Source Of Advice Research Articles

The Paradox of Algorithms and Blame on Public Decision-makers

AbstractPublic decision-makers incorporate algorithm decision aids, often developed by private businesses, into the policy process, in part, as a method for justifying difficult decisions. Ethicists have worried that over-trust in algorithm advice and concerns about punishment if departing from an algorithm’s recommendation will result in over-reliance and harm democratic accountability. We test these concerns in a set of two pre-registered survey experiments in the judicial context conducted on three representative U.S. samples. The results show no support for the hypothesized blame dynamics, regardless of whether the judge agrees or disagrees with the algorithm. Algorithms, moreover, do not have a significant impact relative to other sources of advice. Respondents who are generally more trusting of elites assign greater blame to the decision-maker when they disagree with the algorithm, and they assign more blame when they think the decision-maker is abdicating their responsibility by agreeing with an algorithm.

Science Advisory to Governments and Regional/Sub-Regional Organizations in West and Central Africa

Science advice to governments and regional and sub-regional organizations in West and Central Africa has been reviewed. The objectives were to analyze its evolution and characterize the sources of advice. During the colonial period, it was by the colonial administrations and for their needs. At independence, in general, the new nations (particularly French speaking) entered into agreements with the former colonial powers to develop science, technology and innovation capacity for sustainable development. English speaking nations sought more partners outside the colonial experience. Colonial research institutes were increasingly transformed into national research institutes/institutions with national development mandates. Governments increasingly turned to science advice from consultants, inter- ministerial committees, advisory bodies, ad hoc experts’ groups, or a combination of these. Regional/sub-regional organizations sought advice from consultants, ad hoc technical experts’ groups, advisory bodies or a combination of these. Increasingly, science advice is delivered by Africans. Science advice by science academies is most rigorous. The arrival of more science academies, with varying links with governments, indicates that evidence-based science advice is growing in the region.

(033) Artificial Intelligence ChatGPT and GPT4 Performance on Male and Female Sexual Dysfunction, Sexually Transmitted Infection, and Male Factor Infertility in the 2019 to 2023 American Urological Association Self-Assessment Study Programs

Abstract Introduction Large Language Model (LLM) applications in Medicine are increasing. Chatbots ChatGPT and GPT4 were tested against medical exams. The vetting of these tests as a source of information for both the patient and physician is needed. A credible source of medical information may be used as the gold standard against which the LLM can be tested. Objective We assess the performance of ChatGPT and GPT4 to answer the American Urological Association (AUA) Self-Assessment Study Program (SASP) questions on male sexual dysfunction (MSD), female sexual dysfunction (FSD), sexually transmitted infection (STI), and male factor infertility (MFI). We aim to find out how credible this LLM is as a source of medical advice. Methods Four registered users of the SASP identified the questions using open book mode in tests from 2019 to 2023, spanning their subscriptions. The questions were ranked for difficulty on a five-point Likert scale. OpenAI ChatGPT 3.5 and GPT4 were used to answer the questions. The GPT program was set to turn off chat history. No plug-ins or feedback were permitted. Prompts were generated from question stems masking question ID and adding the phrase "I am a urologist preparing for my board exam. Please answer the following question:" Images were deleted from questions and substituted with a brief description. All questions were answered separately, first using GPT-4 and then ChatGPT. Three consecutive responses were generated for each prompt, and the consensus answer was tallied. Answers were compared between GPT and provided answer key of SASP. Descriptive statistics, chi-Pearson Chi-square, and Fisher's exact tests were applied. Results We identified 115 questions in the domains of sexual dysfunction, STI, and MFI. Only one question had an associated image. GPT4 performed better than ChatGPT in all domains, providing correct answers of 60% versus 40% (p=0.000). A total of 89.9% of correct answers were three times unanimously regenerated by GPT4 (p=0.007) and 67.4% by ChatGPT (p=0.244). Within each domain, there was no significant difference in the correct answers for each chatbot (Table-1) or test year (p=0.682). The SASP source reference answers were Campbell's Urology only in 38.3 %, AUA guidelines only in 17.4%, AUA core curriculum only in 10.4%, and combinations with other sources in 33.9%. There was no significant association of source reference with the correct answers of GPT4 (p=0.058) or ChatGPT (p=0.451). Only 19.1% were open-access sources, 20% were partially open-access, and 60.9% were restricted to subscribers. The availability of the source did not significantly affect the correct answers of GPT4 (p=0.272) or ChatGPT (p=0.231). Both chatbots' correct answers were associated significantly with easier questions (Table-2). Conclusions The LLM tested has an average accuracy as a source of credible medical information on Sexual dysfunction, STI, and MFI. GPT4 performs better than ChatGPT, especially when there is a unanimous regenerated response. The development of a better model to serve a broader group of physicians and patients will require training of the chatbot on credible urology literature that includes the currently 81% restricted sources. Disclosure No.

