older patient regarding hip fracture rehabilitation service configuration: A feasibility discrete choice experiment.

PubMed

Charles, Joanna M; Roberts, Jessica L; Din, Nafees Ud; Williams, Nefyn H; Yeo, Seow Tien; Edwards, Rhiannon T

2018-05-14

As part of a wider feasibility study, the feasibility of gaining older patients' views for hip fracture rehabilitation services was tested using a discrete choice experiment in a UK context. Discrete choice experiment is a method used for eliciting individuals' preferences about goods and services. The discrete choice experiment was administered to 41 participants who had experienced hip fracture (mean age 79.3 years; standard deviation (SD) 7.5 years), recruited from a larger feasibility study exploring a new multidisciplinary rehabilitation for hip fracture. Attributes and levels for this discrete choice experiment were identified from a systematic review and focus groups. The questionnaire was administered at the 3-month follow-up. Participants indicated a significant preference for a fully-qualified physiotherapist or occupational therapist to deliver the rehabilitation sessions (β = 0·605, 95% confidence interval (95% CI) 0.462-0.879), and for their rehabilitation session to last less than 90 min (β = -0.192, 95% CI -0.381 to -0.051). The design of the discrete choice experiment using attributes associated with service configuration could have the potential to inform service implementation, and assist rehabilitation service design that incorporates the preferences of patients.

A regret theory approach to decision curve analysis: a novel method for eliciting decision makers' preferences and decision-making.

PubMed

Tsalatsanis, Athanasios; Hozo, Iztok; Vickers, Andrew; Djulbegovic, Benjamin

2010-09-16

Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA. First, we analysed a classic decision tree describing three decision alternatives: treat, do not treat, and treat or no treat based on a predictive model. We then computed the expected regret for each of these alternatives as the difference between the utility of the action taken and the utility of the action that, in retrospect, should have been taken. For any pair of strategies, we measure the difference in net expected regret. Finally, we employ the concept of acceptable regret to identify the circumstances under which a potentially wrong strategy is tolerable to a decision-maker. We developed a novel dual visual analog scale to describe the relationship between regret associated with "omissions" (e.g. failure to treat) vs. "commissions" (e.g. treating unnecessary) and decision maker's preferences as expressed in terms of threshold probability. We then proved that the Net Expected Regret Difference, first presented in this paper, is equivalent to net benefits as described in the original DCA. Based on the concept of acceptable regret we identified the circumstances under which a decision maker tolerates a potentially wrong decision and expressed it in terms of probability of disease. We present a novel method for eliciting decision maker's preferences and an alternative derivation of DCA based on regret theory. Our approach may be intuitively more appealing to a decision-maker, particularly in those clinical situations when the best management option is the one associated with the least amount of regret (e.g. diagnosis and treatment of advanced cancer, etc).

Conditioned responses elicited by experimentally produced cues for smoking.

PubMed

Mucha, R F; Pauli, P; Angrilli, A

1998-03-01

Several theories of drug-craving postulate that a signal for drug elicits conditioned responses. However, depending on the theory, a drug cue is said to elicit drug similar, drug compensatory, positive motivational, and negative motivational effects. Since animal data alone cannot tease apart the relative importance of different cue-related processes in the addict, we developed and examined a model of drug cues in the human based on a two-sound, differential conditioning procedure using smoking as the reinforcer. After multiple pairings of a sound with smoking, there was a preference for the smoking cue on a conditioned preference test. The acute effects of smoking (increased heart rate, respiration rate, skin conductance level, skin conductance fluctuations, EEG beta power and trapezius EMG, decreased alpha power) were not affected by the smoking cue, although subjects drew more on their cigarette in the presence of the smoking cue than in the presence of a control cue. Moreover, the cue did not change baseline behaviour except for a possible increase in EEG beta power and an increase in trapezius EMG at about the time when smoking should have occurred. The findings confirm the value of experimental models of drug cues in the human for comparing different cue phenomena in the dependent individual. They indicate that an acquired signal for drug in the human may elicit incentive motivational effects and associated preparatory motor responses in addition to possible conditioned tolerance.

Estimating the willingness to pay for a quality-adjusted life year in Thailand: does the context of health gain matter?

PubMed

Thavorncharoensap, Montarat; Teerawattananon, Yot; Natanant, Sirin; Kulpeng, Wantanee; Yothasamut, Jomkwan; Werayingyong, Pitsaphun

2013-01-01

This study aims to elicit the value of the willingness to pay (WTP) for a quality-adjusted life year (QALY) and to examine the factors associated with the WTP for a QALY (WTP/QALY) value under the Thai health care setting. A community-based survey was conducted among 1191 randomly selected respondents. Each respondent was interviewed face-to-face to elicit his/her health state preference in each of three pairs of health conditions: (1) unilateral and bilateral blindness, (2) paraplegia and quadriplegia, and (3) mild and moderate allergies. A visual analog scale (VAS) and time trade off (TTO) were used as the eliciting methods. Subsequently, the respondents were asked about their WTP for the treatment and prevention of each pair of health conditions by using a bidding-game technique. With regards to treatment, the mean WTP for a QALY value (WTP/QALY(treatment)) estimated by the TTO method ranged from 59,000 to 285,000 baht (16.49 baht = US$1 purchasing power parity [PPP]). In contrast, the mean WTP for a QALY value in terms of prevention (WTP/QALY(prevention)) was significantly lower, ranging from 26,000 to 137,000 baht. Gender, household income, and hypothetical scenarios were also significant factors associated with the WTP/QALY values. The WTP/QALY values elicited in this study were approximately 0.4 to 2 times Thailand's 2008 GDP per capita. These values were in line with previous studies conducted in several different settings. This study's findings clearly support the opinion that a single ceiling threshold should not be used for the resource allocation of all types of interventions.

Predicting consumer liking and preference based on emotional responses and sensory perception: A study with basic taste solutions.

PubMed

Samant, Shilpa S; Chapko, Matthew J; Seo, Han-Seok

2017-10-01

Traditional methods of sensory testing focus on capturing information about multisensory perceptions, but do not necessarily measure emotions elicited by these food and beverages. The objective of this study was to develop an optimum model of predicting overall liking (rating) and preference (choice) based on taste intensity and evoked emotions. One hundred and two participants (51 females) were asked to taste water, sucrose, citric acid, salt, and caffeine solutions. Their emotional responses toward each sample were measured by a combination of a self-reported emotion questionnaire (EsSense25), facial expressions, and autonomic nervous system (ANS) responses. In addition, their perceived intensity and overall liking were measured. After a break, participants re-tasted the samples and ranked them according to their preference. The results showed that emotional responses measured using self-reported emotion questionnaire and facial expression analysis along with perceived taste intensity performed best to predict overall liking as well as preference, while ANS measures showed limited contribution. Contrary to some previous research, this study demonstrated that not only negative emotions, but also positive ones could help predict consumer liking and preference. In addition, since there were subtle differences in the prediction models of overall liking and preference, both aspects should be taken into account to understand consumer behavior. In conclusion, combination of evoked emotions along with sensory perception could help better understand consumer acceptance as well as preference toward basic taste solutions. Published by Elsevier Ltd.

Patients Should Define Value in Health Care: A Conceptual Framework.

PubMed

Kamal, Robin N; Lindsay, Sarah E; Eppler, Sara L

2018-05-10

The main tenet of value-based health care is delivering high-quality care that is centered on the patient, improving health, and minimizing cost. Collaborative decision-making frameworks have been developed to help facilitate delivering care based on patient preferences (patient-centered care). The current value-based health care model, however, focuses on improving population health and overlooks the individuality of patients and their preferences for care. We highlight the importance of eliciting patient preferences in collaborative decision making and describe a conceptual framework that incorporates individual patients' preferences when defining value. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Using Preferred Attribute Elicitation to Determine How Males and Females Evaluate Beer.

PubMed

Muggah, Elizabeth M; McSweeney, Matthew B

2017-08-01

The variety of beers available for consumption has increased due to the recent emergence of many craft brewing operations and it has been suggested that this is affecting how consumers evaluate beer. Currently, beer consumers are mostly male and only 20% of women are primarily beer drinkers. The main objective of this project is to compare and contrast descriptions of beer products created by males and females. The preferred attribute elicitation (PAE) method was used to create a description of 4 beers common to residents of Nova Scotia, Canada. Four PAE sessions were held: 2 sessions consisted of females (n = 16 and 15) and 2 sessions of males (n = 11 and 17). Four beer samples were chosen from locally available commercial beers, 2 of these samples were considered to be craft-brewed beer and the other samples were nationally available brands (macrobrewed). Both the males and females generated descriptions that included 5 identical terms; however, they differed in the importance they assigned to each attribute. Notably, bitterness was perceived to be of more importance to female panelists. Throughout all PAE sessions, the craft-brewed beers were associated with considerably more sensory attributes than the macrobrewed beers. It can be concluded that both the female and male groups found discernible differences between the craft and macrobrewed beers; however, they place importance on different sensory attributes. © 2017 Institute of Food Technologists®.

An Empirical Comparison of Discrete Choice Experiment and Best-Worst Scaling to Estimate Stakeholders' Risk Tolerance for Hip Replacement Surgery.

PubMed

van Dijk, Joris D; Groothuis-Oudshoorn, Catharina G M; Marshall, Deborah A; IJzerman, Maarten J

2016-06-01

Previous studies have been inconclusive regarding the validity and reliability of preference elicitation methods. The aim of this study was to compare the metrics obtained from a discrete choice experiment (DCE) and profile-case best-worst scaling (BWS) with respect to hip replacement. We surveyed the general US population of men aged 45 to 65 years, and potentially eligible for hip replacement surgery. The survey included sociodemographic questions, eight DCE questions, and twelve BWS questions. Attributes were the probability of a first and second revision, pain relief, ability to participate in sports and perform daily activities, and length of hospital stay. Conditional logit analysis was used to estimate attribute weights, level preferences, and the maximum acceptable risk (MAR) for undergoing revision surgery in six hypothetical treatment scenarios with different attribute levels. A total of 429 (96%) respondents were included. Comparable attribute weights and level preferences were found for both BWS and DCE. Preferences were greatest for hip replacement surgery with high pain relief and the ability to participate in sports and perform daily activities. Although the estimated MARs for revision surgery followed the same trend, the MARs were systematically higher in five of the six scenarios using DCE. This study confirms previous findings that BWS or DCEs are comparable in estimating attribute weights and level preferences. However, the risk tolerance threshold based on the estimation of MAR differs between these methods, possibly leading to inconsistency in comparing treatment scenarios. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Assessing the multidimensionality of coastal erosion risks: public participation and multicriteria analysis in a Mediterranean coastal system.

PubMed

Roca, Elisabet; Gamboa, Gonzalo; Tàbara, J David

2008-04-01

The complex and multidimensional nature of coastal erosion risks makes it necessary to move away from single-perspective assessment and management methods that have conventionally predominated in coastal management. This article explores the suitability of participatory multicriteria analysis (MCA) for improving the integration of diverse expertises and values and enhancing the social-ecological robustness of the processes that lead to the definition of relevant policy options to deal with those risks. We test this approach in the Mediterranean coastal locality of Lido de Sète in France. Results show that the more adaptive alternatives such as "retreating the shoreline" were preferred by our selected stakeholders to those corresponding to "protecting the shoreline" and the business as usual proposals traditionally put forward by experts and policymakers on these matters. Participative MCA contributed to represent coastal multidimensionality, elicit and integrate different views and preferences, facilitated knowledge exchange, and allowed highlighting existing uncertainties.

Mexican immigrants' attitudes and interest in health insurance: a qualitative descriptive study.

PubMed

Ziemer, Carolyn M; Becker-Dreps, Sylvia; Pathman, Donald E; Mihas, Paul; Frasier, Pamela; Colindres, Melida; Butterworth, Milton; Robinson, Scott S

2014-08-01

Mexican immigrants to the U.S. are nearly three times more likely to be without health insurance than non-Hispanic native citizens. To inform strategies to increase the number of insured within this population, we elicited immigrants' understanding of health insurance and preferences for coverage. Nine focus groups with Mexican immigrants were conducted across the State of North Carolina. Qualitative, descriptive methods were used to assess people's understanding of health insurance, identify their perceived need for health insurance, describe perceived barriers to obtaining coverage, and prioritize the components of insurance that immigrants value most. Individuals have a basic understanding of health insurance and perceive it as necessary. Participants most valued insurance that would cover emergencies, make care affordable, and protect family members. Barriers to obtaining insurance included cost, concerns about immigration status discovery, and communication issues. Strategies that address immigrants' preferences for and barriers to insurance should be considered.

The Right Place at the Right Time: Medical Oncology Outpatients' Perceptions of Location of End-of-Life Care.

PubMed

Waller, Amy; Sanson-Fisher, Rob; Zdenkowski, Nicholas; Douglas, Charles; Hall, Alix; Walsh, Justin

2018-01-01

Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-life (EOL) care. Using a sample of Australian medical oncology outpatients, this study examined (1) their preferred location of EOL care; (2) their perceived benefits and worries of receiving care in that location; (3) the percentage who had discussed preferences with their doctor and/or support person; and (4) whether they wanted their doctor to ask them where they wanted to die. Methods: Adults with a confirmed diagnosis of cancer were approached between September 2015 and January 2016 in the waiting room of an Australian oncology outpatient clinic. Consenting participants completed a home-based pen-and-paper survey indicating preferred location of care, perceived benefits and worries of that location, whether they had discussed preferences with their doctors, and whether they were willing to be asked about their preferences. Results: A total of 203 patients returned the survey (47% of those eligible). Less than half preferred to be cared for at home (47%), 34% preferred a hospice/palliative care unit, and 19% preferred the hospital. Common benefits and worries associated with locations included perceived burden on others, familiarity of environment, availability of expert medical care, symptom management, and likelihood of having wishes respected. More patients had discussed preferences with their support persons (41%) than doctors (7%). Most wanted a doctor to ask them about preferred location of care (87%) and thought it was important to die in the location of their choice (93%). Conclusions: Patients were willing to have clinicians to ask them where they wanted to die, although few had discussed their preferences with doctors. Although home was the most preferred location for many patients, the overall variation suggests that clinicians should adopt a systematic approach to eliciting patient preferences. Copyright © 2018 by the National Comprehensive Cancer Network.

Caregiver Treatment Preferences for Children with a New Versus Existing Attention-Deficit/Hyperactivity Disorder Diagnosis

PubMed Central

Park, Alex; Ng, Xinyi; Frosch, Emily; Reeves, Gloria; Cunningham, Charles; Janssen, Ellen M.; Bridges, John F.P.

2017-01-01

Abstract Objectives: Parental experiences with managing their child's attention-deficit/hyperactivity disorder (ADHD) can influence priorities for treatment. This study aimed to identify the ADHD management options caregivers most prefer and to determine if preferences differ by time since initial ADHD diagnosis. Methods: Primary caregivers (n = 184) of a child aged 4–14 years old in care for ADHD were recruited from January 2013 through March 2015 from community-based pediatric and mental health clinics and family support organizations across the state of Maryland. Participants completed a survey that included child/family demographics, child clinical treatment, and a Best–Worst Scaling (BWS) experiment to elicit ADHD management preferences. The BWS comprised 18 ADHD management profiles showing seven treatment attributes, where the best and worst attribute levels were selected from each profile. A conditional logit model using effect-coded variables was used to estimate preference weights stratified by time since ADHD diagnosis. Results: Participants were primarily the mother (84%) and had a college or postgraduate education (76%) with 75% of the children on stimulant medications. One-on-one caregiver behavior training, medication use seven days a week, therapy in a clinic, and an individualized education program were most preferred for managing ADHD. Aside from caregiver training and monthly out-of-pocket costs, caregivers of children diagnosed with ADHD for less than two years prioritized medication use lower than other care management attributes and caregivers of children diagnosed with ADHD for two or more years preferred school accommodations, medication, and provider specialty. Conclusions: Preferences for ADHD treatment differ based on the duration of the child's ADHD. Acknowledging that preferences change over the course of care could facilitate patient/family-centered care planning across a range of resources and a multidisciplinary team of professionals. PMID:27991834

Statistical Methods for the Analysis of Discrete Choice Experiments: A Report of the ISPOR Conjoint Analysis Good Research Practices Task Force.

PubMed

Hauber, A Brett; González, Juan Marcos; Groothuis-Oudshoorn, Catharina G M; Prior, Thomas; Marshall, Deborah A; Cunningham, Charles; IJzerman, Maarten J; Bridges, John F P

2016-06-01

Conjoint analysis is a stated-preference survey method that can be used to elicit responses that reveal preferences, priorities, and the relative importance of individual features associated with health care interventions or services. Conjoint analysis methods, particularly discrete choice experiments (DCEs), have been increasingly used to quantify preferences of patients, caregivers, physicians, and other stakeholders. Recent consensus-based guidance on good research practices, including two recent task force reports from the International Society for Pharmacoeconomics and Outcomes Research, has aided in improving the quality of conjoint analyses and DCEs in outcomes research. Nevertheless, uncertainty regarding good research practices for the statistical analysis of data from DCEs persists. There are multiple methods for analyzing DCE data. Understanding the characteristics and appropriate use of different analysis methods is critical to conducting a well-designed DCE study. This report will assist researchers in evaluating and selecting among alternative approaches to conducting statistical analysis of DCE data. We first present a simplistic DCE example and a simple method for using the resulting data. We then present a pedagogical example of a DCE and one of the most common approaches to analyzing data from such a question format-conditional logit. We then describe some common alternative methods for analyzing these data and the strengths and weaknesses of each alternative. We present the ESTIMATE checklist, which includes a list of questions to consider when justifying the choice of analysis method, describing the analysis, and interpreting the results. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Corticosterone rapidly reduces male odor preferences in female mice.

PubMed

Kavaliers, M; Ossenkopp, K P

2001-09-17

There is accumulating evidence for rapid, non-genomic behavioral effects of various steroids including that of the glucocorticoid, corticosterone. Using an odor preference test, the responses of which are indicative of mate preferences and sexual interest, we examined the effects of acute corticosterone on the responses of oestrous female mice to male odors. Control female mice displayed an overwhelming preference for the odors of male mice. Peripheral administration of corticosterone elicited a significant dose-related (1.0-5.0 mg/kg) decrease in female preference for male odors at 10 min, but not at 60 min, after administration. These inhibitory effects of corticosterone on odor preferences were significantly reduced by the competitive NMDA antagonist, NPC 12626, and enhanced by the GABA antagonist bicuculline. This indicates that corticosterone has rapid inhibitory effects on olfactory mediated female mate preferences and responses to male odor that in part involve interactions with NMDA and GABA receptor mechanisms.

Women's preference for masculine traits is disrupted by images of male-on-female aggression.

PubMed

Li, Yaoran; Bailey, Drew H; Winegard, Benjamin; Puts, David A; Welling, Lisa L M; Geary, David C

2014-01-01

Women's preferences for men's masculinized faces and voices were assessed after women (n = 331) were primed with images of male-on-male aggression, male-on-female aggression, pathogens, and neutral scenes. Male-on-male aggression and pathogen primes were associated with increased preference for masculine traits, but the same effect emerged in the neutral condition. We show the increased preference for masculine traits was due to repeated exposure to these traits, not the priming images themselves. Images of male-on-female aggression were an exception; these elicited feelings of disgust and anger appeared to disrupt the preference for masculinized traits. The results suggest women process men's facial and vocal traits as signals of aggressive potential and lose any preference for these traits with cues indicating men might direct this aggression toward them.

76 FR 72436 - Agency Information Collection Activities: Proposed Reinstatement with Change of a Previously...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... preference surveys are carefully designed to elicit respondents' willingness to pay for improvements in... the pretest is completed, the NPS will submit a revised Information Collection Request (ICR) to OMB...

Neural underpinnings of the identifiable victim effect: affect shifts preferences for giving.

PubMed

Genevsky, Alexander; Västfjäll, Daniel; Slovic, Paul; Knutson, Brian

2013-10-23

The "identifiable victim effect" refers to peoples' tendency to preferentially give to identified versus anonymous victims of misfortune, and has been proposed to partly depend on affect. By soliciting charitable donations from human subjects during behavioral and neural (i.e., functional magnetic resonance imaging) experiments, we sought to determine whether and how affect might promote the identifiable victim effect. Behaviorally, subjects gave more to orphans depicted by photographs versus silhouettes, and their shift in preferences was mediated by photograph-induced feelings of positive arousal, but not negative arousal. Neurally, while photographs versus silhouettes elicited activity in widespread circuits associated with facial and affective processing, only nucleus accumbens activity predicted and could statistically account for increased donations. Together, these findings suggest that presenting evaluable identifiable information can recruit positive arousal, which then promotes giving. We propose that affect elicited by identifiable stimuli can compel people to give more to strangers, even despite costs to the self.

The Betrayal Aversion Elicitation Task: An Individual Level Betrayal Aversion Measure

PubMed Central

Aimone, Jason; Ball, Sheryl; King-Casas, Brooks

2015-01-01

Research on betrayal aversion shows that individuals’ response to risk depends not only on probabilities and payoffs, but also on whether the risk includes a betrayal of trust. While previous studies focus on measuring aggregate levels of betrayal aversion, the connection between an individual’s own betrayal aversion and other individually varying factors, including risk preferences, are currently unexplored. This paper develops a new task to elicit an individual’s level of betrayal aversion that can then be compared to individual characteristics. We demonstrate the feasibility of our new task and show that our aggregate individual results are consistent with previous studies. We then use this classification to ask whether betrayal aversion is correlated with risk aversion. While we find risk aversion and betrayal aversion have no significant relationship, we do observe that risk aversion is correlated with non-social risk preferences, but not the social, betrayal related, risk component of the new task. PMID:26331944

The Betrayal Aversion Elicitation Task: An Individual Level Betrayal Aversion Measure.

PubMed

Aimone, Jason; Ball, Sheryl; King-Casas, Brooks

2015-01-01

Research on betrayal aversion shows that individuals' response to risk depends not only on probabilities and payoffs, but also on whether the risk includes a betrayal of trust. While previous studies focus on measuring aggregate levels of betrayal aversion, the connection between an individual's own betrayal aversion and other individually varying factors, including risk preferences, are currently unexplored. This paper develops a new task to elicit an individual's level of betrayal aversion that can then be compared to individual characteristics. We demonstrate the feasibility of our new task and show that our aggregate individual results are consistent with previous studies. We then use this classification to ask whether betrayal aversion is correlated with risk aversion. While we find risk aversion and betrayal aversion have no significant relationship, we do observe that risk aversion is correlated with non-social risk preferences, but not the social, betrayal related, risk component of the new task.

Students’ Perception and Attitude on Methods of Anatomy Teaching in a Medical College of West Bengal, India

PubMed Central

Bandyopadhyay, Raktim

2017-01-01

Introduction Incorporating newer teaching aids over traditional one in Anatomy has been challenging both for the teachers and the learners. Different educational strategies are being used for teaching of Anatomy. Aim To elicit the perception and attitude toward teaching approaches in the Anatomy curriculum among first year medical students. Materials and Methods A cross-sectional, descriptive study was undertaken with the help of predesigned, pre-tested questionnaire to elicit knowledge in four domains of classroom teaching which were: a) gross anatomical structure; b) organ identification; c) topography; and d) radiological anatomy and self-assessment of acquired skills in respective fields among 114 first year students. Results A total of 57% of students opined good in gross structure of anatomy. A 60.5% of students preferred chalk and board method and 33.3% with LCD projector. Regarding acquiring knowledge, 72.8% of medical students gathered knowledge in gross anatomical structure domain whereas 58.8% in radiological anatomy. The overall mean score of attitude of the students regarding incorporating newer techniques in Anatomy teaching is 14.17±2.26. Conclusion The perception of Anatomy teaching and attitude among medicos have been studied and opinion from them had thrown light for incorporation of newer techniques in their teaching curriculum. PMID:29207689

A Comparison of Japan and U.K. SF-6D Health-State Valuations Using a Non-Parametric Bayesian Method.

PubMed

Kharroubi, Samer A

2015-08-01

There is interest in the extent to which valuations of health may differ between different countries and cultures, but few studies have compared preference values of health states obtained in different countries. We sought to estimate and compare two directly elicited valuations for SF-6D health states between the Japan and U.K. general adult populations using Bayesian methods. We analysed data from two SF-6D valuation studies where, using similar standard gamble protocols, values for 241 and 249 states were elicited from representative samples of the Japan and U.K. general adult populations, respectively. We estimate a function applicable across both countries that explicitly accounts for the differences between them, and is estimated using data from both countries. The results suggest that differences in SF-6D health-state valuations between the Japan and U.K. general populations are potentially important. The magnitude of these country-specific differences in health-state valuation depended, however, in a complex way on the levels of individual dimensions. The new Bayesian non-parametric method is a powerful approach for analysing data from multiple nationalities or ethnic groups, to understand the differences between them and potentially to estimate the underlying utility functions more efficiently.

Effects of Enrichment Presentation and Other Factors on Behavioral Welfare of Pantropical Spotted Dolphin (Stenella attenuata).

PubMed

Perez, Barbara C; Mehrkam, Lindsay R; Foltz, Amanda R; Dorey, Nicole R

2018-01-01

Environmental enrichment is a crucial element of promoting welfare for animals in captivity. However, enrichment programs are not always formally evaluated for their efficacy. Furthermore, there is little empirical evidence of enrichment evaluation for species of small cetaceans in zoological settings. A wide range of variables may potentially influence enrichment efficacy and how it in turn affects behavior. The purpose of this study was to determine the most preferred environmental enrichment, and method of presentation, for a species that has not been well studied in captivity, the pantropical spotted dolphin (Stenella attenuata). In order to determine which enrichment items and method of presentation were most effective at eliciting enrichment interaction, we systematically examined how several variables of enrichment influenced enrichment interaction. The results suggested that presenting enrichment after training sessions influenced interaction with the enrichment. The results also indicated preference for enrichment type and a specific enrichment device. Finally, factors that influenced interaction were also found to influence aberrant behavior. The results support the premise that enrichment be "redefined" for each species and each individual.

A randomised controlled trial to compare opt-in and opt-out parental consent for childhood vaccine safety surveillance using data linkage: study protocol.

PubMed

Berry, Jesia G; Ryan, Philip; Braunack-Mayer, Annette J; Duszynski, Katherine M; Xafis, Vicki; Gold, Michael S

2011-01-04

The Vaccine Assessment using Linked Data (VALiD) trial compared opt-in and opt-out parental consent for a population-based childhood vaccine safety surveillance program using data linkage. A subsequent telephone interview of all households enrolled in the trial elicited parental intent regarding the return or non-return of reply forms for opt-in and opt-out consent. This paper describes the rationale for the trial and provides an overview of the design and methods. Single-centre, single-blind, randomised controlled trial (RCT) stratified by firstborn status. Mothers who gave birth at one tertiary South Australian hospital were randomised at six weeks post-partum to receive an opt-in or opt-out reply form, along with information explaining data linkage. The primary outcome at 10 weeks post-partum was parental participation in each arm, as indicated by the respective return or non-return of a reply form (or via telephone or email response). A subsequent telephone interview at 10 weeks post-partum elicited parental intent regarding the return or non-return of the reply form, and attitudes and knowledge about data linkage, vaccine safety, consent preferences and vaccination practices. Enrolment began in July 2009 and 1,129 households were recruited in a three-month period. Analysis has not yet been undertaken. The participation rate and selection bias for each method of consent will be compared when the data are analysed. The VALiD RCT represents the first trial of opt-in versus opt-out consent for a data linkage study that assesses consent preferences and intent compared with actual opting in or opting out behaviour, and socioeconomic factors. The limitations to generalisability are discussed. Australian New Zealand Clinical Trials Registry ACTRN12610000332022.

Renal transplant patients' preference for the supply and delivery of immunosuppressants in Wales: a discrete choice experiment.

PubMed

Hagemi, Anke; Plumpton, Catrin; Hughes, Dyfrig A

2017-10-02

Prescribing policy recommendations aimed at moving immunosuppressant prescribing for renal transplant patients from primary to secondary care may result in benefits of increased safety and reduced cost. However, there is little evidence of patients' preferences for receiving their immunosuppressant therapy from hospitals compared to community dispensing. The aim of this study was to elicit patient preferences for different service configurations focusing in particular on home delivery versus collection of medication from hospital. A discrete choice experiment was administered to 265 renal transplant patients in North Wales. Respondents were presented 18 pairwise choices, labelled as either home delivery or hospital collection, and described by the attributes: frequency of supply, waiting time (for delivery or collection) and method of ordering (provider contact, patient contact via phone, patient contact electronically). Data were analysed using a random-effects logit model and marginal rates of substitution calculated based on the waiting time attribute. A response rate of 63% was achieved, with 5332 usable observations from 150 respondents. Method of delivery (β coefficient 1.21; 95% confidence interval 1.05 to 1.38), frequency of supply (0.05; 0.03 to 0.08) waiting time (-0.00, -0.00 to -0.00), provider contact (desirable) (0.20; 0.12 to 0.27), patient contact by telephone (desirable) (0.09; 0.01 to 0.17) and patient contact electronically (undesirable) (-0.292; -0.37 to -0.21) were statistically significant (p < 0.05). Results indicate that patients are willing to increase waiting time by nearly 10 h to have a home delivery service. Patients indicate a clear preference for a home delivery service. They prefer providers to make contact when new immunosuppressant supplies are required and show preference against ordering medication electronically. A policy for secondary care prescribing and hospital collection of medicines does not align with this preference.

Developing consumer-centered, nonprescription drug labeling a study in acetaminophen.

PubMed

King, Jennifer P; Davis, Terry C; Bailey, Stacy Cooper; Jacobson, Kara L; Hedlund, Laurie A; Di Francesco, Lorenzo; Parker, Ruth M; Wolf, Michael S

2011-06-01

In the U.S., acetaminophen overdose has surpassed viral hepatitis as the leading cause of acute liver failure, and misuse contributes to more than 30,000 hospitalizations annually. Half to two thirds of acetaminophen overdoses are unintentional, suggesting the root cause is likely poor understanding of medication labeling or failure to recognize the consequences of exceeding the recommended maximum daily dosage. Elicit subject feedback about active ingredient and dosing information on over-the-counter (OTC) acetaminophen and elicit feedback on proposed plain-language text and icons. Six focus groups, preceded by individual interviews, were conducted in April 2010 among 45 adults in two cities from two clinics and an adult basic education center. The individual interviews evaluated knowledge of OTC pain relievers, attention to product label information and literacy level while the group discussion elicited preference for label messages and icons. Analyses were conducted from April to June 2010. Forty-four percent read at or below the 6th-grade level. Individual interviews revealed that <50% of participants routinely examine product label information. Only 31% know acetaminophen is in Tylenol®. The groups achieved consensus on a preferred icon for acetaminophen, desired explicit statement of potential liver damage in the warning against simultaneous use of acetaminophen products, and indicated preference for an icon and wording for maximum dose. With the high prevalence of OTC use, a consumer-centered approach to developing icons and messages to promote awareness and safe use of acetaminophen could benefit consumers. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Women's preferences for aspects of labor management: results from a discrete choice experiment.

PubMed

Scotland, Graham S; McNamee, Paul; Cheyne, Helen; Hundley, Vanora; Barnett, Carol

2011-03-01

The latent phase of labor can vary greatly in duration, and many women are uncertain about when to contact the maternity unit. The aim of this study was to elicit and value women's preferences for some aspects of labor management. A questionnaire was sent to 1,251 women who had recently given birth to their first child at one of 14 maternity units in Scotland. Discrete choice questions were used to measure women's preferences for five attributes of care: number of visits (assessments) before admission to the labor ward, time spent on the labor ward before delivery, mobility during labor, pain relief required, and mode of delivery. Responses were analyzed for the sample as a whole and for subgroups defined by recent experiences of labor. A total of 730 (58.4%) questionnaires were returned and analyzed. Women expressed a preference for fewer visits before admission, shorter times on the labor ward before delivery, mobility during labor, normal vaginal deliveries, and moderate forms of pain relief (Entonox and opiates). Subgroup analysis suggests that women's preferences for pain relief are influenced by their recent labor experience. The elicited preference values provide a means for estimating the tradeoffs women are willing to make between attributes of labor management. Women appear to dislike being turned away from the labor ward before admission for delivery. Extra visits before admission only appear to be a price worth paying if they result in reductions in the duration of time spent on the labor ward, reductions in the chance of being immobilized in hospital during labor, or a lower chance of requiring an instrumental or operative delivery. © 2010, Copyright the Authors. Journal compilation © 2010, Wiley Periodicals, Inc.

Choice of primary health care source in an urbanized low-income community in Singapore: a mixed-methods study.

PubMed

Wee, Liang En; Lim, Li Yan; Shen, Tong; Lee, Elis Yuexian; Chia, Yet Hong; Tan, Andrew Yen Siong; Koh, Gerald Choon-Huat

2014-02-01

Cost and misperceptions may discourage lower income Singaporeans from utilizing primary care. We investigated sources of primary care in a low-income Singaporean community in a mixed-methods study. Residents of a low-income public rental flat neighbourhood were asked for sociodemographic details and preferred source of primary care relative to their higher income neighbours. In the qualitative component, interviewers elicited, from patients and health care providers, barriers/enablers to seeking care from Western-trained doctors. Interviewees were selected via purposive sampling. Transcripts were analyzed thematically, and iterative analysis was carried out using established qualitative method. Participation was 89.8% (359/400). Only 11.1% (40/359) preferred to approach Western-trained doctors, 29.5% (106/359) preferred alternative medicine, 6.7% (24/359) approached family/friends and 52.6% (189/359) preferred self-reliance. Comparing against higher income neighbours, rental flat residents were more likely to turn to alternative medicine and family members but less likely to turn to Western-trained doctors (P < 0.001). For the qualitative component, a total of 20 patients and 9 providers were interviewed before data saturation was reached. Patient and provider comments fell into the following content areas: primary care characteristics, knowledge, costs, priorities, attitudes and information sources. Self-reliance was perceived as acceptable for 'small' illnesses but not for 'big' ones, communal spirit was cited as a reason for consulting family/friends and social distance from primary care practitioners was highlighted as a reason for not consulting Western-trained doctors. Western-trained physicians are not the first choice of lower income Singaporeans for seeking primary care. Knowledge, primary care characteristics and costs were identified as potential barriers/enablers.

Acquisition of Conditioned Responses to a Novel Alcohol-Paired Cue in Social Drinkers

PubMed Central

Mayo, Leah M.; de Wit, Harriet

2016-01-01

Objective: This study examined the acquisition of conditioning between novel stimuli and single doses of alcohol in social drinkers. Environmental stimuli present during the consumption of alcohol or other drugs come to elicit conditioned responses that subsequently increase drug seeking. However, relatively few studies have examined the process of acquisition of these conditioned drug responses in human subjects. Method: We used a procedure previously developed to study acquisition of conditioned responses to a methamphetamine-associated cue. In the present study we applied the paradigm to alcohol, pairing de novo neutral cues with alcohol in social drinkers (N = 36). We obtained measures of self-report, behavioral preference, emotional reactivity (assessed using facial electromyography), and attention to specific cues paired with administration of 0.6 g/kg 95% absolute alcohol or placebo. Results: After conditioning, participants showed an increase in attention toward the alcohol-paired cue, and this increase was associated with ratings of liking the alcohol-containing beverage during the conditioning sessions. In contrast to our previous findings with methamphetamine, the alcohol-paired cue did not elicit changes in emotional reactivity (measured by facial electromyography) or behavioral preference. Conclusions: This study extends our previous findings with a stimulant drug to alcohol and highlights possible similarities and differences in conditioning with different classes of drugs. Conditioning with alcohol was less robust than with methamphetamine, but in both cases the conditioning that did occur was related to positive subjective drug response. PMID:26997190

Gait Coordination in Parkinson Disease: Effects of Step Length and Cadence Manipulations

PubMed Central

Williams, April J.; Peterson, Daniel S.; Earhart, Gammon M.

2013-01-01

Background Gait impairments are well documented in those with PD. Prior studies suggest that gait impairments may be worse and ongoing in those with PD who demonstrate FOG compared to those with PD who do not. Purpose Our aim was to determine the effects of manipulating step length and cadence individually, and together, on gait coordination in those with PD who experience FOG, those with PD who do not experience FOG, healthy older adults, and healthy young adults. Methods Eleven participants with PD and FOG, 16 with PD and no FOG, 18 healthy older, and 19 healthy young adults walked across a GAITRite walkway under four conditions: Natural, Fast (+50% of preferred cadence), Small (−50% of preferred step length), and SmallFast (+50% cadence and −50% step length). Coordination (i.e. phase coordination index) was measured for each participant during each condition and analyzed using mixed model repeated measure ANOVAs. Results FOG was not elicited. Decreasing step length or decreasing step length and increasing cadence together affected coordination. Small steps combined with fast cadence resulted in poorer coordination in both groups with PD compared to healthy young adults and in those with PD and FOG compared to healthy older adults. Conclusions Coordination deficits can be identified in those with PD by having them walk with small steps combined with fast cadence. Short steps produced at high rate elicit worse coordination than short steps or fast steps alone. PMID:23333356

Evaluation of an advanced physical diagnosis course using consumer preferences methods: the nominal group technique.

PubMed

Coker, Joshua; Castiglioni, Analia; Kraemer, Ryan R; Massie, F Stanford; Morris, Jason L; Rodriguez, Martin; Russell, Stephen W; Shaneyfelt, Terrance; Willett, Lisa L; Estrada, Carlos A

2014-03-01

Current evaluation tools of medical school courses are limited by the scope of questions asked and may not fully engage the student to think on areas to improve. The authors sought to explore whether a technique to study consumer preferences would elicit specific and prioritized information for course evaluation from medical students. Using the nominal group technique (4 sessions), 12 senior medical students prioritized and weighed expectations and topics learned in a 100-hour advanced physical diagnosis course (4-week course; February 2012). Students weighted their top 3 responses (top = 3, middle = 2 and bottom = 1). Before the course, 12 students identified 23 topics they expected to learn; the top 3 were review sensitivity/specificity and high-yield techniques (percentage of total weight, 18.5%), improving diagnosis (13.8%) and reinforce usual and less well-known techniques (13.8%). After the course, students generated 22 topics learned; the top 3 were practice and reinforce advanced maneuvers (25.4%), gaining confidence (22.5%) and learn the evidence (16.9%). The authors observed no differences in the priority of responses before and after the course (P = 0.07). In a physical diagnosis course, medical students elicited specific and prioritized information using the nominal group technique. The course met student expectations regarding education of the evidence-based physical examination, building skills and confidence on the proper techniques and maneuvers and experiential learning. The novel use for curriculum evaluation may be used to evaluate other courses-especially comprehensive and multicomponent courses.

A systematic review of consumer preference for e-cigarette attributes: Flavor, nicotine strength, and type

PubMed Central

Nemati, Mehdi; Zheng, Yuqing

2018-01-01

Objective Systematic review of research examining consumer preference for the main electronic cigarette (e-cigarette) attributes namely flavor, nicotine strength, and type. Method A systematic search of peer-reviewed articles resulted in a pool of 12,933 articles. We included only articles that meet all the selection criteria: (1) peer-reviewed, (2) written in English, and (3) addressed consumer preference for one or more of the e-cigarette attributes including flavor, strength, and type. Results 66 articles met the inclusion criteria for this review. Consumers preferred flavored e-cigarettes, and such preference varied with age groups and smoking status. We also found that several flavors were associated with decreased harm perception while tobacco flavor was associated with increased harm perception. In addition, some flavor chemicals and sweeteners used in e-cigarettes could be of toxicological concern. Finally, consumer preference for nicotine strength and types depended on smoking status, e-cigarette use history, and gender. Conclusion Adolescents could consider flavor the most important factor trying e-cigarettes and were more likely to initiate vaping through flavored e-cigarettes. Young adults overall preferred sweet, menthol, and cherry flavors, while non-smokers in particular preferred coffee and menthol flavors. Adults in general also preferred sweet flavors (though smokers like tobacco flavor the most) and disliked flavors that elicit bitterness or harshness. In terms of whether flavored e-cigarettes assisted quitting smoking, we found inconclusive evidence. E-cigarette users likely initiated use with a cigarette like product and transitioned to an advanced system with more features. Non-smokers and inexperienced e-cigarettes users tended to prefer no nicotine or low nicotine e-cigarettes while smokers and experienced e-cigarettes users preferred medium and high nicotine e-cigarettes. Weak evidence exists regarding a positive interaction between menthol flavor and nicotine strength. PMID:29543907

Facts and Misconceptions about 2D:4D, Social and Risk Preferences

PubMed Central

Alonso, Judit; Di Paolo, Roberto; Ponti, Giovanni; Sartarelli, Marcello

2018-01-01

We study how the ratio between the length of the second and fourth digit (2D:4D) correlates with choices in social and risk preferences elicitation tasks by building a large dataset from five experimental projects with more than 800 subjects. Our results confirm the recent literature that downplays the link between 2D:4D and many domains of economic interest, such as social and risk preferences. As for the former, we find that social preferences are significantly lower when 2D:4D is above the median value only for subjects with low cognitive ability. As for the latter, we find that a high 2D:4D is not correlated with the frequency of subjects' risky choices. PMID:29487510

Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision

PubMed Central

2010-01-01

Background It is recognised as good practice to use qualitative methods to elicit users' views of internet-delivered health-care interventions during their development. This paper seeks to illustrate the advantages of combining usability testing with 'theoretical modelling', i.e. analyses that relate the findings of qualitative studies during intervention development to social science theory, in order to gain deeper insights into the reasons and context for how people respond to the intervention. This paper illustrates how usability testing may be enriched by theoretical modelling by means of two qualitative studies of users' views of the delivery of information in an internet-delivered intervention to help users decide whether they needed to seek medical care for their cold or flu symptoms. Methods In Study 1, 21 participants recruited from a city in southern England were asked to 'think aloud' while viewing draft web-pages presented in paper format. In Study 2, views of our prototype website were elicited, again using think aloud methods, in a sample of 26 participants purposively sampled for diversity in education levels. Both data-sets were analysed by thematic analysis. Results Study 1 revealed that although the information provided by the draft web-pages had many of the intended empowering benefits, users often felt overwhelmed by the quantity of information. Relating these findings to theory and research on factors influencing preferences for information-seeking we hypothesised that to meet the needs of different users (especially those with lower literacy levels) our website should be designed to provide only essential personalised advice, but with options to access further information. Study 2 showed that our website design did prove accessible to users with different literacy levels. However, some users seemed to want still greater control over how information was accessed. Conclusions Educational level need not be an insuperable barrier to appreciating web-based access to detailed health-related information, provided that users feel they can quickly gain access to the specific information they seek. PMID:20849599

Ethics teaching in a medical education environment: preferences for diversity of learning and assessment methods.

PubMed

AlMahmoud, Tahra; Hashim, M Jawad; Elzubeir, Margaret Ann; Branicki, Frank

2017-01-01

Ethics and professionalism are an integral part of medical school curricula; however, medical students' views on these topics have not been assessed in many countries.  The study aimed to examine medical students' perceptions toward ethics and professionalism teaching, and its learning and assessment methods. A self-administered questionnaire eliciting views on professionalism and ethics education was distributed to a total of 128 final-year medical students. A total of 108 students completed the survey, with an 84% response rate. Medical students reported frequently encountering ethical conflicts during training but stated only a moderate level of ethics training at medical school (mean = 5.14 ± 1.8). They noted that their education had helped somewhat to deal with ethical conflicts (mean = 5.39 ± 2.0). Students strongly affirmed the importance of ethics education (mean = 7.63 ± 1.03) and endorsed the value of positive role models (mean = 7.45 ± 1.5) as the preferred learning method. The cohort voiced interest in direct faculty supervision as an approach to assessment of knowledge and skills (mean = 7.62 ± 1.26). Female students perceived greater need for more ethics education compared to males (p = < 0.05). Students who claimed that they had experienced some unprofessional treatment had a more limited view of the importance of ethics as a subject (P = 0.001). Medical students viewed ethics education positively and preferred clinically attuned methods for learning.

Limitations of learning in the proboscis reflex of the flower visiting syrphid fly Eristalis tenax

PubMed Central

An, Lina; Donda, Miriam; Hohmann, Michele; Sermon, Leonie; Stegmanns, Vanessa

2018-01-01

Flower visiting Eristalis hoverflies feed on nectar and pollen and are known to rely on innate colour preferences. In addition to a preference for visiting yellow flowers, the flies possess an innate proboscis reflex elicited by chemical as well as yellow colour stimuli. In this study we show that the flies’ proboscis reflex is only triggered by yellow colour stimuli and not altered by conditioning to other colours. Neither in absolute nor in differential conditioning experiments the flies learned to associate other colours than yellow with reward. Even flies that experienced only blue nutrients during the first four days after hatching could not be trained to extend the proboscis towards other colours than yellow. The natural targets of the visually elicited proboscis reflex are yellow pollen and yellow anthers. One consequence of our findings is that flowers might advertise nectar and pollen rewards for Eristalis hoverflies by a yellow colour hue of nectar guides, nectaries, stamens or pollen. Alternatively, flowers might protect their pollen against Eristalis by displaying other pollen colours than yellow or direct flies by yellow pollen-mimicking floral guides towards nectar resources. Testing the proboscis extension of various hoverfly species in the field showed that only Eristalis hoverflies possess the proboscis reflex elicited by yellow colour hues. PMID:29558491

Viral-mediated knockdown of mGluR7 in the nucleus accumbens mediates excessive alcohol drinking and increased ethanol-elicited conditioned place preference in rats.

PubMed

Bahi, Amine

2013-10-01

Whether metabotropic glutamate 7 (mGluR7) -activation enhances or diminishes the reinforcing properties of psychostimulants remains unclear. We have previously shown that systemic mGluR7 activation reduced alcohol consumption and preference as well as locomotor-stimulating and rewarding properties of ethanol. In this study, we further examined the contribution of mGluR7 on the effect of ethanol within the nucleus accumbens (NAcc), a neural target for many drugs of abuse. Using short hairpin RNA (shRNA)-expressing lentiviral vectors (LV) to alter locally the activity of mGluR7 in male rats, we have shown that blocking mGluR7 expression increased ethanol consumption and preference in a two-bottle choice drinking paradigm with no effect either on saccharin or on quinine used for taste discrimination. In addition, mGluR7 knockdown increases preference for environments previously paired with low doses of ethanol in the conditioned place preference (CPP) test, as it shifted the dose-response curve for ethanol CPP to the left, indicating alterations in the rewarding effects of alcohol. More importantly, mGluR7 blockade in the dorsal striatum (DS) neither affected ethanol consumption nor ethanol-elicited CPP. These results show that levels of mGluR7 in the NAcc regulate responsiveness to alcohol. Taken together, these findings clearly demonstrate that mGluR7 signaling within the NAcc is a key modulator of functional responses to ethanol and offer an important target for regulating the addictive effects of alcohol.

Differential sensitivity of ethanol-elicited ERK phosphorylation in nucleus accumbens of Sardinian alcohol-preferring and -non preferring rats.

PubMed

Rosas, Michela; Zaru, Alessandro; Sabariego, Marta; Giugliano, Valentina; Carboni, Ezio; Colombo, Giancarlo; Acquas, Elio

2014-08-01

Sardinian alcohol-preferring (sP) and -non preferring (sNP) rats have been selectively bred for opposite ethanol preference and consumption; sP rats represent a validated experimental tool to model several aspects of excessive ethanol drinking in humans. Phosphorylated Extracellular signal-Regulated Kinase (pERK) in dopamine-rich terminal areas plays a critical role in several psychopharmacological effects of addictive drugs, including ethanol. This study was aimed at investigating whether ethanol-elicited ERK activation may differ in key brain areas of ethanol-naïve sP and sNP rats. To this end, the effects of ethanol (0, 0.5, 1, and 2 g/kg, administered intra-gastrically [i.g.]) on ERK phosphorylation were assessed by pERK immunohistochemistry in the shell (AcbSh) and core (AcbC) of the nucleus accumbens (Acb) as well as in the prelimbic (PrL) and infralimbic (IL) prefrontal cortex (PFCx), in the bed nucleus of stria terminalis (BSTL) and in the central nucleus of the amygdala (CeA). Ethanol (1 g/kg) significantly increased pERK immunoreactivity in AcbSh and AcbC of sP but not sNP rats. Conversely, ethanol failed to affect pERK expression in PrL and IL PFCx as well as in BSTL and CeA of both sP and sNP rats. These results suggest that selective breeding of these rat lines results in differential effects of acute ethanol on ERK phosphorylation in brain regions critical for the psychopharmacological effects of ethanol. Copyright © 2014 Elsevier Inc. All rights reserved.

Inclusive intake screening: shaping medical problems into specialist-appropriate cases.

PubMed

Jean, Yvette A

2004-05-01

This paper examines medical intake screening through the process of making appointments with medical specialists. By employing a multi-method, qualitative approach, it shows how decisions to schedule doctors' appointments are based on medical knowledge about physicians' specialties and specific organisational practices. It draws on insights from first-contact interactions between clients and institutional gatekeepers to enrich our understanding of intake screening. In relation to gatekeeping, rationing commonly gets framed as restrictive screening practices, with a preference for denying or limiting access to treatment. Restrictive screening practices are typically organised to elicit a narrow range of information ('facts') relevant to specific eligibility criteria; whereas inclusive intake screening tends to involve less scripted, more complex and open-ended interactional exchanges between workers and clients, wherein workers help clients frame their claims in ways that will increase their chances of getting accepted. Front-office workers hold a preference for inclusive intake screening, a preference that is undergirded by the referral-driven nature of this stage of patient processing, and by a work environment that favours inclusive screening. This finding builds on the literature within medical sociology, but also extends our understanding of frontline decision-making and the distribution of resources within a variety of people-processing institutions.

Estimating preferences for treatments in patients with localized prostate cancer.

PubMed

Ávila, Mónica; Becerra, Virginia; Guedea, Ferran; Suárez, José Francisco; Fernandez, Pablo; Macías, Víctor; Mariño, Alfonso; Hervás, Asunción; Herruzo, Ismael; Ortiz, María José; Ponce de León, Javier; Sancho, Gemma; Cunillera, Oriol; Pardo, Yolanda; Cots, Francesc; Ferrer, Montse

2015-02-01

Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical prostatectomy. These time trade-off and standard gamble preference assessments as well as the willingness-to-pay estimation could be useful to perform respectively cost-utility or cost-benefit analyses, which can guide health policy decisions. Copyright © 2015 Elsevier Inc. All rights reserved.

Environmental Systems Conflict Resolution

NASA Astrophysics Data System (ADS)

Hipel, K. W.

2017-12-01

The Graph Model for Conflict Resolution (GMCR) is applied to a real-life groundwater contamination dispute to demonstrate how one can realistically model and analyze the controversy in order to obtain an enhanced understanding and strategic insights for permitting one to make informed decisions. This highly divisive conflict is utilized to explain a rich range of inherent capabilities of GMCR, as well as worthwhile avenues for extensions, which make GMCR a truly powerful decision technology for addressing challenging conflict situations. For instance, a flexible preference elicitation method called option prioritization can be employed to obtain the relative preferences of each decision maker (DM) in the dispute over the states or scenarios which can occur, based upon preference statements regarding the options or courses of actions available to the DMs. Solution concepts, reflecting the way a chess player thinks in terms of moves and counter-moves, are defined to mirror the ways humans may behave under conflict, varying from short to long term thinking. After ascertaining the best outcome that a DM can achieve on his or her own in a conflict, coalition analysis algorithms are available to check if a DM can fare even better via cooperating with others. The ability of GMCR to take into account emotions, strength of preference, attitudes, misunderstandings (referred to as hypergames), and uncertain preferences (unknown, fuzzy, grey and probabilistic) greatly broadens its scope of applicability. Techniques for tracing how a conflict can evolve over time from a status quo state to a final specified outcome, as well as how to handle hierarchical structures, such as when a central government interacts with its provinces or states, further enforces the comprehensive nature of GMCR. Within ongoing conflict research mimicking how physical systems are analyzed, methods for inverse engineering of preferences are explained for determining the preferences required by one or more DMs in order for a desirable resolution to be reached. In the behavioral engine problem, the manner in which a DM may be thinking strategically under conflict can be calculated given the input preferences and a selected equilibrium.

Glutamate and Opioid Antagonists Modulate Dopamine Levels Evoked by Innately Attractive Male Chemosignals in the Nucleus Accumbens of Female Rats

PubMed Central

Sánchez-Catalán, María-José; Orrico, Alejandro; Hipólito, Lucía; Zornoza, Teodoro; Polache, Ana; Lanuza, Enrique; Martínez-García, Fernando; Granero, Luis; Agustín-Pavón, Carmen

2017-01-01

Sexual chemosignals detected by vomeronasal and olfactory systems mediate intersexual attraction in rodents, and act as a natural reinforcer to them. The mesolimbic pathway processes natural rewards, and the nucleus accumbens receives olfactory information via glutamatergic projections from the amygdala. Thus, the aim of this study was to investigate the involvement of the mesolimbic pathway in the attraction toward sexual chemosignals. Our data show that female rats with no previous experience with males or their chemosignals display an innate preference for male-soiled bedding. Focal administration of the opioid antagonist β-funaltrexamine into the posterior ventral tegmental area does not affect preference for male chemosignals. Nevertheless, exposure to male-soiled bedding elicits an increase in dopamine efflux in the nucleus accumbens shell and core, measured by microdialysis. Infusion of the opioid antagonist naltrexone in the accumbens core does not significantly affect dopamine efflux during exposure to male chemosignals, although it enhances dopamine levels 40 min after withdrawal of the stimuli. By contrast, infusion of the glutamate antagonist kynurenic acid in the accumbens shell inhibits the release of dopamine and reduces the time that females spend investigating male-soiled bedding. These data are in agreement with previous reports in male rats showing that exposure to opposite-sex odors elicits dopamine release in the accumbens, and with data in female mice showing that the behavioral preference for male chemosignals is not affected by opioidergic antagonists. We hypothesize that glutamatergic projections from the amygdala into the accumbens might be important to modulate the neurochemical and behavioral responses elicited by sexual chemosignals in rats. PMID:28280461

Glutamate and Opioid Antagonists Modulate Dopamine Levels Evoked by Innately Attractive Male Chemosignals in the Nucleus Accumbens of Female Rats.