Debunking Mental Health Misperceptions in Short-Form Social Media Videos: An Experimental Test of Scientific Credibility Cues

ABSTRACT In recent years, short-form social media videos have emerged as an important source of health-related advice. In this study, we investigate whether experts or ordinary users in such videos are more effective in debunking the common misperception that talking about suicide should be avoided. We also explore a new trend on TikTok and other platforms, in which users attempt to back up their arguments by displaying scientific articles in the background of their videos. To test the effect of source type (expert vs. ordinary user) and scientific references (present or absent), we conducted a 2 × 2 between-subject plus control group experiment (n = 956). In each condition, participants were shown a TikTok video that was approximately 30 seconds long. Our findings show that in all four treatment groups, participants reduced their misperceptions on the topic. The expert was rated as being more authoritative on the topic compared to the ordinary user. However, the expert was also rated as being less credible compared to the ordinary user. The inclusion of a scientific reference did not make a difference. Thus, both experts and ordinary users may be similarly persuasive in a short-form video environment.

Evaluating source credibility effects in health labelling using vending machines in a hospital setting.

Providing advice to consumers in the form of labelling may mitigate the increased availability and low cost of foods that contribute to the obesity problem. Our objective was to test whether making the source of the health advice on the label more credible makes labelling more effective. Vending machines in different locations were stocked with healthy and unhealthy products in a hospital. Healthy products were randomly assigned to one of three conditions (i) a control condition in which no labelling was present (ii) a low source credibility label, "Lighter choices", and (iii) a high source credibility label that included the UK National Health Service (NHS) logo and name, "NHS lighter choices". Unhealthy products received no labelling. The outcome measure was sales volume. There were no main effects of labelling. However, there were significant interactions between labelling, vending machine location and payment type. For one location and payment type, sales of products increased in the high credibility label condition compared to control, particularly for unhealthy products, contrary to expectations. Our findings suggest that high source credibility health labels (NHS endorsement) on food either have little effect, or worse, can "backfire" and lead to effects opposite to those intended. The primary limitations are the limited range of source credibility labels and the scale of the study.

Algorithms in selection decisions: Effective, but unappreciated

AbstractSelection decisions are often affected by irrelevant variables such as gender or race. People can discount this irrelevant information by adjusting their predictions accordingly, yet they fail to do so intuitively. In five online studies (N = 1077), participants were asked to make selection decisions in which the selection test was affected by irrelevant attributes. We examined whether in such decisions people are willing to be advised by algorithms, human advisors or prefer to decide without advice. We found that people fail to adjust for irrelevant information by themselves, and those who received advice from an algorithm or human advisor made better decisions. Interestingly, although most participants stated they prefer advice from human advisors, they tend to rely equally on algorithms in actual selection tasks. The sole exception is when they are forced to choose between an algorithm and a human advisor. In that case, they pick human advisors. We conclude that while algorithms may not be people's preferred source of advice in selection decisions, they are equally useful and can be implemented.

Hukum Meratapi Mayit Menurut Ḥadīṡ Riwayat Al-Bukhārī Nomor 1226: Kajian Ma’ān Al-Hadis