PubMed

Sánchez-Catalán, María-José; Orrico, Alejandro; Hipólito, Lucía; Zornoza, Teodoro; Polache, Ana; Lanuza, Enrique; Martínez-García, Fernando; Granero, Luis; Agustín-Pavón, Carmen

2017-01-01

Sexual chemosignals detected by vomeronasal and olfactory systems mediate intersexual attraction in rodents, and act as a natural reinforcer to them. The mesolimbic pathway processes natural rewards, and the nucleus accumbens receives olfactory information via glutamatergic projections from the amygdala. Thus, the aim of this study was to investigate the involvement of the mesolimbic pathway in the attraction toward sexual chemosignals. Our data show that female rats with no previous experience with males or their chemosignals display an innate preference for male-soiled bedding. Focal administration of the opioid antagonist β-funaltrexamine into the posterior ventral tegmental area does not affect preference for male chemosignals. Nevertheless, exposure to male-soiled bedding elicits an increase in dopamine efflux in the nucleus accumbens shell and core, measured by microdialysis. Infusion of the opioid antagonist naltrexone in the accumbens core does not significantly affect dopamine efflux during exposure to male chemosignals, although it enhances dopamine levels 40 min after withdrawal of the stimuli. By contrast, infusion of the glutamate antagonist kynurenic acid in the accumbens shell inhibits the release of dopamine and reduces the time that females spend investigating male-soiled bedding. These data are in agreement with previous reports in male rats showing that exposure to opposite-sex odors elicits dopamine release in the accumbens, and with data in female mice showing that the behavioral preference for male chemosignals is not affected by opioidergic antagonists. We hypothesize that glutamatergic projections from the amygdala into the accumbens might be important to modulate the neurochemical and behavioral responses elicited by sexual chemosignals in rats.

Community preferences for a social health insurance benefit package: an exploratory study among the uninsured in Vietnam.

PubMed

Nguyen, Hoa Thi; Luu, Tinh Viet; Leppert, Gerald; De Allegri, Manuela

2017-01-01

Understanding public preferences in terms of health benefit packages (HBPs) remains limited, yet gathering community insights is an important endeavour when developing people-centred health systems and moving towards universal health coverage. Our study aimed to address this gap in knowledge by eliciting community preferences for the social health insurance benefit package among the uninsured in Vietnam. We adopted a mixed methods approach that included a ranking exercise followed by focus group discussions. We collected quantitative and qualitative data from 174 uninsured people in Bac Giang, a province in northern Vietnam. Study participants were purposively selected from 12 communities and assembled in 14 group sessions that entailed three stages: participants first selected and ranked benefit items individually, then in groups and finally they engaged in a discussion regarding their decisions. The majority of respondents (both as individuals and as groups) preferred an HBP that covers both curative and preventive care, with a strong preference for the inclusion of high-cost care, resulting from rare and costly events (inpatient care), as well as frequent and less costly events (drugs, tests and outpatient care). The process of group discussion highlighted how individual choices could be modified in the context of group negotiation. The shift in preferences was motivated by the wish to protect low-income people from catastrophic expenditure while maximising community access to vital yet costly healthcare services. Future research, interventions and policies can built on this initial exploration of preferences to explore how stakeholders can engage communities and support greater public involvement in the development of HBPs in Vietnam and other low-income and middle-income countries.

Social Orienting and Attention Is Influenced by the Presence of Competing Nonsocial Information in Adolescents with Autism

PubMed Central

Unruh, Kathryn E.; Sasson, Noah J.; Shafer, Robin L.; Whitten, Allison; Miller, Stephanie J.; Turner-Brown, Lauren; Bodfish, James W.

2016-01-01

Background: Our experiences with the world play a critical role in neural and behavioral development. Children with autism spectrum disorder (ASD) spend a disproportionate amount of time seeking out, attending to, and engaging with aspects of their environment that are largely nonsocial in nature. In this study we adapted an established method for eliciting and quantifying aspects of visual choice behavior related to preference to test the hypothesis that preference for nonsocial sources of stimulation diminishes orientation and attention to social sources of stimulation in children with ASD. Method: Preferential viewing tasks can serve as objective measures of preference, with a greater proportion of viewing time to one item indicative of increased preference. The current task used gaze-tracking technology to examine patterns of visual orientation and attention to stimulus pairs that varied in social (faces) and nonsocial content (high autism interest or low autism interest). Participants included both adolescents diagnosed with ASD and typically developing; groups were matched on IQ and gender. Results: Repeated measures ANOVA revealed that individuals with ASD had a significantly greater latency to first fixate on social images when this image was paired with a high autism interest image, compared to a low autism interest image pairing. Participants with ASD showed greater total look time to objects, while typically developing participants preferred to look at faces. Groups also differed in number and average duration of fixations to social and object images. In the ASD group only, a measure of nonsocial interest was associated with reduced preference for social images when paired with high autism interest images. Conclusions: In ASD, the presence of nonsocial sources of stimulation can significantly increase the latency of look time to social sources of information. These results suggest that atypicalities in social motivation in ASD may be context-dependent, with a greater degree of plasticity than is assumed by existing social motivation accounts of ASD. PMID:28066169

Assessment of the societal and individual preferences for fertility treatment in Australia: study protocol for stated preference discrete choice experiments

PubMed Central

Donnolley, Natasha; Shanahan, Marian; Chambers, Georgina M

2018-01-01

Introduction In Australia, societal and individual preferences for funding fertility treatment remain largely unknown. This has resulted in a lack of evidence about willingness to pay (WTP) for fertility treatment by either the general population (the funders) or infertile individuals (who directly benefit). Using a stated preference discrete choice experiment (SPDCE) approach has been suggested as a more appropriate method to inform economic evaluations of fertility treatment. We outline the protocol for an ongoing study which aims to assess fertility treatment preferences of both the general population and infertile individuals, and indirectly estimate their WTP for fertility treatment. Methods and analysis Two separate but related SPDCEs will be conducted for two population samples—the general population and infertile individuals—to elicit preferences for fertility treatment to indirectly estimate WTP. We describe the qualitative work to be undertaken to design the SPDCEs. We will use D-efficient fractional experimental designs informed by prior coefficients from the pilot surveys. The mode of administration for the SPDCE is also discussed. The final results will be analysed using mixed logit or latent class model. Ethics and dissemination This study is being funded by the Australian National Health and Medical Research Council (NHMRC) project grant AP1104543 and has been approved by the University of New South Wales Human Research Ethics Committee (HEC 17255) and a fertility clinic’s ethics committee. Findings of the study will be disseminated in peer-reviewed journals and presented at various conferences. A lay summary of the results will be made publicly available on the University of New South Wales National Perinatal Epidemiology and Statistics Unit website. Our results will contribute to the development of an evidence-based policy framework for the provision of cost-effective and patient-centred fertility treatment in Australia. PMID:29444788

Compositional changes in (iso)flavonoids and estrogenic activity of three edible Lupinus species by germination and Rhizopus-elicitation.

PubMed

Aisyah, Siti; Vincken, Jean-Paul; Andini, Silvia; Mardiah, Zahara; Gruppen, Harry

2016-02-01

The effects of germination and elicitation on (iso)flavonoid composition of extracts from three edible lupine species (Lupinus luteus, Lupinus albus, Lupinus angustifolius) were determined by RP-UHPLC-MS(n). The total (iso)flavonoid content of lupine increased over 10-fold upon germination, with the total content and composition of isoflavonoids more affected than those of flavonoids. Glycosylated isoflavones were the most predominant compounds found in lupine seedlings. Lesser amounts of isoflavone aglycones, including prenylated ones, were also accumulated. Elicitation with Rhizopus oryzae, in addition to germination, raised the content of isoflavonoids further: the total content of 2'-hydroxygenistein derivatives was increased considerably, without increasing that of genistein derivatives. Elicitation by fungus triggered prenylation of isoflavonoids, especially of the 2'-hydroxygenistein derivatives. The preferred positions of prenylation differed among the three lupine species. The change in isoflavone composition increased the agonistic activity of the extracts towards the human estrogen receptors, whereas no antagonistic activity was observed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Video Elicitation Interviews: A Qualitative Research Method for Investigating Physician-Patient Interactions

PubMed Central

Henry, Stephen G.; Fetters, Michael D.

2012-01-01

We describe the concept and method of video elicitation interviews and provide practical guidance for primary care researchers who want to use this qualitative method to investigate physician-patient interactions. During video elicitation interviews, researchers interview patients or physicians about a recent clinical interaction using a video recording of that interaction as an elicitation tool. Video elicitation is useful because it allows researchers to integrate data about the content of physician-patient interactions gained from video recordings with data about participants’ associated thoughts, beliefs, and emotions gained from elicitation interviews. This method also facilitates investigation of specific events or moments during interactions. Video elicitation interviews are logistically demanding and time consuming, and they should be reserved for research questions that cannot be fully addressed using either standard interviews or video recordings in isolation. As many components of primary care fall into this category, high-quality video elicitation interviews can be an important method for understanding and improving physician-patient interactions in primary care. PMID:22412003

Video elicitation interviews: a qualitative research method for investigating physician-patient interactions.

PubMed

Henry, Stephen G; Fetters, Michael D

2012-01-01

We describe the concept and method of video elicitation interviews and provide practical guidance for primary care researchers who want to use this qualitative method to investigate physician-patient interactions. During video elicitation interviews, researchers interview patients or physicians about a recent clinical interaction using a video recording of that interaction as an elicitation tool. Video elicitation is useful because it allows researchers to integrate data about the content of physician-patient interactions gained from video recordings with data about participants' associated thoughts, beliefs, and emotions gained from elicitation interviews. This method also facilitates investigation of specific events or moments during interactions. Video elicitation interviews are logistically demanding and time consuming, and they should be reserved for research questions that cannot be fully addressed using either standard interviews or video recordings in isolation. As many components of primary care fall into this category, high-quality video elicitation interviews can be an important method for understanding and improving physician-patient interactions in primary care.

An Assessment of Continuing Education Needs of Dietitians.

ERIC Educational Resources Information Center

Burkholder, Vel Rae; Eisele, Jill Elizabeth

1984-01-01

Surveyed dietitians (N=359) from four upper midwestern states to determine their perceived continuing education needs. The self-assessment questionnaire used elicited information about their present continuing education activities, preferences for future activities, employment, and the need for continuing education in management, nutrition care,…

Neural Underpinnings of the Identifiable Victim Effect: Affect Shifts Preferences for Giving

PubMed Central

Västfjäll, Daniel; Slovic, Paul; Knutson, Brian

2013-01-01

The “identifiable victim effect” refers to peoples' tendency to preferentially give to identified versus anonymous victims of misfortune, and has been proposed to partly depend on affect. By soliciting charitable donations from human subjects during behavioral and neural (i.e., functional magnetic resonance imaging) experiments, we sought to determine whether and how affect might promote the identifiable victim effect. Behaviorally, subjects gave more to orphans depicted by photographs versus silhouettes, and their shift in preferences was mediated by photograph-induced feelings of positive arousal, but not negative arousal. Neurally, while photographs versus silhouettes elicited activity in widespread circuits associated with facial and affective processing, only nucleus accumbens activity predicted and could statistically account for increased donations. Together, these findings suggest that presenting evaluable identifiable information can recruit positive arousal, which then promotes giving. We propose that affect elicited by identifiable stimuli can compel people to give more to strangers, even despite costs to the self. PMID:24155323

Fairness violations elicit greater punishment on behalf of another than for oneself.

PubMed

FeldmanHall, Oriel; Sokol-Hessner, Peter; Van Bavel, Jay J; Phelps, Elizabeth A

2014-10-28

Classic psychology and economic studies argue that punishment is the standard response to violations of fairness norms. Typically, individuals are presented with the option to punish the transgressor or not. However, such a narrow choice set may fail to capture stronger alternative preferences for restoring justice. Here we show, in contrast to the majority of findings on social punishment, that other forms of justice restoration (for example, compensation to the victim) are strongly preferred to punitive measures. Furthermore, these alternative preferences for restoring justice depend on the perspective of the deciding agent. When people are the recipient of an unfair offer, they prefer to compensate themselves without seeking retribution, even when punishment is free. Yet when people observe a fairness violation targeted at another, they change their decision to the most punitive option. Together these findings indicate that humans prefer alternative forms of justice restoration to punishment alone.

Fairness violations elicit greater punishment on behalf of another than for oneself

PubMed Central

FeldmanHall, Oriel; Sokol-Hessner, Peter; Van Bavel, Jay J.; Phelps, Elizabeth A.

2014-01-01

Classic psychology and economic studies argue that punishment is the standard response to violations of fairness norms. Typically, individuals are presented with the option to punish the transgressor or not. However, such a narrow choice set may fail to capture stronger alternative preferences for restoring justice. Here we show, in contrast to the majority of findings on social punishment, that other forms of justice restoration (e.g., compensation to the victim) are strongly preferred to punitive measures. Furthermore, these alternative preferences for restoring justice depend on the perspective of the deciding agent. When people are the recipient of an unfair offer, they prefer to compensate themselves without seeking retribution, even when punishment is free. Yet when people observe a fairness violation targeted at another, they change their decision to the most punitive option. Together these findings indicate that humans prefer alternative forms of justice restoration to punishment alone. PMID:25350814

Arousal and gambling mode preference: a review of the literature.

PubMed

Baudinet, Julian; Blaszczynski, Alexander

2013-06-01

The purpose of this paper is to review the literature examining subjective and physiological arousal associated with an individual's preferred modes of gambling. Arousal is hypothesised to play a central role in the onset and maintenance of problem gambling. Most studies have failed to differentiate relevant patterns of arousal elicited by stimuli associated with preferred versus non-preferred modes of gambling on the assumption that similar processes motivate all gamblers. At the conceptual level, sub-typing theories of problem gambling propose differences in the motivation to gamble, and the associated role arousal plays in maintaining behaviours. A review of the existing literature reveals preliminary findings that indicate that gamblers respond differentially to preferred compared to non-preferred gambling stimuli, and that gamblers may display greater reactivity in arousal to gambling cues compared to non-gamblers. Understanding differences in such patterns of arousal can be used to inform clinical interventions by effectively targeting the nature and role of arousal associated with preferred modes of gambling, and determining the extent to which non-preferred modes act as secondary reinforces triggering by gambling urges.

Opinion-enhanced collaborative filtering for recommender systems through sentiment analysis

NASA Astrophysics Data System (ADS)

Wang, Wei; Wang, Hongwei

2015-10-01

The motivation of collaborative filtering (CF) comes from the idea that people often get the best recommendations from someone with similar tastes. With the growing popularity of opinion-rich resources such as online reviews, new opportunities arise as we can identify the preferences from user opinions. The main idea of our approach is to elicit user opinions from online reviews, and map such opinions into preferences that can be understood by CF-based recommender systems. We divide recommender systems into two types depending on the number of product category recommended: the multiple-category recommendation and the single-category recommendation. For the former, sentiment polarity in coarse-grained manner is identified while for the latter fine-grained sentiment analysis is conducted for each product aspect. If the evaluation frequency for an aspect by a user is greater than the average frequency by all users, it indicates that the user is more concerned with that aspect. If a user's rating for an aspect is lower than the average rating by all users, he or she is much pickier than others on that aspect. Through sentiment analysis, we then build an opinion-enhanced user preference model, where the higher the similarity between user opinions the more consistent preferences between users are. Experiment results show that the proposed CF algorithm outperforms baseline methods for product recommendation in terms of accuracy and recall.

Health-related quality of life anticipated with different management strategies for paediatric febrile neutropaenia

PubMed Central

Cheng, S; Teuffel, O; Ethier, M C; Diorio, C; Martino, J; Mayo, C; Regier, D; Wing, R; Alibhai, S M H; Sung, L

2011-01-01

Background: To describe (1) anticipated health-related quality of life during different strategies for febrile neutropaenia (FN) management and (2) attributes of those preferring inpatient management. Methods: Respondents were parents of children 0–18 years and children 12–18 years receiving cancer treatment. Anticipated health-related quality of life was elicited for four different FN management strategies: entire inpatient, early discharge, outpatient oral and outpatient intravenous (i.v.) therapy. Tools used to measure health-related quality of life were visual analogue scale (VAS), willingness to pay and time trade off. Results: A total of 155 parents and 43 children participated. For parents, median VAS scores were highest for early discharge (5.9, interquartile range 4.4–7.2) and outpatient i.v. (5.9, interquartile range 4.4–7.3). For children, median scores were highest for early discharge (6.1, interquartile range 4.6–7.2). In contrast, the most commonly preferred strategy for parents and children was inpatient in 55.0% and 37.2%, respectively. Higher current child health-related quality of life was associated with a stronger preference for outpatient management. Conclusion: Early discharge and outpatient i.v. management are associated with higher anticipated health-related quality of life, although the most commonly preferred strategy was inpatient care. This data may help with determining more cost-effective strategies for paediatric FN. PMID:21694729

Preferences for general practice jobs: a survey of principals and sessional GPs

PubMed Central

Wordsworth, Sarah; Skåtun, Diane; Scott, Anthony; French, Fiona

2004-01-01

Background: Many countries are experiencing recruitment and retention problems in general practice, particularly in rural areas. In the United Kingdom (UK), recent contractual changes aim to address general practitioner (GP) recruitment and retention difficulties. However, the evidence base for their impact is limited, and preference differences between principals and sessional GPs (previously called non-principals) are insufficiently explored. Aim: To elicit GP principals' and sessional GPs' preferences for alternative jobs in general practice, and to identify the most important work attributes. Design of study: A discrete choice experiment. Setting: National Health Service (NHS) general practices throughout Scotland. Method: A postal questionnaire was sent to 1862 principals and 712 sessional GPs. The questionnaire contained a discrete choice experiment to quantify GPs' preferences for different job attributes. Results: A response rate of 49% (904/1862) was achieved for principals and 54% (388/712) for sessional GPs. Of responders, most principals were male (60%), and sessional GPs female (75%), with the average age being 42 years. All GPs preferred a job with longer consultations, no increase in working hours, but an increase in earnings. A job with outside commitments (for example, a health board or hospital) was preferable; one with additional out-of-hours work was less preferable. Sessional GPs placed a lower value on consultation length, were less worried about hours of work, and a job offering sufficient continuing professional development was less important. Conclusion: The differences in preferences between principals and sessional GPs, and also between different personal characteristics, suggests that a general contract could fail to cater for all GPs. Recruitment and retention of GPs may improve if the least preferred aspects of their jobs are changed. However, the long-term success of contractual reform will require enhancement of the positive aspects of working, such as patient contact. PMID:15469673

Eliciting Mathematics Interest: New Directions for Context Personalization and Example Choice

ERIC Educational Resources Information Center

Høgheim, Sigve; Reber, Rolf

2017-01-01

Building on common assumptions in theories of interest and mathematics education, this experimental study examined the effect of context personalization based on individual preferences, group personalization, and example choice with preselected popular examples on middle school students' situational interest and performance in mathematics.…

Social environment elicits lateralized behaviors in gorillas (Gorilla gorilla gorilla) and chimpanzees (Pan troglodytes).

PubMed

Quaresmini, Caterina; Forrester, Gillian S; Spiezio, Caterina; Vallortigara, Giorgio

2014-08-01

The influence of the social environment on lateralized behaviors has now been investigated across a wide variety of animal species. New evidence suggests that the social environment can modulate behavior. Currently, there is a paucity of data relating to how primates navigate their environmental space, and investigations that consider the naturalistic context of the individual are few and fragmented. Moreover, there are competing theories about whether only the right or rather both cerebral hemispheres are involved in the processing of social stimuli, especially in emotion processing. Here we provide the first report of lateralized social behaviors elicited by great apes. We employed a continuous focal animal sampling method to record the spontaneous interactions of a captive zoo-living colony of chimpanzees (Pan troglodytes) and a biological family group of peer-reared western lowland gorillas (Gorilla gorilla gorilla). We specifically focused on which side of the body (i.e., front, rear, left, right) the focal individual preferred to keep conspecifics. Utilizing a newly developed quantitative corpus-coding scheme, analysis revealed both chimpanzees and gorillas demonstrated a significant group-level preference for focal individuals to keep conspecifics positioned to the front of them compared with behind them. More interestingly, both groups also manifested a population-level bias to keep conspecifics on their left side compared with their right side. Our findings suggest a social processing dominance of the right hemisphere for context-specific social environments. Results are discussed in light of the evolutionary adaptive value of social stimulus as a triggering factor for the manifestation of group-level lateralized behaviors.

Simulation study to determine the impact of different design features on design efficiency in discrete choice experiments

PubMed Central

Vanniyasingam, Thuva; Cunningham, Charles E; Foster, Gary; Thabane, Lehana

2016-01-01

Objectives Discrete choice experiments (DCEs) are routinely used to elicit patient preferences to improve health outcomes and healthcare services. While many fractional factorial designs can be created, some are more statistically optimal than others. The objective of this simulation study was to investigate how varying the number of (1) attributes, (2) levels within attributes, (3) alternatives and (4) choice tasks per survey will improve or compromise the statistical efficiency of an experimental design. Design and methods A total of 3204 DCE designs were created to assess how relative design efficiency (d-efficiency) is influenced by varying the number of choice tasks (2–20), alternatives (2–5), attributes (2–20) and attribute levels (2–5) of a design. Choice tasks were created by randomly allocating attribute and attribute level combinations into alternatives. Outcome Relative d-efficiency was used to measure the optimality of each DCE design. Results DCE design complexity influenced statistical efficiency. Across all designs, relative d-efficiency decreased as the number of attributes and attribute levels increased. It increased for designs with more alternatives. Lastly, relative d-efficiency converges as the number of choice tasks increases, where convergence may not be at 100% statistical optimality. Conclusions Achieving 100% d-efficiency is heavily dependent on the number of attributes, attribute levels, choice tasks and alternatives. Further exploration of overlaps and block sizes are needed. This study's results are widely applicable for researchers interested in creating optimal DCE designs to elicit individual preferences on health services, programmes, policies and products. PMID:27436671

Ethics teaching in a medical education environment: preferences for diversity of learning and assessment methods

PubMed Central

AlMahmoud, Tahra; Hashim, M. Jawad; Elzubeir, Margaret Ann; Branicki, Frank

2017-01-01

ABSTRACT Background: Ethics and professionalism are an integral part of medical school curricula; however, medical students’ views on these topics have not been assessed in many countries. Objective: The study aimed to examine medical students’ perceptions toward ethics and professionalism teaching, and its learning and assessment methods. Design: A self-administered questionnaire eliciting views on professionalism and ethics education was distributed to a total of 128 final-year medical students. Results: A total of 108 students completed the survey, with an 84% response rate. Medical students reported frequently encountering ethical conflicts during training but stated only a moderate level of ethics training at medical school (mean = 5.14 ± 1.8). They noted that their education had helped somewhat to deal with ethical conflicts (mean = 5.39 ± 2.0). Students strongly affirmed the importance of ethics education (mean = 7.63 ± 1.03) and endorsed the value of positive role models (mean = 7.45 ± 1.5) as the preferred learning method. The cohort voiced interest in direct faculty supervision as an approach to assessment of knowledge and skills (mean = 7.62 ± 1.26). Female students perceived greater need for more ethics education compared to males (p = < 0.05). Students who claimed that they had experienced some unprofessional treatment had a more limited view of the importance of ethics as a subject (P = 0.001). Conclusion: Medical students viewed ethics education positively and preferred clinically attuned methods for learning. PMID:28562234

Item Response Modeling of Multivariate Count Data with Zero Inflation, Maximum Inflation, and Heaping

ERIC Educational Resources Information Center

Magnus, Brooke E.; Thissen, David

2017-01-01

Questionnaires that include items eliciting count responses are becoming increasingly common in psychology. This study proposes methodological techniques to overcome some of the challenges associated with analyzing multivariate item response data that exhibit zero inflation, maximum inflation, and heaping at preferred digits. The modeling…

Puerto Rican Children's Race Awareness.

ERIC Educational Resources Information Center

Ogletree, Earl J.; Rameriz, Lester

Much of the research on the racial attitudes of young children suggests that black or dark skin color elicits negative attitudes, while white skin color is embraced by all children regardless of their skin color. The authors sought to determine if Puerto Rican children exhibited similar ethnic identification and color preference characteristics.…

Are life-extending treatments for terminal illnesses a special case? Exploring choices and societal viewpoints.

PubMed

McHugh, Neil; van Exel, Job; Mason, Helen; Godwin, Jon; Collins, Marissa; Donaldson, Cam; Baker, Rachel

2018-02-01

Criteria used by the National Institute for Health and Care Excellence (NICE) to assess life-extending, end-of-life (EoL) treatments imply that health gains from such treatments are valued more than other health gains. Despite claims that the policy is supported by societal values, evidence from preference elicitation studies is mixed and in-depth research has shown there are different societal viewpoints. Few studies elicit preferences for policies directly or combine different approaches to understand preferences. Survey questions were designed to investigate support for NICE EoL guidance at national and regional levels. These 'Decision Rule' and 'Treatment Choice' questions were administered to an online sample of 1496 UK respondents in May 2014. The same respondents answered questions designed to elicit their agreement with three viewpoints (previously identified and described) in relation to provision of EoL treatments for terminally ill patients. We report the findings of these choice questions and examine how they relate to each other and respondents' viewpoints. The Decision Rule questions described three policies: DA - a standard 'value for money' test, applied to all health technologies; DB - giving special consideration to all treatments for terminal illnesses; and DC - giving special consideration to specific categories of treatments for terminal illnesses e.g. life extension (as in NICE EoL guidance) or those that improve quality-of-life (QoL). Three Treatment Choices were presented: TA - improving QoL for patients with a non-terminal illness; TB - extending life for EoL patients; and TC - improving QoL at the EoL. DC received most support (45%) with most respondents giving special consideration to EoL only when treatments improved QoL. The most commonly preferred treatment choices were TA (51%) and TC (43%). Overall, this study challenges claims about public support for NICE's EoL guidance and the focus on life extension at EoL and substantiates existing evidence of plurality in societal values. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Risk preference shares the psychometric structure of major psychological traits

PubMed Central

Frey, Renato; Pedroni, Andreas; Mata, Rui; Rieskamp, Jörg; Hertwig, Ralph

2017-01-01

To what extent is there a general factor of risk preference, R, akin to g, the general factor of intelligence? Can risk preference be regarded as a stable psychological trait? These conceptual issues persist because few attempts have been made to integrate multiple risk-taking measures, particularly measures from different and largely unrelated measurement traditions (self-reported propensity measures assessing stated preferences, incentivized behavioral measures eliciting revealed preferences, and frequency measures assessing actual risky activities). Adopting a comprehensive psychometric approach (1507 healthy adults completing 39 risk-taking measures, with a subsample of 109 participants completing a retest session after 6 months), we provide a substantive empirical foundation to address these issues, finding that correlations between propensity and behavioral measures were weak. Yet, a general factor of risk preference, R, emerged from stated preferences and generalized to specific and actual real-world risky activities (for example, smoking). Moreover, R proved to be highly reliable across time, indicative of a stable psychological trait. Our findings offer a first step toward a general mapping of the construct risk preference, which encompasses both general and domain-specific components, and have implications for the assessment of risk preference in the laboratory and in the wild. PMID:28983511

A Systematic Review Comparing the Acceptability, Validity and Concordance of Discrete Choice Experiments and Best-Worst Scaling for Eliciting Preferences in Healthcare.

PubMed

Whitty, Jennifer A; Oliveira Gonçalves, Ana Sofia

2018-06-01

The aim of this study was to compare the acceptability, validity and concordance of discrete choice experiment (DCE) and best-worst scaling (BWS) stated preference approaches in health. A systematic search of EMBASE, Medline, AMED, PubMed, CINAHL, Cochrane Library and EconLit databases was undertaken in October to December 2016 without date restriction. Studies were included if they were published in English, presented empirical data related to the administration or findings of traditional format DCE and object-, profile- or multiprofile-case BWS, and were related to health. Study quality was assessed using the PREFS checklist. Fourteen articles describing 12 studies were included, comparing DCE with profile-case BWS (9 studies), DCE and multiprofile-case BWS (1 study), and profile- and multiprofile-case BWS (2 studies). Although limited and inconsistent, the balance of evidence suggests that preferences derived from DCE and profile-case BWS may not be concordant, regardless of the decision context. Preferences estimated from DCE and multiprofile-case BWS may be concordant (single study). Profile- and multiprofile-case BWS appear more statistically efficient than DCE, but no evidence is available to suggest they have a greater response efficiency. Little evidence suggests superior validity for one format over another. Participant acceptability may favour DCE, which had a lower self-reported task difficulty and was preferred over profile-case BWS in a priority setting but not necessarily in other decision contexts. DCE and profile-case BWS may be of equal validity but give different preference estimates regardless of the health context; thus, they may be measuring different constructs. Therefore, choice between methods is likely to be based on normative considerations related to coherence with theoretical frameworks and on pragmatic considerations related to ease of data collection.

How Well Can Analytic Hierarchy Process be Used to Elicit Individual Preferences? Insights from a Survey in Patients Suffering from Age-Related Macular Degeneration.

PubMed

Danner, Marion; Vennedey, Vera; Hiligsmann, Mickaël; Fauser, Sascha; Gross, Christian; Stock, Stephanie

2016-10-01

In this study, we tested the feasibility of an interviewer-assisted analytic hierarchy process (AHP) in a special patient population with age-related macular degeneration (AMD). One aim was to generate preference weights regarding AMD treatment characteristics. A secondary aim was to explore the consistency of preference judgments and reasons for inconsistency. We generated quantitative importance weights for decision criteria using the matrix multiplication method. A qualitative study component in the form of asking patients to think aloud throughout their judgments was implemented to facilitate understanding of quantitative findings. Consistency ratios were calculated as a measure of logical judgment performance within AHP. If consistency ratios exceeded 0.2, we explored reasons for inconsistency. We interviewed 86 patients and generated preference weights for criteria. Patients rated the injection's effect on visual function the highest (0.44), followed by the frequency of monitoring visits (0.18), approval status (0.13), injection frequency (0.13), and side effects (0.12). Inconsistency in judgments was prevalent at the subcriteria level. Whereas much of the observed inconsistency was due to an excessive use of high/extreme value judgments, these judgments seemed to result from patients reasonably trying to highlight their strong preferences. Our study combines quantitative with qualitative data to explore patients' preference weights and decision processes using the AHP. It suggests that the type of inconsistency observed in judgments of AMD patients mostly results from rational decision making, not from error or lack of understanding. Further research should address which type and extent of inconsistency might be acceptable in different AHP settings.

Congruence between Preferred and Actual Participation Roles Increases Satisfaction with Treatment Decision Making among Japanese Women with Breast Cancer

PubMed

Yamauchi, Keiko; Nakao, Motoyuki; Nakashima, Mitsuyo; Ishihara, Yoko

2017-04-01

Objective: This study investigated the correlation between participation in the treatment decision-making process and satisfaction with the process among Japanese women with breast cancer. The influence of sociodemographic and clinical characteristics on satisfaction with the treatment decision-making process was also examined. Methods: We conducted a cross-sectional, self-administered internet survey of 650 Japanese women with breast cancer in March 2016. Decisional role (active, collaborative, passive) in the treatment decision-making was elicited using the Japanese version of the Control Preference Scale. Satisfaction with the decision-making process was assessed. Result: About half of the participants preferred to play a collaborative role, while half of the participants perceived that they played an active role. Satisfaction among the participants who made their treatment choice collaboratively with their physicians was significantly higher than that of participants who made the choice by themselves or entrusted their physicians to make the decision. However, two-way ANOVA demonstrated that satisfaction level was associated with the congruence between the participants’ preferred and actual decisional roles, but not with the actual decisional roles that they played. This association had no interaction with sociodemographic and clinical status, except for education level. A majority of the participants who participated in the roles they preferred in choosing their treatment option indicated that they would participate in the same role if they were to face a similar decision-making situation in the future. Conclusion: Regardless of their role played in the cancer treatment decision-making process, and irrespective of their sociodemographic and clinical status, Japanese women with breast cancer are more satisfied with the treatment decision-making process when their participation in the process matches their preferred role in the process. Creative Commons Attribution License

Subject preferences of first- and second-year medical students for their future specialization at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal – a questionnaire-based study

PubMed Central

Jha, Rajesh K; Paudel, Keshab R; Shah, Dev K; Sah, Ajit K; Basnet, Sangharshila; Sah, Phoolgen; Adhikari, Sandeep

2015-01-01

Introduction The selection of a discipline for future specialization may be an important factor for the medical students’ future career, and it is influenced by multiple factors. The interest of students in the early stages can be improved in subjects related to public health or of academic importance, as per need. Methods A questionnaire-based study was conducted among 265 first- and second-year medical students of Chitwan Medical College, Nepal to find out their subject of preference for postgraduation and the factors affecting their selection along with their interesting basic science subject. Only the responses from 232 completely filled questionnaires were analyzed. Results The preference of the students for clinical surgical (50.9%), clinical medical (45.3%), and basic medical (3.9%) sciences for postgraduation were in descending order. The most preferred specialty among male students was clinical surgical sciences (56.3%), and among female students, it was clinical medical sciences (53.6%). Although all the students responded to their preferred specialty, only 178 students specified the subject of their interest. General surgery (23.4%), pediatrics (23.4%), and anatomy (2.4%) were the most favored subjects for postgraduation among clinical surgical, clinical medical, and basic medical sciences specialties, respectively. More common reasons for selection of specific subject for future career were found to be: personal interests, good income, intellectual challenge, and others. Conclusion Many students preferred clinical surgical sciences for their future specialization. Among the reasons for the selection of the specialty for postgraduation, no significant reason could be elicited from the present study. PMID:26635491

Congruence between Preferred and Actual Participation Roles Increases Satisfaction with Treatment Decision Making among Japanese Women with Breast Cancer

PubMed Central

Yamauchi, Keiko; Nakao, Motoyuki; Nakashima, Mitsuyo; Ishihara, Yoko

2017-01-01

Objective: This study investigated the correlation between participation in the treatment decision-making process and satisfaction with the process among Japanese women with breast cancer. The influence of sociodemographic and clinical characteristics on satisfaction with the treatment decision-making process was also examined. Methods: We conducted a cross-sectional, self-administered internet survey of 650 Japanese women with breast cancer in March 2016. Decisional role (active, collaborative, passive) in the treatment decision-making was elicited using the Japanese version of the Control Preference Scale. Satisfaction with the decision-making process was assessed. Result: About half of the participants preferred to play a collaborative role, while half of the participants perceived that they played an active role. Satisfaction among the participants who made their treatment choice collaboratively with their physicians was significantly higher than that of participants who made the choice by themselves or entrusted their physicians to make the decision. However, two-way ANOVA demonstrated that satisfaction level was associated with the congruence between the participants’ preferred and actual decisional roles, but not with the actual decisional roles that they played. This association had no interaction with sociodemographic and clinical status, except for education level. A majority of the participants who participated in the roles they preferred in choosing their treatment option indicated that they would participate in the same role if they were to face a similar decision-making situation in the future. Conclusion: Regardless of their role played in the cancer treatment decision-making process, and irrespective of their sociodemographic and clinical status, Japanese women with breast cancer are more satisfied with the treatment decision-making process when their participation in the process matches their preferred role in the process. PMID:28545197

Methods to elicit probability distributions from experts: a systematic review of reported practice in health technology assessment.

PubMed

Grigore, Bogdan; Peters, Jaime; Hyde, Christopher; Stein, Ken

2013-11-01

Elicitation is a technique that can be used to obtain probability distribution from experts about unknown quantities. We conducted a methodology review of reports where probability distributions had been elicited from experts to be used in model-based health technology assessments. Databases including MEDLINE, EMBASE and the CRD database were searched from inception to April 2013. Reference lists were checked and citation mapping was also used. Studies describing their approach to the elicitation of probability distributions were included. Data was abstracted on pre-defined aspects of the elicitation technique. Reports were critically appraised on their consideration of the validity, reliability and feasibility of the elicitation exercise. Fourteen articles were included. Across these studies, the most marked features were heterogeneity in elicitation approach and failure to report key aspects of the elicitation method. The most frequently used approaches to elicitation were the histogram technique and the bisection method. Only three papers explicitly considered the validity, reliability and feasibility of the elicitation exercises. Judged by the studies identified in the review, reports of expert elicitation are insufficient in detail and this impacts on the perceived usability of expert-elicited probability distributions. In this context, the wider credibility of elicitation will only be improved by better reporting and greater standardisation of approach. Until then, the advantage of eliciting probability distributions from experts may be lost.

Scholarly Concentration Program Development: A Generalizable, Data-Driven Approach.

PubMed

Burk-Rafel, Jesse; Mullan, Patricia B; Wagenschutz, Heather; Pulst-Korenberg, Alexandra; Skye, Eric; Davis, Matthew M

2016-11-01

Scholarly concentration programs-also known as scholarly projects, pathways, tracks, or pursuits-are increasingly common in U.S. medical schools. However, systematic, data-driven program development methods have not been described. The authors examined scholarly concentration programs at U.S. medical schools that U.S. News & World Report ranked as top 25 for research or primary care (n = 43 institutions), coding concentrations and mission statements. Subsequently, the authors conducted a targeted needs assessment via a student-led, institution-wide survey, eliciting learners' preferences for 10 "Pathways" (i.e., concentrations) and 30 "Topics" (i.e., potential content) augmenting core curricula at their institution. Exploratory factor analysis (EFA) and a capacity optimization algorithm characterized best institutional options for learner-focused Pathway development. The authors identified scholarly concentration programs at 32 of 43 medical schools (74%), comprising 199 distinct concentrations (mean concentrations per program: 6.2, mode: 5, range: 1-16). Thematic analysis identified 10 content domains; most common were "Global/Public Health" (30 institutions; 94%) and "Clinical/Translational Research" (26 institutions; 81%). The institutional needs assessment (n = 468 medical students; response rate 60% overall, 97% among first-year students) demonstrated myriad student preferences for Pathways and Topics. EFA of Topic preferences identified eight factors, systematically related to Pathway preferences, informing content development. Capacity modeling indicated that offering six Pathways could guarantee 95% of first-year students (162/171) their first- or second-choice Pathway. This study demonstrates a generalizable, data-driven approach to scholarly concentration program development that reflects student preferences and institutional strengths, while optimizing program diversity within capacity constraints.

Pulmonologists' Reported Use of Guidelines and Shared Decision-making in Evaluation of Pulmonary Nodules: A Qualitative Study.

PubMed

Wiener, Renda Soylemez; Slatore, Christopher G; Gillespie, Chris; Clark, Jack A

2015-12-01

Selecting a strategy (surveillance, biopsy, resection) for pulmonary nodule evaluation can be complex given the absence of high-quality data comparing strategies and the important tradeoffs among strategies. Guidelines recommend a three-step approach: (1) assess the likelihood of malignancy, (2) evaluate whether the patient is a candidate for invasive intervention, and (3) elicit the patient's preferences and engage in shared decision-making. We sought to characterize how pulmonologists select a pulmonary nodule evaluation strategy and the extent to which they report following the guideline-recommended approach. We conducted semistructured qualitative interviews with 14 pulmonologists who manage patients with pulmonary nodules at four clinical sites. Transcripts of audiorecorded interviews were analyzed using the principles of grounded theory. Pulmonologists reported consistently performing steps 1 and 2 but described diverse approaches to step 3 that ranged from always engaging the patient in decision-making to never doing so. Many described incorporating patients' preferences only in particular circumstances, such as when the patient appeared particularly anxious or was aggressive in questioning management options. Indeed, other factors, including convenience, physician preferences, physician anxiety, malpractice concerns, and physician experience, appeared to drive decision-making as much as, if not more than, patient preferences. Although pulmonologists appear to routinely personalize pulmonary nodule evaluation strategies based on the individual patient's risk-benefit tradeoffs, they may not consistently take patient preferences into account during the decision-making process. In the absence of high-quality evidence regarding the optimal methods of pulmonary nodule evaluation, physicians should strive to ensure that management decisions are consistent with patients' values.

Parents' reported preference scores for childhood atopic dermatitis disease states

PubMed Central

Friedman, Joëlle Y; Reed, Shelby D; Weinfurt, Kevin P; Kahler, Kristijan H; Walter, Emmanuel B; Schulman, Kevin A

2004-01-01

Background We sought to elicit preference weights from parents for health states corresponding to children with various levels of severity of atopic dermatitis. We also evaluated the hypothesis that parents with children who had been diagnosed with atopic dermatitis would assign different preferences to the health state scenarios compared with parents who did not have a child with atopic dermatitis. Methods Subjects were parents of children aged 3 months to 18 years. The sample was derived from the General Panel, Mommies Sub-Panel, and Chronic Illness Sub-Panel of Harris Interactive. Participants rated health scenarios for atopic dermatitis, asthma, and eyeglasses on a visual analog scale, imagining a child was experiencing the described state. Results A total of 3539 parents completed the survey. Twenty-nine percent had a child with a history of atopic dermatitis. Mean preference scores for atopic dermatitis were as follows: mild, 91 (95% confidence interval [CI], 90.7 to 91.5); mild/moderate, 84 (95%CI, 83.5 to 84.4); moderate, 73 (95%CI, 72.5 to 73.6); moderate/severe, 61 (95%CI, 60.6 to 61.8); severe, 49 (95% CI, 48.7 to 50.1); asthma, 58 (95%CI, 57.4 to 58.8); and eyeglasses, 87(95%CI, 86.3 to 87.4). Conclusions Parents perceive that atopic dermatitis has a negative effect on quality of life that increases with disease severity. Estimates of parents' preferences can provide physicians with insight into the value that parents place on their children's treatment and can be used to evaluate new medical therapies for atopic dermatitis. PMID:15491500

Comparison of elicitation methods for moral and affective beliefs in the theory of planned behaviour.

PubMed

Dean, M; Arvola, A; Vassallo, M; Lähteenmäki, L; Raats, M M; Saba, A; Shepherd, R

2006-09-01

Although the theory of planned behaviour (TPB) has been applied successfully in the area of food choice, it has been criticized for its pure utilitarian approach to the factors determining behaviour. Despite the increase in predictive power of the model with added components such as affective attitude and moral and ethical concerns, in most studies the elicitation process still only addresses people's utilitarian beliefs about the behaviour with little attention paid to other aspects. This study compares the traditional method of elicitation of advantages and disadvantages with two other methods (word association and open-ended) in the elicitations of beliefs, attitudes and moral concerns in relation to the consumption of organic foods. Results show the traditional method to be best for eliciting cognitive beliefs, open-ended emotion task for eliciting emotional beliefs and open-ended beliefs task best for moral concerns. The advantages and disadvantages of each method are discussed.

Increased Exposure to Rigid Routines can Lead to Increased Challenging Behavior Following Changes to Those Routines.

PubMed

Bull, Leah E; Oliver, Chris; Callaghan, Eleanor; Woodcock, Kate A

2015-06-01

Several neurodevelopmental disorders are associated with preference for routine and challenging behavior following changes to routines. We examine individuals with Prader-Willi syndrome, who show elevated levels of this behavior, to better understand how previous experience of a routine can affect challenging behavior elicited by disruption to that routine. Play based challenges exposed 16 participants to routines, which were either adhered to or changed. Temper outburst behaviors, heart rate and movement were measured. As participants were exposed to routines for longer before a change (between 10 and 80 min; within participants), more temper outburst behaviors were elicited by changes. Increased emotional arousal was also elicited, which was indexed by heart rate increases not driven by movement. Further study will be important to understand whether current intervention approaches that limit exposure to changes, may benefit from the structured integration of flexibility to ensure that the opportunity for routine establishment is also limited.

Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision.

PubMed

Yardley, Lucy; Morrison, Leanne G; Andreou, Panayiota; Joseph, Judith; Little, Paul

2010-09-17

It is recognised as good practice to use qualitative methods to elicit users' views of internet-delivered health-care interventions during their development. This paper seeks to illustrate the advantages of combining usability testing with 'theoretical modelling', i.e. analyses that relate the findings of qualitative studies during intervention development to social science theory, in order to gain deeper insights into the reasons and context for how people respond to the intervention. This paper illustrates how usability testing may be enriched by theoretical modelling by means of two qualitative studies of users' views of the delivery of information in an internet-delivered intervention to help users decide whether they needed to seek medical care for their cold or flu symptoms. In Study 1, 21 participants recruited from a city in southern England were asked to 'think aloud' while viewing draft web-pages presented in paper format. In Study 2, views of our prototype website were elicited, again using think aloud methods, in a sample of 26 participants purposively sampled for diversity in education levels. Both data-sets were analysed by thematic analysis. Study 1 revealed that although the information provided by the draft web-pages had many of the intended empowering benefits, users often felt overwhelmed by the quantity of information. Relating these findings to theory and research on factors influencing preferences for information-seeking we hypothesised that to meet the needs of different users (especially those with lower literacy levels) our website should be designed to provide only essential personalised advice, but with options to access further information. Study 2 showed that our website design did prove accessible to users with different literacy levels. However, some users seemed to want still greater control over how information was accessed. Educational level need not be an insuperable barrier to appreciating web-based access to detailed health-related information, provided that users feel they can quickly gain access to the specific information they seek.

Designing a Text Messaging Intervention to Improve Physical Activity Behavior Among Low-Income Latino Patients With Diabetes: A Discrete-Choice Experiment, Los Angeles, 2014-2015.

PubMed

Ramirez, Magaly; Wu, Shinyi; Beale, Elizabeth

2016-12-22

Automated text messaging can deliver self-management education to activate self-care behaviors among people with diabetes. We demonstrated how a discrete-choice experiment was used to determine the features of a text-messaging intervention that are important to urban, low-income Latino patients with diabetes and that could support improvement in their physical activity behavior. In a discrete-choice experiment from December 2014 through August 2015 we conducted a survey to elicit information on patient preferences for 5 features of a text-messaging intervention. We described 2 hypothetical interventions and in 7 pairwise comparisons asked respondents to indicate which they preferred. Respondents (n = 125) were recruited in person from a diabetes management program of a safety-net ambulatory care clinic in Los Angeles; clinicians referred patients to the research assistant after routine clinic visits. Data were analyzed by using conditional logistic regression. We found 2 intervention features that were considered by the survey respondents to be important: 1) the frequency of text messaging and 2) physical activity behavior-change education (the former being more important than the latter). Physical activity goal setting, feedback on physical activity performance, and social support were not significantly important. A discrete-choice experiment is a feasible way to elicit information on patient preferences for a text-messaging intervention designed to support behavior change. However, discrepancies may exist between patients' stated preferences and their actual behavior. Future research should validate and expand our findings.

Eliciting Spontaneous Speech in Bilingual Students: Methods & Techniques.

ERIC Educational Resources Information Center

Cornejo, Ricardo J.; And Others

Intended to provide practical information pertaining to methods and techniques for speech elicitation and production, the monograph offers specific methods and techniques to elicit spontaneous speech in bilingual students. Chapter 1, "Traditional Methodologies for Language Production and Recording," presents an overview of studies using…

[Involving patients, the insured and the general public in healthcare decision making].

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

No doubt, the public should be involved in healthcare decision making, especially when decision makers from politics and self-government agencies are faced with the difficult task of setting priorities. There is a general consensus on the need for a stronger patient centeredness, even in HTA processes, and internationally different ways of public participation are discussed and tested in decision making processes. This paper describes how the public can be involved in different decision situations, and it shows how preference measurement methods are currently being used in an international context to support decision making. It distinguishes between different levels of decision making on health technologies: approval, assessment, pricing, and finally utilization. The range of participation efforts extends from qualitative surveys of patients' needs (Citizen Councils of NICE in the UK) to science-based documentation of quantitative patient preferences, such as in the current pilot projects of the FDA in the US and the EMA at the European level. Possible approaches for the elicitation and documentation of preference structures and trade-offs in relation to alternate health technologies are decision aids, such as multi-criteria decision analysis (MCDA), that provide the necessary information for weighting and prioritizing decision criteria. Copyright © 2015. Published by Elsevier GmbH.

How to ask: Older adults’ preferred tools in health outcome prioritization

PubMed Central

Case, Siobhan M.; Fried, Terri R.; O’Leary, John

2012-01-01

OBJECTIVE To assess older adults’ attitudes toward eliciting health outcome priorities. METHODS This observational cohort study of 356 community-living adults age ≥ 65 included three tools: 1) Health Outcomes: ranking four outcomes (survival, function, freedom from pain, and freedom from other symptoms); 2) Now vs. Later: rating importance of current versus future quality of life; 3) Attitude Scale: agreement with statements about health outcomes and current versus future health. RESULTS Whereas 41% preferred Health Outcomes, 40% preferred the Attitude Scale. Only 7–12% rated any tool as very hard or hard. In bivariate analysis, participants of non-white race and with lower education, health literacy, and functional status were significantly more likely to rate at least one of the tools as easy (p<0.05). Across all tools, 17% of participants believed tools would change care. The main reason for thinking there would be no change was satisfaction with existing care (62%). CONCLUSIONS There is variability in how older persons wish to be asked about health outcome priorities. Few find this task difficult, and difficulty was not greater among participants with lower health literacy, education, or health status. PRACTICE IMPLICATIONS By offering different tools, healthcare providers can help patients clarify their health outcome priorities. PMID:23218242

Incentives for Blood Donation: A Discrete Choice Experiment to Analyze Extrinsic Motivation.

PubMed

Sadler, Andrew; Shi, Ling; Bethge, Susanne; Mühlbacher, Axel

2018-04-01

Background: Demographic trends affect size and age structure of populations. One of the consequences will be an increasing need for blood products to treat age-related diseases. Donation services rely on voluntariness and charitable motivation. It might be questioned whether there will be sufficient blood supply with voluntary donation. The present study focused on elicitation of preferences for incentives and aimed to contribute to the discussion on how to increase donation rates. Methods: A self-administered discrete choice experiment (DCE) was applied. Respondents were repeatedly asked to choose between hypothetical blood donation centers. In case of reluctance to receiving incentives a none-option was included. Random parameter logit (RPL) and latent class models (LCM) were used for analysis. Results: The study sample included 416 college students from the US and Germany. Choice decisions were significantly influenced by the characteristics of the donation center in the DCE. Incentives most preferred were monetary compensation, paid leave, and blood screening test. LCM identified subgroups with preference heterogeneity. Small subgroups indicated moderate to strong aversion to incentives. Conclusion: The majority of the sample positively responded to incentives and indicated a willingness to accept incentives. In face of future challenges, the judicious use and appropriate utilization of incentives might be an option to motivate potential donors and should be open to discussion.

“I see it now”: Using photo elicitation to understand chronic illness self-management

PubMed Central

Fritz, Heather; Lysack, Cathy

2018-01-01

Background How people integrate self-management into daily life remains underexamined, and such processes are difficult to elicit through traditional approaches used to understand human occupation. Purpose This paper will provide a brief overview of one visual research method, photo elicitation, that holds promise for studying self-management of health behaviours and will present findings from an analysis of how the use of photo elicitation interviews contributed additional insights into self-management beyond those generated from the data collected through the other methods used in the study. Method A qualitative, multiple-methods, multiple-case study was conducted with a purposive sample of 10 low-income women ages 40 to 64 with type 2 diabetes. Findings The photo elicitation interviews contributed insights beyond those generated from other study methods about how individuals viewed their self-management behaviours and how occupations changed across time. Implications Photo elicitation is a valuable research method for better understanding clients' chronic illness self-management practices. PMID:29898501

Priorities and prospect theory.

PubMed

Happich, M; Mazurek, B

2002-01-01

Whose preferences are to be used for cost-effectiveness analysis? It has been recommended that community preferences for health states are the most appropriate ones for use in a reference case analysis. However, critics maintain that persons are not able properly to judge a health state if they have not experienced the condition themselves. This problem is analyzed here in the framework of Prospect Theory. It can be argued that the differing reference points of patients and the general public are responsible for deviating results. In addition, we argue that risk attitudes with respect to health-related quality of life are an indicator of reference points. If patients and the general public refer to the same reference point, i.e., they have the same risk attitude, the hypothesis is that deviations no longer significantly differ. Evaluations of the health condition of tinnitus by 210 patients and 210 unaffected persons were compared. The Time Tradeoff and Standard Gamble methods were applied to elicit preferences. Risk attitude was measured with the question of whether participants would undergo a treatment that could either improve or worsen their health condition, both with an equal chance (five possible answers between "in no case" and "in any case"). Affected persons indicated significantly higher values for tinnitus-related quality of life according to the Standard Gamble method. The difference between Time Tradeoff values was less dramatic but still significant. In addition, nonaffected persons are more risk-averse than affected persons. However, differences in evaluations are not significant considering single risk groups (e.g., those who answered "in no case"). Prospect Theory is a reasonable framework for considering the question of whose preferences count. If this result can be generalized for other diseases as well, it allows the mathematical combination of "objective" evaluations by the general public with the illness experience of patients. These evaluations should be weighted with patients' risk attitudes, i.e., community preferences can be used if they are corrected for risk attitudes.

Young doctors' preferences for payment systems: the influence of gender and personality traits.

PubMed

Abelsen, Birgit; Olsen, Jan Abel

2015-08-19

Activity-based payment contracts are common among doctors, but to what extent are they preferred? The aim of this paper is to elicit young doctors' preferences for alternative payment systems before they have adapted to an existing system. We examine the existence of gender differences and the extent to which personality traits determine preferences. A cross-sectional survey of all final-year medical students and all interns in Norway examined the extent to which preferences for different payment systems depend on gender and personality traits. Data analysis relied on one-way ANOVA and multinomial logistic regression. The current activity-based payment systems were the least preferred, both in hospitals (16.6%) and in general practice (19.7%). The contrasting alternative "fixed salary" achieved similar relative support. Approximately half preferred the hybrid alternative. When certainty associated with a payment system increased, its appeal rose for women and individuals who are less prestige-oriented, risk-tolerant or effort-tolerant. Activity-based systems were preferred among status- and income-oriented respondents. The vast majority of young doctors prefer payment systems that are less activity-based than the current contracts offered in the Norwegian health service. Recruitment and retention in less prestigious medical specialities might improve if young doctors could choose payment systems corresponding with their diverse preferences.

Effects of stress on human mating preferences: stressed individuals prefer dissimilar mates

PubMed Central

Lass-Hennemann, Johanna; Deuter, Christian E.; Kuehl, Linn K.; Schulz, André; Blumenthal, Terry D.; Schachinger, Hartmut

2010-01-01

Although humans usually prefer mates that resemble themselves, mating preferences can vary with context. Stress has been shown to alter mating preferences in animals, but the effects of stress on human mating preferences are unknown. Here, we investigated whether stress alters men's preference for self-resembling mates. Participants first underwent a cold-pressor test (stress induction) or a control procedure. Then, participants viewed either neutral pictures or pictures of erotic female nudes whose facial characteristics were computer-modified to resemble either the participant or another participant, or were not modified, while startle eyeblink responses were elicited by noise probes. Erotic pictures were rated as being pleasant, and reduced startle magnitude compared with neutral pictures. In the control group, startle magnitude was smaller during foreground presentation of photographs of self-resembling female nudes compared with other-resembling female nudes and non-manipulated female nudes, indicating a higher approach motivation to self-resembling mates. In the stress group, startle magnitude was larger during foreground presentation of self-resembling female nudes compared with other-resembling female nudes and non-manipulated female nudes, indicating a higher approach motivation to dissimilar mates. Our findings show that stress affects human mating preferences: unstressed individuals showed the expected preference for similar mates, but stressed individuals seem to prefer dissimilar mates. PMID:20219732

Cost-effectiveness of modified-release prednisone in the treatment of moderate to severe rheumatoid arthritis with morning stiffness based on directly elicited public preference values

PubMed Central

Dunlop, William; Iqbal, Itrat; Khan, Ifty; Ouwens, Mario; Heron, Louise

2013-01-01

Background Assessing the cost-effectiveness of treatments in rheumatoid arthritis (RA) is of growing importance due to the chronic nature of the disease, rising treatment costs, and budget-constrained health care systems. This analysis assesses the cost-effectiveness of modified-release (MR) prednisone compared with immediate-release (IR) prednisone for the treatment of morning stiffness due to RA. Methods A health state transition model was used to categorize RA patients into four health states, defined by duration of morning stiffness. The model applied a 1-year time horizon and adopted a UK National Health Service (NHS) perspective. Health benefits were measured in quality-adjusted life years (QALYs) and the final output was the incremental cost-effectiveness ratio (ICER). Efficacy data were derived from the CAPRA-1 (Circadian Administration of Prednisone in Rheumatoid Arthritis) study, drug costs from the British National Formulary (BNF), and utility data from a direct elicitation time-trade-off (TTO) study in the general population. Sensitivity analyses were conducted. Results Mean treatment costs per patient were higher for MR-prednisone (£649.70) than for IR-prednisone (£46.54) for the duration of the model. However, the model generated an incremental QALY of 0.044 in favor of MR-prednisone which resulted in an ICER of £13,577. Deterministic sensitivity analyses did not lead to significant changes in the ICER. Probabilistic sensitivity analysis reported that MR-prednisone had an 84% probability of being cost-effective at a willingness-to-pay threshold of £30,000 per QALY. The model only considers drug costs and there was a lack of comparative long-term data for IR-prednisone. Furthermore, utility benefits were not captured in the clinical setting. Conclusion This analysis demonstrates that, based on the CAPRA-1 trial and directly elicited public preference values, MR-prednisone is a cost-effective treatment option when compared with IR-prednisone for RA patients with morning stiffness over one year, according to commonly applied UK thresholds (£20,000–£30,000 per QALY). Further research into the costs of morning stiffness in RA is required. PMID:24204166

Assessing subjective memory complaints: a comparison of spontaneous reports and structured questionnaire methods.

PubMed

Burmester, Bridget; Leathem, Janet; Merrick, Paul

2015-01-01

Subjective memory complaints (SMCs) are a common occurrence for adults, which increase with age, and cause considerable distress. Traditionally SMCs have been assessed by either questionnaires, which ask whether a person has experienced given examples of SMCs, or open-ended questions which elicit spontaneous reports of SMCs. However, little is known about how these methods of assessment might influence reporting of SMCs. Four hundred and twenty one adults aged 40 years and above were surveyed about SMCs using spontaneous report and questionnaire methods. As expected, spontaneously reported SMCs were fewer in number and rated more distressing overall than SMCs endorsed on a questionnaire. However, comparison of individual SMCs revealed that distress ratings tended to be higher when assessed in a questionnaire than spontaneously reported, which may be due to the context of a questionnaire causing inflated ratings. Participants also reported SMCs which were not well assessed by the questionnaire, including some which were among the most distressing SMCs overall. Conversely, other SMCs were over-sampled by the questionnaire and did not feature in spontaneous reports. Implications for clinical assessment of SMCs are that open-ended questioning might be preferable to initial use of prescriptive questionnaires, in order to elicit SMCs that are most distressing. While use of questionnaires may reveal endorsement of a wider range of SMCs than are spontaneously reported, they can take focus away from, or even fail to assess, those SMCs which cause most subjective distress (and therefore should be the target of interventions).

Picture Book Exposure Elicits Positive Visual Preferences in Toddlers

ERIC Educational Resources Information Center

Houston-Price, Carmel; Burton, Eliza; Hickinson, Rachel; Inett, Jade; Moore, Emma; Salmon, Katherine; Shiba, Paula

2009-01-01

Although the relationship between "mere exposure" and attitude enhancement is well established in the adult domain, there has been little similar work with children. This article examines whether toddlers' visual attention toward pictures of foods can be enhanced by repeated visual exposure to pictures of foods in a parent-administered picture…

Magazine Use of Middle-Class English-Speaking Indians in New Delhi, India.

ERIC Educational Resources Information Center

Johnson, Lynda D.

Before launching any publications, a newly formed publishing company in New Delhi, India, surveyed its potential readership to develop a demographic overview of the community, to determine patterns and preferences of magazine use, and to develop a profile of perceived and real readership needs. A questionnaire eliciting such information was given…

Will Flexible Learning Raise Student Achievement?

ERIC Educational Resources Information Center

Guest, Ross

2005-01-01

This paper presents both theoretical and survey evidence on the effect of flexible learning--in particular, the shift to a more student-centred approach to learning--on academic achievement by students. A survey was conducted of 577 business students at a major Australian university in order to elicit their preferences for academic achievement and…

Increased Exposure to Rigid Routines Can Lead to Increased Challenging Behavior Following Changes to Those Routines

ERIC Educational Resources Information Center

Bull, Leah E.; Oliver, Chris; Callaghan, Eleanor; Woodcock, Kate A.

2015-01-01

Several neurodevelopmental disorders are associated with preference for routine and challenging behavior following changes to routines. We examine individuals with Prader-Willi syndrome, who show elevated levels of this behavior, to better understand how previous experience of a routine can affect challenging behavior elicited by disruption to…

Social Media Use in Academics: Undergraduate Perceptions and Practices

ERIC Educational Resources Information Center

Ciampa, Mark; Thrasher, Evelyn H.; Revels, Mark A.

2016-01-01

The aim of this research was to elicit student perceptions and practices regarding the use of social media in the academic setting. More specifically, the objectives of this study were to (1) assess student perceptions of technology use in an academic setting and to rank their preferences; (2) determine which resources and communication options…

Identity, Context Collapse, and Facebook Use in Higher Education: Putting Presence and Privacy at Odds

ERIC Educational Resources Information Center

Dennen, Vanessa P.; Burner, Kerry J.

2017-01-01

This study examines university student's attitudes toward Facebook use, focusing specifically on how they feel about using a social network that encourages the performance of personal and social identity to support learning and interaction among classmates and instructors. Two surveys elicited student habits, preferences, and beliefs related to…

Automatic evaluations and exercise setting preference in frequent exercisers.

PubMed

Antoniewicz, Franziska; Brand, Ralf

2014-12-01

The goals of this study were to test whether exercise-related stimuli can elicit automatic evaluative responses and whether automatic evaluations reflect exercise setting preference in highly active exercisers. An adapted version of the Affect Misattribution Procedure was employed. Seventy-two highly active exercisers (26 years ± 9.03; 43% female) were subliminally primed (7 ms) with pictures depicting typical fitness center scenarios or gray rectangles (control primes). After each prime, participants consciously evaluated the "pleasantness" of a Chinese symbol. Controlled evaluations were measured with a questionnaire and were more positive in participants who regularly visited fitness centers than in those who reported avoiding this exercise setting. Only center exercisers gave automatic positive evaluations of the fitness center setting (partial eta squared = .08). It is proposed that a subliminal Affect Misattribution Procedure paradigm can elicit automatic evaluations to exercising and that, in highly active exercisers, these evaluations play a role in decisions about the exercise setting rather than the amounts of physical exercise. Findings are interpreted in terms of a dual systems theory of social information processing and behavior.

Cultural influences on neural basis of intergroup empathy.

PubMed

Cheon, Bobby K; Im, Dong-Mi; Harada, Tokiko; Kim, Ji-Sook; Mathur, Vani A; Scimeca, Jason M; Parrish, Todd B; Park, Hyun Wook; Chiao, Joan Y

2011-07-15

Cultures vary in the extent to which people prefer social hierarchical or egalitarian relations between individuals and groups. Here we examined the effect of cultural variation in preference for social hierarchy on the neural basis of intergroup empathy. Using cross-cultural neuroimaging, we measured neural responses while Korean and American participants observed scenes of racial ingroup and outgroup members in emotional pain. Compared to Caucasian-American participants, Korean participants reported experiencing greater empathy and elicited stronger activity in the left temporo-parietal junction (L-TPJ), a region previously associated with mental state inference, for ingroup compared to outgroup members. Furthermore, preferential reactivity within this region to the pain of ingroup relative to outgroup members was associated with greater preference for social hierarchy and ingroup biases in empathy. Together, these results suggest that cultural variation in preference for social hierarchy leads to cultural variation in ingroup-preferences in empathy, due to increased engagement of brain regions associated with representing and inferring the mental states of others. Copyright © 2011 Elsevier Inc. All rights reserved.

Choose, rate or squeeze: Comparison of economic value functions elicited by different behavioral tasks

PubMed Central

Pessiglione, Mathias

2017-01-01

A standard view in neuroeconomics is that to make a choice, an agent first assigns subjective values to available options, and then compares them to select the best. In choice tasks, these cardinal values are typically inferred from the preference expressed by subjects between options presented in pairs. Alternatively, cardinal values can be directly elicited by asking subjects to place a cursor on an analog scale (rating task) or to exert a force on a power grip (effort task). These tasks can vary in many respects: they can notably be more or less costly and consequential. Here, we compared the value functions elicited by choice, rating and effort tasks on options composed of two monetary amounts: one for the subject (gain) and one for a charity (donation). Bayesian model selection showed that despite important differences between the three tasks, they all elicited a same value function, with similar weighting of gain and donation, but variable concavity. Moreover, value functions elicited by the different tasks could predict choices with equivalent accuracy. Our finding therefore suggests that comparable value functions can account for various motivated behaviors, beyond economic choice. Nevertheless, we report slight differences in the computational efficiency of parameter estimation that may guide the design of future studies. PMID:29161252

Developmental stress elicits preference for methamphetamine in the spontaneously hypertensive rat model of attention-deficit/hyperactivity disorder.

PubMed

Womersley, Jacqueline S; Mpeta, Bafokeng; Dimatelis, Jacqueline J; Kellaway, Lauriston A; Stein, Dan J; Russell, Vivienne A

2016-06-17

Developmental stress has been hypothesised to interact with genetic predisposition to increase the risk of developing substance use disorders. Here we have investigated the effects of maternal separation-induced developmental stress using a behavioural proxy of methamphetamine preference in an animal model of attention-deficit/hyperactivity disorder, the spontaneously hypertensive rat, versus Wistar Kyoto and Sprague-Dawley comparator strains. Analysis of results obtained using a conditioned place preference paradigm revealed a significant strain × stress interaction with maternal separation inducing preference for the methamphetamine-associated compartment in spontaneously hypertensive rats. Maternal separation increased behavioural sensitization to the locomotor-stimulatory effects of methamphetamine in both spontaneously hypertensive and Sprague-Dawley strains but not in Wistar Kyoto rats. Our findings indicate that developmental stress in a genetic rat model of attention-deficit/hyperactivity disorder may foster a vulnerability to the development of substance use disorders.

Higher-order risk preferences in social settings.

PubMed

Heinrich, Timo; Mayrhofer, Thomas

2018-01-01

We study prudence and temperance (next to risk aversion) in social settings. Previous experimental studies have shown that these higher-order risk preferences affect the choices of individuals deciding privately on lotteries that only affect their own payoff. Yet, many risky and financially relevant decisions are made in the social settings of households or organizations. We elicit higher-order risk preferences of individuals and systematically vary how an individual's decision is made (alone or while communicating with a partner) and who is affected by the decision (only the individual or the partner as well). In doing so, we can isolate the effects of other-regarding concerns and communication on choices. Our results reveal that the majority of choices are risk averse, prudent, and temperate across social settings. We also observe that individuals are influenced significantly by the preferences of a partner when they are able to communicate and choices are payoff-relevant for both of them.

Polyphenols: factors influencing their sensory properties and their effects on food and beverage preferences.

PubMed

Lesschaeve, Isabelle; Noble, Ann C

2005-01-01

Bitterness and astringency are found in a variety of foods, including nuts, fruits, chocolate, tea, wine, and soymilk. In fruits and beverages, the taste of bitterness and the tactile sensation of astringency are elicited primarily by flavanol polymers (proanthocyanidins or condensed tannins). Variations in proanthocyanidin composition, such as polymer size, extent of galloylation, and formation of derivatives, affect both bitterness and astringency. In beverages, other factors also influence these sensations, including the pH and the levels of ethanol, sweetness, and viscosity. Similarly, foods eaten with beverages can influence astringency. For example, eating dark chocolate increases the astringency of red wine more than does milk chocolate. Individuals perceive astringency differently because of variations in salivary flow rates, and preferences for and acceptance of a product may vary tremendously among individuals; decreasing bitterness and/or astringency may not increase preference. Factors influencing bitterness, astringency, and individual preference decisions are discussed.

The perception of children's computer-imaged facial profiles by patients, mothers and clinicians.

PubMed

Miner, Robert M; Anderson, Nina K; Evans, Carla A; Giddon, Donald B

2007-11-01

To demonstrate the usefulness of a new imaging system for comparing the morphometric bases of children's self-perception of their facial profile with the perceptions of their mothers and treating clinicians. Rather than choosing among a series of static images, a computer imaging program was developed to elicit a range of acceptable responses or tolerance for change from which a midpoint of acceptability was derived. Using the method of Giddon et al, three profile features (upper and lower lips and mandible) from standardized images of 24 patients aged 8- 15 years were distorted and presented to patients, parents, and clinicians in random order as slowly moving images (four frames per second) from retrusive and protrusive extremes. Subjects clicked the mouse when the image became acceptable and released it when it was no longer acceptable. Subjects responded similarly to a neutral facial profile. Patients and their mothers overestimated the protrusiveness of the mandible of the actual pretreatment profile. Consistent with related studies, mothers had a smaller tolerance for change in the soft tissue profile than the children or clinicians. The magnitudes of the children's self-preference and preferred change in a neutral face were also significantly correlated. Both patients and mothers preferred a more protrusive profile than that of the actual or neutral face for the patient and neutral face. Imaging software can be used with children to compare their preferences with those of parents and clinicians to facilitate treatment planning and patient satisfaction.

Parental perspectives on inpatient versus outpatient management of pediatric febrile neutropenia.

PubMed

Diorio, Caroline; Martino, Julia; Boydell, Katherine Mary; Ethier, Marie-Chantal; Mayo, Chris; Wing, Richard; Teuffel, Oliver; Sung, Lillian; Tomlinson, Deborah

2011-01-01

To describe parent preference for treatment of febrile neutropenia and the key drivers of parental decision making, structured face-to-face interviews were used to elicit parent preferences for inpatient versus outpatient management of pediatric febrile neutropenia. Parents were presented with 4 different scenarios and asked to indicate which treatment option they preferred and to describe reasons for this preference during the face-to-face interview. Comments were recorded in writing by research assistants. A consensus approach to thematic analysis was used to identify themes from the written comments of the research assistants. A total of 155 parents participated in the study. Of these, 80 (51.6%) parents identified hospital-based intravenous treatment as the most preferred treatment scenario for febrile neutropenia. The major themes identified included convenience/disruptiveness, physical health, emotional well-being, and modifiers of parental decision making. Most parents preferred hospital-based treatment for febrile neutropenia. An understanding of issues that influence parental decision making may assist health care workers in planning program implementation and further support families in their decision-making process.

A Conjoint Analysis Framework for Evaluating User Preferences in Machine Translation

PubMed Central

Kirchhoff, Katrin; Capurro, Daniel; Turner, Anne M.

2013-01-01

Despite much research on machine translation (MT) evaluation, there is surprisingly little work that directly measures users’ intuitive or emotional preferences regarding different types of MT errors. However, the elicitation and modeling of user preferences is an important prerequisite for research on user adaptation and customization of MT engines. In this paper we explore the use of conjoint analysis as a formal quantitative framework to assess users’ relative preferences for different types of translation errors. We apply our approach to the analysis of MT output from translating public health documents from English into Spanish. Our results indicate that word order errors are clearly the most dispreferred error type, followed by word sense, morphological, and function word errors. The conjoint analysis-based model is able to predict user preferences more accurately than a baseline model that chooses the translation with the fewest errors overall. Additionally we analyze the effect of using a crowd-sourced respondent population versus a sample of domain experts and observe that main preference effects are remarkably stable across the two samples. PMID:24683295

Hand preferences in captive orangutans (Pongo pygmaeus).

PubMed

O'malley, Robert C; McGrew, W C

2006-07-01

The strength of the evidence for population-level handedness in the great apes is a topic of considerable debate, yet there have been few studies of handedness in orangutans. We conducted a study of manual lateralization in a captive group of eight orangutans (Pongo pygmaeus) ranking the degrees of manual preference according to a defined framework. We analyzed five behavioral patterns: eat (one- and two-handed), make/modify tool, oral tool-use, and manual tool-use. Although some individuals showed significant manual preferences for one or more tasks, at the group-level both one-handed and two-handed eating, oral tool-use, and make/modify tool were ranked at level 1 (unlateralized). Manual tool-use was ranked at level 2, with four subjects demonstrating significant hand preferences, but no group-level bias to the right or left. Four subjects also showed hand specialization to the right or left across several tasks. These results are consistent with most previous studies of manual preference in orangutans. The emergence of manual lateralization in orangutans may relate to more complex manipulative tasks. We hypothesize that more challenging manual tasks elicit stronger hand preferences.

Gender-specificity of solitary and dyadic sexual desire among gynephilic and androphilic women and men.

PubMed

Dawson, Samantha J; Chivers, Meredith L

2014-04-01

Incentive motivation theory proposes that sexual desire emerges from sexual arousal, and is triggered by sexually competent stimuli. Research demonstrates gender and sexual orientation differences in the features that contribute to the competency of sexual stimuli. Men's and gynephilic women's genital arousal tends to be gender-specific with preferred gender eliciting significantly greater genital arousal than nonpreferred gender. In contrast, stimuli depicting preferred and nonpreferred gender elicit similar degrees of genital arousal among androphilic women, termed a gender-nonspecific pattern. Given these differences in the features that elicit a sexual response, and that sexual desire is proposed to emerge from sexual arousal, the question remains as to whether sexual desire would emerge only through exposure to preferred stimuli or whether patterns of responsive desire would parallel those observed for genital arousal. The study aims to examine patterns of dyadic and solitary sexual desire in response to stimuli differing in incentive value. Thirty androphilic women, 21 gynephilic women, 21 gynephilic men, and 16 androphilic men participated in a sexual psychophysiological session. Participants viewed sexual stimuli that varied the gender of the actors and the intensity of sexual activities depicted. Participants reported their degree of desire for sex with a partner (dyadic desire) and desire to masturbate (solitary desire), before and after each film. Men and gynephilic women exhibited gender-specific patterns of sexual desire. Androphilic women's dyadic desire showed significantly less differentiation between genders, and their solitary desire did not differentiate at all. No gender difference was observed for either type of desire. All groups reported greater desire as stimulus intensity increased. Gender-nonspecific sexual response is not limited to the sexual arousal patterns of androphilic women, but extends to include responsive sexual desire. Men and gynephilic women, however, show gender-specific responsive sexual desire that parallels their sexual arousal patterns. © 2014 International Society for Sexual Medicine.

Using the stated preference technique for eliciting valuations: the role of the payment vehicle.

PubMed

Gyrd-Hansen, Dorte

2013-10-01

At the core of the stated preference method is choice of payment vehicle. Since payment vehicle is an intrinsic characteristic of a good, the choice of payment vehicle will naturally impact on the valuation of the good. Typical payment vehicles applied in the context of health are income tax levies, out-of-pocket payments at the point of consumption or private health insurance premiums. Where out-of-pocket payments will elicit use value only, private health insurance premiums will also disclose option value, i.e. the utility of knowing that one has access to a healthcare service should one need it. Income tax levies will disclose what in this paper is referred to as citizen's preferences, i.e. individual preferences that include use value, option value as well as (caring) externalities. This paper advocates that researchers design stated preference studies that encompass all relevant dimensions of value, and that serious thought is given to choice of payment vehicle. However, it is important to acknowledge that choice of payment vehicle has other potential implications for valuations. Payment vehicle and provider of services may be strongly linked in people's minds. If respondents implicitly associate a specific type of provider with a certain type of payment vehicle, it is important that any misperception is corrected by way of a precise description of the good being valued. Further, a pertinent issue is the extent to which respondents 'protest' to the stated preference question and how we should deal with these 'protesters'. No agreement currently exists about the procedure used to separate genuine zero values from protest values, nor about the treatment of protest responses in subsequent analyses. Beliefs are strongly associated with protesting, and exclusion of protest bids may therefore exclude individuals who have strong preferences for a payment vehicle. If it is acknowledged that payment vehicle is an intrinsic component of a good, exclusion of respondents who exhibit specific viewpoints may result in biased welfare estimates. Yet another issue is the presence of self-consciousness amongst respondents. If people derive utility from saying they are willing to pay for a public good (social desirability bias or warm glow), this potentially drives a wedge between people's stated value for a good in a survey and people's value for a good provided to them from the government. Tax payments are more binding than out-of-pocket payments. Payment towards public health programs via income tax may therefore generate lower consumer surplus than if the intervention was financed out-of-pocket with the option of opting out both in terms of participation as well as financially. Finally, only a few studies have looked at the impact of frequency of payments. The effect of temporal framing is clearly potentially important and at the same time an unavoidable component of the payment vehicle, yet it remains at present unexplored.

Effects of Simplifying Choice Tasks on Estimates of Taste Heterogeneity in Stated-Choice Surveys

PubMed Central

Johnson, F. Reed; Ozdemir, Semra; Phillips, Kathryn A

2011-01-01

Researchers usually employ orthogonal arrays or D-optimal designs with little or no attribute overlap in stated-choice surveys. The challenge is to balance statistical efficiency and respondent burden to minimize the overall error in the survey responses. This study examined whether simplifying the choice task, by using a design with more overlap, provides advantages over standard minimum-overlap methods. We administered two designs for eliciting HIV test preferences to split samples. Surveys were undertaken at four HIV testing locations in San Francisco, California. Personal characteristics had different effects on willingness to pay for the two treatments, and gains in statistical efficiency in the minimal-overlap version more than compensated for possible imprecision from increased measurement error. PMID:19880234

Is "end of life" a special case? Connecting Q with survey methods to measure societal support for views on the value of life-extending treatments.

PubMed

Mason, Helen; Collins, Marissa; McHugh, Neil; Godwin, Jon; Van Exel, Job; Donaldson, Cam; Baker, Rachel

2018-05-01

Preference elicitation studies reporting societal views on the relative value of end-of-life treatments have produced equivocal results. This paper presents an alternative method, combining Q methodology and survey techniques (Q2S) to determine the distribution of 3 viewpoints on the relative value of end-of-life treatments identified in a previous, published, phase of this work. These were Viewpoint 1, "A population perspective: value for money, no special cases"; Viewpoint 2, "Life is precious: valuing life-extension and patient choice"; and Viewpoint 3, "Valuing wider benefits and opportunity cost: the quality of life and death." A Q2S survey of 4,902 respondents across the United Kingdom measured agreement with these viewpoints; 37% most agreed with Viewpoint 1, 49% with Viewpoint 2, and 9% with Viewpoint 3. Regression analysis showed associations of viewpoints with gender, level of education, religion, voting preferences, and satisfaction with the NHS. The Q2S approach provides a promising means to investigate how in-depth views and opinions are represented in the wider population. As demonstrated in this study, there is often more than 1 viewpoint on a topic and methods that seek to estimate that averages may not provide the best guidance for societal decision-making. © 2018 The Authors. Health Economics Published by John Wiley & Sons Ltd.

Development of a patient decision aid for type 2 diabetes mellitus for patients not achieving glycemic control on metformin alone

PubMed Central

Shillington, Alicia C; Col, Nananda; Bailey, Robert A; Jewell, Mark A

2015-01-01

Purpose To describe the process used to develop an evidence-based patient decision aid (PDA) that facilitates shared decision-making for treatment intensification in inadequately controlled type 2 diabetes mellitus (T2DM) consistent with International Patient Decision Aids Standards. Methods A PDA was developed by a multidisciplinary steering committee of clinicians, patient advocate, nurse, certified diabetes educators, and decision scientist, using a systematic development process. The process included defining the PDA scope and purpose, outlining the framework, content creation, and designing for integration into clinical practice. This was accomplished through a review of the literature and publically available educational materials and input from practicing clinicians and patients during development and iteratively refining content based on input. Patients with poorly controlled T2DM on metformin considering additional medication assessed the PDA during a pilot. Results Testing identified six preference-sensitive domains important for choosing T2DM treatment: degree of glycemic response, avoiding weight gain, hypoglycemia risk and other adverse events, avoiding injections, convenience of dose administration, blood glucose monitoring, and cost of therapy. Patient feedback guided content revision. Treatment options were offered after presenting medication class risk–benefit information and eliciting patient values, goals, and preferences. The PDA received the highest International Patient Decision Aids Standards global score to date, 88/100, with 100% of criteria fully met for the following dimensions: development process, disclosures, evaluation process, evidence quality, guidance for users, information quality, language/readability, testing, and eliciting patient values. Conclusion A PDA was developed to help T2DM patients make decisions regarding medication choice. This approach may be applicable to other chronic conditions. PMID:25995622

Acceptance of Vaccinations in Pandemic Outbreaks: A Discrete Choice Experiment

PubMed Central

Determann, Domino; Korfage, Ida J.; Lambooij, Mattijs S.; Bliemer, Michiel; Richardus, Jan Hendrik; Steyerberg, Ewout W.; de Bekker-Grob, Esther W.

2014-01-01

Background Preventive measures are essential to limit the spread of new viruses; their uptake is key to their success. However, the vaccination uptake in pandemic outbreaks is often low. We aim to elicit how disease and vaccination characteristics determine preferences of the general public for new pandemic vaccinations. Methods In an internet-based discrete choice experiment (DCE) a representative sample of 536 participants (49% participation rate) from the Dutch population was asked for their preference for vaccination programs in hypothetical communicable disease outbreaks. We used scenarios based on two disease characteristics (susceptibility to and severity of the disease) and five vaccination program characteristics (effectiveness, safety, advice regarding vaccination, media attention, and out-of-pocket costs). The DCE design was based on a literature review, expert interviews and focus group discussions. A panel latent class logit model was used to estimate which trade-offs individuals were willing to make. Results All above mentioned characteristics proved to influence respondents’ preferences for vaccination. Preference heterogeneity was substantial. Females who stated that they were never in favor of vaccination made different trade-offs than males who stated that they were (possibly) willing to get vaccinated. As expected, respondents preferred and were willing to pay more for more effective vaccines, especially if the outbreak was more serious (€6–€39 for a 10% more effective vaccine). Changes in effectiveness, out-of-pocket costs and in the body that advises the vaccine all substantially influenced the predicted uptake. Conclusions We conclude that various disease and vaccination program characteristics influence respondents’ preferences for pandemic vaccination programs. Agencies responsible for preventive measures during pandemics can use the knowledge that out-of-pocket costs and the way advice is given affect vaccination uptake to improve their plans for future pandemic outbreaks. The preference heterogeneity shows that information regarding vaccination needs to be targeted differently depending on gender and willingness to get vaccinated. PMID:25057914

Patient Comprehension and Attitudes toward Maintenance Chemotherapy for Lung Cancer

PubMed Central

Gerber, David E.; Hamann, Heidi A.; Rasco, Drew W.; Woodruff, Sharon; Craddock Lee, Simon J.

2012-01-01

Objective Maintenance chemotherapy is a recently approved approach to the treatment of advanced non-small cell lung cancer (NSCLC). We sought to gain insight into patients’ perceptions of maintenance chemotherapy using qualitative methods. Methods We conducted thematic content analysis of focus groups at a freestanding cancer center and at an associated safety-net county hospital. Patients with advanced NSCLC who had started but not yet completed first-line platinum doublet chemotherapy were provided visual and written explanations of maintenance chemotherapy before being guided in group discussion. Results Key themes to emerge for consideration of maintenance chemotherapy included (1) survival benefits, disease control, and “buying time”; (2) the importance of “doing something”; (3) quality of life concerns; (4) the role of provider opinion/preference; and (5) the importance of logistics. Conclusions Patients undergoing first-line chemotherapy for advanced NSCLC were able to understand the concept of maintenance chemotherapy, distinguish it from traditional treatment paradigms, identify pros and cons of this approach, and convey reasons for considering it. Practice Implications Advances in oncology care that alter therapy modalities and delivery may significantly impact patient perceptions and treatment experiences. Clinical team members may wish to elicit treatment preferences of first-line patients through clinical discussions that anticipate these considerations. PMID:22632736

Heterogeneity in general practitioners' preferences for quality improvement programs: a choice experiment and policy simulation in France.

PubMed

Ammi, Mehdi; Peyron, Christine

2016-12-01

Despite increasing popularity, quality improvement programs (QIP) have had modest and variable impacts on enhancing the quality of physician practice. We investigate the heterogeneity of physicians' preferences as a potential explanation of these mixed results in France, where the national voluntary QIP - the CAPI - has been cancelled due to its unpopularity. We rely on a discrete choice experiment to elicit heterogeneity in physicians' preferences for the financial and non-financial components of QIP. Using mixed and latent class logit models, results show that the two models should be used in concert to shed light on different aspects of the heterogeneity in preferences. In particular, the mixed logit demonstrates that heterogeneity in preferences is concentrated on the pay-for-performance component of the QIP, while the latent class model shows that physicians can be grouped in four homogeneous groups with specific preference patterns. Using policy simulation, we compare the French CAPI with other possible QIPs, and show that the majority of the physician subgroups modelled dislike the CAPI, while favouring a QIP using only non-financial interventions. We underline the importance of modelling preference heterogeneity in designing and implementing QIPs.

The Pleasantness of Visual Symmetry: Always, Never or Sometimes

PubMed Central

Pecchinenda, Anna; Bertamini, Marco; Makin, Alexis David James; Ruta, Nicole

2014-01-01

There is evidence of a preference for visual symmetry. This is true from mate selection in the animal world to the aesthetic appreciation of works of art. It has been proposed that this preference is due to processing fluency, which engenders positive affect. But is visual symmetry pleasant? Evidence is mixed as explicit preferences show that this is the case. In contrast, implicit measures show that visual symmetry does not spontaneously engender positive affect but it depends on participants intentionally assessing visual regularities. In four experiments using variants of the affective priming paradigm, we investigated when visual symmetry engenders positive affect. Findings showed that, when no Stroop-like effects or post-lexical mechanisms enter into play, visual symmetry spontaneously elicits positive affect and results in affective congruence effects. PMID:24658112

Narp Deletion Blocks Extinction of Morphine Place Preference Conditioning

PubMed Central

Crombag, Hans S; Dickson, Mercy; Dinenna, Megan; Johnson, Alexander W; Perin, Mark S; Holland, Peter C; Baraban, Jay M; Reti, Irving M

2008-01-01

As drug abuse can be viewed as a maladaptive form of neuronal plasticity, attention has focused on defining the synaptic plasticity mechanisms that mediate the long-term effects of these drugs. As Narp is secreted at synaptic sites and binds to the extracellular surface of AMPA receptors, it has been implicated in mediating enduring forms of synaptic plasticity. Accordingly, to assess its potential role in the long-lasting behavioral effects of drugs of abuse, we have investigated the impact of Narp deletion on sustained behavioral responses elicited by repeated morphine administration. Narp knockout mice display normal locomotor sensitization and conditioned place preference, but are markedly resistant to extinction of place preference. Thus, these findings indicate that Narp plays a selective role in extinction, possibly by its effects on AMPA receptor trafficking. PMID:18536700

Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments.

PubMed

Harrison, Mark; Milbers, Katherine; Hudson, Marie; Bansback, Nick

2017-05-17

To review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences. A systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers. Systematic review. We identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers. Discordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Semantic and Affective Salience: The Role of Meaning and Preference in Attentional Capture and Disengagement

ERIC Educational Resources Information Center

Biggs, Adam T.; Kreager, Ryan D.; Gibson, Bradley S.; Villano, Michael; Crowell, Charles R.

2012-01-01

Emotion appears to have a substantial impact on a wide variety of attentional functions. However, stimuli that elicit affective responses also tend to be meaningful. Here we attempted to disentangle the effects of meaning from the effects of affect on attentional capture by irrelevant distractors. Experiment 1 used a previously unfamiliar…

Asymmetries in Children's Production of Relative Clauses: Data from English and Korean

ERIC Educational Resources Information Center

Kim, Chae-Eun; O'Grady, William

2016-01-01

We report here on a series of elicited production experiments that investigate the production of indirect object and oblique relative clauses by monolingual child learners of English and Korean. Taken together, the results from the two languages point toward a pair of robust asymmetries: children manifest a preference for subject relative clauses…

Values and Academic Achievement Among Rural Indian High School Students in North Dakota.

ERIC Educational Resources Information Center

Clark, Janet Lee

The role of differential values as they relate to educational achievement was investigated by examining school records of and administering the Rosenberg Self-Esteem Scale and questionnaires eliciting personal information, character trait preferences, and perceptions of self, ideal self, and others to 328 Indian and 271 non-Indian students from 7…

Testicular Self Examination--Knowledge of Men Attending a Large Genito Urinary Medicine Clinic

ERIC Educational Resources Information Center

Handy, Pauline; Sankar, K. Nathan

2008-01-01

Objective: To elicit the level of knowledge, training and preferences of men in relation to Testicular Self Examination (TSE). Setting: The Genito Urinary Medicine (GUM) department of a large teaching hospital in the North East of England. The open access clinic serves patients from Newcastle upon Tyne, Northumberland, Gateshead and surrounding…

Sex-Typing of Occupational Preferences and Liberality.

ERIC Educational Resources Information Center

Evelo, Leslie S.; And Others

1991-01-01

A sample of 1,601 female and 1,344 male seventh and eighth graders from large or small schools viewed videotapes of occupations presented either by job title or job description. Boys perceived fewer than half of the careers as more appropriate for one gender, girls one-third. Job titles elicited more sex-typing among girls than did job…

The Role of Speaker Identification in Korean University Students' Attitudes towards Five Varieties of English

ERIC Educational Resources Information Center

Yook, Cheongmin; Lindemann, Stephanie

2013-01-01

This study investigates how the attitudes of 60 Korean university students towards five varieties of English are affected by the identification of the speaker's nationality and ethnicity. The study employed both a verbal guise technique and questions eliciting overt beliefs and preferences related to learning English. While the majority of the…

Negotiating treatment preferences: Physicians' formulations of patients' stance.

PubMed

Landmark, Anne Marie Dalby; Svennevig, Jan; Gulbrandsen, Pål

2016-01-01

Eliciting patients' values and treatment preferences is an essential element in models of shared decision making, yet few studies have investigated the interactional realizations of how physicians do this in authentic encounters. Drawing on video-recorded encounters from Norwegian secondary care, the present study uses the fine-grained empirical methodology of conversation analysis (CA) to identify one conversational practice physicians use, namely, formulations of patients' stance, in which physicians summarize or paraphrase their understanding of the patient's stance towards treatment. The purpose of this study is twofold: (1) to explore what objectives formulations of patients' stance achieve while negotiating treatment and (2) to discuss these objectives in relation to core requirements in shared decision making. Our analysis demonstrates that formulating the patient's stance is a practice physicians use in order to elicit, check, and establish patients' attitudes towards treatment. This practice is in line with general recommendations for making shared decisions, such as exploring and checking patients' preferences and values. However, the formulations may function as a device for doing more than merely checking and establishing common ground and bringing up patients' preferences and views: Accompanied by subtle deprecating expressions, they work to delegitimize the patients' stances and indirectly convey the physicians' opposing stance. Once established, these positions can be used as a basis for challenging and potentially altering the patient's attitude towards the decision, thereby making it more congruent with the physician's view. Therefore, in addition to bringing up patients' views towards treatment, we argue that physicians may use formulations of patients' stance as a resource for directing the patient towards decisions that are congruent with the physician's stance in situations with potential disagreement, whilst (ostensibly) avoiding a more authoritarian or paternalistic approach. Copyright © 2015 Elsevier Ltd. All rights reserved.

An Assessment of Incentive Versus Survey Length Trade-offs in a Web Survey of Radiologists

PubMed Central

Niederhauser, Blake D; Kallmes, David; Beebe, Timothy J

2013-01-01

Background It is generally understood that shorter Web surveys and use of incentives result in higher response rates in Web surveys directed to health care providers. Less is known about potential respondent preference for reduced burden as compared to increased reward. Objective To help elicit preference for minimized burden compared to reward for completion of a survey, we observed physician preferences for shorter Web surveys compared to incentives as well as incentive preference (small guaranteed incentive compared to larger lottery incentive) accompanying an electronic request to complete a survey. Methods This was an observational study that accompanied a large Web survey study of radiology staff, fellows, and residents at select academic medical centers in the United States. With the request to complete the survey, potential respondents were offered three options: (1) a 10-minute Web survey with the chance to win an iPad, (2) a 10-minute Web survey with a guaranteed nominal incentive ($5 amazon.com gift card), or (3) a shorter (5-7 minute) Web survey with no incentive. A total of 254 individuals responded to the Web survey request. Results Overwhelmingly, individuals chose a longer survey accompanied by an incentive compared to a shorter survey with no incentive (85% compared to 15%, P<.001). Of those opting for an incentive, a small, but not significant majority chose the chance to win an iPad over a guaranteed $5 gift card (56% compared to 44%). Conclusions When given the choice, radiologists preferred a reward (either guaranteed or based on a lottery) to a less burdensome survey, indicating that researchers should focus more attention at increasing perceived benefits of completing a Web survey compared to decreasing perceived burden. PMID:23514869

eLearning among Canadian anesthesia residents: a survey of podcast use and content needs

PubMed Central

2013-01-01

Background Podcasts are increasingly being used in medical education. In this study, we conducted a survey of Canadian anesthesia residents to better delineate the content needs, format preferences, and usage patterns among anesthesia residents. Methods 10/16 Canadian anesthesia program directors, representing 443/659 Canadian anesthesia residents, allowed their residents to be included in the study. 169/659 (24%) residents responded to our survey. A 17-item survey tool developed by the investigators was distributed by email eliciting information on patterns of podcast use, preferred content, preferred format, and podcast adjuncts perceived to increase knowledge retention. Results 60% (91/151) had used medical podcasts with 67% of these users spending up to 1 hour per week on podcasts. 72.3% of respondents selected ‘ability to review materials whenever I want’ was selected by the majority of respondents (72%) as the reason they found podcasts to be valuable. No clear preference was shown for audio, video, or slidecast podcasts. Physiology (88%) and pharmacology (87%) were the most requested basic science topics while regional anesthesia (84%), intensive care (79%) and crisis resource management (86%) were the most requested for procedural, clinical and professional topics respectively. Respondents stated they would most likely view podcasts that contained procedural skills, journal article summaries and case presentations and that were between 5-15 minutes in duration A significantly greater proportion of senior residents (81%) requested podcasts on ‘pediatric anesthesia’ compared to junior residents 57% (P = 0.007). Conclusions The majority of respondents are using podcasts. Anesthesia residents have preferred podcast content, types, length and format that educators should be cognizant of when developing and providing podcasts. PMID:23617894

Housing for persons with serious mental illness: consumer and service provider preferences.

PubMed

Piat, Myra; Lesage, Alain; Boyer, Richard; Dorvil, Henri; Couture, Audrey; Grenier, Guy; Bloom, David

2008-09-01

This study evaluated the housing preferences of a representative sample of consumers with serious mental illness living in seven types of housing in Montreal, Quebec, and compared these with their case managers' housing preferences for them. An inventory of all housing for this population was developed in consultation with administrators of three psychiatric hospitals and the regional health board. The inventory included seven categories: housing in a hospital setting, hostels, group homes, foster homes, supervised apartments, social housing (low-income housing or cooperative), and private rooming homes. A stratified random sample of 48 consumers was selected in each category. In all, 315 consumers and their case managers completed the Consumer Housing Preference Survey. Most consumers preferred living in housing that offered them more autonomy than the housing in which they were currently living. Case managers preferred housing that offered some structure, such as supervised apartments. Forty-four percent of consumers preferred to live in their own apartment. More than a third of consumers preferred to live in their current housing. When evaluating housing preferences, it is important to elicit the viewpoints of mental health consumers as well as their case managers. Special attention should be given to the type of housing where consumers currently live. A variety of housing, not just autonomous housing, is needed to meet the specific housing preferences of individuals with serious mental illness.

Deleting 'irrational' responses from discrete choice experiments: a case of investigating or imposing preferences?

PubMed

Lancsar, Emily; Louviere, Jordan

2006-08-01

Investigation of the 'rationality' of responses to discrete choice experiments (DCEs) has been a theme of research in health economics. Responses have been deleted from DCEs where they have been deemed by researchers to (a) be 'irrational', defined by such studies as failing tests for non-satiation, or (b) represent lexicographic preferences. This paper outlines a number of reasons why deleting responses from DCEs may be inappropriate after first reviewing the theory underpinning rationality, highlighting that the importance placed on rationality depends on the approach to consumer theory to which one ascribes. The aim of this paper is not to suggest that all preferences elicited via DCEs are rational. Instead, it is to suggest a number of reasons why it may not be the case that all preferences labelled as 'irrational' are indeed so. Hence, deleting responses may result in the removal of valid preferences; induce sample selection bias; and reduce the statistical efficiency and power of the estimated choice models. Further, evidence suggests random utility theory may be able to cope with such preferences. Finally, we discuss a number of implications for the design, implementation and interpretation of DCEs and recommend caution regarding the deletion of preferences from stated preference experiments. Copyright 2006 John Wiley & Sons, Ltd.

Applying quantitative benefit-risk analysis to aid regulatory decision making in diagnostic imaging: methods, challenges, and opportunities.

PubMed

Agapova, Maria; Devine, Emily Beth; Bresnahan, Brian W; Higashi, Mitchell K; Garrison, Louis P

2014-09-01

Health agencies making regulatory marketing-authorization decisions use qualitative and quantitative approaches to assess expected benefits and expected risks associated with medical interventions. There is, however, no universal standard approach that regulatory agencies consistently use to conduct benefit-risk assessment (BRA) for pharmaceuticals or medical devices, including for imaging technologies. Economics, health services research, and health outcomes research use quantitative approaches to elicit preferences of stakeholders, identify priorities, and model health conditions and health intervention effects. Challenges to BRA in medical devices are outlined, highlighting additional barriers in radiology. Three quantitative methods--multi-criteria decision analysis, health outcomes modeling and stated-choice survey--are assessed using criteria that are important in balancing benefits and risks of medical devices and imaging technologies. To be useful in regulatory BRA, quantitative methods need to: aggregate multiple benefits and risks, incorporate qualitative considerations, account for uncertainty, and make clear whose preferences/priorities are being used. Each quantitative method performs differently across these criteria and little is known about how BRA estimates and conclusions vary by approach. While no specific quantitative method is likely to be the strongest in all of the important areas, quantitative methods may have a place in BRA of medical devices and radiology. Quantitative BRA approaches have been more widely applied in medicines, with fewer BRAs in devices. Despite substantial differences in characteristics of pharmaceuticals and devices, BRA methods may be as applicable to medical devices and imaging technologies as they are to pharmaceuticals. Further research to guide the development and selection of quantitative BRA methods for medical devices and imaging technologies is needed. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Societal values in the allocation of healthcare resources: is it all about the health gain?

PubMed

Stafinski, Tania; Menon, Devidas; Marshall, Deborah; Caulfield, Timothy

2011-01-01

Over the past decade, public distrust in unavoidable value-laden decisions on the allocation of resources to new health technologies has grown. In response, healthcare organizations have made considerable efforts to improve their acceptability by increasing transparency in decision-making processes. However, the social value judgments (distributive preferences of the public) embedded in them have yet to be defined. While the need to explicate such judgments has become widely recognized, the most appropriate approach to accomplishing this remains unclear. The aims of this review were to identify factors around which distributive preferences of the public have been sought, create a list of social values proposed or used in current resource allocation decision-making processes for new health technologies, and review approaches to eliciting such values from the general public. Social values proposed or used in making resource allocation decisions for new health technologies were identified through three approaches: (i) a comprehensive review of published, peer-reviewed, empirical studies of public preferences for the distribution of healthcare; (ii) an analysis of non-technical factors or social value statements considered by technology funding decision-making processes in Canada and abroad; and (iii) a review of appeals to funding decisions on grounds in part related to social value judgments. A total of 34 empirical studies, 10 technology funding decision-making processes, and 12 appeals to decisions were identified and reviewed. The key factors/patient characteristics addressed through policy statements and around which distributive preferences of the public have been sought included severity of illness, immediate need, age (and its relationship to lifetime health), health gain (amount and final outcome/health state), personal responsibility for illness, caregiving responsibilities, and number of patients who could benefit (rarity). Empirical studies typically examined the importance of these factors in isolation. Therefore, the extent to which preferences around one factor may be modified in the presence of others is still unclear. Research that seeks to clarify interactions among factors by asking the public to weigh several of them at once is needed to ensure the relevance of elicited preferences to real-world technology funding decisions.

Understanding Female Condom Use and Negotiation Among Young Women in Cape Town, South Africa.

PubMed

Martin, Julia; de Lora, Patsy; Rochat, Roger; Andes, Karen L

2016-03-01

In most countries, female condoms are not widely available and uptake has been slow. More information is needed on how women and men successfully negotiate female condom use. In-depth interviews were conducted at two sites in Cape Town, South Africa, with 14 women and 13 men who had used female condoms. A structured interview guide was used to elicit information on how women negotiate female condom use, and how male partners negotiate or respond to negotiations of female condom use. Thematic analysis was used to identify key patterns in the data. Participants reported that female condoms are easier for women to negotiate than male condoms, largely because the method is understood to be under a woman's control. The main barrier to use was lack of familiarity with the method; strong negative reactions from partners were not a major barrier. Personal comfort and tensions with partners usually improved after first use. Some male respondents preferred the method because it shifts responsibility for condom use from men to women. Findings suggest that female condoms empower women to initiate barrier method use, and that programs designed to educate potential users about female condoms and familiarize them with the method may be useful. That some men preferred female condoms because they wanted women to take responsibility for condom use is cause for concern, and suggests that counseling efforts should be directed toward men as well as women, and should include a discussion of gender dynamics and responsibility that emphasizes condom use as a choice that couples make together.

Social media in the REI clinic: what do patients want?

PubMed

Broughton, Darcy E; Schelble, Allison; Cipolla, Kristina; Cho, Michele; Franasiak, Jason; Omurtag, Kenan R

2018-05-15

To elicit patient preferences for social media utilization and content in the infertility clinic. This was a cross-sectional survey study conducted in three US fertility practices. Women presenting to the infertility clinic for an initial or return visit were offered an anonymous voluntary social media survey. The survey elicited patient perception of whether social media use in the infertility clinic is beneficial, and preferences regarding topics of interest. A total of 244 surveys were collected during the study period, of which 54.5% were complete. Instagram is a more popular platform than Twitter across all age groups. Use of both platforms varies by age, with patients ≥ 40 less likely to be active users. The majority of respondents felt that social media provided benefit to the patient experience in the infertility clinic (79.9%). "Education regarding infertility testing and treatment" and "Myths and Facts about infertility" were the most popular topics for potential posts, with 93.4 and 92.0% of patients endorsing interest respectively. The least popular topic was "Newborn photos and birth announcements," with only 47.4% endorsing interest. A little over half of respondents (56.3%) would feel comfortable with the clinic posting a picture of their infant. The vast majority of patients (96.2%) feel comfortable communicating electronically with their infertility clinic. Patients are interested in the use of social media as a forum for patient education and support in the infertility clinic. Patient preferences regarding post topics should be carefully considered.

A simple way to unify multicriteria decision analysis (MCDA) and stochastic multicriteria acceptability analysis (SMAA) using a Dirichlet distribution in benefit-risk assessment.

PubMed

Saint-Hilary, Gaelle; Cadour, Stephanie; Robert, Veronique; Gasparini, Mauro

2017-05-01

Quantitative methodologies have been proposed to support decision making in drug development and monitoring. In particular, multicriteria decision analysis (MCDA) and stochastic multicriteria acceptability analysis (SMAA) are useful tools to assess the benefit-risk ratio of medicines according to the performances of the treatments on several criteria, accounting for the preferences of the decision makers regarding the relative importance of these criteria. However, even in its probabilistic form, MCDA requires the exact elicitations of the weights of the criteria by the decision makers, which may be difficult to achieve in practice. SMAA allows for more flexibility and can be used with unknown or partially known preferences, but it is less popular due to its increased complexity and the high degree of uncertainty in its results. In this paper, we propose a simple model as a generalization of MCDA and SMAA, by applying a Dirichlet distribution to the weights of the criteria and by making its parameters vary. This unique model permits to fit both MCDA and SMAA, and allows for a more extended exploration of the benefit-risk assessment of treatments. The precision of its results depends on the precision parameter of the Dirichlet distribution, which could be naturally interpreted as the strength of confidence of the decision makers in their elicitation of preferences. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Reflecting on the use of photo elicitation with children.

PubMed

Whiting, Lisa S

2015-01-01

To reflect on the use of photo elicitation as a data collection method when conducting research with primary school age children (nine to 11 years). There is recognition that children feel an affinity with the visual medium; as a result, visual methods can be useful when conducting research with children. Photo elicitation is one such method, but there has been little discussion of its use with primary school children within a health context. This paper considers the main issues that researchers should consider. This paper draws on a research study conducted by the author that used an ethnographic approach and photo elicitation to identify the assets underpinning children's wellbeing. A reflective discussion is used to highlight issues relating to the use of photo elicitation to collect data from primary school children. Photo elicitation is not without its challenges: it creates additional ethical considerations, and can be more time-consuming and expensive. However, children value the opportunity to be involved in research and have their opinions sought, and photo elicitation provides a method of collecting data that is appropriate for children's developmental and cognitive maturational stages. Photo elicitation can be a positive experience for children, and one that is not only fun and engaging, but that is also empowering and valuing of their contributions. Research that uses photo elicitation needs to be carefully planned to ensure that the study is supported appropriately. The visual process can offer a unique insight into children's lives that allows health professionals to deepen their understanding of children's experiences.

Research Synthesis Methods in an Age of Globalized Risks: Lessons from the Global Burden of Foodborne Disease Expert Elicitation.

PubMed

2016-02-01

We live in an age that increasingly calls for national or regional management of global risks. This article discusses the contributions that expert elicitation can bring to efforts to manage global risks and identifies challenges faced in conducting expert elicitation at this scale. In doing so it draws on lessons learned from conducting an expert elicitation as part of the World Health Organizations (WHO) initiative to estimate the global burden of foodborne disease; a study commissioned by the Foodborne Disease Epidemiology Reference Group (FERG). Expert elicitation is designed to fill gaps in data and research using structured, transparent methods. Such gaps are a significant challenge for global risk modeling. Experience with the WHO FERG expert elicitation shows that it is feasible to conduct an expert elicitation at a global scale, but that challenges do arise, including: defining an informative, yet feasible geographical structure for the elicitation; defining what constitutes expertise in a global setting; structuring international, multidisciplinary expert panels; and managing demands on experts' time in the elicitation. This article was written as part of a workshop, "Methods for Research Synthesis: A Cross-Disciplinary Approach" held at the Harvard Center for Risk Analysis on October 13, 2013. © 2016 Society for Risk Analysis.

Expert elicitation of population-level effects of disturbance

USGS Publications Warehouse

Fleishman, Erica; Burgman, Mark; Runge, Michael C.; Schick, Robert S; Krauss, Scott; Popper, Arthur N.; Hawkins, Anthony

2016-01-01

Expert elicitation is a rigorous method for synthesizing expert knowledge to inform decision making and is reliable and practical when field data are limited. We evaluated the feasibility of applying expert elicitation to estimate population-level effects of disturbance on marine mammals. Diverse experts estimated parameters related to mortality and sublethal injury of North Atlantic right whales (Eubalaena glacialis). We are now eliciting expert knowledge on the movement of right whales among geographic regions to parameterize a spatial model of health. Expert elicitation complements methods such as simulation models or extrapolations from other species, sometimes with greater accuracy and less uncertainty.

Caudal Nucleus Accumbens Core Is Critical in the Regulation of Cue-Elicited Approach-Avoidance Decisions

PubMed Central

Hamel, Laurie; Thangarasa, Tharshika; Samadi, Osai

2017-01-01

The nucleus accumbens (NAc) is thought to be a site of integration of positively and negatively valenced information and action selection. Functional differentiation in valence processing has previously been found along the rostrocaudal axis of the shell region of the NAc in assessments of unconditioned motivation. Given that the core region of the NAc has been implicated in the elicitation of motivated behavior in response to conditioned cues, we sought to assess the role of caudal, intermediate, and rostral sites within this subregion in cue-elicited approach-avoidance decisions. Rats were trained to associate visuo-tactile cues with appetitive, aversive, and neutral outcomes. Following the successful acquisition of the cue-outcome associations, rats received microinfusions of GABAA and GABAB receptor agonists (muscimol/baclofen) or saline into the caudal, intermediate, or rostral NAc core and were then exposed to a superimposition of appetitively and aversively valenced cues versus neutral cues in a “conflict test,” as well as to the appetitive versus neutral cues, and aversive cues versus neutral cues, in separate conditioned preference/avoidance tests. Disruption of activity in the intermediate to caudal parts of the NAc core resulted in a robust avoidance bias in response to motivationally conflicting cues, as well as a potentiated avoidance of aversive cues as compared with control animals, coupled with an attenuated conditioned preference for the appetitive cue. These results suggest that the caudal NAc core may have the capacity to exert bidirectional control over appetitively and aversively motivated responses to valence signals. PMID:28275709

"Are Your Clients Having Fun?" The Implications of Respondents' Preferences for the Delivery of Group Exercise Programs for Falls Prevention.

PubMed

McPhate, Lucy; Simek, Emily M; Haines, Terry P; Hill, Keith D; Finch, Caroline F; Day, Lesley

2016-01-01

Group exercise has been shown to be effective in preventing falls; however, adherence to these interventions is often poor. Older adults' preferences for how these programs can be delivered are unknown. To identify older people's preferences for how group exercise programs for falls prevention can be delivered. A two-wave, cross-sectional, state-wide telephone survey was undertaken. Respondents were community-dwelling men and women aged 70+ in Victoria, Australia. Open-ended questions were asked to elicit information regarding respondent preferences of the program, which were analyzed using a framework approach. Ninety-seven respondents completed the follow-up survey. The results indicate that older adults most frequently report the short-term advantages and disadvantages when describing their preferences for group exercise, such as enjoyment, social interaction, and leader qualities. Longer-term advantages such as falls prevention were described less frequently. This study indicates the importance of interpersonal skills, and that the opportunity for social interaction should not be overlooked as a positive feature of a group exercise program.

A universal preference for equality in health? Reasons to reconsider properties of applied social welfare functions.