Death is either the opposite of life or its absence. One of Allah's unexpected wills is death. Rasūlullāh Ṛaw's instructions on how to care for a corpse are the best sources of advice and direction. The Prophet Ṣaw gave guidance, namely on how family members and other relatives should handle the deceased. In order for living people to take care of the body after someone has passed away, some things need to be done right away. Nevertheless, there are several exceptions made by Muslims to the proper ways to handle corpses, meaning that a significant portion of Muslims are ignorant of the protocol in dealing with corpses in accordance with the teachings of Rasūlullāh Ṣaw. This research aims to find out how ḥadīṡ about mourning the dead in the history of al-Bukhārī number 1226, the perspective of ma'ān al-Ḥadīṡ and its understanding. This type of research is qualitative research. In understanding ḥadīṡ, several approaches are used, including linguistic, anthropological and socio-historical approaches. The result that the author found was that mourning for the dead in Islam is not permitted. If you are just crying as a natural expression of sadness, don't scratch your face, tear your clothes, pull your hair and loudly wail because Rasūlullāh Ṣaw never exemplified this. The corpse that is tortured in the ḥadīṡ is if during his lifetime he made a will to his family so that when he died the family would mourn his passing, whereas if he did not make a will during his lifetime, he would not be tortured because of his family's cries as intended in the ḥadīṡ.

Trust in COVID-19 information sources and vaccination status: Exploring social inequalities and differences within the four United Kingdom nations using a representative survey.

To explore how the use of, and trust in, different sources of advice and information on COVID-19 differed across the four UK nations and between different sociodemographic groups and their associations with COVID-19 vaccination status. We used a UK-wide representative survey conducted in July 2021, which included data on uptake of COVID-19 vaccination, trust in information sources, use of sources and geographical and sociodemographic variables. We used multivariate logistic regression to identify factors associated with completed or planned COVID-19 vaccination. Trust in the NHS, followed by trust in scientists, were the strongest predictors of vaccination intention. NHS websites were the most used (56% across the UK); only the Scottish government website had a higher level of reported use (58%). Using either source was associated with a positive vaccination status as were use of the GP and television as sources of advice. Use of social media, family and friends, and 'none' of the sources enquired about, were all linked to a lower likelihood of being or intending to get vaccinated. Compared to those in England, respondents in other UK nations were less likely to trust the central UK government for advice on COVID-19. There was considerable variation by age in trust and use of some, but not all, sources of advice, with predicted probabilities ranging from 35% among the youngest age group to 62% among those aged 65years or older. There were also significant differences by annual household income and by occupational class for trust in government, with higher incomes correlating with greater likelihood of trust. This study demonstrates high levels of trust in the key sources of public health advice and there was a positive association between using official sources of advice and vaccination intentions, even in the context of overall high vaccination rates. Our findings highlight the need for the UK and devolved governments to value the importance of public trust in the health system and take appropriate measures to avoid undermining such trust.

"She Couldn't Say the Word Penis": Experiences of 2SLGBTQ+ People with Developmental and Intellectual Disabilities with Sex Education in Alberta, Canada.

This exploratory qualitative study sought to better understand the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ+) disabled people when learning about sexuality, sexual orientation, and gender identity. We conducted 31 semi-structured, in-depth interviews with adults labeled/with developmental and intellectual disabilities in Alberta, Canada. Findings showed a significant lack of comprehensive sex education available to 2SLGBTQ+ disabled people. Sexual and gender identities were rarely discussed in formal school-based education settings and most parents and caregivers did not feel comfortable addressing these topics either. As a result, many participants had to do their own research and use other sources for information and advice. Participants then provided recommendations in terms of what they wish they had learned in sex education as well as potentially effective ways of delivering that content to disabled people.

Fine for others but not for me: The role of perspective in patients’ perception of artificial intelligence in online medical platforms

In the near future, online medical platforms enabled by artificial intelligence (AI) technology will become increasingly more prevalent, allowing patients to use them directly without having to consult a human doctor. However, there is still little research from the patient's perspective on such AI-enabled tools. We, therefore, conducted a preregistered 2x3 between-subjects experiment (N = 266) to examine the influence of perspective (oneself vs. average person) and source of advice (AI vs. male physician vs. female physician) on the perception of a medical diagnosis and corresponding treatment recommendations. Results of robust ANOVAs showed a statistically significant interaction between the source of advice and perspective for all three dependent variables (i.e., evaluation of the diagnosis, evaluation of the treatment recommendation, and risk perception). People prefer the advice of human doctors to an AI when it comes to their own situation. In contrast, the participants made no differences between the sources of medical advice when it comes to assessing the situation of an average person. Our study contributes to a better understanding of the patient's perspective of modern digital health technology. As our findings suggest the perception of AI-enabled diagnostic tools is more critical when it comes to oneself, future research should examine the relevant factors that influence this perception.