PubMed

Mæstad, Ottar; Norheim, Ole Frithjof

2012-11-01

The literature on how to combine efficiency and equity considerations in the social valuation of health allocations has borrowed extensively from applied welfare economics, including the literature on inequality measurement. By so doing, it has adopted normative assumptions that have been applied for evaluating the allocation of welfare (or income) rather than the allocation of health, including the assumption of a monotonically declining social marginal value of welfare/income/health. At the same time, empirical studies that have elicited social preferences for allocation of health have reported results that are seemingly incompatible with this assumption. There are two ways of addressing this inconsistency; we may censor the stated preferences by arguing that they cannot be supported by normative arguments, or we may reject or modify the analytical framework in order to accommodate the stated preferences. We argue that the stated preferences can be supported by normative reasoning and therefore conclude that one should be cautious in applying the standard welfare economic framework to the allocation of health. Copyright © 2012 Elsevier Ltd. All rights reserved.

An ERP Study of Causative Cleft Construction in Japanese: Evidence for the Preference of Shorter Linear Distance in Sentence Comprehension

ERIC Educational Resources Information Center

Yano, Masataka; Sakamoto, Tsutomu

2016-01-01

This study examined the processing of two types of Japanese causative cleft constructions (subject-gap vs. object-gap) by conducting an event-related brain potential experiment to clarify the processing mechanism of long-distance dependencies. The results demonstrated that the subject-gap constructions elicited larger P600 effects than the…

Which Terms Should Be Used to Describe Autism? Perspectives from the UK Autism Community

ERIC Educational Resources Information Center

Kenny, Lorcan; Hattersley, Caroline; Molins, Bonnie; Buckley, Carole; Povey, Carol; Pellicano, Elizabeth

2016-01-01

Recent public discussions suggest that there is much disagreement about the way autism is and should be described. This study sought to elicit the views and preferences of UK autism community members--autistic people, parents and their broader support network--about the terms they use to describe autism. In all, 3470 UK residents responded to an…

The Development of NP Selection in School-Age Children: Reference and Spanish Subject Pronouns

ERIC Educational Resources Information Center

Shin, Naomi Lapidus; Cairns, Helen Smith

2012-01-01

To investigate the development of the NP selection process, preferences for overt or null Spanish subject pronouns were elicited from 139 children (5;09 to 15;08) and 30 adults in Mexico. Participants were told stories in which consecutive grammatical subjects shared the same referent (same-reference), or did not (switch-reference). In the…

Valuation of preference-based measures: can existing preference data be used to generate better estimates?

PubMed

Kharroubi, Samer A

2018-06-05

Experimental studies to develop valuations of health state descriptive systems like EQ-5D or SF-6D need to be conducted in different countries, because social and cultural differences are likely to lead to systematically different valuations. There is a scope utilize the evidence in one country to help with the design and the analysis of a study in another, for this to enable the generation of utility estimates of the second country much more precisely than would have been possible when collecting and analyzing the country's data alone. We analyze SF-6D valuation data elicited from representative samples corresponding to the Hong Kong (HK) and United Kingdom (UK) general adult populations through the use of the standard gamble technique to value 197 and 249 health states respectively. We apply a nonparametric Bayesian model to estimate a HK value set using the UK dataset as informative prior to improve its estimation. Estimates are compared to a HK value set estimated using HK values alone using mean predictions and root mean square error. The novel method of modelling utility functions permitted the UK valuations to contribute significant prior information to the Hong Kong analysis. The results suggest that using HK data alongside the existing UK data produces HK utility estimates better than using the HK study data by itself. The promising results suggest that existing preference data could be combined with valuation study in a new country to generate preference weights, making own country value sets more achievable for low and middle income countries. Further research is encouraged.

Sociodemographic Differences in Clients Preferring Video-Call Over In-person Interview: A Pilot Study of HIV Tele-partner Services.

PubMed

Udeagu, Chi-Chi N; Shah, Sharmila; Toussaint, Magalieta M; Pickett, Leonard

2017-11-01

The New York City Department of Health Disease Intervention Specialists (DIS) routinely contact newly HIV-diagnosed persons via telephone calls and in-person meetings to conduct partner services (PS) interviews in order to elicit the names and contact information of the HIV-exposed partners for notification and HIV-testing, and to assist clients with linkage to care. From October 2013 to December 2015, we offered PS interviews conducted via video-call alongside voice-call and in-person modes in a selected geographic area of NYC. PS interviews were conducted according to the clients' preferred mode (in-person, voice- or video-call) and location (health care facility, clients' residences, or other NYC locations). At the conclusion of the PS interviews, DIS elicited responses from persons interviewed via video-call on their perception, satisfaction and personal experiences using video-call for public health and personal purposes. Acceptance and satisfaction with PS interviews via video-call were high among clients aged <30 years, men who have sex with men, or with education above high school; while PS yields were similar across modes. These results provide evidence of the potential effectiveness of video-call interviews for specific populations.

Individual patient's preferences for hypertension management: a Q-methodological approach.

PubMed

Morecroft, Charles; Cantrill, Judy; Tully, Mary P

2006-06-01

To systematically explore and elicit individual patient's preferences in the management of their hypertension using Q-methodology. Using Q-methodology, 120 patients ranking 42 statements according to their agreement or disagreement when considering appropriate hypertension management. The statements were derived from an earlier qualitative study. Factor analysis of the data was undertaken using PQMethod software to determine if any patterns were discernible. Ninety-two patients clustered to five factors, which all varied in the degree of involvement patients had, or wished to have, in their hypertension management. The 42 patients who loaded to factor 1 considered that appropriate antihypertensive treatment involved leaving medical decisions to their GPs and trusting their judgement in such matters. The patients (n = 31) who positively loaded to factor 2 suggested that an autonomous relationship with their healthcare professional(s) was an important issue when considering treatment. It is concluded that this study has successfully used Q-methodology to systematically investigate people's subjectivity and developed a novel approach to elicit the views of individual patients, as well as explore and differentiate between groups of patients. The formation of true partnerships between patients and healthcare professionals which will enhance individual patients' ability to self-manage chronic disease.

Predicting the preferences for involvement in medical decision making among patients with mental disorders.

PubMed

Michaelis, Svea; Kriston, Levente; Härter, Martin; Watzke, Birgit; Schulz, Holger; Melchior, Hanne

2017-01-01

The involvement of patients in medical decision making has been investigated widely in somatic diseases. However, little is known about the preferences for involvement and variables that could predict these preferences in patients with mental disorders. This study aims to determine what roles mentally ill patients actually want to assume when making medical decisions and to identify the variables that could predict this role, including patients' self-efficacy. Demographic and clinical data of 798 patients with mental disorders from three psychotherapeutic units in Germany were elicited using self-report questionnaires. Control preference was measured using the Control Preferences Scale, and patients' perceived self-efficacy was assessed using the Self-Efficacy Scale. Bivariate and multivariate regression analyses were conducted to investigate the associations between patient variables and control preference. Most patients preferred a collaborative role (57.5%), followed by a semi passive (21.2%), a partly autonomous (16.2%), an autonomous (2.8%) and a fully passive (2.3%) role when making medical decisions. Age, sex, diagnosis, employment status, medical pretreatment and perceived self-efficacy were associated with the preference for involvement in the multivariate logistic model. Our results confirm the preferences for involvement in medical decisions of mentally ill patients. We reconfirmed previous findings that older patients prefer a shared role over an autonomous role and that subjects with a high qualification prefer a more autonomous role over a shared role. The knowledge about predictors may help strengthen treatment effectiveness because matching the preferred and actual role preferences has been shown to improve clinical outcome.

Incorporating sign-dependence in health-related social welfare functions.

PubMed

Attema, Arthur E

2015-04-01

It is important to measure people's preferences regarding the trade-off between efficiency and equity in health to make public decisions that are in a society's best interests. This article demonstrates the usefulness of social welfare functions to obtain these measurements. Insights from individual decision making, in particular, prospect theory, turn out to be helpful to estimate societal preferences more accurately. The author shows how one can disentangle the effects of loss aversion in this estimation. The presented approach also allows for sign-dependent societal utility and equity weighting functions. Recent empirical studies that used this approach with choices concerning quality of life of other people reported the presence of substantial inequity aversion both for gains and for losses, as well as loss aversion. Several examples demonstrate the relevance of these insights for preference elicitations and health economic evaluations.

The new health-care quality: value, outcomes, and continuous improvement.

PubMed

O'Connor, S J; Lanning, J A

1991-01-01

No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

Community financing of local ivermectin distribution in Nigeria: potential payment and cost-recovery outlook.

PubMed

Onwujekwe, O E; Shu, E N; Okonkwo, P O

2000-04-01

The preferred payment mechanism in a community financing scheme for local ivermectin distribution was elicited from randomly selected household heads from three communities in Nigeria using interviewer-administered structured questionnaires. The majority of the respondents in the three communities were prepared to pay for local ivermectin distribution. Additionally, the average amounts the respondents were prepared to pay per person treated ($0.28, $0.30 and $0.38 in Nike, Achi and Toro, respectively) were all more than the $0.20 ceiling recommended by the partners of the African Programme on Onchocerciasis Control (APOC). Thus, the cost-recovery outlook is bright in these communities. However, the preferred payment modality varied. Fee-for-service was the predominant payment modality in the Achi and Nike communities, while the Toro community preferred pre-payment. This study demonstrates that many communities have different payment preferences for endemic disease control efforts. This knowledge will help in developing acceptable and sustainable schemes. The imposition of unacceptable payment mechanisms will lead to an unwillingness to pay.

Moving the eye of the beholder. Motor components in vision determine aesthetic preference.

PubMed

Topolinski, Sascha

2010-09-01

Perception entails not only sensory input (e.g., merely seeing), but also subsidiary motor processes (e.g., moving the eyes); such processes have been neglected in research on aesthetic preferences. To fill this gap, the present research manipulated the fluency of perceptual motor processes independently from sensory input and predicted that this increased fluency would result in increased aesthetic preference for stimulus movements that elicited the same motor movements as had been previously trained. Specifically, addressing the muscles that move the eyes, I trained participants to follow a stimulus movement without actually seeing it. Experiment 1 demonstrated that ocular-muscle training resulted in the predicted increase in preference for trained stimulus movements compared with untrained stimulus movements, although participants had not previously seen any of the movements. Experiments 2 and 3 showed that actual motor matching and not perceptual similarity drove this effect. Thus, beauty may be not only in the eye of the beholder, but also in the eyes' movements.

Asymmetric information and user orientation in general practice: Exploring the agency relationship in a best-worst scaling study.

PubMed

Pedersen, Line Bjørnskov; Hess, Stephane; Kjær, Trine

2016-12-01

This study uses a best-worst scaling experiment to test whether general practitioners (GPs) act as perfect agents for the patients in the consultation; and if not, whether this is due to asymmetric information and/or other motivations than user orientation. Survey data were collected from 775 GPs and 1379 Danish citizens eliciting preferences for a consultation. Sequential models allowing for within-person preference heterogeneity and heteroskedasticity between best and worst choices were estimated. We show that GPs do not always act as perfect agents and that this non-alignment stems from GPs being both unable and unwilling to do so. Unable since GPs have imperfect information about patients' preferences, and unwilling since they are also motivated by other factors than user orientation. Our findings highlight the need for multi-pronged strategies targeting different motivational factors to ensure that GPs act in correspondence with patients' preferences in areas where alignment is warranted. Copyright © 2016 Elsevier B.V. All rights reserved.

Decision heuristic or preference? Attribute non-attendance in discrete choice problems.

PubMed

Heidenreich, Sebastian; Watson, Verity; Ryan, Mandy; Phimister, Euan

2018-01-01

This paper investigates if respondents' choice to not consider all characteristics of a multiattribute health service may represent preferences. Over the last decade, an increasing number of studies account for attribute non-attendance (ANA) when using discrete choice experiments to elicit individuals' preferences. Most studies assume such behaviour is a heuristic and therefore uninformative. This assumption may result in misleading welfare estimates if ANA reflects preferences. This is the first paper to assess if ANA is a heuristic or genuine preference without relying on respondents' self-stated motivation and the first study to explore this question within a health context. Based on findings from cognitive psychology, we expect that familiar respondents are less likely to use a decision heuristic to simplify choices than unfamiliar respondents. We employ a latent class model of discrete choice experiment data concerned with National Health Service managers' preferences for support services that assist with performance concerns. We present quantitative and qualitative evidence that in our study ANA mostly represents preferences. We also show that wrong assumptions about ANA result in inadequate welfare measures that can result in suboptimal policy advice. Future research should proceed with caution when assuming that ANA is a heuristic. Copyright © 2017 John Wiley & Sons, Ltd.

The Preferred Substrates for Transglutaminase 2 in a Complex Wheat Gluten Digest Are Peptide Fragments Harboring Celiac Disease T-Cell Epitopes

PubMed Central

Dørum, Siri; Arntzen, Magnus Ø.; Qiao, Shuo-Wang; Holm, Anders; Koehler, Christian J.; Thiede, Bernd; Sollid, Ludvig M.; Fleckenstein, Burkhard

2010-01-01

Background Celiac disease is a T-cell mediated chronic inflammatory disorder of the gut that is induced by dietary exposure to gluten proteins. CD4+ T cells of the intestinal lesion recognize gluten peptides in the context of HLA-DQ2.5 or HLA-DQ8 and the gluten derived peptides become better T-cell antigens after deamidation catalyzed by the enzyme transglutaminase 2 (TG2). In this study we aimed to identify the preferred peptide substrates of TG2 in a heterogeneous proteolytic digest of whole wheat gluten. Methods A method was established to enrich for preferred TG2 substrates in a complex gluten peptide mixture by tagging with 5-biotinamido-pentylamine. Tagged peptides were isolated and then identified by nano-liquid chromatography online-coupled to tandem mass spectrometry, database searching and final manual data validation. Results We identified 31 different peptides as preferred substrates of TG2. Strikingly, the majority of these peptides were harboring known gluten T-cell epitopes. Five TG2 peptide substrates that were predicted to bind to HLA-DQ2.5 did not contain previously characterized sequences of T-cell epitopes. Two of these peptides elicited T-cell responses when tested for recognition by intestinal T-cell lines of celiac disease patients, and thus they contain novel candidate T-cell epitopes. We also found that the intact 9mer core sequences of the respective epitopes were not present in all peptide substrates. Interestingly, those epitopes that were represented by intact forms were frequently recognized by T cells in celiac disease patients, whereas those that were present in truncated versions were infrequently recognized. Conclusion TG2 as well as gastrointestinal proteolysis play important roles in the selection of gluten T-cell epitopes in celiac disease. PMID:21124911

Women's preferences for childbirth experiences in the Republic of Ireland; a mixed methods study.

PubMed

Larkin, Patricia; Begley, Cecily M; Devane, Declan

2017-01-10

How women experience childbirth is acknowledged as critical to the postnatal wellbeing of mother and baby. However there is a knowledge deficit in identifying the important elements of these experiences in order to enhance care. This study elicits women's preferences for the most important elements of their childbirth experiences. A mixed methods design was used. An initial qualitative phase (reported previously) was followed by a second quantitative one using a discrete choice experiment (DCE), which is reported on here. Participants who had experienced labour, were over 18 and had a healthy baby were recruited from four randomly selected and one pilot hospital in the Republic of Ireland. Data were collected by means of a DCE survey instrument. Questions were piloted, refined, and then arranged in eight pair-wise scenarios. Women identified their preferences by choosing one scenario over another. Nine hundred and five women were sent the DCE three months after childbirth, with a response rate of 59.3% (N =531). Women clearly identified priorities for their childbirth experiences as: the availability of pain relief, partnership with the midwife, and individualised care being the most important attributes. In the context of other choices, women rated decision-making, presence of a consultant, and interventions as less important elements. Comments from open questions provided contextual information about their choices. Most women did not want to be typified as wanting the dichotomy of 'all natural' or 'all technology' births but wanted 'the best of both worlds'. The results suggest that availability of pain relief was the most important element of women's childbirth experiences, and superseded all other elements including partnership with the midwife which was the second most important attribute. The preferences identified might reflect the busy medicalised hospital environments, in which the vast majority of women had given birth, and may differ in settings such as midwifery led care or home births.

Societal Preferences for EQ-5D Health States from a Brazilian Population Survey.

PubMed

Viegas Andrade, Mônica; Noronha, Kenya; Kind, Paul; Maia, Ana Carolina; Miranda de Menezes, Renata; De Barros Reis, Carla; Nepomuceno Souza, Michelle; Martins, Diego; Gomes, Lucas; Nichele, Daniel; Calazans, Julia; Mascarenhas, Tamires; Carvalho, Lucas; Lins, Camila

2013-12-01

To elicit preference weights for a subset of EuroQol five-dimensional (EQ-5D) questionnaire health states from a representative sample for the state of Minas Gerais, Brazil, using a time trade-off (TTO) method and to analyze these data so as to estimate social preference weights for the complete set of 243 states. Data came from a valuation study with 3362 literate individuals aged between 18 and 64 years living in urban areas. The present study was based on quota sampling by age and sex. Face-to-face interviews were conducted in participants' own homes. A total of 99 EQ-5D questionnaire health states were selected, presorted into 26 blocks of six unique health states. Each participant valued one block together with the full health, worst health, and dead states. Each health state was evaluated by more than 100 individuals. TTO data were modeled at both individual and aggregate levels by using ordinary least squares and random effects methods. Values estimated by different models yielded very similar results with satisfactory goodness-of-fit statistics: the mean absolute error was around 0.03 and fewer than 25% of the states had a mean absolute error greater than 0.05. Dummies coefficients for each level within the EQ-5D questionnaire dimensions of health displayed an internally consistent ordering, with the mobility dimension demonstrating the largest value decrement. The values of mean observed transformed TTO values range from 0.869 to-0.235. The study demonstrates the feasibility of conducting face-to-face interviews using TTO in a Brazilian population setting. The estimated values for EQ-5D questionnaire health states based on this Minas Gerais survey represent an important first step in establishing national Brazilian social preference weights for the EQ-5D questionnaire. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Estimating Domestic Values for EQ-5D Health States Using Survey Data From External Sources.

PubMed

Chuang, Ling-Hsiang; Zarate, Victor; Kind, Paul

2009-02-01

Health status measures used to quantify outcomes for economic evaluation must be capable of representing health gain in a single index, usually calibrated in terms of the social preferences elicited from "the relevant population." The general problem faced in the majority of countries where social preferences are required for cost-effectiveness analysis is the absence of a value set based on domestic data sources. This article establishes a methodology for estimating domestic visual analog scale (VAS)-based values for EQ-5D health states by adjusting data sets from countries where valuation studies have been carried out. building upon the relationship between the values for respondents' real health states and hypothetical health states, 2 models are investigated. One assumes that the link between VAS scores for real and hypothetical health state is constant across 2 countries (R1), whereas the other adopts the assumption that the relationship of VAS scores for hypothetical heath states between 2 countries functionally corresponds to variation in scores for real health states (R2). Data from national UK and US population surveys were selected to test both methods. The R2 model performed better in generating estimated scores that were closer to observed values. The R2 model seems to offer a viable method for estimating domestic values of health. Such a method could help to bridge the gap between countries as well as region within a country.

Probability Elicitation Under Severe Time Pressure: A Rank-Based Method.

PubMed

Jaspersen, Johannes G; Montibeller, Gilberto

2015-07-01

Probability elicitation protocols are used to assess and incorporate subjective probabilities in risk and decision analysis. While most of these protocols use methods that have focused on the precision of the elicited probabilities, the speed of the elicitation process has often been neglected. However, speed is also important, particularly when experts need to examine a large number of events on a recurrent basis. Furthermore, most existing elicitation methods are numerical in nature, but there are various reasons why an expert would refuse to give such precise ratio-scale estimates, even if highly numerate. This may occur, for instance, when there is lack of sufficient hard evidence, when assessing very uncertain events (such as emergent threats), or when dealing with politicized topics (such as terrorism or disease outbreaks). In this article, we adopt an ordinal ranking approach from multicriteria decision analysis to provide a fast and nonnumerical probability elicitation process. Probabilities are subsequently approximated from the ranking by an algorithm based on the principle of maximum entropy, a rule compatible with the ordinal information provided by the expert. The method can elicit probabilities for a wide range of different event types, including new ways of eliciting probabilities for stochastically independent events and low-probability events. We use a Monte Carlo simulation to test the accuracy of the approximated probabilities and try the method in practice, applying it to a real-world risk analysis recently conducted for DEFRA (the U.K. Department for the Environment, Farming and Rural Affairs): the prioritization of animal health threats. © 2015 Society for Risk Analysis.

Willingness to pay and conjoint analysis to determine women's preferences for ovarian stimulating hormones in the treatment of infertility in Spain

PubMed Central

Palumbo, A.; De La Fuente, P.; Rodríguez, M.; Sánchez, F.; Martínez-Salazar, J.; Muñoz, M.; Marqueta, J.; Hernández, J.; Espallardo, O.; Polanco, C.; Paz, S.; Lizán, L.

2011-01-01

BACKGROUND Despite many advances in assisted reproductive techniques (ART), little is known about preferences for technological developments of women undergoing fertility treatments. The aims of this study were to investigate the preferences of infertile women undergoing ART for controlled ovarian stimulation (COS) treatments; to determine the utility values ascribed to different attributes of COS treatments; and to estimate women's willingness to pay (WTP) for COS. METHODS A representative sample of ambulatory patients ready to receive, or receiving, COS therapies for infertility were recruited from seven specialized private centres in six autonomous communities in Spain. Descriptive, inferential and conjoint analyses (CA) were used to elicit preferences and WTP. Attributes and levels of COS treatments were identified by literature review and two focus groups with experts and patients. WTP valuations were derived by a combination of double-bounded (closed-ended) and open questions and contingent ranking methods. RESULTS In total, 160 patients [mean (standard deviation; SD) age: 35.8 (4.2) years] were interviewed. Over half of the participants (55.0%) had a high level of education (university degree), most (78.8%) were married and half (50.0%) had an estimated net income of >€1502 per month and had paid a mean (SD) €1194.17 (€778.29) for their most recent hormonal treatment. The most frequent causes of infertility were related to sperm abnormalities (50.3%). In 30.6% of cases, there were two causes of infertility. The maximum WTP for COS treatment was €800 (median) per cycle; 35.5% were willing to pay an additional €101–€300 for a 1–2% effectiveness gain in the treatment. Utility values (CA) showed that effectiveness was the most valued attribute (39.82), followed by costs (18.74), safety (17.75) and information sharing with physicians (14.93). CONCLUSIONS WTP for COS therapies exceeds current cost. Additional WTP exists for 1–2% effectiveness improvement. Effectiveness and costs were the most important determinants of preferences, followed by safety and information sharing with physicians. PMID:21558333

An empirical comparison of methods for analyzing correlated data from a discrete choice survey to elicit patient preference for colorectal cancer screening

PubMed Central

2012-01-01

Background A discrete choice experiment (DCE) is a preference survey which asks participants to make a choice among product portfolios comparing the key product characteristics by performing several choice tasks. Analyzing DCE data needs to account for within-participant correlation because choices from the same participant are likely to be similar. In this study, we empirically compared some commonly-used statistical methods for analyzing DCE data while accounting for within-participant correlation based on a survey of patient preference for colorectal cancer (CRC) screening tests conducted in Hamilton, Ontario, Canada in 2002. Methods A two-stage DCE design was used to investigate the impact of six attributes on participants' preferences for CRC screening test and willingness to undertake the test. We compared six models for clustered binary outcomes (logistic and probit regressions using cluster-robust standard error (SE), random-effects and generalized estimating equation approaches) and three models for clustered nominal outcomes (multinomial logistic and probit regressions with cluster-robust SE and random-effects multinomial logistic model). We also fitted a bivariate probit model with cluster-robust SE treating the choices from two stages as two correlated binary outcomes. The rank of relative importance between attributes and the estimates of β coefficient within attributes were used to assess the model robustness. Results In total 468 participants with each completing 10 choices were analyzed. Similar results were reported for the rank of relative importance and β coefficients across models for stage-one data on evaluating participants' preferences for the test. The six attributes ranked from high to low as follows: cost, specificity, process, sensitivity, preparation and pain. However, the results differed across models for stage-two data on evaluating participants' willingness to undertake the tests. Little within-patient correlation (ICC ≈ 0) was found in stage-one data, but substantial within-patient correlation existed (ICC = 0.659) in stage-two data. Conclusions When small clustering effect presented in DCE data, results remained robust across statistical models. However, results varied when larger clustering effect presented. Therefore, it is important to assess the robustness of the estimates via sensitivity analysis using different models for analyzing clustered data from DCE studies. PMID:22348526

Landscape Preferences, Amenity, and Bushfire Risk in New South Wales, Australia.

PubMed

Gill, Nicholas; Dun, Olivia; Brennan-Horley, Chris; Eriksen, Christine

2015-09-01

This paper examines landscape preferences of residents in amenity-rich bushfire-prone landscapes in New South Wales, Australia. Insights are provided into vegetation preferences in areas where properties neighbor large areas of native vegetation, such as national parks, or exist within a matrix of cleared and vegetated private and public land. In such areas, managing fuel loads in the proximity of houses is likely to reduce the risk of house loss and damage. Preferences for vegetation appearance and structure were related to varying fuel loads, particularly the density of understorey vegetation and larger trees. The study adopted a qualitative visual research approach, which used ranking and photo-elicitation as part of a broader interview. A visual approach aids in focusing on outcomes of fuel management interventions, for example, by using the same photo scenes to firstly derive residents' perceptions of amenity and secondly, residents' perceptions of bushfire risk. The results are consistent with existing research on landscape preferences; residents tend to prefer relatively open woodland or forest landscapes with good visual and physical access but with elements that provoke their interest. Overall, residents' landscape preferences were found to be consistent with vegetation management that reduces bushfire risk to houses. The terms in which preferences were expressed provide scope for agency engagement with residents in order to facilitate management that meets amenity and hazard reduction goals on private land.

Road safety perspectives among employees of a multinational corporation in urban India: local context for global injury prevention.

PubMed

Jacoby, Sara F; Winston, Flaura K; Richmond, Therese S

2017-12-01

In rapidly developing economies, like urban India, where road traffic injury rates are among the world's highest, the corporate workplace offers a non-traditional venue for road safety interventions. In partnership with a major multinational corporation (MNC) with a large Indian workforce, this study aimed to elicit local employee perspectives on road safety to inform a global corporate health platform. The safety attitudes and behaviours of 75 employees were collected through self-report survey and focus groups in the MNC offices in Bangalore and Pune. Analysis of these data uncovered incongruity between employee knowledge of safety strategies and their enacted safety behaviours and identified local preference for interventions and policy-level actions. The methods modelled by this study offer a straightforward approach for eliciting employee perspective for local road safety interventions that fit within a global strategy to improve employee health. Study findings suggest that MNCs can employ a range of strategies to improve the road traffic safety of their employees in settings like urban India including: implementing corporate traffic safety policy, making local infrastructure changes to improve road and traffic conditions, advocating for road safety with government partners and providing employees with education and access to safety equipment and safe transportation options.

What parents want from emails with their pediatrician: implications for teaching communication skills.

PubMed

Schiller, Jocelyn H; Christner, Jennifer G; Stansfield, Robert Brent; Watnick, Caroline S; Mullan, Patricia B

2013-07-01

Physician-patient email communication is increasing but trainees receive no education on this communication medium. Research eliciting patient preferences about email communication could inform training. Investigators elicited parents' perspectives on physician-parent email communication and compared parent and faculty assessments of medical students' emails. This mixed methods study explored physician-parent email communication in 5 parent focus groups using qualitative analyses to identify themes. Differences between faculty and parent assessment scores for students' email responses were calculated using univariate general linear modeling. Themes that emerged were: (1) Building the Relationship, (2) Clarity of Communication and (3) Expectations. Parents criticized student's statements as condescending. The sum of assessment scores by parents and faculty were moderately correlated (r(44)=.407, P<.01), but parents gave students lower scores on "acknowledges validity/expresses empathy" (P=.01) and higher scores on "provides next steps" (P<.01) and "identifies issues" (P<.01). Parents place value on students' abilities to communicate clearly and convey respect and empathy in email. Parent and faculty perspectives on email communication are similar but not the same. Differences between parental and faculty assessments of medical students' emails supports the need for the involvement of patients and families in email communication curriculum development. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Contrast of Hand Preferences between Communicative Gestures and Non-Communicative Actions in Baboons: Implications for the Origins of Hemispheric Specialization for Language

ERIC Educational Resources Information Center

Meguerditchian, Adrien; Vauclair, Jacques

2009-01-01

Gestural communication is a modality considered in the literature as a candidate for determining the ancestral prerequisites of the emergence of human language. As reported in captive chimpanzees and human children, a study in captive baboons revealed that a communicative gesture elicits stronger degree of right-hand bias than non-communicative…

Canadian residents' perceived manager training needs.

PubMed

Stergiopoulos, Vicky; Lieff, Susan; Razack, Saleem; Lee, A Curtis; Maniate, Jerry M; Hyde, Stacey; Taber, Sarah; Frank, Jason R

2010-01-01

Despite widespread endorsement for administrative training during residency, teaching and learning in this area remains intermittent and limited in most programmes. To inform the development of a Manager Train-the-Trainer program for faculty, the Royal College of Physicians and Surgeons of Canada undertook a survey of perceived Manager training needs among postgraduate trainees. A representative sample of Canadian specialty residents received a web-based questionnaire in 2009 assessing their perceived deficiencies in 13 Manager knowledge and 11 Manager skill domains, as determined by gap scores (GSs). GSs were defined as the difference between residents' perceived current and desired level of knowledge or skill in selected Manager domains. Residents' educational preferences for furthering their Manager knowledge and skills were also elicited. Among the 549 residents who were emailed the survey, 199 (36.2%) responded. Residents reported significant gaps in most knowledge and skills domains examined. Residents' preferred educational methods for learning Manager knowledge and skills included workshops, web-based formats and interactive small groups. The results of this national survey, highlighting significant perceived gaps in multiple Manager knowledge and skills domains, may inform the development of Manager curricula and faculty development activities to address deficiencies in training in this important area.

Cancer, Warts, or Asymptomatic Infections: Clinical Presentation Matches Codon Usage Preferences in Human Papillomaviruses

PubMed Central

Félez-Sánchez, Marta; Trösemeier, Jan-Hendrik; Bedhomme, Stéphanie; González-Bravo, Maria Isabel; Kamp, Christel; Bravo, Ignacio G.

2015-01-01

Viruses rely completely on the hosts’ machinery for translation of viral transcripts. However, for most viruses infecting humans, codon usage preferences (CUPrefs) do not match those of the host. Human papillomaviruses (HPVs) are a showcase to tackle this paradox: they present a large genotypic diversity and a broad range of phenotypic presentations, from asymptomatic infections to productive lesions and cancer. By applying phylogenetic inference and dimensionality reduction methods, we demonstrate first that genes in HPVs are poorly adapted to the average human CUPrefs, the only exception being capsid genes in viruses causing productive lesions. Phylogenetic relationships between HPVs explained only a small proportion of CUPrefs variation. Instead, the most important explanatory factor for viral CUPrefs was infection phenotype, as orthologous genes in viruses with similar clinical presentation displayed similar CUPrefs. Moreover, viral genes with similar spatiotemporal expression patterns also showed similar CUPrefs. Our results suggest that CUPrefs in HPVs reflect either variations in the mutation bias or differential selection pressures depending on the clinical presentation and expression timing. We propose that poor viral CUPrefs may be central to a trade-off between strong viral gene expression and the potential for eliciting protective immune response. PMID:26139833

The role of time and risk preferences in smoking inequalities: a population-based study.

PubMed

Jusot, Florence; Khlat, Myriam

2013-05-01

Heterogeneity in time and risk preferences has been proposed as one of the mechanisms involved in the educational gradient in smoking, but this mechanism has scarcely been explored empirically. Subjective scales were introduced in the 2008 French National Health, Health Care and Insurance Survey in order to elicit measures of time and risk preferences for a representative sample of 5188 men and 5684 women. Men and women were treated separately. First, logistic regressions were used to test the associations between preferences and education and between preferences and smoking. Second, nested logistic models were built to investigate the mediating role of preferences in the educational gradient in smoking, with an econometric treatment of the rescaling problem. Preference for the present and risk loving were found to be: inversely related to educational level; strongly related to each other, and; strongly associated to current smoking, even after adjustment for educational level. There was a weakening of the educational gradient after the control for preferences, which supports the role of these two preferences as partial mediators in the educational gradient in smoking. Among men, time preference was more strongly associated with smoking than risk aversion, while the reverse was found for women. We provide convincing evidence in favour of the mediating role of time preference and risk aversion in educational inequalities in smoking and highlight the connection between those two dimensions. Gender patterns are discussed and potential implications in terms of designing targeted anti-tobacco programmes are delineated. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessing Women's Preferences and Preference Modeling for Breast Reconstruction Decision-Making.

PubMed

Sun, Clement S; Cantor, Scott B; Reece, Gregory P; Crosby, Melissa A; Fingeret, Michelle C; Markey, Mia K

2014-03-01

Women considering breast reconstruction must make challenging trade-offs amongst issues that often conflict. It may be useful to quantify possible outcomes using a single summary measure to aid a breast cancer patient in choosing a form of breast reconstruction. In this study, we used multiattribute utility theory to combine multiple objectives to yield a summary value using nine different preference models. We elicited the preferences of 36 women, aged 32 or older with no history of breast cancer, for the patient-reported outcome measures of breast satisfaction, psychosocial well-being, chest well-being, abdominal well-being, and sexual wellbeing as measured by the BREAST-Q in addition to time lost to reconstruction and out-of-pocket cost. Participants ranked hypothetical breast reconstruction outcomes. We examined each multiattribute utility preference model and assessed how often each model agreed with participants' rankings. The median amount of time required to assess preferences was 34 minutes. Agreement among the nine preference models with the participants ranged from 75.9% to 78.9%. None of the preference models performed significantly worse than the best performing risk averse multiplicative model. We hypothesize an average theoretical agreement of 94.6% for this model if participant error is included. There was a statistically significant positive correlation with more unequal distribution of weight given to the seven attributes. We recommend the risk averse multiplicative model for modeling the preferences of patients considering different forms of breast reconstruction because it agreed most often with the participants in this study.

Do NHS clinicians and members of the public share the same views about reducing inequalities in health?

PubMed

Tsuchiya, Aki; Dolan, Paul

2007-06-01

Decisions about how to allocate resources in health care are as much about social value judgements as they are about getting the medical facts right. In this context, it is important to compare the social preferences of members of the general public with those of National Health Service (NHS) staff involved in service delivery. A questionnaire eliciting peoples' preferences over maximising life expectancy and reducing inequalities in life expectancy between the highest and lowest social classes was completed by 271 members of the UK public and 220 NHS clinicians. The two samples have different preferences with the general public showing a greater willingness than clinicians to sacrifice total health for a more equal distribution of health. These differences may highlight tensions between what the public wants and what clinicians want, and should be subject to further investigation.

Role of the motor system in language knowledge.

PubMed

Berent, Iris; Brem, Anna-Katharine; Zhao, Xu; Seligson, Erica; Pan, Hong; Epstein, Jane; Stern, Emily; Galaburda, Albert M; Pascual-Leone, Alvaro

2015-02-17

All spoken languages express words by sound patterns, and certain patterns (e.g., blog) are systematically preferred to others (e.g., lbog). What principles account for such preferences: does the language system encode abstract rules banning syllables like lbog, or does their dislike reflect the increased motor demands associated with speech production? More generally, we ask whether linguistic knowledge is fully embodied or whether some linguistic principles could potentially be abstract. To address this question, here we gauge the sensitivity of English speakers to the putative universal syllable hierarchy (e.g., blif ≻ bnif ≻ bdif ≻ lbif) while undergoing transcranial magnetic stimulation (TMS) over the cortical motor representation of the left orbicularis oris muscle. If syllable preferences reflect motor simulation, then worse-formed syllables (e.g., lbif) should (i) elicit more errors; (ii) engage more strongly motor brain areas; and (iii) elicit stronger effects of TMS on these motor regions. In line with the motor account, we found that repetitive TMS pulses impaired participants' global sensitivity to the number of syllables, and functional MRI confirmed that the cortical stimulation site was sensitive to the syllable hierarchy. Contrary to the motor account, however, ill-formed syllables were least likely to engage the lip sensorimotor area and they were least impaired by TMS. Results suggest that speech perception automatically triggers motor action, but this effect is not causally linked to the computation of linguistic structure. We conclude that the language and motor systems are intimately linked, yet distinct. Language is designed to optimize motor action, but its knowledge includes principles that are disembodied and potentially abstract.

Tutor versus computer: a prospective comparison of interactive tutorial and computer-assisted instruction in radiology education.

PubMed

Lieberman, Gillian; Abramson, Richard; Volkan, Kevin; McArdle, Patricia J

2002-01-01

This study compared the educational effectiveness of an interactive tutorial with that of interactive computer-assisted instruction (CAI) and determined the effects of personal preference, learning style, and level of training. Fifty-four medical students and four radiology residents were prospectively, randomly assigned to receive instruction from different sections of an interactive tutorial and an interactive CAI module. Participants took tests of factual knowledge at the beginning and end of the instruction and a test of visual diagnosis at the end. They completed questionnaires to evaluate their preferred learning styles objectively and to elicit their subjective attitudes toward the two formats. Mean test scores of the tutorial and CAI groups were compared by means of analysis of covariance and two-tailed repeated-measures F test. Both the tutorial and CAI groups demonstrated significant improvement in posttest scores (P < .01 and P < .01, respectively) with the tutorial group's mean posttest score marginally but significantly higher (32.84 vs 28.13, P < .001). There were no significant interaction effects with participants' year of training (P = .845), objectively evaluated preferred learning style (P = .312), subjectively elicited attitude toward learning with CAI (P = .703), or visual diagnosis score (tutorial, 7.61; CD-ROM, 7.75; P = .79). Interactive tutorial and optimal CAI are both effective instructional formats. The tutorial was marginally but significantly more effective at teaching factual knowledge, an effect unrelated to students' year of training, learning style, or stated enjoyment of CAI. The superiority of the tutorial is expected to increase when it is compared with commercially expedient CAI modules.

Understanding patients and spouses experiences of patient education following a cardiac event and eliciting attitudes and preferences towards incorporating cardiopulmonary resuscitation training: A qualitative study.

PubMed

Cartledge, Susie; Feldman, Susan; Bray, Janet E; Stub, Dion; Finn, Judith

2018-05-01

The aim of this study was to gain a comprehensive perspective about the experience of patient and spousal education following an acute cardiac event. The second objective was to elicit an understanding of patient and spousal attitudes, preferences and intentions towards future cardiopulmonary resuscitation training. Patients with cardiovascular disease require comprehensive patient and family education to ensure adequate long-term disease management. As cardiac patients are at risk of future cardiac events, including out-of-hospital cardiac arrest, providing cardiopulmonary resuscitation training to patients and family members has long been advocated. We conducted a qualitative study underpinned by phenomenology and the Theory of Planned Behaviour. Semi-structured interviews were conducted with cardiac patients and their spouses (N = 12 patient-spouse pairs) between March 2015-April 2016 purposively sampled from a cardiology ward. Interviews were transcribed verbatim and thematic analysis undertaken. Nine male and three female patients and their spouses were recruited. Ages ranged from 47-75 years. Four strongly interrelated themes emerged: the emotional response to the event, information, control and responsibility. There was evidence of positive attitudes and intentions from the TPB towards undertaking cardiopulmonary resuscitation training in the future. Only the eldest patient spouse pair were not interested in undertaking training. Findings suggest cardiac patients and spouses have unmet education needs following an acute cardiac event. Information increased control and decreased negative emotions associated with diagnosis. Participants' preferences were for inclusion of cardiopulmonary resuscitation training in cardiac rehabilitation programs. © 2018 John Wiley & Sons Ltd.

Role of the motor system in language knowledge

PubMed Central

Berent, Iris; Brem, Anna-Katharine; Zhao, Xu; Seligson, Erica; Pan, Hong; Epstein, Jane; Stern, Emily; Galaburda, Albert M.; Pascual-Leone, Alvaro

2015-01-01

All spoken languages express words by sound patterns, and certain patterns (e.g., blog) are systematically preferred to others (e.g., lbog). What principles account for such preferences: does the language system encode abstract rules banning syllables like lbog, or does their dislike reflect the increased motor demands associated with speech production? More generally, we ask whether linguistic knowledge is fully embodied or whether some linguistic principles could potentially be abstract. To address this question, here we gauge the sensitivity of English speakers to the putative universal syllable hierarchy (e.g., blif≻bnif≻bdif≻lbif) while undergoing transcranial magnetic stimulation (TMS) over the cortical motor representation of the left orbicularis oris muscle. If syllable preferences reflect motor simulation, then worse-formed syllables (e.g., lbif) should (i) elicit more errors; (ii) engage more strongly motor brain areas; and (iii) elicit stronger effects of TMS on these motor regions. In line with the motor account, we found that repetitive TMS pulses impaired participants’ global sensitivity to the number of syllables, and functional MRI confirmed that the cortical stimulation site was sensitive to the syllable hierarchy. Contrary to the motor account, however, ill-formed syllables were least likely to engage the lip sensorimotor area and they were least impaired by TMS. Results suggest that speech perception automatically triggers motor action, but this effect is not causally linked to the computation of linguistic structure. We conclude that the language and motor systems are intimately linked, yet distinct. Language is designed to optimize motor action, but its knowledge includes principles that are disembodied and potentially abstract. PMID:25646465

Research Dilemmas Associated with Photo Elicitation in Comparative Early Childhood Education Research

ERIC Educational Resources Information Center

Birkeland, Asta

2013-01-01

Photo elicitation has become an important method to produce data in qualitative research. There is quite an extensive literature indicating the benefits of photo elicitation in order to facilitate collaboration in meaning making between researcher and the interviewee. This article addresses dilemmas associated with using photo elicitation in a…

Eliciting preferences for social health insurance in Ethiopia: a discrete choice experiment.

PubMed

Obse, Amarech; Ryan, Mandy; Heidenreich, Sebastian; Normand, Charles; Hailemariam, Damen

2016-12-01

As low-income countries are initiating health insurance schemes, Ethiopia is also planning to move away from out-of-pocket private payments to health insurance. The success of such a policy depends on understanding and predicting preferences of potential enrolees. This is because a scarce health care budget forces providers and consumers to make trade-offs between potential benefits within a health insurance. An assessment of preferences of potential enrolees can therefore add important information to optimal resource allocation in the design of health insurance. We used a discrete choice experiment to elicit preferences for social health insurance (SHI) among formal sector employees in Ethiopia. Respondents were presented with 18 binary hypothetical choices of SHI. Each insurance package was described by eight policy relevant attributes: premium, enrolment, exclusions, providers and coverage of inpatient services, outpatient services, drugs and tests. A mixed logit model was estimated to determine respondents' willingness to pay (WTP) for the different health insurance attributes. We also predicted probabilities of uptake for alternative SHI scenarios. Health insurance packages with 'no exclusions', 'public and private' providers, low rate of premium and full coverage of tests and drugs were highly valued and had greatest impact on the choices . Other things being equal, respondents were willing to contribute 1.52% (95% confidence interval (CI): 0.71, 2.32) of their salary to a SHI package with no service exclusions having public and private service providers. This is substantially lower than the proposed 3% premium in the draft SHI strategy. For the typical SHI package proposed by the SHI strategy at the time, the uptake probability was predicted to be 29% (95% CI: 0.25, 0.33). The low uptake probability and WTP for the proposed SHI package suggests considering preferences of the potential enrolees' in revisions of the draft SHI strategy for introduction of optimal SHI scheme would enhance acceptance. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Fruit or aposematic insect? Context-dependent colour preferences in domestic chicks.

PubMed Central

Gamberale-Stille, G.; Tullberg, B. S.

2001-01-01

Colours are common stimuli in signalling systems. Requirements to function well as a signal sometimes conflict between different signallers, and the same colour stimulus is used to convey completely different messages to the same receiver. Fruits and aposematic insects both use red coloration as a signal, in the former case to signal profitability and in the latter case as a warning signal. In two experiments, we investigated whether the domestic chick, an omnivorous predator, differed in its unconditioned preference or avoidance of red and green stimuli depending on whether or not the stimulus was an insect. The experiments were designed as preference tests between red and green painted prey. The prey were live insects and artificial fruits (experiment 1), and, to investigate the effect of movement, live and dead insects (experiment 2). The chicks did not show any difference in pecking preference between red and green when fruit-like stimuli were used, but when the prey were insects, green prey were strongly preferred to red prey, and prey movement did not affect this bias. Thus, young chicks may recognize prey as insects and then discriminate between different prey colorations, or one type of food may elicit an unlearned colour preference-avoidance response that is absent with another type of food. PMID:11749705

Information preferences for the evaluation of coastal development impacts on ecosystem services: A multi-criteria assessment in the Australian context.

PubMed

Marre, Jean-Baptiste; Pascoe, Sean; Thébaud, Olivier; Jennings, Sarah; Boncoeur, Jean; Coglan, Louisa

2016-05-15

Ecosystem based management requires the integration of various types of assessment indicators. Understanding stakeholders' information preferences is important, in selecting those indicators that best support management and policy. Both the preferences of decision-makers and the general public may matter, in democratic participatory management institutions. This paper presents a multi-criteria analysis aimed at quantifying the relative importance to these groups of economic, ecological and socio-economic indicators usually considered when managing ecosystem services in a coastal development context. The Analytic Hierarchy Process (AHP) is applied within two nationwide surveys in Australia, and preferences of both the general public and decision-makers for these indicators are elicited and compared. Results show that, on average across both groups, the priority in assessing a generic coastal development project is for the ecological assessment of its impacts on marine biodiversity. Ecological assessment indicators are globally preferred to both economic and socio-economic indicators regardless of the nature of the impacts studied. These results are observed for a significantly larger proportion of decision-maker than general public respondents, questioning the extent to which the general public's preferences are well reflected in decision-making processes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Do you see what I hear? Vantage point preference and visual dominance in a time-space synaesthete.

PubMed

Jarick, Michelle; Stewart, Mark T; Smilek, Daniel; Dixon, Michael J

2013-01-01

Time-space synaesthetes "see" time units organized in a spatial form. While the structure might be invariant for most synaesthetes, the perspective by which some view their calendar is somewhat flexible. One well-studied synaesthete L adopts different viewpoints for months seen vs. heard. Interestingly, L claims to prefer her auditory perspective, even though the month names are represented visually upside down. To verify this, we used a spatial-cueing task that included audiovisual month cues. These cues were either congruent with L's preferred "auditory" viewpoint (auditory-only and auditory + month inverted) or incongruent (upright visual-only and auditory + month upright). Our prediction was that L would show enhanced cueing effects (larger response time difference between valid and invalid targets) following the audiovisual congruent cues since both elicit the "preferred" auditory perspective. Also, when faced with conflicting cues, we predicted L would choose the preferred auditory perspective over the visual perspective. As we expected, L did show enhanced cueing effects following the audiovisual congruent cues that corresponded with her preferred auditory perspective, but that the visual perspective dominated when L was faced with both viewpoints simultaneously. The results are discussed with relation to the reification hypothesis of sequence space synaesthesia (Eagleman, 2009).

Patients' self-interested preferences: empirical evidence from a priority setting experiment.

PubMed

Alvarez, Begoña; Rodríguez-Míguez, Eva

2011-04-01

This paper explores whether patients act according to self-interest in priority setting experiments. The analysis is based on a ranking experiment, conducted in Galicia (Spain), to elicit preferences regarding the prioritization of patients on a waiting list for an elective surgical intervention (prostatectomy for benign prostatic hyperplasia). Participants were patients awaiting a similar intervention and members of the general populations. All of them were asked to rank hypothetical patients on a waiting list. A rank-ordered logit was then applied to their responses in order to obtain a prioritization scoring system. Using these estimations, we first test for differences in preferences between patients and general population. Second, we implement a procedure based on the similarity between respondents (true patients) and the hypothetical scenarios they evaluate (hypothetical patients) to analyze whether patients provide self-interested rankings. Our results show that patient preferences differ significantly from general population preferences. The findings also indicate that, when patients rank the hypothetical scenarios on the waiting list, they consider not only the explicit attributes but also the similarity of each scenario to their own. In particular, they assign a higher priority to scenarios that more closely match their own states. We also find that such a preference structure increases their likelihood of reporting "irrational" answers. Copyright © 2011 Elsevier Ltd. All rights reserved.

Relationship between meanings, emotions, product preferences and personal values. Application to ceramic tile floorings.

PubMed

Agost, María-Jesús; Vergara, Margarita

2014-07-01

This work aims to validate a conceptual framework which establishes the main relationships between subjective elements in human-product interaction, such as meanings, emotions, product preferences, and personal values. The study analyzes the relationships between meanings and emotions, and between these and preferences, as well as the influence of personal values on such relationships. The study was applied to ceramic tile floorings. A questionnaire with images of a neutral room with different ceramic tile floorings was designed and distributed via the web. Results from the study suggest that both meanings and emotions must be taken into account in the generation of product preferences. The meanings given to the product can cause the generation of emotions, and both types of subjective impressions give rise to product preferences. Personal reference values influence these relationships between subjective impressions and product preferences. As a consequence, not only target customers' demographic data but specifically their values and criteria must be taken into account from the beginning of the development process. The specific results of this paper can be used directly by ceramic tile designers, who can better adjust product design (and the subjective impressions elicited) to the target market. Consequently, the chance of product success is reinforced. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Enhanced subliminal emotional responses to dynamic facial expressions.

PubMed

Sato, Wataru; Kubota, Yasutaka; Toichi, Motomi

2014-01-01

Emotional processing without conscious awareness plays an important role in human social interaction. Several behavioral studies reported that subliminal presentation of photographs of emotional facial expressions induces unconscious emotional processing. However, it was difficult to elicit strong and robust effects using this method. We hypothesized that dynamic presentations of facial expressions would enhance subliminal emotional effects and tested this hypothesis with two experiments. Fearful or happy facial expressions were presented dynamically or statically in either the left or the right visual field for 20 (Experiment 1) and 30 (Experiment 2) ms. Nonsense target ideographs were then presented, and participants reported their preference for them. The results consistently showed that dynamic presentations of emotional facial expressions induced more evident emotional biases toward subsequent targets than did static ones. These results indicate that dynamic presentations of emotional facial expressions induce more evident unconscious emotional processing.

A framework for estimating health state utility values within a discrete choice experiment: modeling risky choices.

PubMed

Robinson, Angela; Spencer, Anne; Moffatt, Peter

2015-04-01

There has been recent interest in using the discrete choice experiment (DCE) method to derive health state utilities for use in quality-adjusted life year (QALY) calculations, but challenges remain. We set out to develop a risk-based DCE approach to derive utility values for health states that allowed 1) utility values to be anchored directly to normal health and death and 2) worse than dead health states to be assessed in the same manner as better than dead states. Furthermore, we set out to estimate alternative models of risky choice within a DCE model. A survey was designed that incorporated a risk-based DCE and a "modified" standard gamble (SG). Health state utility values were elicited for 3 EQ-5D health states assuming "standard" expected utility (EU) preferences. The DCE model was then generalized to allow for rank-dependent expected utility (RDU) preferences, thereby allowing for probability weighting. A convenience sample of 60 students was recruited and data collected in small groups. Under the assumption of "standard" EU preferences, the utility values derived within the DCE corresponded fairly closely to the mean results from the modified SG. Under the assumption of RDU preferences, the utility values estimated are somewhat lower than under the assumption of standard EU, suggesting that the latter may be biased upward. Applying the correct model of risky choice is important whether a modified SG or a risk-based DCE is deployed. It is, however, possible to estimate a probability weighting function within a DCE and estimate "unbiased" utility values directly, which is not possible within a modified SG. We conclude by setting out the relative strengths and weaknesses of the 2 approaches in this context. © The Author(s) 2014.

Does responsibility affect the public's valuation of health care interventions? A relative valuation approach to health care safety.

PubMed

Singh, Jeshika; Lord, Joanne; Longworth, Louise; Orr, Shepley; McGarry, Teresa; Sheldon, Rob; Buxton, Martin

2012-01-01

Health services often spend more on safety interventions than seems cost-effective. This study investigates whether the public value safety-related health care improvements more highly than the same improvements in contexts where the health care system is not responsible. An online survey was conducted to elicit the relative importance placed on preventing harms caused by 1) health care (hospital-acquired infections, drug administration errors, injuries to health care staff), 2) individuals (personal lifestyle choices, sports-related injuries), and 3) nature (genetic disorders). Direct valuations were obtained from members of the public by using a person trade-off or "matching" method. Participants were asked to choose between two preventative interventions of equal cost and equal health benefit per person for the same number of people, but differing in causation. If participants indicated a preference, their strength of preference was measured by using person trade-off. Responses were obtained from 1030 people, reflecting the sociodemographic mix of the UK population. Participants valued interventions preventing hospital-acquired infections (1.31) more highly than genetic disorders (1.0), although drug errors were valued similarly to genetic disorders (1.07), and interventions to prevent injury to health care staff were given less weight than genetic disorders (0.71). Less weight was also given to interventions related to lifestyle (0.65) and sports injuries (0.41). Our results suggest that people do not attach a simple fixed premium to "safety-related" interventions but that preferences depend more subtly on context. The use of the results of such public preference surveys to directly inform policy would therefore be premature. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Veterans' voices: use of the American Customer Satisfaction Index (ACSI) Survey to identify My HealtheVet personal health record users' characteristics, needs, and preferences

PubMed Central

2010-01-01

Background Consumer research reveals considerable interest in the use of Personal Health Records (PHRs), yet adoption remains relatively low. Both adopters and nonadopters represent important perspectives from which to understand this paradox. Objective This study focuses on direct feedback from adopters obtained using the American Customer Satisfaction Index (ACSI) survey on the My HealtheVet PHR portal (http://www.myhealth.va.gov) of the Veterans Health Administration (VHA). The results represent a source of direct feedback with which to better understand veterans' needs and preferences. Methods The ACSI Survey was implemented in October 2007 to measure satisfaction and elicit information about characteristics and preferences of My HealtheVet PHR adopters. The data represent a continuous random sample of site visitors who have navigated at least four pages on the site. A total of 100 617 surveys were completed (17.2%). Results Satisfaction with My HealtheVet is high (8.3/10.0), and users are highly likely to return to the site (8.6/10.0) and recommend the site to other veterans (9.1/10.0). The majority of system adopters are male (91%), between the ages of 51 and 70 (68%), and served in the Vietnam War (60%). Most veterans currently visit the site to utilize pharmacy-related features. Conclusion VHA has used the ACSI to monitor satisfaction, and to better understand the characteristics, needs, and preferences of early adopters. The data provide an important source of direct feedback to inform program development. Future research will include monitoring the impact of enhancements and new features on satisfaction, and conducting additional research with nonadopters to identify barriers to adoption and use. PMID:20190065

Managing Expectations of Antibiotics for Upper Respiratory Tract Infections: A Qualitative Study

PubMed Central

Mustafa, Mohammed; Wood, Fiona; Butler, Christopher C.; Elwyn, Glyn

2014-01-01

PURPOSE Communication experts have suggested that it is good practice to ask patients’ directly whether they expect to receive antibiotics as part of asking about the triad of ideas, concerns, and expectations for health care. Our aim was to explore the views and experiences of family physicians about using this strategy with their patients, focusing the interview on the problem of eliciting expectations of antibiotics as a possible treatment for upper respiratory tract infections. METHODS We conducted a qualitative study using semistructured interviews with 20 family physicians in South Wales, United Kingdom, and performing thematic analysis. RESULTS Family physicians assumed most patients or parents wanted antibiotics, as well as wanting to be “checked out” to make sure the illness was “nothing serious.” Physicians said they did not ask direct questions about expectations, as that might lead to confrontation. They preferred to elicit expectations for antibiotics in an indirect manner, before performing a physical examination. The majority described reporting their findings of the examination as a “running commentary” so as to influence expectations and help avoid generating resistance to a soon-to-be-made-explicit plan not to prescribe antibiotics. The physicians used the running commentary to preserve and enhance the physician-patient relationship. CONCLUSIONS Real-world family physicians use indirect methods to explore expectations for treatment and, on the basis of their physical examination, build an argument for reassuring the patient or parent. In contrast to proposed models in the communication literature, interventions to promote appropriate antibiotic prescribing might include a focus on training in communication skills that (1) integrates these indirect methods as part of building collaborative physician-patient relationships and (2) uses the running commentary of examination findings to facilitate participation in clinical decisions. PMID:24445101

Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men.