Evaluating the Applicability and Appropriateness of ChatGPT as a Source for Tailored Nutrition Advice: A Multi-Scenario Study

Background: In the rapidly evolving domain of healthcare technology, the integration of advanced computational models has opened up new possibilities for personalized nutrition guidance. The emergence of sophisticated language models, such as Chat Generative Pre-training Transformer (ChatGPT), offers potential in providing interactive and tailored dietary advice. However, concerns remain about the applicability and appropriateness of ChatGPT's recommendations, especially for those with distinct health conditions. Objectives: This study aimed to evaluate the reliability of ChatGPT as a source of nutritional advice. Methods: Three hypothetical scenarios representing various health conditions were presented alongside precise dietary requirements. ChatGPT was tasked to generate personalized dietary programs, encompassing meal timing, specific caloric portions (measured in grams and spoons), as well as alternative meal options for each scenario. Following this, ChatGPT’s generated dietary programs underwent a thorough review by a multidisciplinary team of nutritionist, specialist physicians and clinical researchers. The evaluation focused on the programs' suitability, alignment with dietary standards, consideration of individual health factors, and additional guidance Safety. Results: ChatGPT demonstrated its ability to generate various options of meal plans in accordance with basic nutrition principles. However, there are apparent issues with the recommended individual macronutrient distribution, handling health conditions, drug interactions, and setting realistic weight loss goals. Conclusions: While ChatGPT exhibits promise as a dietary program generator, its application for intervention should be restricted to certified nutrition professionals. Until July 2023, it is not advisable for patients to engage in self-prescription using ChatGPT version 3.5, owing to its inability to provide professional knowledge and acceptable guidance, particularly for individuals with co-existing conditions. The prevailing absence of clinical reasoning highlights the importance of employing ChatGPT solely as a tool, rather than relying on it as an autonomous decision-maker. Its lack of clinical reasoning highlighted the need for human intervention and expert collaboration for precise personalized evaluations.

Physical activity in Parkinson's disease: examining prescription sources, patterns, and the influence of quality of life and disease severity.

Limited research has explored the influence of quality of life (QoL) and disease severity on physical activity (PA) in Parkinson's disease (PD) patients, and the sources of PA prescription and advice for this population. This study aims to expand scientific knowledge on these topics. Two-hundred eleven PD patients were personally interviewed to collect data on PA levels using the International Physical Activity Questionnaire-Short Form and QoL using the Parkinson's Disease Questionnaire-8. An ad hoc questionnaire gathered information on disease severity (Hoehn and Yahr stages), PA behaviors, and PA recommendations. Weak but significant associations were found between PA levels, disease severity (r: -0.218; p = 0.004), and QoL (r: -0.244; p = 0.001). Most participants (85%) received PA counselling, predominantly from neurologists, either at diagnosis (52%) or shortly after (28%). Before PD onset, ~86% engaged in PA, decreasing to 66% post-diagnosis. Approximately 78% reported changes in PA, including reduced frequency (18.4%) and duration (32.8%), with walking as the primary activity. Disease severity and QoL significantly affect PA levels in PD patients. Diagnosis is associated with decreased PA frequency and duration, and walking is the preferred activity. Neurologists primarily provide PA advice.

Percepcija roditeljske podrške u karijernom razvoju učenika sa intelektualnom ometenošću

Introduction. Parents are the primary source of advice, information, and mediation in children's career development. For persons with intellectual disabilities, parental support is necessary during all stages of career development, and it is especially important in the period of vocational education. Objectives. The main goal of the paper was to determine how students with intellectual disabilities perceived their parents' support during education for a chosen occupation, with special attention to some factors of the family and school environments. Methodes. The sample consisted of 155 participants with mild intellectual disability undergoing professional training in schools for students with developmental disabilities. The Career-Related Parental Support Scale was used in the research. It was designed to assess adolescent perceptions of parental support across the domains of instrumental assistance, emotional support, verbal encouragement, and career-related modeling. Results. In the sample as a whole, the participants perceived the greatest parental support in the domain of verbal encouragement and the least in career-related modeling. Greater support from their parents in career development was perceived by those who lived in a family environment with both parents, as well as those whose parents were more educated, compared to students of senior classes and those who achieved excellent results, while no differences were found in relation to the gender. Conclusion. The analysis of the obtained results indicated certain deficiencies in the field of career guidance and counseling of students with intellectual disabilities. The obtained findings point to the need to improve cooperation with students' families in this field and empower them in relation to the ways in which they can contribute to the career success of children. Also, the necessity of expanding knowledge in the field of career development for a deeper understanding of the key problems in this field was highlighted.

How Online Consumers Use Multiple Advice Sources: An Empirical Exploration Using Verbal Protocol Analysis

With more online stores providing recommendations and reviews simultaneously from multiple advice sources—such as recommendation agents, other consumers, and experts—consumers are facing the challenge of deciding how to use wide-ranging and possibly conflicting sets of information to improve their product selection. Although previous studies have investigated the classical decision-making strategies used in preferential choice problems, most of these are not directly applicable to multiple advice source environments. In addition, since most of these studies have mainly focused on a variance model rather than a process model, they cannot fully explain how decision makers reach their product selection decisions. To shed light on the processes that online consumers use in making product selections when using multiple advice sources, this study: (1) explores if, how, and when consumers use consistency as a part of their decision-making strategies through developing process models; (2) identifies the consistency strategies utilized when using multiple advice sources; and (3) proposes a new consistency-based decision-making model. Through concurrent verbal protocol analysis, we identified four consistency strategies and found that the use of consistency strategies increases decision quality more than traditional nonconsistency strategies. Our findings are triangulated through the theoretical lens of cognitive dissonance theory, information search process model, and confirmation bias for rigorous validation. We also describe the theoretical and practical implications of our findings.

Scientizing the 'environment': Solly Zuckerman and the idea of the School of Environmental Sciences.

In 1960 Sir Solly Zuckerman proposed the idea of an interdisciplinary department of 'environmental sciences' (ENV) for the newly established University of East Anglia (UEA). Prior to this point, the concept of 'environmental sciences' was little known: since then, departments and degree courses have rapidly proliferated through universities and colleges around the globe. This paper draws on archival research to explore the conditions and contexts that led to the proposal of a new and interdisciplinary grouping of sciences by Zuckerman. It argues that the activities of Zuckerman and other scientists in Britain during the Second World War and in the post-war period helped to create fertile conditions for a new kind of scientific authority to emerge as a tool of governance and source of policy advice. In particular, the specific challenges of post-war Britain - as addressed through scientific advisers and civil servants - led to the 'environment' becoming both the subject of sustained scientific study and an object of concern.

Support group or transgender lobby? Representing Mermaids in the British press

ABSTRACT This article examines representations of Mermaids, a charity that supports trans young people and their families, in the British press. Using corpus-assisted critical discourse analysis, we identify and chart patterns in reporting between Mermaids’ inception as a charity in 2015, and 2022, a turbulent year for both the charity and trans people in the UK more generally. The findings show that, in the early years, there is relatively little attention to Mermaids in the press. Where they are mentioned, the charity is represented as a useful source of advice and support, and their service users as happy and united. However, 2018 represents a turning point, with increasingly negative and misleading portrayals of Mermaids coinciding with a rise in public interest and funding. By 2019, media interest in the charity has surged and the impression of Mermaids as a support group for families is supplanted by the image of a powerful, dangerous and controversial organisation. We argue that the increasingly excessive, negative and polarised reporting around Mermaids is a strategy for indirectly delegitimising and attacking the lives of trans young people themselves. In a burgeoning culture war, Mermaids is used as a weapon against the very people they seek to support.

Who Australasians trusted during COVID-19: lessons from the pandemic response.

Public trust in authoritative information sources is a key element of a successful public health response to a pandemic. This study investigated which sources of COVID-19 advice were most trusted by a primarily New Zealand-based cohort and considers implications for policy and practice regarding future pandemics. Data were from a COVID-19 vaccine intention survey presented to Australia- and New Zealand-based members of the longitudinal Dunedin Study (n=832) between ages 48 and 49, immediately before vaccines became available for the general population within New Zealand. We assessed participants' trust in specific sources of COVID-19 advice and investigated whether the pattern of responses differed by sex, socio-economic status (SES) or education. Doctors and healthcare providers were the most trusted source of COVID-19 advice, over and above other institutional sources. This pattern was consistent across sex, SES and education. Institutional experts were trusted significantly more by those with higher SES compared to those with lower SES, and by those with formal qualifications compared to those without formal qualifications. Our findings suggest that it is important to empower healthcare providers early in a pandemic to share advice with the public alongside other trusted sources, such as the government.