PubMed

Spielberg, Freya; Branson, Bernard M; Goldbaum, Gary M; Lockhart, David; Kurth, Ann; Celum, Connie L; Rossini, Anthony; Critchlow, Cathy W; Wood, Robert W

2003-03-01

To determine strategies to overcome barriers to HIV testing among persons at risk. We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home self-testing (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing. Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status.

Participatory design of probability-based decision support tools for in-hospital nurses.

PubMed

Jeffery, Alvin D; Novak, Laurie L; Kennedy, Betsy; Dietrich, Mary S; Mion, Lorraine C

2017-11-01

To describe nurses' preferences for the design of a probability-based clinical decision support (PB-CDS) tool for in-hospital clinical deterioration. A convenience sample of bedside nurses, charge nurses, and rapid response nurses (n = 20) from adult and pediatric hospitals completed participatory design sessions with researchers in a simulation laboratory to elicit preferred design considerations for a PB-CDS tool. Following theme-based content analysis, we shared findings with user interface designers and created a low-fidelity prototype. Three major themes and several considerations for design elements of a PB-CDS tool surfaced from end users. Themes focused on "painting a picture" of the patient condition over time, promoting empowerment, and aligning probability information with what a nurse already believes about the patient. The most notable design element consideration included visualizing a temporal trend of the predicted probability of the outcome along with user-selected overlapping depictions of vital signs, laboratory values, and outcome-related treatments and interventions. Participants expressed that the prototype adequately operationalized requests from the design sessions. Participatory design served as a valuable method in taking the first step toward developing PB-CDS tools for nurses. This information about preferred design elements of tools that support, rather than interrupt, nurses' cognitive workflows can benefit future studies in this field as well as nurses' practice. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

Cataract Surgery Planning in Amblyopic Patients – Which eye first? Awareness of the Potential for Post-operative Diplopia amongst Consultant Ophthalmic Surgeons in Wales

PubMed Central

Samuel Williams, Gwyn; Radwan, Mahmoud; Menon, Jay

2013-01-01

Aim To explore the views of consultant ophthalmic surgeons in Wales in the context of planning cataract surgery in patients with amblyopia. To compare prevailing views and preferences with recommendations in published literature. Method A cross-sectional survey was conducted in which all consultant ophthalmologists working in Wales were invited to complete an online survey designed using the Survey Monkey tool (http://www.surveymonkey.com). The survey included a clinical scenario involving an amblyopic patient with bilateral cataracts with questions designed to elicit responders’ preferences with regard to which eye they would operate on first as well as the reasoning behind their clinical decision making. Results 32 out of 42 consultants responded to the survey (a response rate of >75%). With regards to the chronological order of surgery 18 (56.26%) indicated that they would perform cataract surgery first on the non-amblyopic eye, 11 (34.4%) would surgically address the amblyopic eye first and three (9.4%) indicated that patient preference would dictate the choice regarding the laterality of the eye to be operated on first. While 24 responders (75.0%) had encountered amblyopic patients who had developed problems after cataract surgery only 10 (31.3%) opined that formal guidance from the Royal College of Ophthalmologists was warranted. Conclusion These results indicate that awareness of post-cataract surgery diplopia, and in particular fixation switch diplopia, is not widespread amongst consultant ophthalmic surgeons in Wales. PMID:24082284

The use of the analytic hierarchy process to aid decision making in acquired equinovarus deformity.

PubMed

van Til, Janine A; Renzenbrink, Gerbert J; Dolan, James G; Ijzerman, Maarten J

2008-03-01

To increase the transparency of decision making about treatment in patients with equinovarus deformity poststroke. The analytic hierarchy process (AHP) was used as a structured methodology to study the subjective rationale behind choice of treatment. An 8-hour meeting at a centrally located rehabilitation center in The Netherlands, during which a patient video was shown to all participants (using a personal computer and a large screen) and the patient details were provided on paper. A panel of 10 health professionals from different backgrounds. Not applicable. The performance of the applicable treatments on outcome, impact, comfort, cosmetics, daily effort, and risks and side effects of treatment, as well as the relative importance of criteria in the choice of treatment. According to the model, soft-tissue surgery (.413) ranked first as the preferred treatment, followed by orthopedic footwear (.181), ankle-foot orthosis (.147), surface electrostimulation (.137), and finally implanted electrostimulation (.123). Outcome was the most influential consideration affecting treatment choice (.509), followed by risk and side effects (.194), comfort (.104), daily effort (.098), cosmetics (.065), and impact of treatment (.030). Soft-tissue surgery was judged best on outcome, daily effort, comfortable shoe wear, and cosmetically acceptable result and was thereby preferred as a treatment alternative by the panel in this study. In contrast, orthosis and orthopedic footwear are usually preferred in daily practice. The AHP method was found to be suitable methodology for eliciting subjective opinions and quantitatively comparing treatments in the absence of scientific evidence.

Individual Differences in Beat Perception Affect Gait Responses to Low- and High-Groove Music

PubMed Central

Leow, Li-Ann; Parrott, Taylor; Grahn, Jessica A.

2014-01-01

Slowed gait in patients with Parkinson’s disease (PD) can be improved when patients synchronize footsteps to isochronous metronome cues, but limited retention of such improvements suggest that permanent cueing regimes are needed for long-term improvements. If so, music might make permanent cueing regimes more pleasant, improving adherence; however, music cueing requires patients to synchronize movements to the “beat,” which might be difficult for patients with PD who tend to show weak beat perception. One solution may be to use high-groove music, which has high beat salience that may facilitate synchronization, and affective properties, which may improve motivation to move. As a first step to understanding how beat perception affects gait in complex neurological disorders, we examined how beat perception ability affected gait in neurotypical adults. Synchronization performance and gait parameters were assessed as healthy young adults with strong or weak beat perception synchronized to low-groove music, high-groove music, and metronome cues. High-groove music was predicted to elicit better synchronization than low-groove music, due to its higher beat salience. Two musical tempi, or rates, were used: (1) preferred tempo: beat rate matched to preferred step rate and (2) faster tempo: beat rate adjusted to 22.5% faster than preferred step rate. For both strong and weak beat-perceivers, synchronization performance was best with metronome cues, followed by high-groove music, and worst with low-groove music. In addition, high-groove music elicited longer and faster steps than low-groove music, both at preferred tempo and at faster tempo. Low-groove music was particularly detrimental to gait in weak beat-perceivers, who showed slower and shorter steps compared to uncued walking. The findings show that individual differences in beat perception affect gait when synchronizing footsteps to music, and have implications for using music in gait rehabilitation. PMID:25374521

Discussing disease progression and end-of-life decisions.

PubMed

Baile, W F; Glober, G A; Lenzi, R; Beale, E A; Kudelka, A P

1999-07-01

Because most patients now want to know the truth about their diagnosis and prognosis, the ability to discuss the cancer diagnosis, disease recurrence, or treatment failure, and to solicit patients' views about resuscitation or hospice care, are important verbal skills for oncologists and other oncology health care providers. Moreover, the ability to clearly articulate a treatment plan or elicit patient preferences for treatment are a prerequisite to informed consent. Despite these imperatives, clinicians do not routinely receive training in key communication skills that could enable them to accomplish these tasks. A body of literature is available, however, that identifies communication strategies that can (1) facilitate the establishment of a close rapport with the patient, (2) identify the patient's information preferences, (3) ensure comprehension of key knowledge and information, (4) address the patient's emotions in a supportive fashion, (5) elicit the patient's key concerns, and (6) involve the patient in the treatment plan. In this article, we use dialogues between a physician and a hypothetical patient with advanced ovarian cancer to illustrate how communication techniques can be applied to accomplish these goals. We identify important benefits of the use of these techniques for both the physician and patient, and pose several questions regarding the training of physicians in this area.

Visual stimuli that elicit appetitive behaviors in three morphologically distinct species of praying mantis.

PubMed

Prete, Frederick R; Komito, Justin L; Dominguez, Salina; Svenson, Gavin; López, LeoLin Y; Guillen, Alex; Bogdanivich, Nicole

2011-09-01

We assessed the differences in appetitive responses to visual stimuli by three species of praying mantis (Insecta: Mantodea), Tenodera aridifolia sinensis, Mantis religiosa, and Cilnia humeralis. Tethered, adult females watched computer generated stimuli (erratically moving disks or linearly moving rectangles) that varied along predetermined parameters. Three responses were scored: tracking, approaching, and striking. Threshold stimulus size (diameter) for tracking and striking at disks ranged from 3.5 deg (C. humeralis) to 7.8 deg (M. religiosa), and from 3.3 deg (C. humeralis) to 11.7 deg (M. religiosa), respectively. Unlike the other species which struck at disks as large as 44 deg, T. a. sinensis displayed a preference for 14 deg disks. Disks moving at 143 deg/s were preferred by all species. M. religiosa exhibited the most approaching behavior, and with T. a. sinensis distinguished between rectangular stimuli moving parallel versus perpendicular to their long axes. C. humeralis did not make this distinction. Stimulus sizes that elicited the target behaviors were not related to mantis size. However, differences in compound eye morphology may be related to species differences: C. humeralis' eyes are farthest apart, and it has an apparently narrower binocular visual field which may affect retinal inputs to movement-sensitive visual interneurons.

Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens' jury.

PubMed

Laver, Kate; Gnanamanickam, Emmanuel; Whitehead, Craig; Kurrle, Susan; Corlis, Megan; Ratcliffe, Julie; Shulver, Wendy; Crotty, Maria

2018-07-01

Objectives Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens' jury to elicit views of members of the public regarding consumer directed care in residential care. Methods A citizens' jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person's funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable and are associated with high levels of satisfaction among users.

The P600 in Implicit Artificial Grammar Learning.

PubMed

Silva, Susana; Folia, Vasiliki; Hagoort, Peter; Petersson, Karl Magnus

2017-01-01

The suitability of the artificial grammar learning (AGL) paradigm to capture relevant aspects of the acquisition of linguistic structures has been empirically tested in a number of EEG studies. Some have shown a syntax-related P600 component, but it has not been ruled out that the AGL P600 effect is a response to surface features (e.g., subsequence familiarity) rather than the underlying syntax structure. Therefore, in this study, we controlled for the surface characteristics of the test sequences (associative chunk strength) and recorded the EEG before (baseline preference classification) and after (preference and grammaticality classification) exposure to a grammar. After exposure, a typical, centroparietal P600 effect was elicited by grammatical violations and not by unfamiliar subsequences, suggesting that the AGL P600 effect signals a response to structural irregularities. Moreover, preference and grammaticality classification showed a qualitatively similar ERP profile, strengthening the idea that the implicit structural mere-exposure paradigm in combination with preference classification is a suitable alternative to the traditional grammaticality classification test. Copyright © 2016 Cognitive Science Society, Inc.

A review of preference-based measures for the assessment of quality of life in children and adolescents with cerebral palsy.

PubMed

Mpundu-Kaambwa, Christine; Chen, Gang; Huynh, Elisabeth; Russo, Remo; Ratcliffe, Julie

2018-07-01

To examine the psychometric properties and suitability for use within the context of cerebral palsy research in children and adolescents of generic preference-based outcome measures (PROMs). Nine electronic databases were searched in this systematic review. The consensus-based standards for the selection of health measurement instruments (COSMIN) checklist were used to measure the psychometric properties of the PROMs. A meta-analysis was used to pool correlation coefficients for convergent validity using the Schmidt-Hunter method. Heterogeneity was assessed using the I-squared statistic (I 2 ). Four preference-based PROMs were identified from eight studies: Health Utilities Index-Mark 2 and 3 (HUI-2 and HUI-3, respectively), the Assessment Quality of Life-4 dimension (AQoL-4D) and the EuroQol-5 dimension 3 level (EQ-5D-3L). Only the HUI system was primarily developed for application with children/adolescents though health-state values for scoring the PROM were elicited from adults. The HUI-3 covered the most relevant constructs though it excludes important modules of health-related quality of life (HRQOL) such as activity limitations and participation restrictions. In terms of psychometric properties, evidence was presented for only five of COSMIN measurement properties: reliability (HUI3), measurement error (HUI-3), content validity (HUI-2 and HUI-3), Hypotheses testing (HUI-3 and AQoL-4D) and criterion validity (HUI-3). No papers reported on internal consistency, structural validity, cross-cultural validity or responsiveness of the preference-based measures in children and adolescents with cerebral palsy. This review highlights the dearth in studies using preference-based PROMs to measure HRQOL associated with cerebral palsy in children and adolescents. The HUI-3 demonstrated the strongest psychometric properties, though it does not cover all dimensions relevant to this population.

Pain Now or Later: An Outgrowth Account of Pain-Minimization

PubMed Central

Chen, Shuai; Zhao, Dan; Rao, Li-Lin; Liang, Zhu-Yuan; Li, Shu

2015-01-01

The preference for immediate negative events contradicts the minimizing loss principle given that the value of a delayed negative event is discounted by the amount of time it is delayed. However, this preference is understandable if we assume that the value of a future outcome is not restricted to the discounted utility of the outcome per se but is complemented by an anticipated negative utility assigned to an unoffered dimension, which we termed the “outgrowth.” We conducted three studies to establish the existence of the outgrowth and empirically investigated the mechanism underlying the preference for immediate negative outcomes. Study 1 used a content analysis method to examine whether the outgrowth was generated in accompaniment with the delayed negative events. The results revealed that the investigated outgrowth was composed of two elements. The first component is the anticipated negative emotions elicited by the delayed negative event, and the other is the anticipated rumination during the waiting process, in which one cannot stop thinking about the negative event. Study 2 used a follow-up investigation to examine whether people actually experienced the negative emotions they anticipated in a real situation of waiting for a delayed negative event. The results showed that the participants actually experienced a number of negative emotions when waiting for a negative event. Study 3 examined whether the existence of the outgrowth could make the minimizing loss principle work. The results showed that the difference in pain anticipation between the immediate event and the delayed event could significantly predict the timing preference of the negative event. Our findings suggest that people’s preference for experiencing negative events sooner serves to minimize the overall negative utility, which is divided into two parts: the discounted utility of the outcome itself and an anticipated negative utility assigned to the outgrowth. PMID:25747461

A Latent Class Analysis to Identify Variation in Caregivers' Preferences for their Child's Attention-Deficit/Hyperactivity Disorder Treatment: Do Stated Preferences Match Current Treatment?

PubMed

Ng, Xinyi; Bridges, John F P; Ross, Melissa M; Frosch, Emily; Reeves, Gloria; Cunningham, Charles E; dosReis, Susan

2017-04-01

To investigate variation in caregiver preferences for their child's attention-deficit/hyperactivity disorder (ADHD) care and to determine if their stated preferences align with current care management. Caregivers of a child aged 4-14 years and in care for ADHD were recruited from pediatric outpatient clinics and advocacy groups across the state of Maryland. Participants completed a survey collecting demographics, the child's treatment, and caregiver preferences-elicited using a best-worst scaling experiment (case 2). Latent class analysis was used to identify distinct preference segments and bivariate analyses were used to compare the association between segment membership with what the child was currently receiving for their ADHD. Participants (n = 184) were predominantly White (68%) and the child's mother (84%). Most children had ADHD for 2 or more years (79%). Caregiver preferences were distinguished by two segments: continuous medication (36%) and minimal medication (64%). The two groups had very different preferences for when medication was administered (p < 0.001), but they had similar preferences for provider-oriented and non-medication interventions (p > 0.05 for the caregiver behavior training, provider communication, provider specialty, and out-of-pocket costs). One third of the sample did not receive the preferred individualized education program and 42% of the minimal medication group reported using medication 7 days a week all year round. Although behavior management training and school accommodations aspects of an ADHD care plan are more important to caregivers than evidence-based medication, fewer families had access to educational accommodations. Further research is needed to clarify how stated preferences for care align with treatments used in actual practice settings.

Depressive symptoms and decision-making preferences in patients with comorbid illnesses.

PubMed

Moise, Nathalie; Ye, Siqin; Alcántara, Carmela; Davidson, Karina W; Kronish, Ian

2017-01-01

Shared decision-making (SDM) is increasingly promoted in the primary care setting, but depressive symptoms, which are associated with cognitive changes, may influence decision-making preferences. We sought to assess whether elevated depressive symptoms are associated with decision-making preference in patients with comorbid chronic illness. We enrolled 195 patients ≥18years old with uncontrolled hypertension from two urban, academic primary care clinics. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire. Clinician-directed decision-making preference was assessed according to the Control Preference Scale. The impact of depressive symptoms on decision-making preference was assessed using generalized linear mixed models adjusted for age, gender, race, ethnicity, education, Medicaid status, Charlson Comorbidity Index, partner status, and clustering within clinicians. The mean age was 64.2years; 72% were women, 77% Hispanic, 38% Black, and 33% had elevated depressive symptoms. Overall, 35% of patients preferred clinician-directed decision-making, 19% mostly clinician-directed, 39% shared, and 7% some or little clinician-input. Patients with (vs. without) elevated depressive symptoms were more likely to prefer clinician-directed decision-making (46% versus 29%; p=0.02; AOR 2.51, 95% CI 1.30-4.85, p=0.005). Remitted depressive symptoms (vs. never depressed) were not associated with preference. Elevated depressive symptoms are associated with preference for clinician-directed decision-making. We suggest that clinicians should be aware of this effect when incorporating preference into their communication styles and take an active role in eliciting patient values and exchanging information about treatment choice, all important components of shared decision-making, particularly when patients are depressed. Copyright © 2015 Elsevier Inc. All rights reserved.

Older adults newly diagnosed with symptomatic myeloma and treatment decision making.

PubMed

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

2014-07-01

To describe the preferences for participation in decision making of older adult patients newly diagnosed with symptomatic myeloma and to explore the association between sociodemographic variables and decisional role preferences. Descriptive, cross-sectional design. Participants' homes and two large academic cancer centers in Seattle, WA, and Chicago, IL. A convenience sample of 20 older adults (60 years of age and older) with symptomatic myeloma diagnosed within the past six months. The Control Preferences Scale was administered followed by an in-person, one-time, semistructured interview. Role preferences for participation in treatment decision making, age, gender, race, work status, personal relationship status, education, and income. Fifty-five percent of the participants preferred a shared role with the physician and 40% preferred to make the decisions after seriously considering the opinion of their physicians. Only one participant preferred to leave the decision to the doctor, as long as the doctor considered the patient's treatment preferences. The study findings indicate that older adults newly diagnosed with myeloma want to participate in treatment decision making. Oncology nurses must respect the patient's desired role preference and oncology clinicians must listen to the patient and allow him or her to be autonomous in making treatment decisions. Nurses and other oncology clinicians can elicit a patient's preferred level of participation in treatment decision making. Oncology nurses can make sure patients receive disease- and treatment-related information, encourage them to express their decisional role preference to the physician, develop a culture of mutual respect and value their desire for autonomy for treatment decision making, acknowledge that the right to make a treatment choice belongs to the patient, and provide support during treatment decision making throughout the care continuum.

A systematic review of consumer preference for e-cigarette attributes: Flavor, nicotine strength, and type.

PubMed

Zare, Samane; Nemati, Mehdi; Zheng, Yuqing

2018-01-01

Systematic review of research examining consumer preference for the main electronic cigarette (e-cigarette) attributes namely flavor, nicotine strength, and type. A systematic search of peer-reviewed articles resulted in a pool of 12,933 articles. We included only articles that meet all the selection criteria: (1) peer-reviewed, (2) written in English, and (3) addressed consumer preference for one or more of the e-cigarette attributes including flavor, strength, and type. 66 articles met the inclusion criteria for this review. Consumers preferred flavored e-cigarettes, and such preference varied with age groups and smoking status. We also found that several flavors were associated with decreased harm perception while tobacco flavor was associated with increased harm perception. In addition, some flavor chemicals and sweeteners used in e-cigarettes could be of toxicological concern. Finally, consumer preference for nicotine strength and types depended on smoking status, e-cigarette use history, and gender. Adolescents could consider flavor the most important factor trying e-cigarettes and were more likely to initiate vaping through flavored e-cigarettes. Young adults overall preferred sweet, menthol, and cherry flavors, while non-smokers in particular preferred coffee and menthol flavors. Adults in general also preferred sweet flavors (though smokers like tobacco flavor the most) and disliked flavors that elicit bitterness or harshness. In terms of whether flavored e-cigarettes assisted quitting smoking, we found inconclusive evidence. E-cigarette users likely initiated use with a cigarette like product and transitioned to an advanced system with more features. Non-smokers and inexperienced e-cigarettes users tended to prefer no nicotine or low nicotine e-cigarettes while smokers and experienced e-cigarettes users preferred medium and high nicotine e-cigarettes. Weak evidence exists regarding a positive interaction between menthol flavor and nicotine strength.

Sample Size for Measuring Grammaticality in Preschool Children from Picture-Elicited Language Samples

ERIC Educational Resources Information Center

Eisenberg, Sarita L.; Guo, Ling-Yu

2015-01-01

Purpose: The purpose of this study was to investigate whether a shorter language sample elicited with fewer pictures (i.e., 7) would yield a percent grammatical utterances (PGU) score similar to that computed from a longer language sample elicited with 15 pictures for 3-year-old children. Method: Language samples were elicited by asking forty…

Specificity of laboratory trail following by the argentine ant,Iridomyrmex humilis (Mayr), to (Z)-9-hexadecenal, analogs, and gaster extract.

PubMed

Van Vorhis Key, S E; Baker, T C

1982-07-01

In laboratory trail-following bioassays of Argentine ant workers,Iridomyrmex humilis (Mayr), the geometric isomer, (E)-9-hexadecenal, of the trail pheromone component (Z)-9-hexadecenal elicited insignificant trail following as did the potentially more stable formate analogs, (Z)-7-tetradecenyl formate, (E)-7-tetradecenyl formate, and tetradecyl formate. Further, in direct choice tests, workers showed no preference for gaster extract trails (0.002 ant equiv/cm) over trails of (Z)-9-hexadecenal (0.2 ng/cm). Moreover, a 10-fold increase in synthetic trail concentration to 2.0 ng/cm caused (Z)-9-hexadecenal trails to be significantly preferred over gaster extract trails by trail-following ants.

Preferences of content of psychological reports for community placement programs.

PubMed

VandeCreek, L; Smith, B E

1983-01-01

With the shift toward community-based care for mentally retarded persons has come a change in programming goals aimed more at habilitation. The information from psychological reports is frequently used as one type of information for decision making about clients although such reports have frequently been criticized for not providing relevant data. Staff members of community programs in Pennsylvania were surveyed to elicit their preferences for various types of report data. Of the categories of information included in this survey, personality dynamics information and descriptions of general emotional and personality factors were rated as less useful than was information regarding academic achievement, vocational achievement, adaptive skills, and client-examiner interaction. Implications of these findings for psychologists who assess mentally retarded clients are discussed.

Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study

PubMed Central

Robertson, Michael C; Tsai, Edward; Lyons, Elizabeth J; Srinivasan, Sanjana; Swartz, Maria C; Baum, Miranda L

2017-01-01

Background Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective The aim of this study was to take a qualitative approach to provide practical insight regarding this population’s preferences for the features and messages of an app to increase PA. Methods A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69%) and mostly white (25/35, 71%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors’ preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors. PMID:28119278

Promising ethical arguments for product differentiation in the organic food sector. A mixed methods research approach.

PubMed

Zander, Katrin; Stolz, Hanna; Hamm, Ulrich

2013-03-01

Ethical consumerism is a growing trend worldwide. Ethical consumers' expectations are increasing and neither the Fairtrade nor the organic farming concept covers all the ethical concerns of consumers. Against this background the aim of this research is to elicit consumers' preferences regarding organic food with additional ethical attributes and their relevance at the market place. A mixed methods research approach was applied by combining an Information Display Matrix, Focus Group Discussions and Choice Experiments in five European countries. According to the results of the Information Display Matrix, 'higher animal welfare', 'local production' and 'fair producer prices' were preferred in all countries. These three attributes were discussed with Focus Groups in depth, using rather emotive ways of labelling. While the ranking of the attributes was the same, the emotive way of communicating these attributes was, for the most part, disliked by participants. The same attributes were then used in Choice Experiments, but with completely revised communication arguments. According to the results of the Focus Groups, the arguments were presented in a factual manner, using short and concise statements. In this research step, consumers in all countries except Austria gave priority to 'local production'. 'Higher animal welfare' and 'fair producer prices' turned out to be relevant for buying decisions only in Germany and Switzerland. According to our results, there is substantial potential for product differentiation in the organic sector through making use of production standards that exceed existing minimum regulations. The combination of different research methods in a mixed methods approach proved to be very helpful. The results of earlier research steps provided the basis from which to learn - findings could be applied in subsequent steps, and used to adjust and deepen the research design. Copyright © 2012 Elsevier Ltd. All rights reserved.

Using qualitative research methods in biomedical innovation: the case of cultured red blood cells for transfusion.

PubMed

Lyall, Catherine; King, Emma

2016-05-11

Qualitative research has a key role to play in biomedical innovation projects. This article focuses on the appropriate use of robust social science methodologies (primarily focus group studies) for identifying the public's willingness and preference for emerging medical technologies. Our study was part of the BloodPharma project (now known as the Novosang project) to deliver industrially generated red blood cells for transfusion. Previous work on blood substitutes shows that the public prefers donated human blood. However, no research has been conducted concerning attitudes to stem cell derived red blood cells. Qualitative research methods including interviews and focus groups provide the methodological context for this paper. Focus groups were used to elicit views from sub-sections of the UK population about the potential use of such cultured red blood cells. We reflect on the appropriateness of that methodology in the context of the BloodPharma project. Findings are in the form of lessons transferable to other interdisciplinary, science-led teams about what a social science dimension can bring; why qualitative research should be included; and how it can be used effectively. Qualitative data collection offers the strength of exploring ambivalence and investigating the reasons for views, but not necessarily their prevalence in wider society. The inherent value of a qualitative method, such as focus groups, therefore lies in its ability to uncover new information. This contrasts with a quantitative approach to simply 'measuring' public opinion on a topic about which participants may have little prior knowledge. We discuss a number of challenges including: appropriate roles for embedded social scientists and the intricacies of doing upstream engagement as well as some of the design issues and limitations associated with the focus group method.

Approximations of Two-Attribute Utility Functions

DTIC Science & Technology

1976-09-01

preferred to") be a bina-zy relation on the set • of simple probability measures or ’gambles’ defined on a set T of consequences. Throughout this study it...simplifying independence assumptions. Although there are several approaches to this problem, the21 present study will focus on approximations of u... study will elicit additional interest in the topic. 2. REMARKS ON APPROXIMATION THEORY This section outlines a few basic ideas of approximation theory

Attraction, Oviposition Preferences, and Olfactory Responses of Corn-Infesting Ulidiidae (Diptera) to Various Host-Based Substrates.

PubMed

Owens, D; Nuessly, G S; Kendra, P E; Colquhoun, T A; Seal, D R

2017-08-01

Fresh market sweet corn (Zea mays L., convar. saccharata var. rugosa, Poales: Poaceae) ears produced in Florida are damaged by the larvae of Euxesta stigmatias Loew, Euxesta eluta Loew, and Chaetopsis massyla Walker (Diptera: Ulidiidae) that renders ears unmarketable. No standard lure exists for monitoring these pests. Oviposition substrate and attractant bioassays were designed to identify attractive substrates for further semiochemical investigation. Frass from the fall armyworm, Spodoptera frugiperda J.E. Smith (Lepidoptera: Noctuidae), was more attractive than other ovipositional substrates tested for E. eluta and C. massyla, and resulted in greater ovipositional output. Tassel-derived armyworm frass was more attractive than leaf-derived frass for oviposition. Frass also resulted in greater oviposition output by two species. In attraction bioassays, frass was generally preferred over the corresponding corn tissue, and only C. massyla demonstrated a preference for silk-frass over tassel-frass. The most promising substrates were then evaluated by electroantennography (EAG) to quantify olfactory responses. Frass volatiles also elicited greater antennal responses than corn volatiles. With tassel-frass, greater amplitude EAG responses were recorded from immature E. eluta female antennae, while mature female E. stigmatias exhibited greater responses. Equivalent antennal response to silk-frass was observed from E. eluta. Overall, silk-frass elicited the greatest EAG responses among all three fly species. Our results indicate that armyworm frass is an important resource in the chemical ecology of corn-infesting silk flies, and this substrate warrants further investigation for potential attractants that may facilitate development of novel management tools for these pests. © The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Note on the Validity and Reliability of Multi-Criteria Decision Analysis for the Benefit-Risk Assessment of Medicines.

PubMed

Garcia-Hernandez, Alberto

2015-11-01

The comparative evaluation of benefits and risks is one of the most important tasks during the development, market authorization and post-approval pharmacovigilance of medicinal products. Multi-criteria decision analysis (MCDA) has been recommended to support decision making in the benefit-risk assessment (BRA) of medicines. This paper identifies challenges associated with bias or variability that practitioners may encounter in this field and presents solutions to overcome them. The inclusion of overlapping or preference-complementary criteria, which are frequent violations to the assumptions of this model, should be avoided. For each criterion, a value function translates the original outcomes into preference-related scores. Applying non-linear value functions to criteria defined as the risk of suffering a certain event during the study introduces specific risk behaviours in this prescriptive, rather than descriptive, model and is therefore a questionable practice. MCDA uses weights to compare the importance of the model criteria with each other; during their elicitation a frequent situation where (generally favourable) mild effects are directly traded off against low probabilities of suffering (generally unfavourable) severe effects during the study is known to lead to biased and variable weights and ought to be prevented. The way the outcomes are framed during the elicitation process, positively versus negatively for instance, may also lead to differences in the preference weights, warranting an appropriate justification during each implementation. Finally, extending the weighted-sum MCDA model into a fully inferential tool through a probabilistic sensitivity analysis is desirable. However, this task is troublesome and should not ignore that clinical trial endpoints generally are positively correlated.

Interval training elicits higher enjoyment versus moderate exercise in persons with spinal cord injury.

PubMed

Astorino, Todd A; Thum, Jacob S

2018-01-01

High intensity interval training (HIIT) is a robust and time-efficient approach to improve multiple health indices including maximal oxygen uptake (VO 2 max). Despite the intense nature of HIIT, data in untrained adults report greater enjoyment of HIIT versus continuous exercise (CEX). However, this has yet to be investigated in persons with spinal cord injury (SCI). To examine differences in enjoyment in response to CEX and HIIT in persons with SCI. Repeated measures, within-subjects design. University laboratory in San Diego, CA. Nine habitually active men and women (age = 33.3 ± 10.5 years) with chronic SCI. Participants performed progressive arm ergometry to volitional exhaustion to determine VO 2 peak. During subsequent sessions, they completed CEX, sprint interval training (SIT), or HIIT in randomized order. Physical activity enjoyment (PACES), affect, rating of perceived exertion (RPE), VO 2 , and blood lactate concentration (BLa) were measured. Despite a higher VO 2 , RPE, and BLa consequent with HIIT and SIT (P < 0.05), PACES was significantly higher (P = 0.03) in response to HIIT (107.4 ± 13.4) and SIT (103.7 ± 12.5) compared to CEX (81.6 ± 25.4). Fifty-five percent of participants preferred HIIT and 45% preferred SIT, with none identifying CEX as their preferred exercise mode. Compared to CEX, brief sessions of submaximal or supramaximal interval training elicit higher enjoyment despite higher metabolic strain. The long-term efficacy and feasibility of HIIT in this population should be explored considering that it is not viewed as more aversive than CEX.

Mine is better than yours: Investigating the ownership effect in children with autism spectrum disorder and typically developing children.

PubMed

Hartley, Calum; Fisher, Sophie

2018-03-01

Ownership has a unique and privileged influence on human psychology. Typically developing (TD) children judge their objects to be more desirable and valuable than similar objects belonging to others. This 'ownership effect' is due to processing one's property in relation to 'the self'. Here we explore whether children with autism spectrum disorder (ASD) - a population with impaired self-understanding - prefer and over-value property due to ownership. In Experiment 1, we discovered that children with ASD did not favour a randomly endowed toy and frequently traded for a different object. By contrast, TD children showed a clear preference for their randomly endowed toy and traded infrequently. Both populations also demonstrated highly-accurate tracking of owner-object relationships. Experiment 2 showed that both TD children and children with ASD over-value their toys if they are self-selected and different from other-owned toys. Unlike TD children, children with ASD did not over-value their toys in comparison to non-owned identical copies. This finding was replicated in Experiment 3, which also established that mere ownership elicited over-valuation of randomly endowed property in TD children. However, children with ASD did not consistently regard their randomly endowed toys as the most valuable, and evaluated property irrespective of ownership. Our findings show that mere ownership increases preferences and valuations for self-owned property in TD children, but not children with ASD. We propose that deficits in self-understanding may diminish ownership effects in ASD, eliciting a more economically-rational strategy that prioritises material qualities (e.g. what a toy is) rather than whom it belongs to. Copyright © 2017 Elsevier B.V. All rights reserved.

The Measurement of Subjective Value and Its Relation to Contingent Valuation and Environmental Public Goods

PubMed Central

Khaw, Mel W.; Grab, Denise A.; Livermore, Michael A.; Vossler, Christian A.; Glimcher, Paul W.

2015-01-01

Environmental public goods—including national parks, clean air/water, and ecosystem services—provide substantial benefits on a global scale. These goods have unique characteristics in that they are typically “nonmarket” goods, with values from both use and passive use that accrue to a large number of individuals both in current and future generations. In this study, we test the hypothesis that neural signals in areas correlated with subjective valuations for essentially all other previously studied categories of goods (ventromedial prefrontal cortex and ventral striatum) also correlate with environmental valuations. We use contingent valuation (CV) as our behavioral tool for measuring valuations of environmental public goods. CV is a standard stated preference approach that presents survey respondents with information on an issue and asks questions that help policymakers determine how much citizens are willing to pay for a public good or policy. We scanned human subjects while they viewed environmental proposals, along with three other classes of goods. The presentation of all four classes of goods yielded robust and similar patterns of temporally synchronized brain activation within attentional networks. The activations associated with the traditional classes of goods replicate previous correlations between neural activity in valuation areas and behavioral preferences. In contrast, CV-elicited values for environmental proposals did not correlate with brain activity at either the individual or population level. For a sub-population of participants, CV-elicited values were correlated with activity within the dorsomedial prefrontal cortex, a region associated with cognitive control and shifting decision strategies. The results show that neural activity associated with the subjective valuation of environmental proposals differs profoundly from the neural activity associated with previously examined goods and preference measures. PMID:26221734

Economic preferences and fast food consumption in US adults: Insights from behavioral economics.

PubMed

Shuval, Kerem; Stoklosa, Michal; Pachucki, Mark C; Yaroch, Amy L; Drope, Jeffrey; Harding, Matthew

2016-12-01

To examine the relationship between economic time preferences and frequency of fast food and full-service restaurant consumption among U.S. adults. Participants included 5871U.S. adults who responded to a survey conducted in 2011 pertaining to the lifestyle behaviors of families and the social context of these behaviors. The primary independent variable was a measure of time preferences, an intertemporal choice assessing delay discounting. This was elicited via responses to preferences for an immediate dollar amount or a larger sum in 30 (30-day time horizon) or 60days (60-day time horizon). Outcomes were the frequency of fast food and full-service restaurant consumption. Ordered logistic regression was performed to examine the relationship between time preferences and food consumption while adjusting for covariates (e.g. socio-demographics). Multivariable analysis revealed that higher future time preferences were significantly related to less frequent fast food intake for both the 30- and 60-day time horizon variables (P for linear trend <0.05; both). Notably, participants with the highest future time preference were significantly less likely to consume fast food than those with very low future time preferences (30-day: OR=0.74, 95%CI: 0.62-0.89; and 60-day: OR=0.86, 95%CI: 0.74-1.00). In comparison, higher future time preferences were not significantly associated with full-service restaurant intake (30-day: p for linear trend=0.73; 60-day: p for linear trend=0.83). Higher future time preferences were related to a lower frequency of fast food consumption. Utilizing concepts from behavioral economics (e.g. pre-commitment contracts) to facilitate more healthful eating is warranted using experimental studies. Copyright © 2016 Elsevier Inc. All rights reserved.

Why do health workers in rural Tanzania prefer public sector employment?

PubMed Central

2012-01-01

Background Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. Methods The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Results The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. Conclusions The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required. PMID:22480347

Preference-based measures to obtain health state utility values for use in economic evaluations with child-based populations: a review and UK-based focus group assessment of patient and parent choices.

PubMed

Wolstenholme, Jane L; Bargo, Danielle; Wang, Kay; Harnden, Anthony; Räisänen, Ulla; Abel, Lucy

2018-03-21

No current guidance is available in the UK on the choice of preference-based measure (PBM) that should be used in obtaining health-related quality of life from children. The aim of this study is to review the current usage of PBMs for obtaining health state utility values in child and adolescent populations, and to obtain information on patient and parent-proxy respondent preferences in completing PBMs in the UK. A literature review was conducted to determine which instrument is most frequently used for child-based economic evaluations and whether child or proxy responses are used. Instruments were compared on dimensions, severity levels, elicitation and valuation methods, availability of value sets and validation studies, and the range of utility values generated. Additionally, a series of focus groups of parents and young people (11-20 years) were convened to determine patient and proxy preferences. Five PBMs suitable for child populations were identified, although only the Health Utilities Index 2 (HUI2) and Child Heath Utility 9D (CHU-9D) have UK value sets. 45 papers used PBMs in this population, but many used non-child-specific PBMs. Most respondents were parent proxies, even in adolescent populations. Reported missing data ranged from 0.5 to 49.3%. The focus groups reported their experiences with the EQ-5D-Y and CHU-9D. Both the young persons' group and parent/proxy groups felt that the CHU-9D was more comprehensive but may be harder for a proxy to complete. Some younger children had difficulty understanding the CHU-9D questions, but the young persons' group nonetheless preferred responding directly. The use of PBMs in child populations is increasing, but many studies use PBMs that do not have appropriate value sets. Parent proxies are the most common respondents, but the focus group responses suggest it would be preferred, and may be more informative, for older children to self-report or for child-parent dyads to respond.

Understanding Preferences for Osteoporosis Information to Develop an Osteoporosis Patient Education Brochure.

PubMed

Edmonds, Stephanie W; Solimeo, Samantha L; Nguyen, Vu-Thuy; Wright, Nicole C; Roblin, Douglas W; Saag, Kenneth G; Cram, Peter

2017-01-01

Patient education materials can provide important information related to osteoporosis prevention and treatment. However, available osteoporosis education materials fail to follow best-practice guidelines for patient education. To develop an educational brochure on bone health for adults aged 50 years and older using mixed-method, semistructured interviews. This project consisted of 3 phases. In Phase 1, we developed written content that included information about osteoporosis. Additionally, we designed 2 graphic-rich brochures, Brochure A (photographs) and Brochure B (illustrations). In Phase 2, interviewers presented the text-only document and both brochure designs to 53 participants from an academic Medical Center in the Midwest and an outpatient clinic in the Southeastern region of the US. Interviewers used open- and closed-ended questions to elicit opinions regarding the brochures. In Phase 3, using feedback from Phase 2, we revised the brochure and presented it to 11 participants at a third site in the Southeastern US. Participants' comprehension of brochure text and acceptability of brochure design. We enrolled 64 participants. Most were women, white, and college-educated, with an average age of 66.1 years. Participants were able to restate the basic content of the brochure and preferred Brochure A's use of photographs. Using feedback from older adults, we developed and refined a brochure for communicating bone health information to older adults at risk of osteoporosis and fragility fractures. The methods outlined in this article may serve to guide others in developing health educational brochures for chronic medical conditions.

Initial orienting towards sexually relevant stimuli: preliminary evidence from eye movement measures.

PubMed

Fromberger, Peter; Jordan, Kirsten; von Herder, Jakob; Steinkrauss, Henrike; Nemetschek, Rebekka; Stolpmann, Georg; Müller, Jürgen Leo

2012-08-01

It has been proposed that sexual stimuli will be processed in a comparable manner to other evolutionarily meaningful stimuli (such as spiders or snakes) and therefore elicit an attentional bias and more attentional engagement (Spiering and Everaerd, In E. Janssen (Ed.), The psychophysiology of sex (pp. 166-183). Bloomington: Indiana University Press, 2007). To investigate early and late attentional processes while looking at sexual stimuli, heterosexual men (n = 12) viewed pairs of sexually preferred (images of women) and sexually non-preferred images (images of girls, boys or men), while eye movements were measured. Early attentional processing (initial orienting) was assessed by the number of first fixations and late attentional processing (maintenance of attention) was assessed by relative fixation time. Results showed that relative fixation time was significantly longer for sexually preferred stimuli than for sexually non-preferred stimuli. Furthermore, the first fixation was more often directed towards the preferred sexual stimulus, when simultaneously presented with a non-sexually preferred stimulus. Thus, the current study showed for the first time an attentional bias to sexually relevant stimuli when presented simultaneously with sexually irrelevant pictures. This finding, along with the discovery that heterosexual men maintained their attention to sexually relevant stimuli, highlights the importance of investigating early and late attentional processes while viewing sexual stimuli. Furthermore, the current study showed that sexually relevant stimuli are favored by the human attentional system.

Short- and long-term effects of nicotine and the histone deacetylase inhibitor phenylbutyrate on novel object recognition in zebrafish.

PubMed

Faillace, M P; Pisera-Fuster, A; Medrano, M P; Bejarano, A C; Bernabeu, R O

2017-03-01

Zebrafish have a sophisticated color- and shape-sensitive visual system, so we examined color cue-based novel object recognition in zebrafish. We evaluated preference in the absence or presence of drugs that affect attention and memory retention in rodents: nicotine and the histone deacetylase inhibitor (HDACi) phenylbutyrate (PhB). The objective of this study was to evaluate whether nicotine and PhB affect innate preferences of zebrafish for familiar and novel objects after short- and long-retention intervals. We developed modified object recognition (OR) tasks using neutral novel and familiar objects in different colors. We also tested objects which differed with respect to the exploratory behavior they elicited from naïve zebrafish. Zebrafish showed an innate preference for exploring red or green objects rather than yellow or blue objects. Zebrafish were better at discriminating color changes than changes in object shape or size. Nicotine significantly enhanced or changed short-term innate novel object preference whereas PhB had similar effects when preference was assessed 24 h after training. Analysis of other zebrafish behaviors corroborated these results. Zebrafish were innately reluctant or prone to explore colored novel objects, so drug effects on innate preference for objects can be evaluated changing the color of objects with a simple geometry. Zebrafish exhibited recognition memory for novel objects with similar innate significance. Interestingly, nicotine and PhB significantly modified innate object preference.

Stated time preferences for health: a systematic review and meta analysis of private and social discount rates.

PubMed

Mahboub-Ahari, Alireza; Pourreza, Abolghasem; Sari, Ali Akbari; Rahimi Foroushani, Abbas; Heydari, Hassan

2014-01-01

The present study aimed to provide better insight on methodological issues related to time preference studies, and to estimate private and social discount rates, using a rigorous systematic review and meta-analysis. We searched PubMed, EMBASE and Proquest databases in June 2013. All studies had estimated private and social time preference rates for health outcomes through stated preference approach, recognized eligible for inclusion. We conducted both fixed and random effect meta-analyses using mean discount rate and standard deviation of the included studies. I-square statistics was used for testing heterogeneity of the studies. Private and social discount rates were estimated separately via Stata11 software. Out of 44 screened full texts, 8 population-based empirical studies were included in qualitative synthesis. Reported time preference rates for own health were from 0.036 to 0.07 and for social health from 0.04 to 0.2. Private and social discount rates were estimated at 0.056 (95% CI: 0.038, 0.074) and 0.066 (95% CI: 0.064, 0.068), respectively. Considering the impact of time preference on healthy behaviors and because of timing issues, individual's time preference as a key determinant of policy making should be taken into account. Direct translation of elicited discount rates to the official discount rates has been remained questionable. Decisions about the proper discount rate for health context, may need a cross-party consensus among health economists and policy makers.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: III. Preferred Level of Participation in Decision-making.

PubMed

Varughese, Rae E; Andrews, Paul; Sigal, Michael J; Azarpazhooh, Amir

2016-11-15

The purpose of this study was to assess Canadian and American pediatric dentists' preferred level of participation in clinical decision-making. A web-based survey was used to collect the opinions of all active Royal College of Dentists of Canada members and American Academy of Pediatric Dentistry members on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain to elicit participants' preferred role in clinical decision-making, ranging from an active role (the dentist takes the primary role in decision-making while considering patients/caregivers opinions) to a passive role (the dentist prefers to have the patient guide the decision-making). Bivariate and multivariate analyses for the preferred role and its predictor were performed (two-tailed P<0.05). Fifty-eight percent of participants preferred an active role. The passive role was chosen three times more by those who worked in a hospital-based setting (odds ratio [OR] equals 3.15, 95 percent confidence interval [CI] equals 1.13 to 8.79) or a university-based setting versus a combined setting (OR equals 3.61, 95 percent CI equals 1.11 to 11.77). The majority of participants preferred an active role in decision-making, a role that may not be consistent with a patient-centered practice that emphasizes patient autonomy in decision-making.

Estimation of a Preference-Based Summary Score for the Patient-Reported Outcomes Measurement Information System: The PROMIS®-Preference (PROPr) Scoring System.

PubMed

Dewitt, Barry; Feeny, David; Fischhoff, Baruch; Cella, David; Hays, Ron D; Hess, Rachel; Pilkonis, Paul A; Revicki, Dennis A; Roberts, Mark S; Tsevat, Joel; Yu, Lan; Hanmer, Janel

2018-06-01

Health-related quality of life (HRQL) preference-based scores are used to assess the health of populations and patients and for cost-effectiveness analyses. The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS ® ) consists of patient-reported outcome measures developed using item response theory. PROMIS is in need of a direct preference-based scoring system for assigning values to health states. To produce societal preference-based scores for 7 PROMIS domains: Cognitive Function-Abilities, Depression, Fatigue, Pain Interference, Physical Function, Sleep Disturbance, and Ability to Participate in Social Roles and Activities. Online survey of a US nationally representative sample ( n = 983). Preferences for PROMIS health states were elicited with the standard gamble to obtain both single-attribute scoring functions for each of the 7 PROMIS domains and a multiplicative multiattribute utility (scoring) function. The 7 single-attribute scoring functions were fit using isotonic regression with linear interpolation. The multiplicative multiattribute summary function estimates utilities for PROMIS multiattribute health states on a scale where 0 is the utility of being dead and 1 the utility of "full health." The lowest possible score is -0.022 (for a state viewed as worse than dead), and the highest possible score is 1. The online survey systematically excludes some subgroups, such as the visually impaired and illiterate. A generic societal preference-based scoring system is now available for all studies using these 7 PROMIS health domains.

A new method for eliciting three speaking styles in the laboratory

PubMed Central

Harnsberger, James D.; Wright, Richard; Pisoni, David B.

2009-01-01

In this study, a method was developed to elicit three different speaking styles, reduced, citation, and hyperarticulated, using controlled sentence materials in a laboratory setting. In the first set of experiments, the reduced style was elicited by having twelve talkers read a sentence while carrying out a distractor task that involved recalling from short-term memory an individually-calibrated number of digits. The citation style corresponded to read speech in the laboratory. The hyperarticulated style was elicited by prompting talkers (twice) to reread the sentences more carefully. The results of perceptual tests with naïve listeners and an acoustic analysis showed that six of the twelve talkers produced a reduced style of speech for the test sentences in the distractor task relative to the same sentences in the citation style condition. In addition, all talkers consistently produced sentences in the citation and hyperarticulated styles. In the second set of experiments, the reduced style was elicited by increasing the number of digits in the distractor task by one (a heavier cognitive load). The procedures for eliciting citation and hyperarticulated sentences remained unchanged. Ten talkers were recorded in the second experiment. The results showed that six out of ten talkers differentiated all three styles as predicted (70% of all sentences recorded). In addition, all talkers consistently produced sentences in the citation and hyperarticulated styles. Overall, the results demonstrate that it is possible to elicit controlled sentence stimulus materials varying in speaking style in a laboratory setting, although the method requires further refinement to elicit these styles more consistently from individual participants. PMID:19562041

A new method for eliciting three speaking styles in the laboratory.

PubMed

Harnsberger, James D; Wright, Richard; Pisoni, David B

2008-04-01

In this study, a method was developed to elicit three different speaking styles, reduced, citation, and hyperarticulated, using controlled sentence materials in a laboratory setting. In the first set of experiments, the reduced style was elicited by having twelve talkers read a sentence while carrying out a distractor task that involved recalling from short-term memory an individually-calibrated number of digits. The citation style corresponded to read speech in the laboratory. The hyperarticulated style was elicited by prompting talkers (twice) to reread the sentences more carefully. The results of perceptual tests with naïve listeners and an acoustic analysis showed that six of the twelve talkers produced a reduced style of speech for the test sentences in the distractor task relative to the same sentences in the citation style condition. In addition, all talkers consistently produced sentences in the citation and hyperarticulated styles. In the second set of experiments, the reduced style was elicited by increasing the number of digits in the distractor task by one (a heavier cognitive load). The procedures for eliciting citation and hyperarticulated sentences remained unchanged. Ten talkers were recorded in the second experiment. The results showed that six out of ten talkers differentiated all three styles as predicted (70% of all sentences recorded). In addition, all talkers consistently produced sentences in the citation and hyperarticulated styles. Overall, the results demonstrate that it is possible to elicit controlled sentence stimulus materials varying in speaking style in a laboratory setting, although the method requires further refinement to elicit these styles more consistently from individual participants.

A Participatory Method to Identify Root Determinants of Health: The Heart of the Matter

PubMed Central

Barnidge, Ellen; Baker, Elizabeth A.; Motton, Freda; Rose, Frank; Fitzgerald, Teresa

2010-01-01

Background Co-learning is one of the core principles of community-based participatory research (CBPR). Often, it is difficult to engage community members beyond those involved in the formal partnership in co-learning processes. However, to understand and address locally relevant root factors of health, it is essential to engage the broader community in participatory dialogues around these factors. Objective This article provides a glimpse into how using a photo-elicitation process allowed a community–academic partnership to engage community members in a participatory dialogue about root factors influencing health. The article details the decision to use photo-elicitation and describes the photo-elicitation method. Method Similar to a focus group process, photo-elicitation uses photographs and questions to prompt reflection and dialogue. Used in conjunction with an economic development framework, this method allows participants to discuss underlying, or root, community processes and structures that influence health. Conclusion Photo-elicitation is one way to engage community members in a participatory dialogue that stimulates action around root factors of health. To use this method successfully within a CBPR approach, it is important to build on existing relationships of trust among community and academic partners and create opportunities for community partners to determine the issues for discussion. PMID:20364079

The Role of Scientific Studies in Building Consensus in ...

EPA Pesticide Factsheets

We present a new approach for characterizing the potential of scientific studies to reduce conflict among stakeholders in an analytic-deliberative environmental decision-making process. The approach computes a normalized metric, the Expected Consensus Index of New Research (ECINR), for identifying where additional scientific research will best support improved decisions and resolve possible conflicts over preferred management actions. The ECINR reflects the expected change in agreement among parties over preferred management actions with the implementation and consideration of new scientific studies. We demonstrate the ECINR method based on a preliminary application to coral reef protection and restoration in the Gua´nica Bay Watershed, Puerto Rico, focusing on assessing and managing anthropogenic stressors, including sedimentation and pollution from landbased sources such as sewage, agriculture, and development. Structured elicitations of values and beliefs conducted at a coral reef decision support workshop held at La Parguera, Puerto Rico, are used to develop information for illustrating the methodology. The ECINR analysis was focused on a final study group of seven stakeholders, consisting of resource managers and scientists, who were not in agreement on the efficacy and respective benefits of reducing loadings from three sources: sewage, agriculture, and development. The scenario assumed that loadings would be reduced incrementally from each source through

A study of ergonomics factors in washbasin design.

PubMed

Aksoy, O; Ertürk, Z; Oztürk, K; Saltik, H; Ward, J S

1977-06-01

A 4-week UNESCO-sponsored mission to the Department of Architecture, Karadeniz Technical University in Eastern Turkey, gave an opportunity to apply ergonomics techniques to some aspects of that country's domestic washbasin design. The study was intended to provide experience in questionnaire design and administration, in the application of psycho-physical methods, and to highlight the importance of determining user characteristics and preferences with regard to the built environment. A field study elicited information on dimensions and positioning of existing wash-basins and ancillary equipment and the opinions of users as to the suitability of these features in relation to the activities performed. A laboratory study, using an adjustable rig permitting variation in the heights of basin, taps and mirror/shelf, followed. The data obtained on preferred heights of these items led to the conclusions that basin height should be increased to between 95 and 100 cm to satisfy the majority of users; tap height above the basin should be reduced to about 11 cm; the shelf and lower edge of a mirror sited above the basin should be 136 cm above the floor; and a clear space of 110 cm should be available between the front of the basin and a wall or other obstruction. Suggestions on other design aspects of the bathroom, resulting from the study, are discussed.

Do you see what I hear? Vantage point preference and visual dominance in a time-space synaesthete

PubMed Central

Jarick, Michelle; Stewart, Mark T.; Smilek, Daniel; Dixon, Michael J.

2013-01-01

Time-space synaesthetes “see” time units organized in a spatial form. While the structure might be invariant for most synaesthetes, the perspective by which some view their calendar is somewhat flexible. One well-studied synaesthete L adopts different viewpoints for months seen vs. heard. Interestingly, L claims to prefer her auditory perspective, even though the month names are represented visually upside down. To verify this, we used a spatial-cueing task that included audiovisual month cues. These cues were either congruent with L's preferred “auditory” viewpoint (auditory-only and auditory + month inverted) or incongruent (upright visual-only and auditory + month upright). Our prediction was that L would show enhanced cueing effects (larger response time difference between valid and invalid targets) following the audiovisual congruent cues since both elicit the “preferred” auditory perspective. Also, when faced with conflicting cues, we predicted L would choose the preferred auditory perspective over the visual perspective. As we expected, L did show enhanced cueing effects following the audiovisual congruent cues that corresponded with her preferred auditory perspective, but that the visual perspective dominated when L was faced with both viewpoints simultaneously. The results are discussed with relation to the reification hypothesis of sequence space synaesthesia (Eagleman, 2009). PMID:24137140

Which terms should be used to describe autism? Perspectives from the UK autism community.

PubMed

Kenny, Lorcan; Hattersley, Caroline; Molins, Bonnie; Buckley, Carole; Povey, Carol; Pellicano, Elizabeth

2016-05-01

Recent public discussions suggest that there is much disagreement about the way autism is and should be described. This study sought to elicit the views and preferences of UK autism community members - autistic people, parents and their broader support network - about the terms they use to describe autism. In all, 3470 UK residents responded to an online survey on their preferred ways of describing autism and their rationale for such preferences. The results clearly show that people use many terms to describe autism. The most highly endorsed terms were 'autism' and 'on the autism spectrum', and to a lesser extent, 'autism spectrum disorder', for which there was consensus across community groups. The groups disagreed, however, on the use of several terms. The term 'autistic' was endorsed by a large percentage of autistic adults, family members/friends and parents but by considerably fewer professionals; 'person with autism' was endorsed by almost half of professionals but by fewer autistic adults and parents. Qualitative analysis of an open-ended question revealed the reasons underlying respondents' preferences. These findings demonstrate that there is no single way of describing autism that is universally accepted and preferred by the UK's autism community and that some disagreements appear deeply entrenched. © The Author(s) 2015.

Bleomycin Can Cleave an Oncogenic Noncoding RNA.

PubMed

Angelbello, Alicia J; Disney, Matthew D

2018-01-04

Noncoding RNAs are pervasive in cells and contribute to diseases such as cancer. A question in biomedical research is whether noncoding RNAs are targets of medicines. Bleomycin is a natural product that cleaves DNA; however, it is known to cleave RNA in vitro. Herein, an in-depth analysis of the RNA cleavage preferences of bleomycin A5 is presented. Bleomycin A5 prefers to cleave RNAs with stretches of AU base pairs. Based on these preferences and bioinformatic analysis, the microRNA-10b hairpin precursor was identified as a potential substrate for bleomycin A5. Both in vitro and cellular experiments demonstrated cleavage. Importantly, chemical cleavage by bleomycin A5 in the microRNA-10b hairpin precursors occurred near the Drosha and Dicer enzymatic processing sites and led to destruction of the microRNA. Evidently, oncogenic noncoding RNAs can be considered targets of cancer medicines and might elicit their pharmacological effects by targeting noncoding RNA. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Unconscious Affective Responses to Food.

PubMed

Sato, Wataru; Sawada, Reiko; Kubota, Yasutaka; Toichi, Motomi; Fushiki, Tohru

2016-01-01

Affective or hedonic responses to food are crucial for humans, both advantageously (e.g., enhancing survival) and disadvantageously (e.g., promoting overeating and lifestyle-related disease). Although previous psychological studies have reported evidence of unconscious cognitive and behavioral processing related to food, it remains unknown whether affective reactions to food can be triggered unconsciously and its relationship with daily eating behaviors. We investigated these issues by using the subliminal affective priming paradigm. Photographs of food or corresponding mosaic images were presented in the peripheral visual field for 33 ms. Target photos of faces with emotionally neutral expressions were then presented, and participants rated their preferences for the faces. Eating behaviors were also assessed using questionnaires. The food images, relative to the mosaics, increased participants' preference for subsequent target faces. Furthermore, the difference in the preference induced by food versus mosaic images was positively correlated with the tendency to engage in external eating. These results suggest that unconscious affective reactions are elicited by the sight of food and that these responses contribute to daily eating behaviors related to overeating.

Implicit discount rates of vascular surgeons in the management of abdominal aortic aneurysms.

PubMed

Enemark, U; Lyttkens, C H; Troëng, T; Weibull, H; Ranstam, J

1998-01-01

A growing empirical literature has investigated attitudes towards discounting of health benefits with regard to social choices of life-saving and health-improving measures and individuals' time preferences for the management of their own health. In this study, the authors elicited the time preferences of vascular surgeons in the context of management of small abdominal aortic aneurysms, for which the choice between early elective surgery and watchful waiting is not straightforward. They interviewed 25 of a random sample of 30 Swedish vascular surgeons. Considerable variation in the time preferences was found in the choices between watchful waiting and surgical intervention among the otherwise very homogeneous group of surgeons. The discount rates derived ranged from 5.3% to 19.4%. The median discount rate (10.4%) is similar to those usually reported for social choices concerning life-saving measures. The surgeons who were employed in university hospitals had higher discount rates than did their colleagues in county and district hospitals.

Urban women's preferences for learning of their mammogram result: a qualitative study.

PubMed

Marcus, Erin N; Drummond, Darlene; Dietz, Noella

2012-03-01

Research suggests that communication of mammogram results is flawed for many low-income ethnic minority women. This study conducted four focus groups with low-income inner-city minority women (n = 34). The goals of our project were: (1) to elucidate women's experiences learning of their result; (2) to elicit their preferences as to how this communication could be improved; and (3) to gather information to help inform the development of a new tool for communicating mammogram results. Salient themes included dissatisfaction with result communication; difficulty elucidating the meaning of a typical results notification letter; a preference for direct verbal communication of results and for print materials that included pictures, testimonials, and an action plan including a hotline to call with questions; and a strong interest in advance education about the likelihood of having to return for additional follow up. Video and other programs to inform patients before the test about what happens after may improve patient satisfaction and enhance women's understanding of their personal result and follow up plan.

Tonic or Phasic Stimulation of Dopaminergic Projections to Prefrontal Cortex Causes Mice to Maintain or Deviate from Previously Learned Behavioral Strategies

PubMed Central

Ellwood, Ian T.; Patel, Tosha; Wadia, Varun; Lee, Anthony T.; Liptak, Alayna T.

2017-01-01

Dopamine neurons in the ventral tegmental area (VTA) encode reward prediction errors and can drive reinforcement learning through their projections to striatum, but much less is known about their projections to prefrontal cortex (PFC). Here, we studied these projections and observed phasic VTA–PFC fiber photometry signals after the delivery of rewards. Next, we studied how optogenetic stimulation of these projections affects behavior using conditioned place preference and a task in which mice learn associations between cues and food rewards and then use those associations to make choices. Neither phasic nor tonic stimulation of dopaminergic VTA–PFC projections elicited place preference. Furthermore, substituting phasic VTA–PFC stimulation for food rewards was not sufficient to reinforce new cue–reward associations nor maintain previously learned ones. However, the same patterns of stimulation that failed to reinforce place preference or cue–reward associations were able to modify behavior in other ways. First, continuous tonic stimulation maintained previously learned cue–reward associations even after they ceased being valid. Second, delivering phasic stimulation either continuously or after choices not previously associated with reward induced mice to make choices that deviated from previously learned associations. In summary, despite the fact that dopaminergic VTA–PFC projections exhibit phasic increases in activity that are time locked to the delivery of rewards, phasic activation of these projections does not necessarily reinforce specific actions. Rather, dopaminergic VTA–PFC activity can control whether mice maintain or deviate from previously learned cue–reward associations. SIGNIFICANCE STATEMENT Dopaminergic inputs from ventral tegmental area (VTA) to striatum encode reward prediction errors and reinforce specific actions; however, it is currently unknown whether dopaminergic inputs to prefrontal cortex (PFC) play similar or distinct roles. Here, we used bulk Ca2+ imaging to show that unexpected rewards or reward-predicting cues elicit phasic increases in the activity of dopaminergic VTA–PFC fibers. However, in multiple behavioral paradigms, we failed to observe reinforcing effects after stimulation of these fibers. In these same experiments, we did find that tonic or phasic patterns of stimulation caused mice to maintain or deviate from previously learned cue–reward associations, respectively. Therefore, although they may exhibit similar patterns of activity, dopaminergic inputs to striatum and PFC can elicit divergent behavioral effects. PMID:28739583

A nonproliferating parvovirus vaccine vector elicits sustained, protective humoral immunity following a single intravenous or intranasal inoculation.

PubMed

Palmer, Gene A; Brogdon, Jennifer L; Constant, Stephanie L; Tattersall, Peter

2004-02-01

An ideal vaccine delivery system would elicit persistent protection following a single administration, preferably by a noninvasive route, and be safe even in the face of immunosuppression, either inherited or acquired, of the recipient. We have exploited the unique life cycle of the autonomous parvoviruses to develop a nonproliferating vaccine platform that appears to both induce priming and continually boost a protective immune response following a single inoculation. A crippled parvovirus vector was constructed, based on a chimera between minute virus of mice (MVM) and LuIII, which expresses Borrelia burgdorferi outer surface protein A (OspA) instead of its coat protein. The vector was packaged into an MVM lymphotropic capsid and inoculated into naive C3H/HeNcr mice. Vaccination with a single vector dose, either intravenously or intranasally, elicited high-titer anti-OspA-specific antibody that provided protection from live spirochete challenge and was sustained over the lifetime of the animal. Both humoral and cell-mediated Th(1) immunity was induced, as shown by anti-OspA immunoglobulin G2a antibody and preferential gamma interferon production by OspA-specific CD4(+) T cells.

A Nonproliferating Parvovirus Vaccine Vector Elicits Sustained, Protective Humoral Immunity following a Single Intravenous or Intranasal Inoculation

PubMed Central

Palmer, Gene A.; Brogdon, Jennifer L.; Constant, Stephanie L.; Tattersall, Peter

2004-01-01

An ideal vaccine delivery system would elicit persistent protection following a single administration, preferably by a noninvasive route, and be safe even in the face of immunosuppression, either inherited or acquired, of the recipient. We have exploited the unique life cycle of the autonomous parvoviruses to develop a nonproliferating vaccine platform that appears to both induce priming and continually boost a protective immune response following a single inoculation. A crippled parvovirus vector was constructed, based on a chimera between minute virus of mice (MVM) and LuIII, which expresses Borrelia burgdorferi outer surface protein A (OspA) instead of its coat protein. The vector was packaged into an MVM lymphotropic capsid and inoculated into naive C3H/HeNcr mice. Vaccination with a single vector dose, either intravenously or intranasally, elicited high-titer anti-OspA-specific antibody that provided protection from live spirochete challenge and was sustained over the lifetime of the animal. Both humoral and cell-mediated Th1 immunity was induced, as shown by anti-OspA immunoglobulin G2a antibody and preferential gamma interferon production by OspA-specific CD4+ T cells. PMID:14722265

A person trade-off study to estimate age-related weights for health gains in economic evaluation.

PubMed

Petrou, Stavros; Kandala, Ngianga-Bakwin; Robinson, Angela; Baker, Rachel

2013-10-01

An increasing body of literature is exploring whether the age of the recipient of health care should be a criterion in how health care resources are allocated. The existing literature is constrained both by the relatively small number of age comparison groups within preference-elicitation studies, and by a paucity of methodological robustness tests for order and framing effects and the reliability and transitivity of preferences that would strengthen confidence in the results. This paper reports the results of a study aimed at estimating granulated age-related weights for health gains across the age spectrum that can potentially inform health care decision-making. A sample of 2,500 participants recruited from the health care consumer panels of a social research company completed a person trade-off (or 'matching') study designed to estimate age-related weights for 5- and 10-year life extensions. The results are presented in terms of matrices for alternative age comparisons across the age spectrum. The results revealed a general, although not invariable, tendency to give more weight to health gains, expressed in terms of life extensions, in younger age groups. In over 85% of age comparisons, the person trade-off exercises revealed a preference for life extensions by the younger of the two age groups that were compared. This pattern held regardless of the method of aggregating responses across study participants. Moreover, the relative weight placed on life extensions by the younger of the two age groups was generally, although not invariably, found to increase as the age difference between the comparator age groups increased. Further analyses revealed that the highest mean relative weight placed on life extensions was estimated for 30-year-olds when the ratio of means method was used to aggregate person trade-off responses across study participants. The highest mean relative weight placed on life extensions was estimated for 10-year-olds for 5-year life extensions and for 30-year-olds for 10-year life extensions, when the median of individual ratios method was used to aggregate person trade-off responses across study participants. Methodological tests framed around alternative referents in the person trade-off questions and the stability of preferences had no discernible effects on the study results. This study has produced new evidence on age-related weights for health gains that can potentially inform health care decision-making.

Values and preferences in oral anticoagulation in patients with atrial fibrillation, physicians' and patients' perspectives: protocol for a two-phase study.

PubMed

Alonso-Coello, Pablo; Montori, Victor M; Solà, Ivan; Schünemann, Holger J; Devereaux, Philipe; Charles, Cathy; Roura, Mercè; Díaz, M Gloria; Souto, Juan Carlos; Alonso, Rafael; Oliver, Sven; Ruiz, Rafael; Coll-Vinent, Blanca; Diez, Ana Isabel; Gich, Ignasi; Guyatt, Gordon

2008-10-27

Oral anticoagulation prevents strokes in patients with atrial fibrillation but, for reasons that remain unclear, less than 40% of all patients with atrial fibrillation receive warfarin. The literature postulates that patient and clinician preferences may explain this low utilization. The proposed research seeks to answer the following questions: i) When assessed systematically, do patients' and clinicians' preferences explain the utilization of warfarin to prevent strokes associated with atrial fibrillation? ii) To what extent do patients' and clinicians' treatment preferences differ? iii) What factors explain any differences that exist in treatment preferences between patients and clinicians? To answer these questions we will conduct a two-phase study of patient and clinician preferences for health states and treatments. In the first phase of this study we will conduct structured interviews to determine their treatment preferences for warfarin vs. aspirin to prevent strokes associated with atrial fibrillation using the probability trade-off technique. In the same interview, we will conduct preference-elicitation exercises using the feeling thermometer to identify the utilities that patients place on taking medication (warfarin and aspirin), and on having a mild stroke, a severe stroke, and a major bleed. In the second phase of the study we will convene focus groups of clinicians and patients to explore their answers to the exercises in the first phase. This is a study of patient and clinician preferences for health states and treatments. Because of its clinical importance and our previous work in this area, we will conduct our study in the clinical context of the decision to use antithrombotic agents to reduce the risk of stroke in patients with non-valvular chronic atrial fibrillation.

Caregiver Treatment Preferences for Children with a New Versus Existing Attention-Deficit/Hyperactivity Disorder Diagnosis.

PubMed

dosReis, Susan; Park, Alex; Ng, Xinyi; Frosch, Emily; Reeves, Gloria; Cunningham, Charles; Janssen, Ellen M; Bridges, John F P

2017-04-01

Parental experiences with managing their child's attention-deficit/hyperactivity disorder (ADHD) can influence priorities for treatment. This study aimed to identify the ADHD management options caregivers most prefer and to determine if preferences differ by time since initial ADHD diagnosis. Primary caregivers (n = 184) of a child aged 4-14 years old in care for ADHD were recruited from January 2013 through March 2015 from community-based pediatric and mental health clinics and family support organizations across the state of Maryland. Participants completed a survey that included child/family demographics, child clinical treatment, and a Best-Worst Scaling (BWS) experiment to elicit ADHD management preferences. The BWS comprised 18 ADHD management profiles showing seven treatment attributes, where the best and worst attribute levels were selected from each profile. A conditional logit model using effect-coded variables was used to estimate preference weights stratified by time since ADHD diagnosis. Participants were primarily the mother (84%) and had a college or postgraduate education (76%) with 75% of the children on stimulant medications. One-on-one caregiver behavior training, medication use seven days a week, therapy in a clinic, and an individualized education program were most preferred for managing ADHD. Aside from caregiver training and monthly out-of-pocket costs, caregivers of children diagnosed with ADHD for less than two years prioritized medication use lower than other care management attributes and caregivers of children diagnosed with ADHD for two or more years preferred school accommodations, medication, and provider specialty. Preferences for ADHD treatment differ based on the duration of the child's ADHD. Acknowledging that preferences change over the course of care could facilitate patient/family-centered care planning across a range of resources and a multidisciplinary team of professionals.

Measuring Preferences for a Diabetes Pay-for-Performance for Patient (P4P4P) Program using a Discrete Choice Experiment.

PubMed

Chen, Tsung-Tai; Tung, Tao-Hsin; Hsueh, Ya-Seng Arthur; Tsai, Ming-Han; Liang, Hsiu-Mei; Li, Kay-Lun; Chung, Kuo-Piao; Tang, Chao-Hsiun

2015-07-01

To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method. The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes. The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%. Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Estimating Preferences for Complex Health Technologies: Lessons Learned and Implications for Personalized Medicine.

PubMed

Marshall, Deborah A; Gonzalez, Juan Marcos; MacDonald, Karen V; Johnson, F Reed

2017-01-01

We examine key study design challenges of using stated-preference methods to estimate the value of whole-genome sequencing (WGS) as a specific example of genomic testing. Assessing the value of WGS is complex because WGS provides multiple findings, some of which can be incidental in nature and unrelated to the specific health concerns that motivated the test. In addition, WGS results can include actionable findings (variants considered to be clinically useful and can be acted on), findings for which evidence for best clinical action is not available (variants considered clinically valid but do not meet as high of a standard for clinical usefulness), and findings of unknown significance. We consider three key challenges encountered in designing our national study on the value of WGS-layers of uncertainty, potential downstream consequences with endogenous aspects, and both positive and negative utility associated with testing information-and potential solutions as strategies to address these challenges. We conceptualized the decision to acquire WGS information as a series of sequential choices that are resolved separately. To determine the value of WGS information at the initial decision to undergo WGS, we used contingent valuation questions, and to elicit respondent preferences for reducing risks of health problems and the consequences of taking the steps to reduce these risks, we used a discrete-choice experiment. We conclude by considering the implications for evaluating the value of other complex health technologies that involve multiple forms of uncertainty. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

“ADHD Knowledge, Perceptions and Information Sources: Perspectives from a Community Sample of Adolescents and their Parents”

PubMed Central

Bussing, Regina; Zima, Bonnie T.; Mason, Dana M.; Meyer, Johanna.M.; White, Kimberly; Garvan, Cynthia W.

2012-01-01

PURPOSE The chronic illness model advocates for psychoeducation within a collaborative care model to enhance outcomes. To inform psychoeducational approaches for attention-deficit/hyperactivity disorder (ADHD), this study describes parent and adolescent knowledge, perceptions and information sources and explores how these vary by sociodemographic characteristics, ADHD risk, and past child mental health service use. METHODS Parents and adolescents were assessed 7.7 years after initial school district screening for ADHD risk. The study sample included 374 adolescents (56% high and 44% low ADHD risk), on average 15.4 (SD 1.8) years old, and 36% were African American. Survey questions assessed ADHD knowledge, perceptions, and cues to action, and elicited utilized and preferred information sources. Multiple logistic regression was used to determine potential independent predictors of ADHD knowledge. McNemar's tests compared information source utilization against preference. RESULTS Despite relatively high self-rated ADHD familiarity, misperceptions among parents and adolescents were common, including a sugar etiology (25% and 27%, respectively) and medication overuse (85% and 67%). African American respondents expressed lower ADHD awareness and greater belief in sugar etiology than Caucasians. Parents used a wide range of ADHD information sources while adolescents relied on social network members and teachers/school. However, parents and adolescents expressed similar strong preferences for the Internet (49% and 51%) and doctor (40% and 27%) as ADHD information sources. CONCLUSION Culturally appropriate psychoeducational strategies are needed that combine doctor-provided ADHD information with reputable Internet sources. Despite time limitations during patient visits, both parents and teens place high priority on receiving information from their doctor. PMID:23174470

Contrasting approaches to 'doing' family meals: a qualitative study of how parents frame children's food preferences.

PubMed

Thompson, Claire; Cummins, Steven; Brown, Tim; Kyle, Rosemary

2016-05-26

Family meals, as acts of domestic food provisioning, are shaped by the competing influences of household resources, food preferences and broader cultural norms around dietary practices. The place of children's food tastes in family meal practices is particularly complex. Food tastes stand in a reciprocal relationship with family food practices: being both an influence on and a product of them. This paper explores how parents think about and respond to their children's food preferences in relation to family meal practices. A qualitative study was conducted with residents of Sandwell, UK. The results presented here are based on the responses of nine key participants and their families. Photo elicitation methods generated participant food photo diaries that were used to inform subsequent interviews. A thematic analysis revealed two contrasting ways of incorporating children's tastes into family meal routines: (1) 'what we fancy' and (2) 'regulated'. The former entails repeatedly consulting and negotiating with children over what to cook for each meal. It is supported by the practical strategies of multiple and individually modified meals. The latter relies upon parents developing a repertoire of meals that 'work' for the family. This repertoire is performed as a series of 'set meals' in which any requests for variation are strongly resisted. Our findings add to the small body of literature on household food provisioning and suggest that achieving the idealised ritual of the family meal is underpinned by a range of values and strategies, some of which may run counter to health messages about nutrition.

Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians

PubMed Central

Demirci, Jill R.; Bogen, Debra L.; Mehrotra, Ateev; Miller, Elizabeth

2015-01-01

Abstract Background: Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. Materials and Methods: Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained. Results: Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists. Conclusions: Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be crucial for optimizing specific telehealth strategies and designing effective telehealth systems. PMID:25919585

Generation of referring expressions: assessing the Incremental Algorithm.

PubMed

van Deemter, Kees; Gatt, Albert; van der Sluis, Ielka; Power, Richard

2012-07-01

A substantial amount of recent work in natural language generation has focused on the generation of ''one-shot'' referring expressions whose only aim is to identify a target referent. Dale and Reiter's Incremental Algorithm (IA) is often thought to be the best algorithm for maximizing the similarity to referring expressions produced by people. We test this hypothesis by eliciting referring expressions from human subjects and computing the similarity between the expressions elicited and the ones generated by algorithms. It turns out that the success of the IA depends substantially on the ''preference order'' (PO) employed by the IA, particularly in complex domains. While some POs cause the IA to produce referring expressions that are very similar to expressions produced by human subjects, others cause the IA to perform worse than its main competitors; moreover, it turns out to be difficult to predict the success of a PO on the basis of existing psycholinguistic findings or frequencies in corpora. We also examine the computational complexity of the algorithms in question and argue that there are no compelling reasons for preferring the IA over some of its main competitors on these grounds. We conclude that future research on the generation of referring expressions should explore alternatives to the IA, focusing on algorithms, inspired by the Greedy Algorithm, which do not work with a fixed PO. Copyright © 2011 Cognitive Science Society, Inc.

Physician recruitment and retention in Manitoba: results from a survey of physicians' preferences for rural jobs.

PubMed

Witt, Julia

2017-01-01

Rural recruitment and retention continues to present challenges to health workforce planners. This paper reports and analyzes the results of a survey sent to physicians in Manitoba, eliciting their opinions regarding rural jobs. A survey was sent to all physicians in Manitoba. Part 1 of the survey included questions about background and demographic information; part 2 was a set of job satisfaction questions regarding respondents' current job; and part 3 included 2 sets of stated-choice questions eliciting preferences for a set of attributes relevant to rural recruitment and retention. Of the 2487 physicians who received surveys, 561 (22.6%) responded. Respondents indicated that income, hours worked and on-call frequency are very important: overall job satisfaction increased with income and decreased with hours worked. Income, hours and on-call frequency were ranked "very important" by the largest proportions of physicians. The estimated compensation for on-call more frequent than 1-in-4 was very high (82% of average income), and additional hours worked were worth $183 per hour. Other attributes that were important included professional interaction, housing availability and community incentives during the first year, which were valued at 11%-31% of annual income. Work-life balance is a key consideration for rural jobs, and there are incentives that can compensate for less desirable attributes.

Vaginal scent marking: effects on ultrasonic calling and attraction of male golden hamsters.

PubMed

Johnston, R E; Kwan, M

1984-11-01

Male hamsters were tested for their responses to areas that had been scent marked by intact or vaginectomized females to determine the effects of naturally deposited vaginal secretions on male behavior. In the first experiment males produced more ultrasonic courtship calls when investigating areas marked by intact females than areas scented by vaginectomized females, demonstrating that vaginal marks facilitate such calling. In a wind-tunnel preference test situation in which scent-marked alleys and clean alleys served as sources of odor, males approached the scented alley first if it had been freshly marked by intact females but not if it had been scented by vaginectomized females or other males. Thus, the odors of vaginal marks are sufficient to attract males over short distances. After males entered these alleys they showed a preference for odors of both intact and vaginectomized females over no odors, but still spent significantly more time investigating the odors of intact females than those of vaginectomized females. These experiments indicate that vaginal secretions are one of the primary cues that elicit male courtship calling, and the small quantities of vaginal secretions deposited by females in vaginal marks are sufficient to elicit ultrasonic calling and attract males over short distances. Thus it is likely that vaginal scent marking and ultrasonic calling by females interact to facilitate attraction and location of mates during courtship.

Patient participation in clinical decision-making in nursing: A comparative study of nurses' and patients' perceptions.

PubMed

Florin, Jan; Ehrenberg, Anna; Ehnfors, Margareta

2006-12-01

The aim of this study was to compare the degree of concordance between patients and Registered Nurses' perceptions of the patients' preferences for participation in clinical decision-making in nursing care. A further aim was to compare patients' experienced participation with their preferred participatory role. Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients' preferences. A comparative design was adopted with a convenient sample of 80 nurse-patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision-making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. Registered Nurses are not always aware of their patients' perspective and tend to overestimate patients' willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision-making in nursing care according to their own perceptions and not even to the patients' more moderate preferences of participation. A thorough assessment of the individual's preferences for participation in decision-making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.

5-(2-Aminopropyl)benzofuran and phenazepam demonstrate the possibility of dependence by increasing dopamine levels in the brain.

PubMed

Cha, Hye Jin; Lee, Kwang-Wook; Eom, Jang-Hyeon; Kim, Young-Hoon; Shin, Jisoon; Yun, Jaesuk; Han, Kyoungmoon; Kim, Hyung Soo

2016-10-01

Although 5-(2-aminopropyl)benzofuran (5-APB) and 7-bromo-5-(2-chlorophenyl)-1,3-dihydro-2H-1,4-benzodiazepin-2-one (phenazepam) are being used as recreational drugs, research on their dependence liability or mechanisms of action is lacking. The present study aimed to evaluate the behavioral effects and dependence liability of these drugs using conditioned place preference and self-administration paradigms in rodents. Additionally, biochemical techniques were used to assess the substance-induced alterations in synaptosome-released dopamine. While both of the tested substances elicited increases in conditioned place preference and dopamine, neither of them facilitated self-administration, suggesting that 5-APB and phenazepam have rewarding effects, rather than reinforcing effects. Copyright © 2016 Elsevier Inc. All rights reserved.

Mere exposure effect can be elicited in transient global amnesia.

PubMed

Marin-Garcia, Eugenia; Ruiz-Vargas, Jose M; Kapur, Narinder

2013-01-01

Transient global amnesia (TGA) is one of the most severe forms of anterograde amnesia seen in clinical practice, yet patients may show evidence of spared learning during the amnesic episode. The scope of spared learning in such a severe form of amnesia remains uncertain, and it is also unclear whether findings from single-case studies hold up in group studies of TGA patients. In this group study, we found evidence that extended the domain of spared learning in TGA to include the mere exposure effect, whereby enhanced preference is primed by prior exposure to stimuli. We demonstrate this effect during an acute episode in a group of TGA patients, where they showed enhanced preference for previously exposed faces, despite markedly impaired performance on standard anterograde memory tests.

The predatory mite Phytoseiulus persimilis does not perceive odor mixtures as strictly elemental objects.

PubMed

van Wijk, Michiel; de Bruijn, Paulien J A; Sabelis, Maurice W

2010-11-01

Phytoseiulus persimilis is a predatory mite that in absence of vision relies on the detection of herbivore-induced plant odors to locate its prey, the two-spotted spider-mite Tetranychus urticae. This herbivorous prey is feeding on leaves of a wide variety of plant species in different families. The predatory mites respond to numerous structurally different compounds. However, typical spider-mite induced plant compounds do not attract more predatory mites than plant compounds not associated with prey. Because the mites are sensitive to many compounds, components of odor mixtures may affect each other's perception. Although the response to pure compounds has been well documented, little is known how interactions among compounds affect the response to odor mixtures. We assessed the relation between the mites' responses elicited by simple mixtures of two compounds and by the single components of these mixtures. The preference for the mixture was compared to predictions under three conceptual models, each based on one of the following assumptions: (1) the responses elicited by each of the individual components can be added to each other; (2) they can be averaged; or (3) one response overshadows the other. The observed response differed significantly from the response predicted under the additive response, average response, and overshadowing response model in 52, 36, and 32% of the experimental tests, respectively. Moreover, the behavioral responses elicited by individual compounds and their binary mixtures were determined as a function of the odor concentration. The relative contribution of each component to the behavioral response elicited by the mixture varied with the odor concentration, even though the ratio of both compounds in the mixture was kept constant. Our experiments revealed that compounds that elicited no response had an effect on the response elicited by binary mixtures that they were part of. The results are not consistent with the hypothesis that P. persimilis perceives odor mixtures as a collection of strictly elemental objects. They suggest that odor mixtures rather are perceived as one synthetic whole.

Cleavage-Independent HIV-1 Trimers From CHO Cell Lines Elicit Robust Autologous Tier 2 Neutralizing Antibodies

PubMed Central

Bale, Shridhar; Martiné, Alexandra; Wilson, Richard; Behrens, Anna-Janina; Le Fourn, Valérie; de Val, Natalia; Sharma, Shailendra K.; Tran, Karen; Torres, Jonathan L.; Girod, Pierre-Alain; Ward, Andrew B.; Crispin, Max; Wyatt, Richard T.

2018-01-01

Native flexibly linked (NFL) HIV-1 envelope glycoprotein (Env) trimers are cleavage-independent and display a native-like, well-folded conformation that preferentially displays broadly neutralizing determinants. The NFL platform simplifies large-scale production of Env by eliminating the need to co-transfect the precursor-cleaving protease, furin that is required by the cleavage-dependent SOSIP trimers. Here, we report the development of a CHO-M cell line that expressed BG505 NFL trimers at a high level of homogeneity and yields of ~1.8 g/l. BG505 NFL trimers purified by single-step lectin-affinity chromatography displayed a native-like closed structure, efficient recognition by trimer-preferring bNAbs, no recognition by non-neutralizing CD4 binding site-directed and V3-directed antibodies, long-term stability, and proper N-glycan processing. Following negative-selection, formulation in ISCOMATRIX adjuvant and inoculation into rabbits, the trimers rapidly elicited potent autologous tier 2 neutralizing antibodies. These antibodies targeted the N-glycan “hole” naturally present on the BG505 Env proximal to residues at positions 230, 241, and 289. The BG505 NFL trimers that did not expose V3 in vitro, elicited low-to-no tier 1 virus neutralization in vivo, indicating that they remained intact during the immunization process, not exposing V3. In addition, BG505 NFL and BG505 SOSIP trimers expressed from 293F cells, when formulated in Adjuplex adjuvant, elicited equivalent BG505 tier 2 autologous neutralizing titers. These titers were lower in potency when compared to the titers elicited by CHO-M cell derived trimers. In addition, increased neutralization of tier 1 viruses was detected. Taken together, these data indicate that both adjuvant and cell-type expression can affect the elicitation of tier 2 and tier 1 neutralizing responses in vivo.

Fairness influences early signatures of reward-related neural processing.

PubMed

Massi, Bart; Luhmann, Christian C

2015-12-01

Many humans exhibit a strong preference for fairness during decision-making. Although there is evidence that social factors influence reward-related and affective neural processing, it is unclear if this effect is mediated by compulsory outcome evaluation processes or results from slower deliberate cognition. Here we show that the feedback-related negativity (FRN) and late positive potential (LPP), two signatures of early hedonic processing, are modulated by the fairness of rewards during a passive rating task. We find that unfair payouts elicit larger FRNs than fair payouts, whereas fair payouts elicit larger LPPs than unfair payouts. This is true both in the time-domain, where the FRN and LPP are related, and in the time-frequency domain, where the two signals are largely independent. Ultimately, this work demonstrates that fairness affects the early stages of reward and affective processing, suggesting a common biological mechanism for social and personal reward evaluation.

Comparison of Increasingly Detailed Elicitation Methods for the Assessment of Adverse Events in Pediatric Psychopharmacology.

ERIC Educational Resources Information Center

Greenhill, Laurence L.; Vitiello, Benedetto; Fisher, Prudence; Levine, Jerome; Davies, Mark; Abikoff, Howard; Chrisman, Allan K.; Chuang, Shirley; Findling, Robert L.; March, John; Scahill, Lawrence; Walkup, John; Riddle, Mark A.

2004-01-01

Objective: To improve the gathering of adverse events (AEs) in pediatric psychopharmacology by examining the value and acceptability of increasingly detailed elicitation methods. Method: Trained clinicians administered the Safety Monitoring Uniform Report Form (SMURF) to 59 parents and outpatients (mean age [+ or -] SD = 11.9 [+ or -] 3.2 years)…

Women's Contraceptive Preference-Use Mismatch

PubMed Central

He, Katherine; Dalton, Vanessa K.; Zochowski, Melissa K.

2017-01-01

Abstract Background: Family planning research has not adequately addressed women's preferences for different contraceptive methods and whether women's contraceptive experiences match their preferences. Methods: Data were drawn from the Women's Healthcare Experiences and Preferences Study, an Internet survey of 1,078 women aged 18–55 randomly sampled from a national probability panel. Survey items assessed women's preferences for contraceptive methods, match between methods preferred and used, and perceived reasons for mismatch. We estimated predictors of contraceptive preference with multinomial logistic regression models. Results: Among women at risk for pregnancy who responded with their preferred method (n = 363), hormonal methods (non-LARC [long-acting reversible contraception]) were the most preferred method (34%), followed by no method (23%) and LARC (18%). Sociodemographic differences in contraception method preferences were noted (p-values <0.05), generally with minority, married, and older women having higher rates of preferring less effective methods, compared to their counterparts. Thirty-six percent of women reported preference-use mismatch, with the majority preferring more effective methods than those they were using. Rates of match between preferred and usual methods were highest for LARC (76%), hormonal (non-LARC) (65%), and no method (65%). The most common reasons for mismatch were cost/insurance (41%), lack of perceived/actual need (34%), and method-specific preference concerns (19%). Conclusion: While preference for effective contraception was common among this sample of women, we found substantial mismatch between preferred and usual methods, notably among women of lower socioeconomic status and women using less effective methods. Findings may have implications for patient-centered contraceptive interventions. PMID:27710196

Ungulate exclusion, conifer thinning and mule deer forage in northeastern New Mexico

USGS Publications Warehouse

Kramer, David W.; Sorensen, Grant E.; Taylor, Chase A.; Cox, Robert D.; Gipson, Philip S.; Cain, James W.

2015-01-01

The southwestern United States has experienced expansion of conifer species (Juniperus spp. and Pinus ponderosa) into areas of semi-arid grassland over the past century. The expansion of conifers can limit palatable forage and reduce grass and forb communities. Conifer species are sometimes thinned through hydraulic mulching or selective cutting. We assessed the effects of these treatments on mule deer (Odocoileus hemionus) habitat in northeastern New Mexico to determine if conifer thinning improved cover of preferred forage species for mule deer in areas with and without ungulates. We measured plant cover and occurrence of preferred forage species in the summers of 2011 and 2012. An ongoing regional drought probably reduced vegetation response, with preferred forage species and herbaceous cover responding to conifer thinning or ungulate exclusion immediately following treatment, but not the following year. In 2011, areas that received thinning treatments had a higher abundance of preferred forage when compared to sites with no treatment. Grass coverage exhibited an immediate response in 2011, with ungulate exclosures containing 8% more coverage than areas without exclosures. The results suggest that conifer thinning and ungulate exclusion may elicit a positive response, however in the presence of drought; the positive effects are only short-term.

Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes.

PubMed

Milte, Rachel; Ratcliffe, Julie; Chen, Gang; Miller, Michelle; Crotty, Maria

2018-03-01

There has been little empirical investigation of the preferences of people living in aged care homes for food services. The aim of the present study was to elicit consumer preferences and their willingness to pay for food service in aged care homes. Current residents or their family members were invited to take part in the discrete choice experiment questionnaire administered via interview. Of the 109 eligible residents and 175 eligible family members approached for consent 121 (43%) participated, including 43 residents. Participant preferences were influenced by food taste, choice in relation to serving size, timing of meal selection, visual appeal, and additional cost. Participants indicated they would be willing to pay an additional $24 (US$18.42) per week for food which tasted excellent and $8 (US$6.14) per week to have choice in serving sizes. The study found that respondents were willing to pay a premium to receive food that met their expectations of taste, and for a high level of control over serving sizes, which has implications for the funding and provision of food and dining in long-term care in the future. © 2018 The Authors Nursing & Health Sciences Published by John Wiley & Sons Australia, Ltd.

Processing Demands Impact 3-Year-Olds' Performance in a Spontaneous-Response Task: New Evidence for the Processing-Load Account of Early False-Belief Understanding.

PubMed

Scott, Rose M; Roby, Erin

2015-01-01

Prior to age four, children succeed in non-elicited-response false-belief tasks but fail elicited-response false-belief tasks. To explain this discrepancy, the processing-load account argues that the capacity to represent beliefs emerges in infancy, as indicated by early success on non-elicited-response tasks, but that children's ability to demonstrate this capacity depends on the processing demands of the task and children's processing skills. When processing demands exceed young children's processing abilities, such as in standard elicited-response tasks, children fail despite their capacity to represent beliefs. Support for this account comes from recent evidence that reducing processing demands improves young children's performance: when demands are sufficiently reduced, 2.5-year-olds succeed in elicited-response tasks. Here we sought complementary evidence for the processing-load account by examining whether increasing processing demands impeded children's performance in a non-elicited-response task. 3-year-olds were tested in a preferential-looking task in which they heard a change-of-location false-belief story accompanied by a picture book; across children, we manipulated the amount of linguistic ambiguity in the story. The final page of the book showed two images: one that was consistent with the main character's false belief and one that was consistent with reality. When the story was relatively unambiguous, children looked reliably longer at the false-belief-consistent image, successfully demonstrating their false-belief understanding. When the story was ambiguous, however, this undermined children's performance: looking times to the belief-consistent image were correlated with verbal ability, and only children with verbal skills in the upper quartile of the sample demonstrated a significant preference for the belief-consistent image. These results support the processing-load account by demonstrating that regardless of whether a task involves an elicited response, children's performance depends on the processing demands of the task and their processing skills. These findings also have implications for alternative, deflationary accounts of early false-belief understanding.

Processing Demands Impact 3-Year-Olds’ Performance in a Spontaneous-Response Task: New Evidence for the Processing-Load Account of Early False-Belief Understanding

PubMed Central

Scott, Rose M.; Roby, Erin

2015-01-01

Prior to age four, children succeed in non-elicited-response false-belief tasks but fail elicited-response false-belief tasks. To explain this discrepancy, the processing-load account argues that the capacity to represent beliefs emerges in infancy, as indicated by early success on non-elicited-response tasks, but that children’s ability to demonstrate this capacity depends on the processing demands of the task and children’s processing skills. When processing demands exceed young children’s processing abilities, such as in standard elicited-response tasks, children fail despite their capacity to represent beliefs. Support for this account comes from recent evidence that reducing processing demands improves young children’s performance: when demands are sufficiently reduced, 2.5-year-olds succeed in elicited-response tasks. Here we sought complementary evidence for the processing-load account by examining whether increasing processing demands impeded children’s performance in a non-elicited-response task. 3-year-olds were tested in a preferential-looking task in which they heard a change-of-location false-belief story accompanied by a picture book; across children, we manipulated the amount of linguistic ambiguity in the story. The final page of the book showed two images: one that was consistent with the main character’s false belief and one that was consistent with reality. When the story was relatively unambiguous, children looked reliably longer at the false-belief-consistent image, successfully demonstrating their false-belief understanding. When the story was ambiguous, however, this undermined children’s performance: looking times to the belief-consistent image were correlated with verbal ability, and only children with verbal skills in the upper quartile of the sample demonstrated a significant preference for the belief-consistent image. These results support the processing-load account by demonstrating that regardless of whether a task involves an elicited response, children’s performance depends on the processing demands of the task and their processing skills. These findings also have implications for alternative, deflationary accounts of early false-belief understanding. PMID:26562840

Uncovering Pre-Service Teacher Beliefs about Young Children: A Photographic Elicitation Methodology

ERIC Educational Resources Information Center

Stockall, Nancy; Davis, Sara

2011-01-01

This illustrative paper provides an introduction to using mixed qualitative methods of photo-elicitation, face to face interviews and semiotic analysis to uncover pre-service students' beliefs about young children. The researchers share their experience on conducting a study using photo-elicitation and engaging pre-service teachers in a discussion…

Visualising community: using participant-driven photo-elicitation for research and application

Treesearch

Paul M. Van Auken; Svein J. Frisvoll; Susan I. Stewart

2010-01-01

Despite a contemporary socio-culture revolving around cultural consumption of imagery, metaphors, representations and "gaze", photo-elicitation is a rarely used method for social scientists and planners to acquire knowledge. In this paper, we discuss participant-driven photo-elicitation, a process in which participant photos are paired with in-depth...

Introducing Forum Theatre to Elicit and Advocate Children's Views

ERIC Educational Resources Information Center

Hammond, Nick

2013-01-01

Eliciting and advocating the voice of the child remains at the heart of international political agenda and also remains a central role for educational psychologists (EPs). Previous research indicates that EPs tend to use language-based methods for eliciting and advocating views of children. However, these approaches are often limited. Taking a…

[Q:] When would you prefer a SOSSAGE to a SAUSAGE? [A:] At about 100 msec. ERP correlates of orthographic typicality and lexicality in written word recognition.

PubMed

Hauk, O; Patterson, K; Woollams, A; Watling, L; Pulvermüller, F; Rogers, T T

2006-05-01

Using a speeded lexical decision task, event-related potentials (ERPs), and minimum norm current source estimates, we investigated early spatiotemporal aspects of cortical activation elicited by words and pseudo-words that varied in their orthographic typicality, that is, in the frequency of their component letter pairs (bi-grams) and triplets (tri-grams). At around 100 msec after stimulus onset, the ERP pattern revealed a significant typicality effect, where words and pseudo-words with atypical orthography (e.g., yacht, cacht) elicited stronger brain activation than items characterized by typical spelling patterns (cart, yart). At approximately 200 msec, the ERP pattern revealed a significant lexicality effect, with pseudo-words eliciting stronger brain activity than words. The two main factors interacted significantly at around 160 msec, where words showed a typicality effect but pseudo-words did not. The principal cortical sources of the effects of both typicality and lexicality were localized in the inferior temporal cortex. Around 160 msec, atypical words elicited the stronger source currents in the left anterior inferior temporal cortex, whereas the left perisylvian cortex was the site of greater activation to typical words. Our data support distinct but interactive processing stages in word recognition, with surface features of the stimulus being processed before the word as a meaningful lexical entry. The interaction of typicality and lexicality can be explained by integration of information from the early form-based system and lexicosemantic processes.

Conjoint analysis applications in health--a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force.

PubMed

Bridges, John F P; Hauber, A Brett; Marshall, Deborah; Lloyd, Andrew; Prosser, Lisa A; Regier, Dean A; Johnson, F Reed; Mauskopf, Josephine

2011-06-01

The application of conjoint analysis (including discrete-choice experiments and other multiattribute stated-preference methods) in health has increased rapidly over the past decade. A wider acceptance of these methods is limited by an absence of consensus-based methodological standards. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Research Practices for Conjoint Analysis Task Force was established to identify good research practices for conjoint-analysis applications in health. The task force met regularly to identify the important steps in a conjoint analysis, to discuss good research practices for conjoint analysis, and to develop and refine the key criteria for identifying good research practices. ISPOR members contributed to this process through an extensive consultation process. A final consensus meeting was held to revise the article using these comments, and those of a number of international reviewers. Task force findings are presented as a 10-item checklist covering: 1) research question; 2) attributes and levels; 3) construction of tasks; 4) experimental design; 5) preference elicitation; 6) instrument design; 7) data-collection plan; 8) statistical analyses; 9) results and conclusions; and 10) study presentation. A primary question relating to each of the 10 items is posed, and three sub-questions examine finer issues within items. Although the checklist should not be interpreted as endorsing any specific methodological approach to conjoint analysis, it can facilitate future training activities and discussions of good research practices for the application of conjoint-analysis methods in health care studies. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Eliciting regret improves decision making at the end of life.

PubMed

Djulbegovic, Benjamin; Tsalatsanis, Athanasios; Mhaskar, Rahul; Hozo, Iztok; Miladinovic, Branko; Tuch, Howard

2016-11-01

Management choices at the end of life are high-stake decisions fraught with emotions, chief among is regret. Our objective in this paper is to test the utility of a regret-based model to facilitate referral to hospice care while helping patients clarify their preferences on how they wish to spend the remaining days of their lives. A prospective cohort study that enrolled consecutive adult patients (n = 178) aware of the terminal nature of their disease. The patients were at the point in care where they had to decide between continuing potentially 'curative/life-prolonging' treatment (Rx) versus hospice care. Preferences were elicited using a Dual Visual Analog Scale regarding the level of regret of omission versus commission (RgO/RgC) towards hospice care and Rx. Each patient's RgO/RgC was contrasted against the predictive probability of death to suggest a management plan, which was then compared with the patient's actual choice. The probability of death was estimated using validated Palliative Performance Scale predictive model. Eighty-five percent (151/178) of patients agreed with the model's recommendations (p < 0.000001). Model predicted the actual choices for 72% (128/178) of patients (p < 0.00001). Logistic regression analysis showed that people who were initially inclined to be referred to hospice and were predicted to choose hospice over disease-directed treatment by the regret model have close to 98% probability of choosing hospice care at the end of their lives. No other factors (age, gender, race, educational status and pain level) affected their choice. Using regret to elicit choices in the end-of-life setting is both descriptively and prescriptively valid. People with terminal disease who are initially inclined to choose hospice and do not regret such a choice will select hospice care with high level of certainty. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Imbalances in prefrontal cortex CC-Homer1 versus –Homer2 expression promote cocaine preference

PubMed Central

Ary, Alexis W.; Lominac, Kevin D.; Wroten, Melissa G.; Williams, Amy R.; Campbell, Rianne R.; Ben-Shahar, Osnat; Klugmann, Matthias; Szumlinski, Karen K.

2013-01-01

Homer post-synaptic scaffolding proteins regulate forebrain glutamate transmission and thus, are likely molecular candidates mediating hypofrontality in addiction. Protracted withdrawal from cocaine experience increases the relative expression of Homer2 versus Homer1 isoforms within medial prefrontal cortex (mPFC). Thus, this study employed virus-mediated gene transfer strategies to investigate the functional relevance of an imbalance in mPFC Homer1/2 expression as it relates to various measures of sensorimotor, cognitive, emotional and motivational processing, as well as accompanying alterations in extracellular glutamate in C57BL/6J mice. mPFC Homer2b over-expression elevated basal glutamate content and blunted cocaine-induced glutamate release within the mPFC, while Homer2b knock-down produced the opposite effects. Despite altering mPFC glutamate, Homer2b knock-down failed to influence cocaine-elicited conditioned place-preferences, nor did it produce consistent effects on any other behavioral measures. In contrast, elevating the relative expression of Homer2b versus Homer1 within mPFC, by over-expressing Homer2b or knocking down Homer1c, shifted the dose-response function for cocaine-conditioned reward to the left, without affecting cocaine locomotion or sensitization. Intriguingly, both these transgenic manipulations produced glutamate anomalies within the nucleus accumbens (NAC) of cocaine-naïve animals that are reminiscent of those observed in cocaine experienced animals, including reduced basal extracellular glutamate content, reduced Homer1/2 and glutamate receptor expression, and augmented cocaine-elicited glutamate release. Together, these data provide novel evidence in support of opposing roles for constitutively expressed Homer1 and Homer2 isoforms in regulating mPFC glutamate transmission in vivo and support the hypothesis that cocaine-elicited increases in the relative amount of mPFC Homer2 versus Homer1 signaling produces abnormalities in NAC glutamate transmission that enhance vulnerability to cocaine reward. PMID:23658151

Should "standard gamble" and "'time trade off" utility measurement be used more in mental health research?

PubMed

Flood, Chris

2010-06-01

This review and discussion paper demonstrates that utility and preference measurement in mental health research is increasing. However there is still a general reluctance around using the methods due to methodological challenges and concerns around the capacity of users to understand utility methods during the research process. This paper sets out to describe and review some of the previously documented difficulties of using utility measurements in mental health services research and to highlight where they have been used successfully as measures. Additionally the paper aims to discuss a means of improving the methods used to capture service user utility and preference measurement and why decision making would be better informed as a result. International literature on utility measurement is reviewed, specifically examining the use of standard gamble and time trade off methods in mental health. Utility measurement in mental health is increasing though as the review demonstrates, concerns still exist over its application. A number of methods can be used to improve the approach overall and these are discussed as well as specific areas worthy of utility measurement including 'disutility' of admission, medication and medication side effects. Overall this paper argues that it is necessary to persist with efforts to conduct utility measurement calculation albeit with a critical eye on the methods in an attempt to ensure improvements are continually made. Utility and preference scores may be limited in that they only provide a rough score but they are defended as a means of providing some form of strength of preference for health states. The review is limited to English only texts. The debate on whether to use standard gamble and time trade off has implications for health services resource allocations, decision making, health economics research, policy making and health services research generally involving psychiatric service users. The paper argues that the absence of utility measurement in mental health runs the risk of mental health being disadvantaged in decisions around resource allocation. Institutions involved in decision making like the United Kingdom's National Institute for Health and Clinical Excellence, would be better served in their decision making and calculation of Quality Adjusted Life Years if more utility measurement in psychiatric research was carried out. Other arguments for using utility measurement include the desirability of using utility measurement to elicit a patient dimension of risk. Future utility research should aim for better involvement of service users in the design stage, the changing of time frames offered to users in health state scenarios used, a greater need for comparative work of utilities scoring across illness and between standard gamble and time trade off and more staff training in the use of utility methodology with mental health service users.

Factors Related to the Accuracy of Self-Reported Dietary Intake of Children Aged 6 to 12 Years Elicited with Interviews: A Systematic Review.

PubMed

Sharman, Stefanie J; Skouteris, Helen; Powell, Martine B; Watson, Brittany

2016-01-01

Understanding the relationship between children's dietary consumption and health is important. As such, it is crucial to explore factors related to the accuracy of children's reports of what they consumed. The objective was to evaluate factors related to the accuracy of self-reported dietary intake information elicited by interview methods from children aged 6 to 12 years. A systematic review of English articles using PsycINFO, PsycARTICLES, PsycEXTRA, PsycBOOKS, CINAHL Complete, Global Health, and MEDLINE Complete was performed. Search terms included interview, diet, children, and recall; studies were limited to those published from 1970 onward. Additional studies were identified using the reference lists of published articles. Studies that assessed children's dietary intake using direct observation, doubly labeled water, or the double-portion method and compared it with their recall of that intake (unassisted by parents) using an interview were included. The 45 studies that met the inclusion criteria showed that specific interview techniques designed to enhance children's recall accuracy had little effect. Rather, the timing of the interview appeared most important: The shorter the retention interval between children's consumption and their recall, the more accurate their memories. Children's age, body mass index, social desirability, food preferences, and cognitive ability were also related to accuracy. Factors related to the accuracy of children's dietary reporting should be taken into consideration when asking about consumption. Further research is required to examine whether other interview techniques, such as those developed to enhance children's recall of repeated staged events, can improve children's dietary reporting accuracy. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Managing expectations of antibiotics for upper respiratory tract infections: a qualitative study.

PubMed

Mustafa, Mohammed; Wood, Fiona; Butler, Christopher C; Elwyn, Glyn

2014-01-01

Communication experts have suggested that it is good practice to ask patients' directly whether they expect to receive antibiotics as part of asking about the triad of ideas, concerns, and expectations for health care. Our aim was to explore the views and experiences of family physicians about using this strategy with their patients, focusing the interview on the problem of eliciting expectations of antibiotics as a possible treatment for upper respiratory tract infections. We conducted a qualitative study using semistructured interviews with 20 family physicians in South Wales, United Kingdom, and performing thematic analysis. Family physicians assumed most patients or parents wanted antibiotics, as well as wanting to be "checked out" to make sure the illness was "nothing serious." Physicians said they did not ask direct questions about expectations, as that might lead to confrontation. They preferred to elicit expectations for antibiotics in an indirect manner, before performing a physical examination. The majority described reporting their findings of the examination as a "running commentary" so as to influence expectations and help avoid generating resistance to a soon-to-be-made-explicit plan not to prescribe antibiotics. The physicians used the running commentary to preserve and enhance the physician-patient relationship. Real-world family physicians use indirect methods to explore expectations for treatment and, on the basis of their physical examination, build an argument for reassuring the patient or parent. In contrast to proposed models in the communication literature, interventions to promote appropriate antibiotic prescribing might include a focus on training in communication skills that (1) integrates these indirect methods as part of building collaborative physician-patient relationships and (2) uses the running commentary of examination findings to facilitate participation in clinical decisions.

Challenges in Valuing Temporary Health States for Economic Evaluation: A Review of Empirical Applications of the Chained Time Trade-Off Method.

PubMed

Stoniute, Julija; Mott, David John; Shen, Jing

2018-05-01

The time trade-off (TTO) technique is commonly used to elicit health state utilities. Nevertheless, when the health states being valued are temporary, the TTO approach may be unsuitable. A variant of TTO- chained TTO-has been suggested to be used when the health states are temporary, but little research has been done on how chained TTO should be conducted. To systematically review the use of chained TTO in valuing temporary health states. A systematic literature search was conducted using the following major databases: Ovid MEDLINE(R), Embase, EBM Reviews, and PsycINFO. Abstracts (full articles if necessary) were screened by two independent reviewers, with a third reviewer resolving any disagreements. The resulting number of articles for review was low (n = 9). All the reviewed studies used face-to-face interviews, most had small sample sizes (<100), and all studies valued a small number of health states (<7), with time horizons typically ranging from 4 weeks to 1 year. All studies discussed methodological issues of using chained TTO, and some compared the results with those generated using other preference elicitation methods. Chained TTO appears to be feasible, consistent, and responsive and allows the valuation of temporary health states that would improve the efficiency and accuracy of decision making in health and health care. Nevertheless, the evidence is limited due to the low number of relevant studies in the literature. Further research is needed to examine the performance and validity of chained TTO compared with conventional TTO in the valuation of temporary health states. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Preferences for Type 2 Diabetes Health States among Adolescents With or at Risk of Type 2 Diabetes Mellitus

PubMed Central

Rhodes, Erinn T.; Prosser, Lisa A.; Lieu, Tracy A.; Songer, Thomas J.; Ludwig, David S.; Laffel, Lori M.