Austerity, Health and Public Safety in Low-Income Neighborhoods: Grassroots Responses to the Decline of Local Services in Southeast England

This article uses ethnographic and qualitative research to explore the health implications and social responses of a low-income neighborhood in Southeast England, to more than a decade of austerity policies and declining institutional and welfare support. Findings examine how cuts to public services and welfare programs alongside changes to the area’s social structure shape resident’s perceptions of health risks and threats. Residents pointed to poor levels of mental health that were exacerbated by financial insecurity, the closure of community facilities and difficulties accessing support and professional help. An increase in social disorder and sense of danger within the vicinity were attributed to changes in the area’s social composition and a reduction of policing in the neighborhood, which were an additional cause of anxiety for residents. Many people felt their neighborhood was treated inequitably with regard to law-and-order, health provision and other services designed to address health problems and risks and dangers in their social environment. This institutional vacuum generates unmet health needs facilitating informal practices and methods for managing health, such as through self-provision or using alternative, and more readily available, sources of medical advice and treatment. The demise of older forms of social control and surveillance that ran parallel with closure of the area’s communal spaces had been partly compensated by social media usage, while informal methods of policing were a growing presence in the neighborhood in reaction to rising lawlessness and the ineffectiveness of police and local authorities.

Prevalence and Determinants of Self-medication among Attendants of Primary Health Care Centers in Abha City, Saudi Arabia

Objectives: To determine the prevalence and determinants of self-medication practices among attendants of primary healthcare centers (PHCCs) in Abha City, Saudi Arabia. Methods: The researchers interviewed 400 patients attending Al-Numees PHCC. A data collection sheet was constructed for data collection, which comprised participants’ personal features and self-medication practices. Results: About one-third of participants practiced self-medication during the last year, mostly 1-3 times (22.5%). The main motive toward self-medication was a previous positive personal experience with the medication (31.4%), while the main complaint was having minor ailments (41.5%). Analgesics were mainly sought (47.9%), with pharmacists being the main advice providers (50.2%). The condition of 70.7% improved after self-medication. Self-medication was significantly more practiced by older participants (p=0.028), males (p=0.016), Saudis (p=0.001), and both illiterate and university-educated participants than others (p=0.018). It was also significantly influenced by participants’ occupation, being highest among retired participants (100%). Conclusions: Self-medication is commonly practiced in Abha City, mainly due to having prior experience. It is mainly practiced when having a minor ailment. Analgesics are the most frequently purchased drugs for self-medication. Pharmacists are the main source of advice for self-medication. Determinants of more practice of self-medication include older age, male gender, Saudi nationality, and educational level. Key Words: Self-medication; prevalence; primary health care.

Brief lifestyle advice in cardiac care: an experimental study on message source and framing.

Communicating risk information and offering lifestyle advice are important goals in cardiac rehabilitation. However, the most effective way and the most effective source to communicate this information are not yet known. Therefore, we examined the effect of source (cardiologist, physiotherapist) and framing (gain, loss) of brief lifestyle advice on patients' intention-to-change-lifestyle. In an online experimental study, 636 cardiac patients (40% female, 67(10)yrs.) were randomly assigned to one of four textual vignettes. Effect of source and framing on intention-to-change-lifestyle (assessed using a5-point Likert scale) was analysed using analysis of covariance (ANCOVA). Patients expressed positive intention-to-change-lifestyle after receiving advice from the cardiologist (M = 4.1) and physiotherapist (M = 3.9). However, patients showed significantly higher intention-to-change-lifestyle after receiving advice from the cardiologist (0.58 [0.54-0.61]) when compared with the physiotherapist (0.52 [0.48-0.56]), (F[1,609] = 7.06, P = 0.01). Gain-framed and loss-framed advice appeared equally effective. However, communicating risks (loss) was remembered by only 9% of patients, whereas 89% remembered benefits (gain). Our study shows the value of cardiologists and physiotherapists communicating brief lifestyle advice, as cardiac patients expressed positive intention for lifestyle change after receiving advice, irrespective of framing. Lifestyle advice should include benefits due to better recall.