2015-01-01

Objective We evaluated how adolescents with or at risk of type 2 diabetes (T2DM) and their parent/guardians (parents) value health states associated with T2DM. Methods We interviewed overweight/obese (BMI≥85th percentile), 12–18 year-old adolescents with T2DM, prediabetes, or insulin resistance (IR) and a parent. The standard gamble (SG) method elicited preferences (utilities) for 7 hypothetical T2DM health states reported on a scale from 0 (dead) to 1 (perfect health). Adolescent’s current health was evaluated with the SG and Health Utilities Index (HUI). Results There were 70 adolescents and 69 parents. Adolescents were 67.1% female and 15.5±2.2 years old; 30% had T2DM, 30% prediabetes, and 40% IR. Almost half (48.6%) had a BMI>99th percentile. Parents (83% mothers) were 45.1±7.3 years old and 75% had at least some college/technical school education. Adolescents and parents rated T2DM with no complications treated with diet as most desirable (median [IQR]; adolescent 0.72 [0.54, 0.98]; parent 1.0 [0.88, 1.0]) and end stage renal disease as least desirable (adolescent 0.51 [0.31, 0.70]; parent 0.80 [0.65, 0.94]). However, adolescents’ utilities were significantly lower (p≤0.001) than parents for all health states assessed. Adolescents’ assessment of their current health with the SG and HUI were not correlated. Conclusions Adolescents with or at risk of T2DM rated treatments and sequelae of diabetes as significantly worse than their parents. These adolescent utilities should be considered in the evaluation of treatment strategies for youth with T2DM. Family-based programs for T2DM must also be prepared to address conflicting preferences in order to promote shared-decision making. PMID:21489091

A randomised controlled trial to explore attitudes to routine scale and polish and compare manual versus ultrasonic scaling in the general dental service in Scotland [ISRCTN99609795

PubMed Central

Bonner, Brian C; Young, Linda; Smith, Patricia A; McCombes, Wendy; Clarkson, Jan E

2005-01-01

Background To investigate, within general dental practice, patients' and vocational dental practitioners' (VDP) attitudes towards the benefits and costs of a simple scale and polish and to compare the experience of using manual versus ultrasonic instruments to scale teeth. Methods 28 VDPs and 420 patients participated. Patients were randomly allocated to either group. Patients' and VDPs' attitudes towards, and experience of, the scale and polish were elicited by means of self-administered questionnaires. Results The majority of patients (99%) believed a scale and polish was beneficial. VDPs considered ultrasonic treatment to be appropriate on significantly more occasions than they did for manual scale and polish (P < 0.001). Patient discomfort: with ultrasonic scaling 69.2% felt 'a little uncomfortable' or worse compared with 60% of those undergoing manual treatment (P = 0.072). VDPs considered treatment charges were appropriate for 77% of patients. Conclusion Routine scaling and polishing is considered beneficial by both patients and vocational trainees. The majority of patients, regardless of treatment method, experience some degree of discomfort when undergoing a scale and polish. VDPs showed a preference for the ultrasonic treatment method. PMID:15975140

Patient preferences and willingness-to-pay for a home or clinic based program of chronic heart failure management: findings from the Which? trial.

PubMed

Whitty, Jennifer A; Stewart, Simon; Carrington, Melinda J; Calderone, Alicia; Marwick, Thomas; Horowitz, John D; Krum, Henry; Davidson, Patricia M; Macdonald, Peter S; Reid, Christopher; Scuffham, Paul A

2013-01-01

Beyond examining their overall cost-effectiveness and mechanisms of effect, it is important to understand patient preferences for the delivery of different modes of chronic heart failure management programs (CHF-MPs). We elicited patient preferences around the characteristics and willingness-to-pay (WTP) for a clinic or home-based CHF-MP. A Discrete Choice Experiment was completed by a sub-set of patients (n = 91) enrolled in the WHICH? trial comparing home versus clinic-based CHF-MP. Participants provided 5 choices between hypothetical clinic and home-based programs varying by frequency of nurse consultations, nurse continuity, patient costs, and availability of telephone or education support. Participants (aged 71±13 yrs, 72.5% male, 25.3% NYHA class III/IV) displayed two distinct preference classes. A latent class model of the choice data indicated 56% of participants preferred clinic delivery, access to group CHF education classes, and lower cost programs (p<0.05). The remainder preferred home-based CHF-MPs, monthly rather than weekly visits, and access to a phone advice service (p<0.05). Continuity of nurse contact was consistently important. No significant association was observed between program preference and participant allocation in the parent trial. WTP was estimated from the model and a dichotomous bidding technique. For those preferring clinic, estimated WTP was ≈AU$9-20 per visit; however for those preferring home-based programs, WTP varied widely (AU$15-105). Patient preferences for CHF-MPs were dichotomised between a home-based model which is more likely to suit older patients, those who live alone, and those with a lower household income; and a clinic-based model which is more likely to suit those who are more socially active and wealthier. To optimise the delivery of CHF-MPs, health care services should consider their patients' preferences when designing CHF-MPs.

Celebrating the work of Gavin Mooney: inclusiveness and involvement in global and public health issues.

PubMed

McIntyre, Diane

2014-05-01

This paper considers Gavin Mooney's contributions to the research literature on inclusiveness in global and public health issues. Much of his contribution in this area stems from engaging with Indigenous people, which cemented his conviction that it is important to recognise the heterogeneity of groups in society, especially in relation to cultural differences. He believed that in order to develop appropriate equitable and efficient health and related policies, the preferences of citizens should be elicited. While this could feed into very specific policy decisions, such as how to allocate available resources within a particular community, more generally, community preferences should determine the core values that underpin a health system. He proposed that these values be documented in a 'constitution' and serve as the basis on which policy-makers and health managers make decisions. Preference elicitation has value in itself, as procedural justice allows for self-determination and contributes to empowerment. Further, engagement by citizens in deliberative processes can overcome polarisation. Health systems themselves, if developed as social institutions, can influence the nature of society and contribute to greater unity. Mooney raised similar concerns about policies arising from mono-cultural global perspectives and argued that, whether at the national or global level, values for health systems should be based on community preferences. He particularly highlighted the unequal distribution of benefits of neoliberal globalisation as the cause of growing health and wealth inequalities globally. There is resonance between Mooney's views on these issues and some of the contributions to the post-2015 development agenda debates. While it is unlikely that we have reached a point where the stranglehold of neo-liberal governments on key global institutions will be broken, the current debates nevertheless present an important window of opportunity to struggle for shifts in the global political economy. Current debates about universal coverage also provide a critical opportunity to move towards health systems that are built on values determined by citizens and are social institutions that build solidarity, redress inequalities and unite fractured societies. Copyright © 2014 Elsevier Ltd. All rights reserved.

Naïve Chicks Prefer Hollow Objects

PubMed Central

Schill, Jana; Nencini, Andrea Maria; Vallortigara, Giorgio

2016-01-01

Biological predispositions influence approach and avoid responses from the time of birth or hatching. Neonates of species that require parental care (e.g. human babies and chicks of the domestic fowl) are attracted by stimuli associated with animate social partners, such as face-like configurations, biological motion and self-propulsion. The property of being filled is used as a cue of animacy by 8-month-old human infants but it is not known whether this reflects the effect of previous experience. We used chicks of the domestic fowl (Gallus gallus) to investigate whether the property of being filled vs. hollow elicits spontaneous or learned preferences. To this aim we tested preferences of naïve and imprinted chicks for hollow and closed cylinders. Contrary to our expectations, we documented an unlearned attraction for hollow stimuli. The preference for hollow stimuli decreased when chicks were imprinted on filled stimuli but did not increase when chicks were imprinted on hollow stimuli, suggesting that hollowness is not crucial to determine affiliative responses for imprinting objects. When chicks were imprinted on occluded stimuli that could be either filled or hollow, the preference for hollow stimuli emerged again, showing that imprinting does not disrupt the spontaneous preference for hollow objects. Further experiments revealed that hollow objects were mainly attractive by means of depth cues such as darker innards, more than as places to hide or as objects with high contrast. Our findings point to predisposed preferences for hollow objects, and suggest that early predispositions might be driven by factors different from animacy cues. PMID:27851773

Patient Preferences for Device-Aided Treatments Indicated for Advanced Parkinson Disease.

PubMed

Marshall, Thomas; Pugh, Amy; Fairchild, Angelyn; Hass, Steven

2017-12-01

Effective treatment for advanced Parkinson disease (PD) uncontrolled with oral medication includes device-aided therapies such as deep brain stimulation (DBS) and continuous levodopa-carbidopa infusion to the duodenum via a portable pump. Our objective was to quantify patient preferences for attributes of these device-aided treatments. We administered a Web-enabled survey to 401 patients in the United States. A discrete-choice experiment (DCE) was used to evaluate patients' willingness to accept tradeoffs among efficacy, tolerability, and convenience of alternative treatments. DCE data were analyzed using random-parameters logit. Best-worst scaling (BWS) was used to elicit the relative importance of device-specific attributes. Conditional logit was used to analyze the BWS data. We tested for differences in preferences among subgroups of patients. Improving ability to think clearly was twice as important as a 6-hour-per-day improvement in control of movement symptoms. After controlling for efficacy, treatment delivered via portable infusion pump was preferred over DBS, and both devices were preferred to oral therapy with poor symptom control. Patients were most concerned about device attributes relating to risk of stroke, difficulty thinking, and neurosurgery. Avoiding surgery to insert a wire in the brain was more important than avoiding surgery to insert a tube into the small intestine. Some differences in preferences among subgroups were statistically, but not qualitatively, significant. This study clarifies the patient perspective in therapeutic choices for advanced PD. These findings may help improve communication between patients and providers and also provide evidence on patient preferences to inform regulatory and access decisions. Copyright © 2017. Published by Elsevier Inc.

Aggregating Individual Preferences in the Analytic Hierarchy Process Applied to the 1983 Battelle TAV Study.

DTIC Science & Technology

1985-03-15

elicitation - rankings, ratings, and pairwise comparisons, 2) Value Theory: includes an explanation of the AHP and fuzzy set theory, and 3) Group... AHP are better tools for these " fuzzy " applications. These results apply directly to this thesis. The original Battelle survey used direct ratings to...iridepeindent uf three arggretation toctiiIque5: geometric mean input, arithmetic me;n voctor output, and Majority rle,, output. The AHP consi:3tcncy index was

Pro-sociality and strategic reasoning in economic decisions

PubMed Central

Arruñada, Benito; Casari, Marco; Pancotto, Francesca

2015-01-01

We study the relationship between pro-social preferences and strategic reasoning. These aspects are typically studied separately but little is known about their joint distribution. In an experiment, for each participant we elicit individual concerns toward pro-sociality—inequality aversion and efficiency—as well as the number of steps of reasoning through a guessing game. We report that self-regarding and pro-social participants exhibit similar levels of strategic reasoning, which supports the view that pro-sociality and strategic reasoning can be studied independently. PMID:26074799

Eliciting Responsivity: Exploring Programming Interests of Federal Inmates as a Function of Security Classification.

PubMed

Neller, Daniel J; Vitacco, Michael J; Magaletta, Philip R; Phillips-Boyles, A Brooke

2016-03-01

Research supports the effectiveness of the Risk-Needs-Responsivity model for reducing criminal recidivism. Yet programming interests of inmates--one facet of responsivity--remain an understudied phenomenon. In the present study, we explored the programming interests of 753 federal inmates housed across three levels of security. Results suggest that inmates, as a group, prefer specific programs over others, and that some of their interests may differ by security level. We discuss possible implications of these findings. © The Author(s) 2014.

Photo-Elicitation and Visual Semiotics: A Unique Methodology for Studying Inclusion for Children with Disabilities

ERIC Educational Resources Information Center

Stockall, Nancy

2013-01-01

The methodology in this paper discusses the use of photographs as an elicitation strategy that can reveal the thinking processes of participants in a qualitatively rich manner. Photo-elicitation techniques combined with a Piercian semiotic perspective offer a unique method for creating a frame of action for later participant analysis. Illustrative…

Evaluating the Role of Attention in the Context of Unconscious Thought Theory: Differential Impact of Attentional Scope and Load on Preference and Memory

PubMed Central

Srinivasan, Narayanan; Mukherjee, Sumitava; Mishra, Maruti V.; Kesarwani, Smriti

2013-01-01

Attention is a key process used to conceptualize and define modes of thought, but we lack information about the role of specific attentional processes on preferential choice and memory in multi-attribute decision making. In this study, we examine the role of attention based on two dimensions, attentional scope and load on choice preference strength and memory using a paradigm that arguably elicits unconscious thought. Scope of attention was manipulated by using global or local processing during distraction (Experiment 1) and before the information-encoding stage (Experiment 2). Load was manipulated by using the n-back task in Experiment 1. Results from Experiment 1 show that global processing or distributed attention during distraction results in stronger preference irrespective of load but better memory only at low cognitive load. Task difficulty or load did not have any effect on preference or memory. In Experiment 2, distributed attention before attribute encoding facilitated only memory but did not influence preference. Results show that attentional processes at different stages of processing like distraction and information-encoding influence decision making processes. Scope of attention not only influences preference and memory but the manner in which attentional scope influences them depends on both load and stage of information processing. The results indicate the important role of attention in processes critical for decision making and calls for a re-evaluation of the unconscious thought theory (UTT) and the need for reconceptualizing the role of attention. PMID:23382726

Values and preferences for oral antithrombotic therapy in patients with atrial fibrillation: physician and patient perspectives.

PubMed

Alonso-Coello, Pablo; Montori, Victor M; Díaz, M Gloria; Devereaux, Philip J; Mas, Gemma; Diez, Ana I; Solà, Ivan; Roura, Mercè; Souto, Juan C; Oliver, Sven; Ruiz, Rafael; Coll-Vinent, Blanca; Gich, Ignasi; Schünemann, Holger J; Guyatt, Gordon

2015-12-01

Exploration of values and preferences in the context of anticoagulation therapy for atrial fibrillation (AF) remains limited. To better characterize the distribution of patient and physician values and preferences relevant to decisions regarding anticoagulation in patients with AF, we conducted interviews with patients at risk of developing AF and physicians who manage patients with AF. We interviewed 96 outpatients and 96 physicians in a multicenter study and elicited the maximal increased risk of bleeding (threshold risk) that respondents would tolerate with warfarin vs. aspirin to achieve a reduction in three strokes in 100 patients over a 2-year period. We used the probabilistic version of the threshold technique. The median threshold risk for both patients and physicians was 10 additional bleeds (10 P = 0.7). In both groups, we observed large variability in the threshold number of bleeds, with wider variability in patients than clinicians [patient range: 0-100, physician range: 0-50]. We observed one cluster of patients and physicians who would tolerate <10 bleeds and another cluster of patients, but not physicians, who would accept more than 35. Our findings suggest wide variability in patient and physician values and preferences regarding the trade-off between strokes and bleeds. Results suggest that in individual decision making, physician and patient values and preferences will often be discordant; this mandates tailoring treatment to the individual patient's preferences. © 2014 John Wiley & Sons Ltd.

Evaluating the role of attention in the context of unconscious thought theory: differential impact of attentional scope and load on preference and memory.

PubMed

Srinivasan, Narayanan; Mukherjee, Sumitava; Mishra, Maruti V; Kesarwani, Smriti

2013-01-01

Attention is a key process used to conceptualize and define modes of thought, but we lack information about the role of specific attentional processes on preferential choice and memory in multi-attribute decision making. In this study, we examine the role of attention based on two dimensions, attentional scope and load on choice preference strength and memory using a paradigm that arguably elicits unconscious thought. Scope of attention was manipulated by using global or local processing during distraction (Experiment 1) and before the information-encoding stage (Experiment 2). Load was manipulated by using the n-back task in Experiment 1. Results from Experiment 1 show that global processing or distributed attention during distraction results in stronger preference irrespective of load but better memory only at low cognitive load. Task difficulty or load did not have any effect on preference or memory. In Experiment 2, distributed attention before attribute encoding facilitated only memory but did not influence preference. Results show that attentional processes at different stages of processing like distraction and information-encoding influence decision making processes. Scope of attention not only influences preference and memory but the manner in which attentional scope influences them depends on both load and stage of information processing. The results indicate the important role of attention in processes critical for decision making and calls for a re-evaluation of the unconscious thought theory (UTT) and the need for reconceptualizing the role of attention.

Electrodermal reactivity to emotional stimuli in healthy subjects and patients with disorders of consciousness.

PubMed

Luauté, Jacques; Dubois, Anne; Heine, Lizette; Guironnet, Chloé; Juliat, Ariane; Gaveau, Valérie; Tillmann, Barbara; Perrin, Fabien

2018-05-18

After a coma, one major challenge is the detection of awareness in patients with disorders of consciousness. In some patients, the only manifestation indicative of awareness is an appropriate emotional response. Preferred music is a powerful medium to elicit emotions and autobiographical memory. Furthermore, music has been shown to improve cognitive functions both in healthy subjects and patients with neurological impairment. We hypothesized that signs of awareness could be enhanced in some patients with disorders of consciousness under appropriate emotional stimulation such as preferred music and also probably preferred odors. To investigate an objective, easily recordable marker of emotions at the patients' bedside, electrodermal activity (skin conductance level, SCL) was assessed with stimulations in auditory and olfactory modalities, notably with preferred music, neutral sound, preferred odors, and neutral odors. The study was conducted in 11 patients with disorders of consciousness (DOC) and 7 healthy participants. In healthy subjects, the mean amplitude of the SCL was increased during exposure to preferred music as compared to neutral sounds (respectively: 0.00037±0.0004 vs. - 0.00004±0.00019μS). No significant difference between conditions was detected in patients. The results of this study suggest that electrodermal activity could be a useful marker of emotions induced by music in healthy controls. However, it failed to show any significant difference between conditions in patients with DOC. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

How different terminology for ductal carcinoma in situ (DCIS) impacts women's concern and management preferences: A qualitative study.

PubMed

Nickel, Brooke; Barratt, Alexandra; Hersch, Jolyn; Moynihan, Ray; Irwig, Les; McCaffery, Kirsten

2015-10-01

There are increasing rates of mastectomy and bi-lateral mastectomy in women diagnosed with ductal carcinoma in situ (DCIS). To help women avoid decisions that lead to unnecessary aggressive treatments, there have been recent calls to remove the cancer terminology from descriptions of DCIS. We investigated how different proposed terminologies for DCIS affect women's perceived concern and management preferences. Qualitative study using semi-structured interviews with a community sample of 26 Australian women varying by education and cancer screening experience. Women responded to a hypothetical scenario using terminology with and without the cancer term to describe DCIS. Among a sample of women with no experience of a DCIS diagnosis, a hypothetical scenario involving a diagnosis of DCIS elicited high concern regardless of the terminology used to describe it. Women generally exhibited stronger negative reactions when a cancer term was used to describe DCIS compared to a non-cancer term, and most preferred the diagnosis be given as a description of abnormal cells. Overall women expressed interest in watchful waiting for DCIS but displayed preferences for very frequent monitoring with this management approach. Communicating a diagnosis of DCIS using terminology that does not include the cancer term was preferred by many women and may enable discussions about more conservative management options. However, women's preference for frequent monitoring during watchful waiting suggests women need more education and reassurance about this management approach. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Personalized Approach of Patient-Health Care Provider Communication Regarding Colorectal Cancer Screening Options.

PubMed

Sava, M Gabriela; Dolan, James G; May, Jerrold H; Vargas, Luis G

2018-07-01

Current colorectal cancer screening guidelines by the US Preventive Services Task Force endorse multiple options for average-risk patients and recommend that screening choices should be guided by individual patient preferences. Implementing these recommendations in practice is challenging because they depend on accurate and efficient elicitation and assessment of preferences from patients who are facing a novel task. To present a methodology for analyzing the sensitivity and stability of a patient's preferences regarding colorectal cancer screening options and to provide a starting point for a personalized discussion between the patient and the health care provider about the selection of the appropriate screening option. This research is a secondary analysis of patient preference data collected as part of a previous study. We propose new measures of preference sensitivity and stability that can be used to determine if additional information provided would result in a change to the initially most preferred colorectal cancer screening option. Illustrative results of applying the methodology to the preferences of 2 patients, of different ages, are provided. The results show that different combinations of screening options are viable for each patient and that the health care provider should emphasize different information during the medical decision-making process. Sensitivity and stability analysis can supply health care providers with key topics to focus on when communicating with a patient and the degree of emphasis to place on each of them to accomplish specific goals. The insights provided by the analysis can be used by health care providers to approach communication with patients in a more personalized way, by taking into consideration patients' preferences before adding their own expertise to the discussion.

Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach.

PubMed

Zhang, Yuan; Coello, Pablo Alonso; Brożek, Jan; Wiercioch, Wojtek; Etxeandia-Ikobaltzeta, Itziar; Akl, Elie A; Meerpohl, Joerg J; Alhazzani, Waleed; Carrasco-Labra, Alonso; Morgan, Rebecca L; Mustafa, Reem A; Riva, John J; Moore, Ainsley; Yepes-Nuñez, Juan José; Cuello-Garcia, Carlos; AlRayees, Zulfa; Manja, Veena; Falavigna, Maicon; Neumann, Ignacio; Brignardello-Petersen, Romina; Santesso, Nancy; Rochwerg, Bram; Darzi, Andrea; Rojas, Maria Ximena; Adi, Yaser; Bollig, Claudia; Waziry, Reem; Schünemann, Holger J

2017-05-02

There are diverse opinions and confusion about defining and including patient values and preferences (i.e. the importance people place on the health outcomes) in the guideline development processes. This article aims to provide an overview of a process for systematically incorporating values and preferences in guideline development. In 2013 and 2014, we followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to adopt, adapt and develop 226 recommendations in 22 guidelines for the Ministry of Health of the Kingdom of Saudi Arabia. To collect context-specific values and preferences for each recommendation, we performed systematic reviews, asked clinical experts to provide feedback according to their clinical experience, and consulted patient representatives. We found several types of studies addressing the importance of outcomes, including those reporting utilities, non-utility measures of health states based on structured questionnaires or scales, and qualitative studies. Guideline panels used the relative importance of outcomes based on values and preferences to weigh the balance of desirable and undesirable consequences of alternative intervention options. However, we found few studies addressing local values and preferences. Currently there are different but no firmly established processes for integrating patient values and preferences in healthcare decision-making of practice guideline development. With GRADE Evidence-to-Decision (EtD) frameworks, we provide an empirical strategy to find and incorporate values and preferences in guidelines by performing systematic reviews and eliciting information from guideline panel members and patient representatives. However, more research and practical guidance are needed on how to search for relevant studies and grey literature, assess the certainty of this evidence, and best summarize and present the findings.

Expert Elicitation Methods in Quantifying the Consequences of Acoustic Disturbance from Offshore Renewable Energy Developments.

PubMed

Donovan, Carl; Harwood, John; King, Stephanie; Booth, Cormac; Caneco, Bruno; Walker, Cameron

2016-01-01

There are many developments for offshore renewable energy around the United Kingdom whose installation typically produces large amounts of far-reaching noise, potentially disturbing many marine mammals. The potential to affect the favorable conservation status of many species means extensive environmental impact assessment requirements for the licensing of such installation activities. Quantification of such complex risk problems is difficult and much of the key information is not readily available. Expert elicitation methods can be employed in such pressing cases. We describe the methodology used in an expert elicitation study conducted in the United Kingdom for combining expert opinions based on statistical distributions and copula-like methods.

Consumer preferences for the predictive genetic test for Alzheimer disease.

PubMed

Huang, Ming-Yi; Huston, Sally A; Perri, Matthew

2014-04-01

The purpose of this study was to assess consumer preferences for predictive genetic testing for Alzheimer disease in the United States. A rating conjoint analysis was conducted using an anonymous online survey distributed by Qualtrics to a general population panel in April 2011 in the United States. The study design included three attributes: Accuracy (40%, 80%, and 100%), Treatment Availability (Cure is available/Drug for symptom relief but no cure), and Anonymity (Anonymous/Not anonymous). A total of 12 scenarios were used to elicit people's preference, assessed by an 11-point scale. The respondents also indicated their highest willingness-to-pay (WTP) for each scenario through open-ended questions. A total of 295 responses were collected over 4 days. The most important attribute for the aggregate model was Accuracy, contributing 64.73% to the preference rating. Treatment Availability and Anonymity contributed 20.72% and 14.59%, respectively, to the preference rating. The median WTP for the highest-rating scenario (Accuracy 100%, a cure is available, test result is anonymous) was $100 (mean = $276). The median WTP for the lowest-rating scenario (40% accuracy, no cure but drugs for symptom relief, not anonymous) was zero (mean = $34). The results of this study highlight attributes people find important when making the hypothetical decision to obtain an AD genetic test. These results should be of interests to policy makers, genetic test developers and health care providers.

Egyptian mothers' preferences regarding how physicians break bad news about their child's disability: a structured verbal questionnaire.

PubMed

Abdelmoktader, Ahmed Mahmoud; Abd Elhamed, Khalil A

2012-07-02

Breaking bad news to mothers whose children has disability is an important role of physicians. There has been considerable speculation about the inevitability of parental dissatisfaction with how they are informed of their child's disability. Egyptian mothers' preferences for how to be told the bad news about their child's disability has not been investigated adequately. The objective of this study was to elicit Egyptian mothers' preferences for how to be told the bad news about their child's disability. Mothers of 100 infants recently diagnosed with Down syndrome were interviewed regarding their preferences for how to be told bad news. Mothers were recruited through outpatient clinics of the Pediatric Genetics Department at Fayoum University Hospital (located 90 km southwest of Cairo, Egypt) from January to June 2011. Questionnaire analyses revealed nine themes of parental preferences for how to be told information difficult to hear. Mothers affirmed previously reported recommendations for conveying bad medical news to parents, including being told early, being told of others with a similar condition, and being informed of the prognosis. Mothers affirmed communication themes previously discussed in the literature, such as being told early, and being informed of the prognosis. Although more research is needed in this important area, we hope that our findings will stimulate future search and help health care providers in different societies establish guidelines for effectively communicating bad news.

Understanding Preferences for Osteoporosis Information to Develop an Osteoporosis Patient Education Brochure

PubMed Central

Edmonds, Stephanie W; Solimeo, Samantha L; Nguyen, Vu-Thuy; Wright, Nicole C; Roblin, Douglas W; Saag, Kenneth G; Cram, Peter

2017-01-01

Context Patient education materials can provide important information related to osteoporosis prevention and treatment. However, available osteoporosis education materials fail to follow best-practice guidelines for patient education. Objective To develop an educational brochure on bone health for adults aged 50 years and older using mixed-method, semistructured interviews. Design This project consisted of 3 phases. In Phase 1, we developed written content that included information about osteoporosis. Additionally, we designed 2 graphic-rich brochures, Brochure A (photographs) and Brochure B (illustrations). In Phase 2, interviewers presented the text-only document and both brochure designs to 53 participants from an academic Medical Center in the Midwest and an outpatient clinic in the Southeastern region of the US. Interviewers used open- and closed-ended questions to elicit opinions regarding the brochures. In Phase 3, using feedback from Phase 2, we revised the brochure and presented it to 11 participants at a third site in the Southeastern US. Main Outcome Measures Participants’ comprehension of brochure text and acceptability of brochure design. Results We enrolled 64 participants. Most were women, white, and college-educated, with an average age of 66.1 years. Participants were able to restate the basic content of the brochure and preferred Brochure A’s use of photographs. Conclusions Using feedback from older adults, we developed and refined a brochure for communicating bone health information to older adults at risk of osteoporosis and fragility fractures. The methods outlined in this article may serve to guide others in developing health educational brochures for chronic medical conditions. PMID:28080957

Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit.

PubMed

Brown, Samuel M; Aboumatar, Hanan J; Francis, Leslie; Halamka, John; Rozenblum, Ronen; Rubin, Eileen; Sarnoff Lee, Barbara; Sugarman, Jeremy; Turner, Kathleen; Vorwaller, Micah; Frosch, Dominick L

2016-09-01

Patients in intensive care units (ICUs) may lack decisional capacity and may depend on proxy decision makers (PDMs) to make medical decisions on their behalf. High-quality information-sharing with PDMs, including through such means as health information technology, could improve communication and decision making and could potentially minimize the psychological consequences of an ICU stay for both patients and their family members. However, alongside these anticipated benefits of information-sharing are risks of unwanted disclosure of sensitive information. Approaches to identifying the optimal balance between access to digital health information to facilitate engagement and protecting patient privacy are urgently needed. We identified eight themes that should be considered in balancing health information access and patient privacy: 1) potential benefits to patients from PDM data access; 2) potential harms to patients from such access; 3) the moral status of families within the patient-clinician relationship; 4) the scope of relevant information provided to PDMs; 5) issues around defining PDMs' authority; 6) methods for eliciting and documenting patient preferences about their family's information access; 7) the relevance of methods for ascertaining the identity of PDMs; and 8) the obligations of hospitals to prevent privacy breaches by PDMs. We conclude that PDMs should typically have access to health information from the current episode of care when the patient is decisionally impaired, unless the patient has previously expressed a clear preference that PDMs not have such access. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The impact of a belief in life after death on health-state preferences: True difference or artifact?

PubMed

Jakubczyk, Michał; Golicki, Dominik; Niewada, Maciej

2016-12-01

In most religions, the preservation of one's own, God-given, life is considered obligatory, while the time trade-off method (TTO) forces one to voluntarily forego life years. We sought to verify how this conflict impacts TTO-results among the religious. We used the data from the only EQ-5D valuation in Poland (2008, three-level, 321 respondents, 23 states each)-a very religious, mostly Catholic country. We measured the religiosity with the belief in afterlife question on two levels: strong (definitely yes) and some (also rather yes), both about a third of the sample. The religious more often are non-traders, unwilling to give up any time in exchange for quality of life: odds ratio (OR) equal to 1.97 (strong religiosity), OR 1.55 (some religiosity); and less often consider a state worse than death: OR 0.67 (strong), OR 0.81 (some). These associations are statistically significant ([Formula: see text]) and hold when controlling for possible demographic confounders. Strong religiosity abates the utility loss: in the additive approach by 0.14, in the multiplicative approach by the factor of 2.1 (both [Formula: see text]), especially among the older. Removing the effect of religiosity from the value set reduces the utility by 0.05 on average. The results may stem from a true difference in preferences or be a TTO-artifact and would vanish for other elicitation methods. Juxtaposing our findings with comments from respondents in other studies suggests the latter. Therefore, this Weltanschauung effect should be removed in cost-utility analysis.

Identification and Prioritization of Important Attributes of Disease-Modifying Drugs in Decision Making among Patients with Multiple Sclerosis: A Nominal Group Technique and Best-Worst Scaling

PubMed Central

Kremer, Ingrid E. H.; van der Weijden, Trudy; van de Kolk, Ilona

2016-01-01

Objectives Understanding the preferences of patients with multiple sclerosis (MS) for disease-modifying drugs and involving these patients in clinical decision making can improve the concordance between medical decisions and patient values and may, subsequently, improve adherence to disease-modifying drugs. This study aims first to identify which characteristics–or attributes–of disease-modifying drugs influence patients´ decisions about these treatments and second to quantify the attributes’ relative importance among patients. Methods First, three focus groups of relapsing-remitting MS patients were formed to compile a preliminary list of attributes using a nominal group technique. Based on this qualitative research, a survey with several choice tasks (best-worst scaling) was developed to prioritize attributes, asking a larger patient group to choose the most and least important attributes. The attributes’ mean relative importance scores (RIS) were calculated. Results Nineteen patients reported 34 attributes during the focus groups and 185 patients evaluated the importance of the attributes in the survey. The effect on disease progression received the highest RIS (RIS = 9.64, 95% confidence interval: [9.48–9.81]), followed by quality of life (RIS = 9.21 [9.00–9.42]), relapse rate (RIS = 7.76 [7.39–8.13]), severity of side effects (RIS = 7.63 [7.33–7.94]) and relapse severity (RIS = 7.39 [7.06–7.73]). Subgroup analyses showed heterogeneity in preference of patients. For example, side effect-related attributes were statistically more important for patients who had no experience in using disease-modifying drugs compared to experienced patients (p < .001). Conclusions This study shows that, on average, patients valued effectiveness and unwanted effects as most important. Clinicians should be aware of the average preferences but also that attributes of disease-modifying drugs are valued differently by different patients. Person-centred clinical decision making would be needed and requires eliciting individual preferences. PMID:27812117

Willingness to pay and conjoint analysis to determine women's preferences for ovarian stimulating hormones in the treatment of infertility in Spain.

PubMed

Palumbo, A; De La Fuente, P; Rodríguez, M; Sánchez, F; Martínez-Salazar, J; Muñoz, M; Marqueta, J; Hernández, J; Espallardo, O; Polanco, C; Paz, S; Lizán, L

2011-07-01

Despite many advances in assisted reproductive techniques (ART), little is known about preferences for technological developments of women undergoing fertility treatments. The aims of this study were to investigate the preferences of infertile women undergoing ART for controlled ovarian stimulation (COS) treatments; to determine the utility values ascribed to different attributes of COS treatments; and to estimate women's willingness to pay (WTP) for COS. A representative sample of ambulatory patients ready to receive, or receiving, COS therapies for infertility were recruited from seven specialized private centres in six autonomous communities in Spain. Descriptive, inferential and conjoint analyses (CA) were used to elicit preferences and WTP. Attributes and levels of COS treatments were identified by literature review and two focus groups with experts and patients. WTP valuations were derived by a combination of double-bounded (closed-ended) and open questions and contingent ranking methods. In total, 160 patients [mean (standard deviation; SD) age: 35.8 (4.2) years] were interviewed. Over half of the participants (55.0%) had a high level of education (university degree), most (78.8%) were married and half (50.0%) had an estimated net income of >€1502 per month and had paid a mean (SD) €1194.17 (€778.29) for their most recent hormonal treatment. The most frequent causes of infertility were related to sperm abnormalities (50.3%). In 30.6% of cases, there were two causes of infertility. The maximum WTP for COS treatment was €800 (median) per cycle; 35.5% were willing to pay an additional €101-€300 for a 1-2% effectiveness gain in the treatment. Utility values (CA) showed that effectiveness was the most valued attribute (39.82), followed by costs (18.74), safety (17.75) and information sharing with physicians (14.93). WTP for COS therapies exceeds current cost. Additional WTP exists for 1-2% effectiveness improvement. Effectiveness and costs were the most important determinants of preferences, followed by safety and information sharing with physicians.

Prioritising health service innovation investments using public preferences: a discrete choice experiment.

PubMed

Erdem, Seda; Thompson, Carl

2014-08-28

Prioritising scarce resources for investment in innovation by publically funded health systems is unavoidable. Many healthcare systems wish to foster transparency and accountability in the decisions they make by incorporating the public in decision-making processes. This paper presents a unique conceptual approach exploring the public's preferences for health service innovations by viewing healthcare innovations as 'bundles' of characteristics. This decompositional approach allows policy-makers to compare numerous competing health service innovations without repeatedly administering surveys for specific innovation choices. A Discrete Choice Experiment (DCE) was used to elicit preferences. Individuals chose from presented innovation options that they believe the UK National Health Service (NHS) should invest the most in. Innovations differed according to: (i) target population; (ii) target age; (iii) implementation time; (iv) uncertainty associated with their likely effects; (v) potential health benefits; and, (vi) cost to a taxpayer. This approach fosters multidimensional decision-making, rather than imposing a single decision criterion (e.g., cost, target age) in prioritisation. Choice data was then analysed using scale-adjusted Latent Class models to investigate variability in preferences and scale and valuations amongst respondents. Three latent classes with considerable heterogeneity in the preferences were present. Each latent class is composed of two consumer subgroups varying in the level of certainty in their choices. All groups preferred scientifically proven innovations, those with potential health benefits that cost less. There were, however, some important differences in their preferences for innovation investment choices: Class-1 (54%) prefers innovations benefitting adults and young people and does not prefer innovations targeting people with 'drug addiction' and 'obesity'. Class- 2 (34%) prefers innovations targeting 'cancer' patients only and has negative preferences for innovations targeting elderly, and Class-3 (12%) prefers spending on elderly and cancer patients the most. DCE can help policy-makers incorporate public preferences for health service innovation investment choices into decision making. The findings provide useful information on the public's valuation and acceptability of potential health service innovations. Such information can be used to guide innovation prioritisation decisions by comparing competing innovation options. The approach in this paper makes, these often implicit and opaque decisions, more transparent and explicit.

Blended near-optimal tools for flexible water resources decision making

NASA Astrophysics Data System (ADS)

Rosenberg, David

2015-04-01

State-of-the-art systems analysis techniques focus on efficiently finding optimal solutions. Yet an optimal solution is optimal only for the static modelled issues and managers often seek near-optimal alternatives that address un-modelled or changing objectives, preferences, limits, uncertainties, and other issues. Early on, Modelling to Generate Alternatives (MGA) formalized near-optimal as performance within a tolerable deviation from the optimal objective function value and identified a few maximally-different alternatives that addressed select un-modelled issues. This paper presents new stratified, Monte Carlo Markov Chain sampling and parallel coordinate plotting tools that generate and communicate the structure and full extent of the near-optimal region to an optimization problem. Plot controls allow users to interactively explore region features of most interest. Controls also streamline the process to elicit un-modelled issues and update the model formulation in response to elicited issues. Use for a single-objective water quality management problem at Echo Reservoir, Utah identifies numerous and flexible practices to reduce the phosphorus load to the reservoir and maintain close-to-optimal performance. Compared to MGA, the new blended tools generate more numerous alternatives faster, more fully show the near-optimal region, help elicit a larger set of un-modelled issues, and offer managers greater flexibility to cope in a changing world.

Unconscious Affective Responses to Food

PubMed Central

Sato, Wataru; Sawada, Reiko; Kubota, Yasutaka; Toichi, Motomi; Fushiki, Tohru

2016-01-01

Affective or hedonic responses to food are crucial for humans, both advantageously (e.g., enhancing survival) and disadvantageously (e.g., promoting overeating and lifestyle-related disease). Although previous psychological studies have reported evidence of unconscious cognitive and behavioral processing related to food, it remains unknown whether affective reactions to food can be triggered unconsciously and its relationship with daily eating behaviors. We investigated these issues by using the subliminal affective priming paradigm. Photographs of food or corresponding mosaic images were presented in the peripheral visual field for 33 ms. Target photos of faces with emotionally neutral expressions were then presented, and participants rated their preferences for the faces. Eating behaviors were also assessed using questionnaires. The food images, relative to the mosaics, increased participants’ preference for subsequent target faces. Furthermore, the difference in the preference induced by food versus mosaic images was positively correlated with the tendency to engage in external eating. These results suggest that unconscious affective reactions are elicited by the sight of food and that these responses contribute to daily eating behaviors related to overeating. PMID:27501443

Student use and perceptions of mobile technology in clinical clerkships - Guidance for curriculum design.

PubMed

Law, Joanna K; Thome, Parker A; Lindeman, Brenessa; Jackson, Daren C; Lidor, Anne O

2018-01-01

We examined the types of technology used by medical students in clinical clerkships, and the perception of technology implementation into the curriculum. An online survey about technology use was completed prior to general surgery clinical clerkship. Types of devices and frequency/comfort of use were recorded. Perceptions of the benefits and barriers to technology use in clerkship learning were elicited. 125/131 (95.4%) students responded. Most students owned a smart phone (95.2%), tablet (52.8%), or both (50%); 61.6% spent > 11 h/week learning on a device at the Johns Hopkins School of Medicine for educational purposes. Technology use was seen as beneficial by 97.6% of students. Classes that used technology extensively were preferred by 54% of students, although 47.2% perceived decreased faculty/classmate interaction. Students use mobile technology to improve how they learn new material, and prefer taking classes that incorporate information technology. However, in-person/blended curricula are preferable to completely online courses. Copyright © 2017 Elsevier Inc. All rights reserved.

Attitudes toward Infection Prophylaxis in Pediatric Oncology: A Qualitative Approach

PubMed Central

Diorio, Caroline; Tomlinson, Deborah; Boydell, Katherine M.; Regier, Dean A.; Ethier, Marie-Chantal; Alli, Amanda; Alexander, Sarah; Gassas, Adam; Taylor, Jonathan; Kellow, Charis; Mills, Denise; Sung, Lillian

2012-01-01

Background The risks and benefits of infection prophylaxis are uncertain in children with cancer and thus, preferences should be considered in decision making. The purpose of this report was to describe the attitudes of parents, children and healthcare professionals to infection prophylaxis in pediatric oncology. Methods The study was completed in three phases: 1) An initial qualitative pilot to identify the main attributes influencing the decision to use infection prophylaxis, which were then incorporated into a discrete choice experiment; 2) A think aloud during the discrete choice experiment in which preferences for infection prophylaxis were elicited quantitatively; and 3) In-depth follow up interviews. Interviews were recorded verbatim and analyzed using an iterative, thematic analysis. Final themes were selected using a consensus approach. Results A total of 35 parents, 22 children and 28 healthcare professionals participated. All three groups suggested that the most important factor influencing their decision making was the effect of prophylaxis on reducing the chance of death. Themes of importance to the three groups included antimicrobial resistance, side effects of medications, the financial impact of outpatient prophylaxis and the route and schedule of administration. Conclusion Effect of prophylaxis on risk of death was a key factor in decision making. Other identified factors were antimicrobial resistance, side effects of medication, financial impact and administration details. Better understanding of factors driving decision making for infection prophylaxis will help facilitate future implementation of prophylactic regiments. PMID:23112849

Consumers’ Perceptions of Preconception Health

PubMed Central

Squiers, Linda; Mitchell, Elizabeth W.; Levis, Denise M.; Lynch, Molly; Dolina, Suzanne; Margolis, Marjorie; Scales, Monica; Kish-Doto, Julia

2015-01-01

Purpose To inform the development of a preconception health (PCH) social marketing plan, we conducted qualitative research with prospective consumers. Approach We present formative findings based on the four Ps of social marketing: product, price, promotion, and place. Setting We conducted focus groups with 10 groups of women in Atlanta, Georgia, in fall 2010. Participants We classified women aged 18 to 44 into five groups based on their pregnancy plans, and then further segmented the groups based on socioeconomic status for a total of 10 groups. Method The focus group guide was designed to elicit participants’ responses about the product, price, promotion, and placement of PCH. We used NVivo 9 software to analyze focus group data. Results Women planning a pregnancy in the future had different perspectives on PCH as a product than women not planning a pregnancy. Barriers to PCH included lack of social support, addiction, and lack of awareness about PCH. Participants preferred to think of PCH behaviors as “promoting” a healthy baby rather than preventing an unhealthy birth outcome. Many women in the focus groups preferred to hear PCH messages from a health care provider, among other channels. Conclusion The results from this research will inform the development of a social marketing plan for PCH and the development of concepts that will be tested with consumers to determine their viability for use in a national campaign. PMID:23286658

Effective follow-up consultations: the importance of patient-centered communication and shared decision making.

PubMed

Brand, Paul L P; Stiggelbout, Anne M

2013-12-01

Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Discrimination between cocaine-associated context and cue in a modified conditioned place preference paradigm: role of the nNOS gene in cue conditioning.

PubMed

Itzhak, Yossef; Roger-Sánchez, Concepción; Kelley, Jonathan B; Anderson, Karen L

2010-03-01

The conditioned place preference (CPP) paradigm entails appetitive learning and is utilized to investigate the motivational effects of drug and natural reward in rodents. However, a typical CPP design does not allow dissociation between cue- and context-dependent appetitive learning. In humans, context and cues that had been associated with drug reward can elicit conditioned response and drug craving. Therefore, we investigated (a) methods by which to discriminate between cue- and context-dependent appetitive learning, and (b) the role of the neuronal nitric oxide synthase (nNOS) gene in appetitive learning. Wild-type (WT) and nNOS knockout (KO) mice were trained by cocaine (20 mg/kg) in a discrete context paired with a light cue (a compound context-cue stimulus). In test 1, approach behaviour to either the training context or to the cue in a novel context was determined. WT mice showed robust preference for both cocaine-associated context and cue. nNOS KO mice acquired approach behaviour for the cocaine-associated context but not cue. This finding suggests that the nNOS gene is required for cue-dependent appetitive learning. On the following day (test 2), mice were tested for approach behaviour to the compound context-cue stimulus. Context but not cue exposure in test 1 reduced approach behaviour to the compound context-cue stimulus in test 2, suggesting that repeated context but not cue exposures diminished the conditioned response. Hence, this modified CPP paradigm is useful for the investigation of approach behaviour for both drug-associated context and cue, and allows further investigation of mechanisms underlying cue- and context-dependent appetitive learning.

Four Common Simplifications of Multi-Criteria Decision Analysis do not hold for River Rehabilitation

PubMed Central

2016-01-01

River rehabilitation aims at alleviating negative effects of human impacts such as loss of biodiversity and reduction of ecosystem services. Such interventions entail difficult trade-offs between different ecological and often socio-economic objectives. Multi-Criteria Decision Analysis (MCDA) is a very suitable approach that helps assessing the current ecological state and prioritizing river rehabilitation measures in a standardized way, based on stakeholder or expert preferences. Applications of MCDA in river rehabilitation projects are often simplified, i.e. using a limited number of objectives and indicators, assuming linear value functions, aggregating individual indicator assessments additively, and/or assuming risk neutrality of experts. Here, we demonstrate an implementation of MCDA expert preference assessments to river rehabilitation and provide ample material for other applications. To test whether the above simplifications reflect common expert opinion, we carried out very detailed interviews with five river ecologists and a hydraulic engineer. We defined essential objectives and measurable quality indicators (attributes), elicited the experts´ preferences for objectives on a standardized scale (value functions) and their risk attitude, and identified suitable aggregation methods. The experts recommended an extensive objectives hierarchy including between 54 and 93 essential objectives and between 37 to 61 essential attributes. For 81% of these, they defined non-linear value functions and in 76% recommended multiplicative aggregation. The experts were risk averse or risk prone (but never risk neutral), depending on the current ecological state of the river, and the experts´ personal importance of objectives. We conclude that the four commonly applied simplifications clearly do not reflect the opinion of river rehabilitation experts. The optimal level of model complexity, however, remains highly case-study specific depending on data and resource availability, the context, and the complexity of the decision problem. PMID:26954353

Parental Preference Assessment for Vesicoureteral Reflux Management in Children.

PubMed

Tran, Geraldine N; Bodapati, Anand V; Routh, Jonathan C; Saigal, Christopher S; Copp, Hillary L

2017-03-01

Parents of children with vesicoureteral reflux are presented with a variety of management options, which in many cases offer a similar risk-benefit ratio. To facilitate shared decision making, parental preferences regarding vesicoureteral reflux treatment options need to be acknowledged. We aimed to characterize the clinical experience of parents and elicit core themes affecting decision making in regard to managing vesicoureteral reflux in their child. A semistructured, qualitative interview script was developed and vetted by 25 pediatric urologists to discuss treatment options for vesicoureteral reflux. Additional patient interviews were conducted until new themes failed to arise. Content analysis was performed to extract all statements that described treatment options. Similar statements were combined until a final list of unique themes emerged. A total of 26 interviews were performed, yielding 689 statements about overall parent experiences with managing vesicoureteral reflux in the child and 450 statements (65%) pertaining to treatment options. Of the 13 themes that emerged, those most commonly considered were the prevention of future urinary tract infections by 85% of parents, the efficacy rate of treatment options by 85%, the burden of daily maintenance or compliance by 77%, antibiotic resistance by 69%, chronic kidney damage by 62% and invasiveness by 58%. Our study emphasizes that when choosing a treatment option for vesicoureteral reflux in their child, parent preferences regarding risks and benefits are variable. However, their chief concerns include whether a method decreases the risk of urinary tract infections, has an acceptable efficacy rate and aligns itself with the capabilities of the family. These themes help frame discussions between families and clinicians regarding vesicoureteral reflux management, and they can facilitate shared decision making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Qualitative and quantitative analysis of women's perceptions of transvaginal surgery.

PubMed

Bingener, Juliane; Sloan, Jeff A; Ghosh, Karthik; McConico, Andrea; Mariani, Andrea

2012-04-01

Prior surveys evaluating women's perceptions of transvaginal surgery both support and refute the acceptability of transvaginal access. Most surveys employed mainly quantitative analysis, limiting the insight into the women's perspective. In this mixed-methods study, we include qualitative and quantitative methodology to assess women's perceptions of transvaginal procedures. Women seen at the outpatient clinics of a tertiary-care center were asked to complete a survey. Demographics and preferences for appendectomy, cholecystectomy, and tubal ligation were elicited, along with open-ended questions about concerns or benefits of transvaginal access. Multivariate logistic regression models were constructed to examine the impact of age, education, parity, and prior transvaginal procedures on preferences. For the qualitative evaluation, content analysis by independent investigators identified themes, issues, and concerns raised in the comments. The completed survey tool was returned by 409 women (grouped mean age 53 years, mean number of 2 children, 82% ≥ some college education, and 56% with previous transvaginal procedure). The transvaginal approach was acceptable for tubal ligation to 59%, for appendectomy to 43%, and for cholecystectomy to 41% of the women. The most frequently mentioned factors that would make women prefer a vaginal approach were decreased invasiveness (14.4%), recovery time (13.9%), scarring (13.7%), pain (6%), and surgical entry location relative to organ removed (4.4%). The most frequently mentioned concerns about the vaginal approach were the possibility of complications/safety (14.7%), pain (9%), infection (5.6%), and recovery time (4.9%). A number of women voiced technical concerns about the vaginal approach. As in prior studies, scarring and pain were important issues to be considered, but recovery time and increased invasiveness were also in the "top five" list. The surveyed women appeared to actively participate in evaluating the technical components of the procedures.

Using willingness-to-pay to establish patient preferences for cancer testing in primary care.

PubMed

Hollinghurst, Sandra; Banks, Jonathan; Bigwood, Lin; Walter, Fiona M; Hamilton, Willie; Peters, Tim J

2016-08-09

Shared decision making is a stated aim of several healthcare systems. In the area of cancer, patients' views have informed policy on screening and treatment but there is little information about their views on diagnostic testing in relation to symptom severity. We used the technique of willingness-to-pay to determine public preferences around diagnostic testing for colorectal, lung, and pancreatic cancer in primary care in the UK. Participants were approached in general practice waiting rooms and asked to complete a two-stage electronic survey that described symptoms of cancer, the likelihood that the symptoms indicate cancer, and information about the appropriate diagnostic test. Part 1 asked for a binary response (yes/no) as to whether they would choose to have a test if it were offered. Part 2 elicited willingness-to-pay values of the tests using a payment scale followed by a bidding exercise, with the aim that these values would provide a strength of preference not detectable using the binary approach. A large majority of participants chose to be tested for all cancers, with only colonoscopy (colorectal cancer) demonstrating a risk gradient. In the willingness-to-pay exercise participants placed a lower value on an X-ray (lung cancer) than the tests for colorectal or pancreatic cancer and X-ray was the only test where risk was clearly related to the willingness-to-pay value. Willingness-to-pay values did not enhance the binary responses in the way intended; participants appeared to be motivated differently when responding to the two parts of the questionnaire. More work is needed to understand how participants perceive risk in this context and how they respond to questions about willingness-to-pay. Qualitative methods could provide useful insights.

Decision Aid to Technologically Enhance Shared decision making (DATES): study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Clinicians face challenges in promoting colorectal cancer screening due to multiple competing demands. A decision aid that clarifies patient preferences and improves decision quality can aid shared decision making and be effective at increasing colorectal cancer screening rates. However, exactly how such an intervention improves shared decision making is unclear. This study, funded by the National Cancer Institute, seeks to provide detailed understanding of how an interactive decision aid that elicits patient’s risks and preferences impacts patient-clinician communication and shared decision making, and ultimately colorectal cancer screening adherence. Methods/Design This is a two-armed single-blinded randomized controlled trial with the target of 300 patients per arm. The setting is eleven community and three academic primary care practices in Metro Detroit. Patients are men and women aged between 50 and 75 years who are not up to date on colorectal cancer screening. ColoDATES Web (intervention arm), a decision aid that incorporates interactive personal risk assessment and preference clarification tools, is compared to a non-interactive website that matches ColoDATES Web in content but does not contain interactive tools (control arm). Primary outcomes are patient uptake of colorectal cancer screening; patient decision quality (knowledge, preference clarification, intent); clinician’s degree of shared decision making; and patient-clinician concordance in the screening test chosen. Secondary outcome incorporates a Structural Equation Modeling approach to understand the mechanism of the causal pathway and test the validity of the proposed conceptual model based on Theory of Planned Behavior. Clinicians and those performing the analysis are blinded to arms. Discussion The central hypothesis is that ColoDATES Web will improve colorectal cancer screening adherence through improvement in patient behavioral factors, shared decision making between the patient and the clinician, and concordance between the patient’s and clinician’s preferred colorectal cancer screening test. The results of this study will be among the first to examine the effect of a real-time preference assessment exercise on colorectal cancer screening and mediators, and, in doing so, will shed light on the patient-clinician communication and shared decision making ‘black box’ that currently exists between the delivery of decision aids to patients and subsequent patient behavior. Trial Registration ClinicalTrials.gov ID NCT01514786 PMID:24216139

Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool.

PubMed

Streufert, Ben; Reed, Shelby D; Orlando, Lori A; Taylor, Dean C; Huber, Joel C; Mather, Richard C

2017-03-01

Although surgical management of a first-time anterior shoulder dislocation (FTASD) can reduce the risk of recurrent dislocation, other treatment characteristics, costs, and outcomes are important to patients considering treatment options. While patient preferences, such as those elicited by conjoint analysis, have been shown to be important in medical decision-making, the magnitudes or effects of patient preferences in treating an FTASD are unknown. To test a novel shared decision-making tool after sustained FTASD. Specifically measured were the following: (1) importance of aspects of operative versus nonoperative treatment, (2) respondents' agreement with results generated by the tool, (3) willingness to share these results with physicians, and (4) association of results with choice of treatment after FTASD. Cross-sectional study; Level of evidence, 3. A tool was designed and tested using members of Amazon Mechanical Turk, an online panel. The tool included an adaptive conjoint analysis exercise, a method to understand individuals' perceived importance of the following attributes of treatment: (1) chance of recurrent dislocation, (2) cost, (3) short-term limits on shoulder motion, (4) limits on participation in high-risk activities, and (5) duration of physical therapy. Respondents then chose between operative and nonoperative treatment for hypothetical shoulder dislocation. Overall, 374 of 501 (75%) respondents met the inclusion criteria, of which most were young, active males; one-third reported prior dislocation. From the conjoint analysis, the importance of recurrent dislocation and cost of treatment were the most important attributes. A substantial majority agreed with the tool's ability to generate representative preferences and indicated that they would share these preferences with their physician. Importance of recurrence proved significantly predictive of respondents' treatment choices, independent of sex or age; however, activity level was important to previous dislocators. A total of 125 (55%) males and 33 (23%) females chose surgery after FTASD, as did 37% of previous dislocators compared with 45% of nondislocators. When given thorough information about the risks and benefits, respondents had strong preferences for operative treatment after an FTASD. Respondents agreed with the survey results and wanted to share the information with providers. Recurrence was the most important attribute and played a role in decisions about treatment.

Social preferences for health states associated with acute myeloid leukemia for patients undergoing treatment in the United Kingdom.

PubMed

Castejón, Nacho; Cappelleri, Joseph C; Cuervo, Jesús; Lang, Kathryn; Mehta, Priyanka; Mokgokong, Ruth; Mamolo, Carla

2018-04-18

Health state (HS) utility values for patients with acute myeloid leukemia (AML), a hematological malignancy, are not available in the United Kingdom (UK). This study aims to develop clinically sound HSs for previously untreated patients with AML and to assign utility values based on preferences of the general UK population. This study was conducted in the UK and comprised 2 stages. During the first stage, AML HSs were drafted based on evidence from a literature review of AML clinical and health-related quality-of-life studies (published January 2000-June 2016) and patient-reported outcome measures previously used in this population. A panel of UK hematologists with AML experience validated the clinical relevance and accuracy of the HSs. During the second stage, validated HSs were valued in an elicitation survey with a representative UK population sample using the time trade-off (TTO) method. Descriptive statistics and bivariate tests were obtained and performed. A total of eight HSs were developed and clinically validated, including treatment with chemotherapy, consolidation therapy, transplant, graft-vs-host disease (GvHD), remission, relapse, refractory, and functionally cured. In total, 125 adults participated (mean age, 49.6 years [range, 18-87 years], 52.8% female). Mean (95% confidence interval [CI]) TTO preference values (n = 120), ranked from lowest (worst HS) to highest (best HS) were as follows: refractory - 0.11 (- 0.21 to - 0.01), relapse 0.10 (0.00-0.20), transplant 0.28 (0.20-0.37), treatment with chemotherapy 0.36 (0.28-0.43), GvHD 0.43 (0.36-0.50), consolidation 0.46 (0.40-0.53), remission 0.62 (0.57-0.67), and functionally cured 0.76 (0.72-0.79). Mean (95% CI) visual analog scale preference values followed the same rank order, ranging from 0.15 (0.13-0.17) for refractory to 0.71 (0.68-0.73) for functionally cured. To our knowledge, this is the first study to report utility values for AML from the UK societal perspective. Participants were able to distinguish differences in severity among AML HSs, and preference values were consistent with clinical perception of HS severity. HS preference values observed in this study may be useful in future evaluations of treatment benefit, including cost-effectiveness analyses and improved patient well-being.

A Double Take: The Practical and Ethical Dilemmas of Teaching the Visual Method of Photo Elicitation

ERIC Educational Resources Information Center

Wakefield, Caroline; Watt, Sal

2014-01-01

This paper advocates the teaching of photo elicitation in higher education as a valuable data collection technique and draws on our experience of teaching this visual method across two consecutive postgraduate cohorts. Building on previous work (Watt & Wakefield, 2014) and based on a former concern regarding student duty of care, a…

Investigation of a Brownfield Conflict Considering the Strength of Preferences

PubMed Central

Yu, Jing; Pei, Ling-Ling

2018-01-01

By employing the Graph Model for Conflict Resolution methodology, this paper models and analyzes a brownfield conflict that occurred at the Changzhou Foreign Language School in Jiangsu, China, in 2016. This conflict made national headlines when news reports revealed that a large number of students and staff suffered from health issues after the school moved to a new site that is built on recently restored land adjacent to the original “Chang Long Chemical” block. Since stakeholders in the conflict hold different strengths of preference, a new option prioritization technique is employed to elicit both crisp preferences and the strength of preferences for the decision-makers (DMs) in the conflict. The conflict analysis result is consistent with the actual trajectory of the conflict and provides strategic insights into the conflict. More specifically, equilibrium results suggest that the firm should have been required to thoroughly clean the site, the local government should not have relocated the school, and the environmental agency and other stakeholders should have closely monitored the firm’s activities. In short, strategic insights garnered from this case study indicate that positive interactions should be fostered among the local government, the enterprise, and the public to ensure sustainable brownfield land redevelopment in the future. PMID:29495314

Usability Guidelines for Product Recommenders Based on Example Critiquing Research

NASA Astrophysics Data System (ADS)

Pu, Pearl; Faltings, Boi; Chen, Li; Zhang, Jiyong; Viappiani, Paolo

Over the past decade, our group has developed a suite of decision tools based on example critiquing to help users find their preferred products in e-commerce environments. In this chapter, we survey important usability research work relative to example critiquing and summarize the major results by deriving a set of usability guidelines. Our survey is focused on three key interaction activities between the user and the system: the initial preference elicitation process, the preference revision process, and the presentation of the systems recommendation results. To provide a basis for the derivation of the guidelines, we developed a multi-objective framework of three interacting criteria: accuracy, confidence, and effort (ACE). We use this framework to analyze our past work and provide a specific context for each guideline: when the system should maximize its ability to increase users' decision accuracy, when to increase user confidence, and when to minimize the interaction effort for the users. Due to the general nature of this multi-criteria model, the set of guidelines that we propose can be used to ease the usability engineering process of other recommender systems, especially those used in e-commerce environments. The ACE framework presented here is also the first in the field to evaluate the performance of preference-based recommenders from a user-centric point of view.

Behavioral responses of honey bees (Apis mellifera) to natural and synthetic xenobiotics in food.

PubMed

Liao, Ling-Hsiu; Wu, Wen-Yen; Berenbaum, May R

2017-11-21

While the natural foods of the western honey bee (Apis mellifera) contain diverse phytochemicals, in contemporary agroecosystems honey bees also encounter pesticides as floral tissue contaminants. Whereas some ubiquitous phytochemicals in bee foods up-regulate detoxification and immunity genes, thereby benefiting nestmates, many agrochemical pesticides adversely affect bee health even at sublethal levels. How honey bees assess xenobiotic risk to nestmates as they forage is poorly understood. Accordingly, we tested nine phytochemicals ubiquitous in nectar, pollen, or propolis, as well as five synthetic xenobiotics that frequently contaminate hives-two herbicides (atrazine and glyphosate) and three fungicides (boscalid, chlorothalonil, and prochloraz). In semi-field free-flight experiments, bees were offered a choice between paired sugar water feeders amended with either a xenobiotic or solvent only (control). Among the phytochemicals, foragers consistently preferred quercetin at all five concentrations tested, as evidenced by both visitation frequency and consumption rates. This preference may reflect the long evolutionary association between honey bees and floral tissues. Of pesticides eliciting a response, bees displayed a preference at specific concentrations for glyphosate and chlorothalonil. This paradoxical preference may account for the frequency with which these pesticides occur as hive contaminants and suggests that they present a greater risk factor for honey bee health than previously suspected.

How Important Is ‘Accuracy’ of Surrogate Decision-Making for Research Participation?

PubMed Central

Kim, Scott Y. H.; Kim, H. Myra; Ryan, Kerry A.; Appelbaum, Paul S.; Knopman, David S.; Damschroder, Laura; De Vries, Raymond

2013-01-01

Background There is a longstanding concern about the accuracy of surrogate consent in representing the health care and research preferences of those who lose their ability to decide for themselves. We sought informed, deliberative views of the older general public (≥50 years old) regarding their willingness to participate in dementia research and to grant leeway to future surrogates to choose an option contrary to their stated wishes. Methodology/Principal Findings 503 persons aged 50+ recruited by random digit dialing were randomly assigned to one of three groups: deliberation, education, or control. The deliberation group attended an all-day education/peer deliberation session; the education group received written information only. Participants were surveyed at baseline, after the deliberation session (or equivalent time), and one month after the session, regarding their willingness to participate in dementia research and to give leeway to surrogates, regarding studies of varying risk-benefit profiles (a lumbar puncture study, a drug randomized controlled trial, a vaccine randomized controlled trial, and an early phase gene transfer trial). At baseline, 48% (gene transfer scenario) to 92% (drug RCT) were willing to participate in future dementia research. A majority of respondents (57–71% depending on scenario) were willing to give leeway to future surrogate decision-makers. Democratic deliberation increased willingness to participate in all scenarios, to grant leeway in 3 of 4 scenarios (lumbar puncture, vaccine, and gene transfer), and to enroll loved ones in research in all scenarios. On average, respondents were more willing to volunteer themselves for research than to enroll their loved ones. Conclusions/Significance Most people were willing to grant leeway to their surrogates, and this willingness was either sustained or increased after democratic deliberation, suggesting that the attitude toward leeway is a reliable opinion. Eliciting a person’s current preferences about future research participation should also involve eliciting his or her leeway preferences. PMID:23382969

Social time preferences for health and money elicited with a choice experiment.

PubMed

Meerding, Willem Jan; Bonsel, Gouke J; Brouwer, Werner B F; Stuifbergen, Marja C; Essink-Bot, Marie-Louise

2010-01-01

In economic evaluations future health and monetary outcomes are commonly discounted at equal and constant rates. The theoretical foundation of this practice is being debated and appropriate discount rates for costs and health effects are sought. Here, we have derived social discount rates for health, money, and environmental benefits by means of a choice experiment. All choices were framed from a social perspective. We investigated differences in time preference by domain (health, monetary benefits, environmental benefits), time delay (5, 10, and 40 years), and respondent characteristics. Respondents were 173 health-care professionals and 34 health policymakers. Choice titration was used to determine when the respondent was indifferent between future and present benefits. At least two-thirds of respondents preferred an intervention with immediate benefits to delayed benefits in the different domains. The median (mean) yearly discount rates for health benefits were 2.7% (10.7%), 1.3% (3.5%), and 1.1% (2.3%) assuming a 5, 10, and 40 years delay, respectively. Social time preference for monetary benefits was significantly stronger, with median (mean) yearly discount rates of 6.6% (18.7%) and 4.8% (11.2%) assuming a 5 and 10 years delay, respectively. The social time preference with regard to environmental benefits was similar to the monetary benefits. Social time preference for the different domains was significantly correlated at the individual level. The empirically derived social time preference is in line with current theoretical arguments for a lower discount rate for health benefits than for monetary benefits. Moreover, the implied median discount rates for health were lower than those commonly used or advocated in guidelines.

Public Perceptions of Regulatory Costs, Their Uncertainty and Interindividual Distribution.

PubMed

Johnson, Branden B; Finkel, Adam M

2016-06-01

Public perceptions of both risks and regulatory costs shape rational regulatory choices. Despite decades of risk perception studies, this article is the first on regulatory cost perceptions. A survey of 744 U.S. residents probed: (1) How knowledgeable are laypeople about regulatory costs incurred to reduce risks? (2) Do laypeople see official estimates of cost and benefit (lives saved) as accurate? (3) (How) do preferences for hypothetical regulations change when mean-preserving spreads of uncertainty replace certain cost or benefit? and (4) (How) do preferences change when unequal interindividual distributions of hypothetical regulatory costs replace equal distributions? Respondents overestimated costs of regulatory compliance, while assuming agencies underestimate costs. Most assumed agency estimates of benefits are accurate; a third believed both cost and benefit estimates are accurate. Cost and benefit estimates presented without uncertainty were slightly preferred to those surrounded by "narrow uncertainty" (a range of costs or lives entirely within a personally-calibrated zone without clear acceptance or rejection of tradeoffs). Certain estimates were more preferred than "wide uncertainty" (a range of agency estimates extending beyond these personal bounds, thus posing a gamble between favored and unacceptable tradeoffs), particularly for costs as opposed to benefits (but even for costs a quarter of respondents preferred wide uncertainty to certainty). Agency-acknowledged uncertainty in general elicited mixed judgments of honesty and trustworthiness. People preferred egalitarian distributions of regulatory costs, despite skewed actual cost distributions, and preferred progressive cost distributions (the rich pay a greater than proportional share) to regressive ones. Efficient and socially responsive regulations require disclosure of much more information about regulatory costs and risks. © 2016 Society for Risk Analysis.

Impact of Treatment Subsidies and Cash Payouts on Treatment Choices at the End of Life.

PubMed

Finkelstein, Eric; Malhotra, Chetna; Chay, Junxing; Ozdemir, Semra; Chopra, Akhil; Kanesvaran, Ravindran

To examine the extent to which financial assistance, in the form of subsidies for life-extending treatments (LETs) or cash payouts, distorts the demand for end-of-life treatments. A discrete choice experiment was administered to 290 patients with cancer in Singapore to elicit preferences for LETs and only palliative care (PC). Responses were fitted to a latent class conditional logistic regression model. We also quantified patients' willingness to pay to avoid and willingness to accept a less effective LET or PC-only. We then simulated the effects of various LET subsidy and cash payout policies on treatment choices. We identified three classes of patients according to their preferences. The first class (26.1% of the sample) had a strong preference for PC and were willing to give up life expectancy gains and even pay for receiving only PC. The second class (29.8% of the sample) had a strong preference for LETs and preferred to extend life regardless of cost or quality of life. The final class (44.1% of the sample) preferred LETs to PC, but actively traded off costs and length and quality of life when making end-of-life treatment choices. Policy simulations showed that LET subsidies increase demand for LETs at the expense of demand for PC, but an equivalent cash payout was not shown to distort demand. Patients with cancer have heterogeneous end-of-life preferences. LET subsidies and cash payouts have differing effects on the use of LETs. Policymakers should be mindful of these differences when designing health care financing schemes for patients with life-limiting illnesses. Copyright © 2016. Published by Elsevier Inc.

Thank you for asking: Exploring patient perceptions of barcode medication administration identification practices in inpatient mental health settings.

PubMed

Strudwick, Gillian; Clark, Carrie; McBride, Brittany; Sakal, Moshe; Kalia, Kamini

2017-09-01

Barcode medication administration systems have been implemented in a number of healthcare settings in an effort to decrease medication errors. To use the technology, nurses are required to login to an electronic health record, scan a medication and a form of patient identification to ensure that these correspond correctly with the ordered medications prior to medication administration. In acute care settings, patient wristbands have been traditionally used as a form of identification; however, past research has suggested that this method of identification may not be preferred in inpatient mental health settings. If barcode medication administration technology is to be effectively used in this context, healthcare organizations need to understand patient preferences with regards to identification methods. The purpose of this study was to elicit patient perceptions of barcode medication administration identification practices in inpatient mental health settings. Insights gathered can be used to determine patient-centered preferences of identifying patients using barcode medication administration technology. Using a qualitative descriptive approach, fifty-two (n=52) inpatient interviews were completed by a Peer Support Worker using a semi-structured interview guide over a period of two months. Interviews were conducted in a number of inpatient mental health areas including forensic, youth, geriatric, acute, and rehabilitation services. An interprofessional team, inclusive of a Peer Support Worker, completed a thematic analysis of the interview data. Six themes emerged as a result of the inductive data analysis. These included: management of information, privacy and security, stigma, relationships, safety and comfort, and negative associations with the technology. Patients also indicated that they would like a choice in the type of identification method used during barcode medication administration. As well, suggestions were made for how barcode medication administration practices could be modified to become more patient-centered. The results of this study have a number of implications for healthcare organizations. As patients indicated that they would like a choice in the type of identification method used during barcode medication administration, healthcare organizations will need to determine how they can facilitate this process. Furthermore, many of the concerns that patients had with barcode medication administration technology could be addressed through patient education. Copyright © 2017 Elsevier B.V. All rights reserved.

Identifying Societal Preferences for River Restoration in a Densely Populated Urban Environment: Evidence from a Discrete Choice Experiment in Central Brussels

NASA Astrophysics Data System (ADS)

Chen, Wendy Y.; Liekens, Inge; Broekx, Steven

2017-08-01

One of the major challenges facing river restoration in densely populated urban areas has been the disparity between the expectations of policy-makers and societal preferences. This study aimed to elicit public preferences and elucidate underlying sources of preference heterogeneity, using the Zenne River in central Brussels, Belgium, as a case study. A discrete choice experiment was administered to a representative sample of the Brussels population. Five attributes were specified, including water quality, ecological status, hydromorphological features of channels, recreational opportunities, and monetary cost. Our econometric analysis based on mixed logit models revealed that overall public would like to have a more natural river (open and naturalized channel, good water quality, and with rich species diversity), while achieving good water quality was the most preferred attribute. Respondents categorized as male, non-Belgian citizen, or not being a member of an environmental organization constituted an inclination to prefer the status quo. Belgian citizens showed a pronounced preference for good biodiversity, and being a member of an environmental organization could moderate the strong preference for good water quality. This study provided insights into the relative attractiveness of key attributes pertaining to river restoration, in general, and served as a useful input to the ongoing discussion concerning the future plan for the Zenne River in Brussels, specifically. Possible implications also exist for other urban river restorations in the rest of Europe, where the Water Framework Directive has become a major impetus for the expansion of freshwater ecosystem restoration from rural and peri-urban areas to densely populated urban areas. Particularly, the cultural heterogeneity of societal preferences should be tested and accounted for to compare the welfare impacts of river restoration and to facilitate benefit transfer, within and between river basins, in the Water Framework Directive implementation.

Identifying Societal Preferences for River Restoration in a Densely Populated Urban Environment: Evidence from a Discrete Choice Experiment in Central Brussels.

PubMed

Chen, Wendy Y; Liekens, Inge; Broekx, Steven

2017-08-01

One of the major challenges facing river restoration in densely populated urban areas has been the disparity between the expectations of policy-makers and societal preferences. This study aimed to elicit public preferences and elucidate underlying sources of preference heterogeneity, using the Zenne River in central Brussels, Belgium, as a case study. A discrete choice experiment was administered to a representative sample of the Brussels population. Five attributes were specified, including water quality, ecological status, hydromorphological features of channels, recreational opportunities, and monetary cost. Our econometric analysis based on mixed logit models revealed that overall public would like to have a more natural river (open and naturalized channel, good water quality, and with rich species diversity), while achieving good water quality was the most preferred attribute. Respondents categorized as male, non-Belgian citizen, or not being a member of an environmental organization constituted an inclination to prefer the status quo. Belgian citizens showed a pronounced preference for good biodiversity, and being a member of an environmental organization could moderate the strong preference for good water quality. This study provided insights into the relative attractiveness of key attributes pertaining to river restoration, in general, and served as a useful input to the ongoing discussion concerning the future plan for the Zenne River in Brussels, specifically. Possible implications also exist for other urban river restorations in the rest of Europe, where the Water Framework Directive has become a major impetus for the expansion of freshwater ecosystem restoration from rural and peri-urban areas to densely populated urban areas. Particularly, the cultural heterogeneity of societal preferences should be tested and accounted for to compare the welfare impacts of river restoration and to facilitate benefit transfer, within and between river basins, in the Water Framework Directive implementation.

Development of a preference-based index from the National Eye Institute Visual Function Questionnaire-25.

PubMed

Rentz, Anne M; Kowalski, Jonathan W; Walt, John G; Hays, Ron D; Brazier, John E; Yu, Ren; Lee, Paul; Bressler, Neil; Revicki, Dennis A

2014-03-01

Understanding how individuals value health states is central to patient-centered care and to health policy decision making. Generic preference-based measures of health may not effectively capture the impact of ocular diseases. Recently, 6 items from the National Eye Institute Visual Function Questionnaire-25 were used to develop the Visual Function Questionnaire-Utility Index health state classification, which defines visual function health states. To describe elicitation of preferences for health states generated from the Visual Function Questionnaire-Utility Index health state classification and development of an algorithm to estimate health preference scores for any health state. Nonintervention, cross-sectional study of the general community in 4 countries (Australia, Canada, United Kingdom, and United States). A total of 607 adult participants were recruited from local newspaper advertisements. In the United Kingdom, an existing database of participants from previous studies was used for recruitment. Eight of 15,625 possible health states from the Visual Function Questionnaire-Utility Index were valued using time trade-off technique. A θ severity score was calculated for Visual Function Questionnaire-Utility Index-defined health states using item response theory analysis. Regression models were then used to develop an algorithm to assign health state preference values for all potential health states defined by the Visual Function Questionnaire-Utility Index. Health state preference values for the 8 states ranged from a mean (SD) of 0.343 (0.395) to 0.956 (0.124). As expected, preference values declined with worsening visual function. Results indicate that the Visual Function Questionnaire-Utility Index describes states that participants view as spanning most of the continuum from full health to dead. Visual Function Questionnaire-Utility Index health state classification produces health preference scores that can be estimated in vision-related studies that include the National Eye Institute Visual Function Questionnaire-25. These preference scores may be of value for estimating utilities in economic and health policy analyses.

Preferred and Perceived Participation of Younger and Older Patients in Decision Making About Treatment for Early Breast Cancer: A Prospective Study.

PubMed

Hamelinck, Victoria C; Bastiaannet, Esther; Pieterse, Arwen H; van de Velde, Cornelis J H; Liefers, Gerrit-Jan; Stiggelbout, Anne M

2018-04-01

Older patients are believed to prefer a more passive role in treatment decision making, but studies reporting this relation were conducted over a decade ago or were retrospective. We prospectively compared younger (40-64 years) versus older (≥ 65 years) breast cancer patients' preferences for decision-making roles and their perceived actual roles. A prospective multicenter study was conducted in Leiden, The Hague, and Tilburg over a 2-year period. Early-stage breast cancer patients were surveyed about their preferred and perceived decision-making roles (active, shared, or passive) concerning surgery type (breast-conserving vs. mastectomy) (n = 74), adjuvant chemotherapy (aCT, n = 43), and adjuvant hormonal therapy (aHT, n = 39). For all decisions, both age groups most frequently preferred a shared role before consultation, except for decisions about aHT, for which younger patients more commonly preferred an active role. The proportion of patients favoring an active or passive role in each decision was lower for the older than the younger patients, but none of the differences was significant. Regarding perceived actual roles, both groups most frequently reported an active role in the surgical decision after consultation. In deciding about both aCT and aHT, a larger proportion of older patients perceived having had a passive role compared to younger patients, and a greater proportion of younger patients perceived having been active. Again, differences were not statistically significant. Most older patients preferred to decide together with their clinician, but preferences varied widely. Older patients more often than younger patients perceived they had not been involved in decisions about systemic therapy. Clinicians should invite all patients to participate in decision making and elicit their preferred role. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

What determines providers' stated preference for the treatment of uncomplicated malaria?

PubMed

Mangham-Jefferies, Lindsay; Hanson, Kara; Mbacham, Wilfred; Onwujekwe, Obinna; Wiseman, Virginia

2014-03-01

As agents for their patients, providers often make treatment decisions on behalf of patients, and their choices can affect health outcomes. However, providers operate within a network of relationships and are agents not only for their patients, but also other health sector actors, such as their employer, the Ministry of Health, and pharmaceutical suppliers. Providers' stated preferences for the treatment of uncomplicated malaria were examined to determine what factors predict their choice of treatment in the absence of information and institutional constraints, such as the stock of medicines or the patient's ability to pay. 518 providers working at non-profit health facilities and for-profit pharmacies and drug stores in Yaoundé and Bamenda in Cameroon and in Enugu State in Nigeria were surveyed between July and December 2009 to elicit the antimalarial they prefer to supply for uncomplicated malaria. Multilevel modelling was used to determine the effect of financial and non-financial incentives on their preference, while controlling for information and institutional constraints, and accounting for the clustering of providers within facilities and geographic areas. 69% of providers stated a preference for artemisinin-combination therapy (ACT), which is the recommended treatment for uncomplicated malaria in Cameroon and Nigeria. A preference for ACT was significantly associated with working at a for-profit facility, reporting that patients prefer ACT, and working at facilities that obtain antimalarials from drug company representatives. Preferences were similar among colleagues within a facility, and among providers working in the same locality. Knowing the government recommends ACT was a significant predictor, though having access to clinical guidelines was not sufficient. Providers are agents serving multiple principals and their preferences over alternative antimalarials were influenced by patients, drug company representatives, and other providers working at the same facility and in the local area. Efforts to disseminate drug policy should target the full range of actors involved in supplying drugs, including providers, employers, suppliers and local communities. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Strong rightward lateralization of the dorsal attentional network in left-handers with right sighting-eye: an evolutionary advantage.

PubMed

Petit, Laurent; Zago, Laure; Mellet, Emmanuel; Jobard, Gaël; Crivello, Fabrice; Joliot, Marc; Mazoyer, Bernard; Tzourio-Mazoyer, Nathalie

2015-03-01

Hemispheric lateralization for spatial attention and its relationships with manual preference strength and eye preference were studied in a sample of 293 healthy individuals balanced for manual preference. Functional magnetic resonance imaging was used to map this large sample while performing visually guided saccadic eye movements. This activated a bilateral distributed cortico-subcortical network in which dorsal and ventral attentional/saccadic pathways elicited rightward asymmetrical activation depending on manual preference strength and sighting eye. While the ventral pathway showed a strong rightward asymmetry irrespective of both manual preference strength and eye preference, the dorsal frontoparietal network showed a robust rightward asymmetry in strongly left-handers, even more pronounced in left-handed subjects with a right sighting-eye. Our findings brings support to the hypothesis that the origin of the rightward hemispheric dominance for spatial attention may have a manipulo-spatial origin neither perceptual nor motor per se but rather reflecting a mechanism by which a spatial context is mapped onto the perceptual and motor activities, including the exploration of the spatial environment with eyes and hands. Within this context, strongly left-handers with a right sighting-eye may benefit from the advantage of having the same right hemispheric control of their dominant hand and visuospatial attention processing. We suggest that this phenomenon explains why left-handed right sighting-eye athletes can outperform their competitors in sporting duels and that the prehistoric and historical constancy of the left-handers ratio over the general population may relate in part on the hemispheric specialization of spatial attention. © 2014 Wiley Periodicals, Inc.

Subject preferences of first- and second-year medical students for their future specialization at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal - a questionnaire-based study.

PubMed

Jha, Rajesh K; Paudel, Keshab R; Shah, Dev K; Sah, Ajit K; Basnet, Sangharshila; Sah, Phoolgen; Adhikari, Sandeep

2015-01-01

The selection of a discipline for future specialization may be an important factor for the medical students' future career, and it is influenced by multiple factors. The interest of students in the early stages can be improved in subjects related to public health or of academic importance, as per need. A questionnaire-based study was conducted among 265 first- and second-year medical students of Chitwan Medical College, Nepal to find out their subject of preference for postgraduation and the factors affecting their selection along with their interesting basic science subject. Only the responses from 232 completely filled questionnaires were analyzed. The preference of the students for clinical surgical (50.9%), clinical medical (45.3%), and basic medical (3.9%) sciences for postgraduation were in descending order. The most preferred specialty among male students was clinical surgical sciences (56.3%), and among female students, it was clinical medical sciences (53.6%). Although all the students responded to their preferred specialty, only 178 students specified the subject of their interest. General surgery (23.4%), pediatrics (23.4%), and anatomy (2.4%) were the most favored subjects for postgraduation among clinical surgical, clinical medical, and basic medical sciences specialties, respectively. More common reasons for selection of specific subject for future career were found to be: personal interests, good income, intellectual challenge, and others. Many students preferred clinical surgical sciences for their future specialization. Among the reasons for the selection of the specialty for postgraduation, no significant reason could be elicited from the present study.

Preferences for a third-trimester ultrasound scan in a low-risk obstetric population: a discrete choice experiment.

PubMed

Lynn, Fiona A; Crealey, Grainne E; Alderdice, Fiona A; McElnay, James C

2015-10-01

Establish maternal preferences for a third-trimester ultrasound scan in a healthy, low-risk pregnant population. Cross-sectional study incorporating a discrete choice experiment. A large, urban maternity hospital in Northern Ireland. One hundred and forty-six women in their second trimester of pregnancy. A discrete choice experiment was designed to elicit preferences for four attributes of a third-trimester ultrasound scan: health-care professional conducting the scan, detection rate for abnormal foetal growth, provision of non-medical information, cost. Additional data collected included age, marital status, socio-economic status, obstetric history, pregnancy-specific stress levels, perceived health and whether pregnancy was planned. Analysis was undertaken using a mixed logit model with interaction effects. Women's preferences for, and trade-offs between, the attributes of a hypothetical scan and indirect willingness-to-pay estimates. Women had significant positive preference for higher rate of detection, lower cost and provision of non-medical information, with no significant value placed on scan operator. Interaction effects revealed subgroups that valued the scan most: women experiencing their first pregnancy, women reporting higher levels of stress, an adverse obstetric history and older women. Women were able to trade on aspects of care and place relative importance on clinical, non-clinical outcomes and processes of service delivery, thus highlighting the potential of using health utilities in the development of services from a clinical, economic and social perspective. Specifically, maternal preferences exhibited provide valuable information for designing a randomized trial of effectiveness and insight for clinical and policy decision makers to inform woman-centred care. © 2013 Blackwell Publishing Ltd.

What do potential jurors know about police interrogation techniques and false confessions?

PubMed

Leo, Richard A; Liu, Brittany

2009-01-01

Psychological police interrogation methods in America inevitably involve some level of pressure and persuasion to achieve their goal of eliciting confessions of guilt from custodial suspects. In this article, we surveyed potential jurors about their perceptions of a range of psychological interrogation techniques, the likelihood that such techniques would elicit a true confession from guilty suspects, and the likelihood that such techniques could elicit a false confession from innocent suspects. Participants recognized that these interrogation techniques may be psychologically coercive and may elicit true confessions, but believed that psychologically coercive interrogation techniques are not likely to elicit false confessions. The findings from this survey study indicate that potential jurors believe that false confessions are both counter- intuitive and unlikely, even in response to psychologically coercive interrogation techniques that have been shown to lead to false confessions from the innocent. This study provides empirical support for the idea that expert witnesses may helpfully inform jurors about the social science research on psychologically coercive interrogation methods and how and why such interrogation techniques can lead to false confessions. (c) 2009 John Wiley & Sons, Ltd.

The Predatory Mite Phytoseiulus persimilis Does Not Perceive Odor Mixtures As Strictly Elemental Objects

PubMed Central

de Bruijn, Paulien J. A.; Sabelis, Maurice W.

2010-01-01

Phytoseiulus persimilis is a predatory mite that in absence of vision relies on the detection of herbivore-induced plant odors to locate its prey, the two-spotted spider-mite Tetranychus urticae. This herbivorous prey is feeding on leaves of a wide variety of plant species in different families. The predatory mites respond to numerous structurally different compounds. However, typical spider-mite induced plant compounds do not attract more predatory mites than plant compounds not associated with prey. Because the mites are sensitive to many compounds, components of odor mixtures may affect each other’s perception. Although the response to pure compounds has been well documented, little is known how interactions among compounds affect the response to odor mixtures. We assessed the relation between the mites’ responses elicited by simple mixtures of two compounds and by the single components of these mixtures. The preference for the mixture was compared to predictions under three conceptual models, each based on one of the following assumptions: (1) the responses elicited by each of the individual components can be added to each other; (2) they can be averaged; or (3) one response overshadows the other. The observed response differed significantly from the response predicted under the additive response, average response, and overshadowing response model in 52, 36, and 32% of the experimental tests, respectively. Moreover, the behavioral responses elicited by individual compounds and their binary mixtures were determined as a function of the odor concentration. The relative contribution of each component to the behavioral response elicited by the mixture varied with the odor concentration, even though the ratio of both compounds in the mixture was kept constant. Our experiments revealed that compounds that elicited no response had an effect on the response elicited by binary mixtures that they were part of. The results are not consistent with the hypothesis that P. persimilis perceives odor mixtures as a collection of strictly elemental objects. They suggest that odor mixtures rather are perceived as one synthetic whole. Electronic supplementary material The online version of this article (doi:10.1007/s10886-010-9858-3) contains supplementary material, which is available to authorized users. PMID:20872172

A guide to reading and using systematic reviews of qualitative research.

PubMed

Tong, Allison; Palmer, Suetonia; Craig, Jonathan C; Strippoli, Giovanni F M

2016-06-01

There is an increasingly widespread policy momentum to increase patient-centred care and to improve quality of life outcomes within health services. Qualitative research methods are used to elicit in-depth and detailed insights into people's attitudes, beliefs, emotions and experiences-much of which may remain unspoken during clinical encounters. Questions about patients' beliefs and preferences for treatment can be addressed by qualitative research and inform evidence-based strategies for delivering patient-centred care. Systematic reviews of multiple primary qualitative studies bring together findings from different studies to offer new and more comprehensive understandings of social phenomena across various healthcare contexts and populations and are an emerging methodology in the literature including for care in chronic kidney disease. This article will provide a framework for the systematic review of qualitative research so readers can make sense of these study types and use them in clinical care and policy. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Designing smart analytical data services for a personal health framework.

PubMed

Koumakis, Lefteris; Kondylakis, Haridimos; Chatzimina, Maria; Iatraki, Galatia; Argyropaidas, Panagiotis; Kazantzaki, Eleni; Tsiknakis, Manolis; Kiefer, Stephan; Marias, Kostas

2016-01-01

Information in the healthcare domain and in particular personal health record information is heterogeneous by nature. Clinical, lifestyle, environmental data and personal preferences are stored and managed within such platforms. As a result, significant information from such diverse data is difficult to be delivered, especially to non-IT users like patients, physicians or managers. Another issue related to the management and analysis is the volume, which increases more and more making the need for efficient data visualization and analysis methods mandatory. The objective of this work is to present the architectural design for seamless integration and intelligent analysis of distributed and heterogeneous clinical information in the PHR context, as a result of a requirements elicitation process in iManageCancer project. This systemic approach aims to assist health-care professionals to orient themselves in the disperse information space and enhance their decision-making capabilities, to encourage patients to have an active role by managing their health information and interacting with health-care professionals.

Multiattribute Decision Modeling Techniques: A Comparative Analysis

DTIC Science & Technology

1988-08-01

Analytic Hierarchy Process ( AHP ). It is structurally similar to SMART, but elicitation methods are different and there are several algorithms for...reconciliation of inconsistent judgments and for consistency checks that are not available in any of the utility procedures. The AHP has been applied...of commercially available software packages that implement the AHP algorithms. Elicitation Methods. The AHP builds heavily on value trees, which

Integrating values and consumer involvement in guidelines with the patient at the center: article 8 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Kelson, Marcia; Akl, Elie A; Bastian, Hilda; Cluzeau, Françoise; Curtis, J Randall; Guyatt, Gordon; Montori, Victor M; Oliver, Sandy; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence. They are also realizing the need to involve consumers of healthcare (patients, caregivers, and the public) and integrate their values and preferences in clinical guideline development. This is the eighth of a series of 14 articles that were prepared to advise guideline developers in respiratory and other diseases. It focuses on where to find information about consumer values and preferences, at what points in the guideline development process to integrate their values and preferences, and why. In this review, we addressed the following questions: (1) What do we mean by "consumers"? (2) Why integrate the values and preferences of consumers of healthcare (patients, caregivers, and the public) into clinical practice guidelines? (3) What are the sources of information on consumer values? (4) When and how should consumer values and preferences be integrated into chronic obstructive pulmonary disease guideline recommendations? We defined consumers as patients, caregivers, and members of the public, excluding groups that may also be identified as consumers of guidelines including health professionals, providers, and commissioners of services. We searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on available evidence, supplemented by a rapid appraisal of a selection of qualitative studies, experience of what guideline developers are doing, and workshop discussions. A clear distinction needs to be made between the use of information on consumer values and preferences by guideline developers, and the direct involvement of consumers in guideline development processes. Sources of information on consumer values include the research literature and direct elicitation of values both from organizations representing consumer interests and from individuals. To complement the identification of consumer values, there are a range of methods for involving consumers at all stages of guideline development, from consultation to direct membership of guideline development groups. Evidence-based guidelines need to consider explicitly the values and preferences of all relevant stakeholders (including those of consumers) and to provide opportunities for patients, caregivers, and the public to engage in the processes that consider and integrate those values into the development of guideline recommendations.

A common bacterial metabolite elicits prion-based bypass of glucose repression

PubMed Central

Garcia, David M; Dietrich, David; Clardy, Jon; Jarosz, Daniel F

2016-01-01

Robust preference for fermentative glucose metabolism has motivated domestication of the budding yeast Saccharomyces cerevisiae. This program can be circumvented by a protein-based genetic element, the [GAR+] prion, permitting simultaneous metabolism of glucose and other carbon sources. Diverse bacteria can elicit yeast cells to acquire [GAR+], although the molecular details of this interaction remain unknown. Here we identify the common bacterial metabolite lactic acid as a strong [GAR+] inducer. Transient exposure to lactic acid caused yeast cells to heritably circumvent glucose repression. This trait had the defining genetic properties of [GAR+], and did not require utilization of lactic acid as a carbon source. Lactic acid also induced [GAR+]-like epigenetic states in fungi that diverged from S. cerevisiae ~200 million years ago, and in which glucose repression evolved independently. To our knowledge, this is the first study to uncover a bacterial metabolite with the capacity to potently induce a prion. DOI: http://dx.doi.org/10.7554/eLife.17978.001 PMID:27906649

An event-related potential study of deception to self preferences.

PubMed

Tu, Shen; Li, Hong; Jou, Jerwen; Zhang, Qinglin; Wang, Ting; Yu, Caiyun; Qiu, Jiang

2009-01-09

The spatiotemporal analysis of brain activation during the execution of deceptive decision-making was performed in 14 normal young adult subjects by using high-density event-related brain potentials (ERPs) with a delayed-response paradigm (subjects were required to hide their true attitudes for a moment). Our results showed that between 400 and 700 ms after stimulus onset, Deceptive items elicited a more negative ERP deflection (N400-700) than Truthful items, and between 1000 and 2000 ms, Deceptive items elicited a more positive ERP deflection (P1000-2000) than Truthful items. Analyses using dipole locations indicated that: (1) the generators of N400-700 were localized in the medial frontal gyrus (GFM) and middle temporal gyrus (GTM), which might be involved in conflict detection and control during deceptive decision-making; and (2) the generators of P1000-2000 were localized near the cuneus (CU) and the cingulate gyrus, which might be involved in conflict coordination in working memory due to deception.

Application and Evaluation of an Expert Judgment Elicitation Procedure for Correlations.

PubMed

Zondervan-Zwijnenburg, Mariëlle; van de Schoot-Hubeek, Wenneke; Lek, Kimberley; Hoijtink, Herbert; van de Schoot, Rens

2017-01-01

The purpose of the current study was to apply and evaluate a procedure to elicit expert judgments about correlations, and to update this information with empirical data. The result is a face-to-face group elicitation procedure with as its central element a trial roulette question that elicits experts' judgments expressed as distributions. During the elicitation procedure, a concordance probability question was used to provide feedback to the experts on their judgments. We evaluated the elicitation procedure in terms of validity and reliability by means of an application with a small sample of experts. Validity means that the elicited distributions accurately represent the experts' judgments. Reliability concerns the consistency of the elicited judgments over time. Four behavioral scientists provided their judgments with respect to the correlation between cognitive potential and academic performance for two separate populations enrolled at a specific school in the Netherlands that provides special education to youth with severe behavioral problems: youth with autism spectrum disorder (ASD), and youth with diagnoses other than ASD. Measures of face-validity, feasibility, convergent validity, coherence, and intra-rater reliability showed promising results. Furthermore, the current study illustrates the use of the elicitation procedure and elicited distributions in a social science application. The elicited distributions were used as a prior for the correlation, and updated with data for both populations collected at the school of interest. The current study shows that the newly developed elicitation procedure combining the trial roulette method with the elicitation of correlations is a promising tool, and that the results of the procedure are useful as prior information in a Bayesian analysis.

Assessing family medicine trainees--what can we learn from the European neighbours?

PubMed

Flum, Elisabeth; Maagaard, Roar; Godycki-Cwirko, Maciek; Scarborough, Nigel; Scherpbier, Nynke; Ledig, Thomas; Roos, Marco; Steinhäuser, Jost

2015-01-01

Although demands on family physicians (FP) are to a large extent similar in the European Union, uniform assessment standards for family medicine (FM) specialty training and assessment do not exist. Aim of this pilot study was to elicit and compare the different modalities and assessment methods of FM specialty training in five European countries. A semi structured survey was undertaken based on a convenient sample in five European countries (Denmark, Germany, Poland, the Netherlands and the United Kingdom). The respondents were asked to respond to ten items about aspects of FM specialty training and assessment methods in their respective countries. If available, this data was completed with information from official websites of the countries involved. FM specialty training is performed heterogeneously in the surveyed countries. Training time periods range from three to five years, in some countries requiring a foundation program of up to two years. Most countries perform longitudinal assessment during FM specialty training using a combination of competence-based approach with additional formative and summative assessment. There is some evidence on the assessments methods used, however the assessment method used and costs of assessment differs remarkably between the participating countries. Longitudinal and competence-based assessment is the presently preferred approach for FM specialty training. Countries which use less multifaceted methods for assessment could learn from best practice. Potential changes have significant cost implications.

Eliciting Values of Patients with Multiple Chronic Conditions: Evaluation of a Patient-centered Framework

PubMed Central

Berry, Andrew B.L.; Lim, Catherine; Hartzler, Andrea L.; Hirsch, Tad; Ludman, Evette; Wagner, Edward H.; Ralston, James D.

2017-01-01

Patients with multiple chronic conditions often face competing demands for care, and they often do not agree with physicians on priorities for care. Patients ’ values shape their healthcare priorities, but existing methods for eliciting values do not necessarily meet patients ’ care planning needs. We developed a patient-centered values framework based on a field study with patients and caregivers. In this paper we report on a survey to evaluate how the framework generalizes beyond field study participants, and how well the framework supports values elicitation. We found that respondents frame values in a way that is consistent with the framework, and that domains of the framework can be used to elicit a breadth of potential values individuals with MCC express. These findings demonstrate how a patient-centered perspective on values can expand on the domains considered in values clarification methods andfacilitate patient-provider communication in establishing shared care priorities. PMID:29854107

Eliciting Values of Patients with Multiple Chronic Conditions: Evaluation of a Patient-centered Framework.

PubMed

Berry, Andrew B L; Lim, Catherine; Hartzler, Andrea L; Hirsch, Tad; Ludman, Evette; Wagner, Edward H; Ralston, James D

2017-01-01

Patients with multiple chronic conditions often face competing demands for care, and they often do not agree with physicians on priorities for care. Patients ' values shape their healthcare priorities, but existing methods for eliciting values do not necessarily meet patients ' care planning needs. We developed a patient-centered values framework based on a field study with patients and caregivers. In this paper we report on a survey to evaluate how the framework generalizes beyond field study participants, and how well the framework supports values elicitation. We found that respondents frame values in a way that is consistent with the framework, and that domains of the framework can be used to elicit a breadth of potential values individuals with MCC express. These findings demonstrate how a patient-centered perspective on values can expand on the domains considered in values clarification methods andfacilitate patient-provider communication in establishing shared care priorities.

Trait Anxiety and Economic Risk Avoidance Are Not Necessarily Associated: Evidence from the Framing Effect.

PubMed

Gu, Ruolei; Wu, Runguo; Broster, Lucas S; Jiang, Yang; Xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-Jia

2017-01-01

According to previous literature, trait anxiety is related to the tendency to choose safety options during risk decision-making, that is, risk avoidance. In our opinion, anxious people's risk preference might actually reflect their hypersensitivity to emotional information. To examine this hypothesis, a decision-making task that could elicit the framing effect was employed. The framing effect indicates that risk preference could be modulated by emotional messages contained in the description (i.e., frame) of options. The behavioral results have showed the classic framing effect. In addition, individual level of trait anxiety was positively correlated with the framing effect size. However, trait anxiety was not correlated with risk-avoidance ratio in any condition. Finally, the relationship between anxiety and the framing effect remained significant after the level of depression was also taken into account. The theoretical significance and the major limitations of this study are discussed.

Trait Anxiety and Economic Risk Avoidance Are Not Necessarily Associated: Evidence from the Framing Effect

PubMed Central

Gu, Ruolei; Wu, Runguo; Broster, Lucas S.; Jiang, Yang; Xu, Rui; Yang, Qiwei; Xu, Pengfei; Luo, Yue-Jia

2017-01-01

According to previous literature, trait anxiety is related to the tendency to choose safety options during risk decision-making, that is, risk avoidance. In our opinion, anxious people’s risk preference might actually reflect their hypersensitivity to emotional information. To examine this hypothesis, a decision-making task that could elicit the framing effect was employed. The framing effect indicates that risk preference could be modulated by emotional messages contained in the description (i.e., frame) of options. The behavioral results have showed the classic framing effect. In addition, individual level of trait anxiety was positively correlated with the framing effect size. However, trait anxiety was not correlated with risk-avoidance ratio in any condition. Finally, the relationship between anxiety and the framing effect remained significant after the level of depression was also taken into account. The theoretical significance and the major limitations of this study are discussed. PMID:28197116

Economic Behavior under the Influence of Alcohol: An Experiment on Time Preferences, Risk-Taking, and Altruism

PubMed Central

Corazzini, Luca; Filippin, Antonio; Vanin, Paolo

2015-01-01

We report results from an incentivized laboratory experiment undertaken with the purpose of providing controlled evidence on the causal effects of alcohol consumption on risk-taking, time preferences and altruism. Our design disentangles the pharmacological effects of alcohol intoxication from those mediated by expectations, as we compare the behavior of three groups of subjects: those who participated in an experiment with no reference to alcohol, those who were exposed to the possibility of consuming alcohol but were given a placebo and those who effectively consumed alcohol. All subjects participated in a series of economic tasks administered in the same sequence across treatments. After controlling for both the willingness to pay for an object and the potential misperception of probabilities as elicited in the experiment, we detect no effect of alcohol in depleting subjects’ risk tolerance. However, we find that alcohol intoxication increases impatience and makes subjects less altruistic. PMID:25853520

Other People’s Money: The Role of Reciprocity and Social Uncertainty in Decisions for Others

PubMed Central

2017-01-01

Many important decisions are taken not by the person who will ultimately gain or lose from the outcome, but on their behalf, by somebody else. We examined economic decision-making about risk and time in situations in which deciders chose for others who also chose for them. We propose that this unique setting, which has not been studied before, elicits perception of reciprocity that prompts a unique bias in preferences. We found that decision-makers are less patient (more discounting), and more risk averse for losses than gains, with other peoples’ money, especially when their choices for others are more uncertain. Those results were derived by exploiting a computational modeling framework that has been shown to account for the underlying psychological and neural decision processes. We propose a novel theoretical mechanism—precautionary preferences under social uncertainty, which explains the findings. Implications for future research and alternative models are also discussed. PMID:29456782

Self-reported tactics of impulse control.

PubMed

Ainslie, G

1987-02-01

Recent behavioral research has suggested that delayed incentives are discounted in a highly concave curve, which should produce temporary preference for the poorer of two alternatives when that alternative is available earlier than the better one. Unlike the psychoanalytic model of impulsiveness, the temporary preference model implies a rational need for people to forestall impulses by committing their choices in advance. A questionnaire elicited college students' and prisoners' self-reports of approval of four basic kinds of precommitting tactics as applied to 14 commonplace temptations. Endorsement of private rules as a precommitting device was correlated with self-reported compulsive personality traits and negatively correlated with endorsement of extra-psychic (social or physical) devices; the latter endorsement was correlated with self-reported oral/paranoid traits. Female subjects endorsed attention control as a precommitting device more than males, and male subjects endorsed extrapsychic devices more than females. The ego psychology of conflict may be practical at the conscious level.

Public preferences for prioritizing preventive and curative health care interventions: a discrete choice experiment.

PubMed

Luyten, Jeroen; Kessels, Roselinde; Goos, Peter; Beutels, Philippe

2015-03-01

Setting fair health care priorities counts among the most difficult ethical challenges our societies are facing. To elicit through a discrete choice experiment the Belgian adult population's (18-75 years; N = 750) preferences for prioritizing health care and investigate whether these preferences are different for prevention versus cure. We used a Bayesian D-efficient design with partial profiles, which enables considering a large number of attributes and interaction effects. We included the following attributes: 1) type of intervention (cure vs. prevention), 2) effectiveness, 3) risk of adverse effects, 4) severity of illness, 5) link between the illness and patient's health-related lifestyle, 6) time span between intervention and effect, and 7) patient's age group. All attributes were statistically significant contributors to the social value of a health care program, with patient's lifestyle and age being the most influential ones. Interaction effects were found, showing that prevention was preferred to cure for disease in young adults, as well as for severe and lethal disease in people of any age. However, substantial differences were found in the preferences of respondents from different age groups, with different lifestyles and different health states. Our study suggests that according to the Belgian public, contextual factors of health gains such as patient's age and health-related lifestyle should be considered in priority setting decisions. The studies, however, revealed substantial disagreement in opinion between different population subgroups. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Anticipating explanations in relative clause processing.

PubMed

Rohde, H; Levy, R; Kehler, A

2011-03-01

We show that comprehenders' expectations about upcoming discourse coherence relations influence the resolution of local structural ambiguity. We employ cases in which two clauses share both a syntactic relationship and a discourse relationship, and hence in which syntactic and discourse processing might be expected to interact. An off-line sentence-completion study and an on-line self-paced reading study examined readers' expectations for high/low relative-clause attachments following implicit-causality and non-implicit causality verbs (John detests/babysits the children of the musician who…). In the off-line study, the widely reported low-attachment preference for English is observed in the non-implicit causality condition, but this preference gives way to more high attachments in the implicit-causality condition in cases in which (i) the verb's causally implicated referent occupies the high-attachment position and (ii) the relative clause provides an explanation for the event described by the matrix clause (e.g., …who are arrogant and rude). In the on-line study, a similar preference for high attachment emerges in the implicit-causality context-crucially, before the occurrence of any linguistic evidence that the RC does in fact provide an explanation-whereas the low-attachment preference is consistent elsewhere. These findings constitute the first demonstration that expectations about ensuing discourse coherence relationships can elicit full reversals in syntactic attachment preferences, and that these discourse-level expectations can affect on-line disambiguation as rapidly as lexical and morphosyntactic cues. Copyright © 2010 Elsevier B.V. All rights reserved.

Anticipating Explanations in Relative Clause Processing

PubMed Central

Rohde, H.; Levy, R.; Kehler, A.

2011-01-01

We show that comprehenders’ expectations about upcoming discourse coherence relations influence the resolution of local structural ambiguity. We employ cases in which two clauses share both a syntactic relationship and a discourse relationship, and hence in which syntactic and discourse processing might be expected to interact. An off-line sentence-completion study and an on-line self-paced reading study examined readers’ expectations for high/low relative clause attachments following implicit-causality and non-implicit-causality verbs (John detests/babysits the children of the musician who…). In the off-line study, the widely reported low-attachment preference for English is observed in the non-implicit causality condition, but this preference gives way to more high attachments in the implicit causality condition in cases in which (i) the verb’s causally implicated referent occupies the high-attachment position and (ii) the relative clause provides an explanation for the event described by the matrix clause (e.g., …who are arrogant and rude). In the on-line study, a similar preference for high attachment emerges in the implicit causality context—crucially, before the occurrence of any linguistic evidence that the RC does in fact provide an explanation—whereas the low-attachment preference is consistent elsewhere. These findings constitute the first demonstration that expectations about ensuing discourse coherence relationships can elicit full reversals in syntactic attachment preferences, and that these discourse-level expectations can affect on-line disambiguation as rapidly as lexical and morphosyntactic cues. PMID:21216396

Neural pathways from thalamus associated with regulation of aggressive behavior.

PubMed

Bandler, R J; Flynn, J P

1974-01-11

Small electrolytic lesions were made through electrodes in the thalamus of cats at sites where electrical stimulation elicited attack on a rat. Staining by modified Nauta reduced silver methods revealed that significant degeneration passed caudally from the lesions and entered the midbrain dorsal central gray region. Electrical stimulation of this dorsal midbrain region elicited attack on a rat, and destruction of this region suppressed the attack elicited by thalamic stimulation.

A Step-Wise Approach to Elicit Triangular Distributions

NASA Technical Reports Server (NTRS)

Greenberg, Marc W.

2013-01-01

Adapt/combine known methods to demonstrate an expert judgment elicitation process that: 1.Models expert's inputs as a triangular distribution, 2.Incorporates techniques to account for expert bias and 3.Is structured in a way to help justify expert's inputs. This paper will show one way of "extracting" expert opinion for estimating purposes. Nevertheless, as with most subjective methods, there are many ways to do this.

Integrating cobenefits produced with water quality BMPs into credits markets: Conceptualization and experimental illustration for EPRI's Ohio River Basin Trading

NASA Astrophysics Data System (ADS)

Liu, Pengfei; Swallow, Stephen K.

2016-05-01

This paper develops a method that incorporates the public value for environmental cobenefits when a conservation buyer can purchase water quality credits based on nonmarket valuation results. We demonstrate this approach through an experiment with adult students in a classroom laboratory environment. Our application contributes to the study of individual preference and willingness to pay for cobenefits associated with the production of water quality credits in relation to the Ohio River Basin Trading Project. We use three different methods to elicit individuals' willingness to pay (WTP), including (1) a hypothetical referendum, (2) a real referendum lacking incentive compatibility, and (3) a real choice with incentive compatibility. Methodologically, our WTP estimates suggest individuals are more sensitive to the cost changes and reveal the lowest value in the real choice with incentive compatibility. Practically, we find individuals value certain cobenefits and credits as public goods. Incorporating public value toward cobenefits may improve the overall efficiency of a water quality trading market. Based on our specification of a planner's welfare function, results suggest a substantial welfare improvement after identifying an optimal allocation of a buyer's budget across credits derived from agricultural management practices producing different portfolios of cobenefits.

Interactive graphics to demonstrate health risks: formative development and qualitative evaluation

PubMed Central

Ancker, Jessica S.; Chan, Connie; Kukafka, Rita

2015-01-01

Background Recent findings suggest that interactive game-like graphics might be useful in communicating probabilities. We developed a prototype for a risk communication module, focusing on eliciting users’ preferences for different interactive graphics and assessing usability and user interpretations. Methods Focus groups and iterative design methods. Results Feedback from five focus groups was used to design the graphics. The final version displayed a matrix of square buttons; clicking on any button allowed the user to see whether the stick figure underneath was affected by the health outcome. When participants used this interaction to learn about a risk, they expressed more emotional responses, both positive and negative, than when viewing any static graphic or numerical description of a risk. Their responses included relief about small risks and concern about large risks. The groups also commented on static graphics: arranging the figures affected by disease randomly throughout a group of figures made it more difficult to judge the proportion affected but was described as more realistic. Conclusions Interactive graphics appear to have potential for expressing risk magnitude as well as the affective feeling of risk. Quantitative studies are planned to assess the effect on perceived risks and estimated risk magnitudes. PMID:19657926