Decision-making Process Research Articles

Living with peripartum cardiomyopathy: A statement from the Heart Failure Association and the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology.

This statement focuses on the fact that women with peripartum cardiomyopathy (PPCM) have a substantial mortality and morbidity rate. Less than 50% of patients have full recovery of their cardiac function within 6 months of diagnosis. Also, patients with recovered cardiac function often suffer from comorbidities, such as hypertension or arrhythmias, which require long-term treatment. This has major implications which extend beyond the life of the patient, as it may also substantially impact her family. Women with a new diagnosis of PPCM should be involved in the decision-making processes regarding therapies, e.g. the recommendation to abstain from breastfeeding, or the use of cardiac implantable electronic devices. Women living with PPCM face the uncertainty of not knowing for some time whether their cardiac function will recover to allow them a near-to-normal life expectancy. This not only impacts their ability to work, which may have financial implications, but may also affect mental health and quality of life for the extended family. Women living with PPCM must be informed that a future pregnancy always carries a substantial risk and, in case of poor cardiac recovery, is associated with a high morbidity and mortality. Patients with PPCM are best managed by an interdisciplinary and multiprofessional approach including e.g. a cardiologist, a gynaecologist, nurses, a psychologist, and social workers. The scope of this document encompasses contemporary challenges and approaches for the management of women diagnosed with PPCM.

Latest knowledge on a comprehensive understanding of cervical deformity and selection of effective treatment methods using recent classification systems: a narrative review.

Surgical treatment for patients with cervical spine deformities is challenging for both patients and doctors. For successful surgical treatment, mastery of processes is important to objectively evaluate and classify the degree of deformity. Recently, efforts have been increasing to systematically understand, evaluate, and effectively treat complex cervical spine deformities. Various parameters are being developed to quantify and objectively evaluate the degree of cervical spine deformity, and classification methods are being introduced to help establish the treatment scope by categorizing it according to the degree of deformity. However, a comprehensive and systematic understanding of complex deformities using only the currently introduced classification methods and related knowledge is not easy. Through this review, we aimed to introduce various classification methods and their pros and cons to evaluate cervical deformities, analyze their meaning, and provide a basic understanding of the evaluation and classification of patients with cervical spine deformities. This review also aimed to aid in the decision-making process for the treatment of cervical spine deformities by presenting a structured treatment algorithm based on recently known classification systems and lay the foundation for efficient treatment.

Exploring the motivations and career choices of expatriate teachers in international schools: Embracing personal growth, professional development, and teacher autonomy

The worldwide growth of international schools has prompted increasing interest in the growing body of expatriate teachers who choose to work in them. The decision to work internationally is complex, encompassing both push and pull factors that change throughout a teacher's career. This qualitative study explores the motivations and career choices of 20 international school teachers. Through a reflexive thematic analysis, we identified two primary themes in teachers' accounts of their decisions: personal growth and professional identity. The theme of travel, learning, and personal growth captures motivations typically related to travel and adventure that drive the decision to work internationally, including the opportunity to travel and experience new cultures, develop global mindedness, and learn more about the wider world. The theme of professional development and teacher autonomy explores participants' motivations related to the opportunities to teach in ways that are professionally fulfilling in international schools, which often provide freedom from what are perceived to be constrained or limited opportunities in the educational systems of participants' home countries. The study also explores how the evolution of teachers' decision-making processes and motivations evolved throughout their careers, revealing a transition from initial, somewhat random moves overseas to subsequent, more strategic moves aligned with higher expectations around professionalism and autonomy. These findings highlight the complex interplay of changing personal and professional aspirations that influence teachers' decisions to work in international school contexts. This study offers further empirical support for our understanding of international school teachers and critically engages with existing typologies of international school teacher motivation, informing recruitment and retention strategies, professional development programs, and educational policies.

Association Between Korean Adults' Electronic Health Literacy and Active Participation in Health Decision-Making.

This study aimed to investigate the association between Korean adults' electronic health literacy and active participation in health decision-making while communicating with healthcare providers. A total of 421 adults 18 years and older were recruited from a survey panel developed by a survey company and completed an online survey asking about individual characteristics and electronic health literacy. Data were analyzed using descriptive statistics, independent-samples t tests, analysis of variance, and binomial logistic regression analysis. In results, for every one-unit increase in electronic health literacy, the rate of active participation in health decision-making was likely to increase by 3.62 times compared with the rate of passive participation in health decision-making. It was also likely to increase in those with a college degree or higher, those who used both Web sites and YouTube, those who perceived online health information to be useful, those who actively participated as a patient, and those with a desire to actively participate as a patient. To encourage active participation in health-related situations or decision-making processes, educational programs or interventions to improve individuals' electronic health literacy are needed. Healthcare providers must ensure that individuals feel comfortable expressing their preferences, needs, and values.

Developing a rural paediatrician workforce: Using social network analysis to examine influence on reasons to go rural.

This pilot study examines how rural and remote junior doctors' career decisions are influenced by collegial relationships within the discipline of general paediatrics. Social network analysis (SNA) was undertaken by structured interviews with 10 paediatricians working in regional towns in Western Australia. UNICET software was used to determine the interactions between individual networks to look for overlap and common influencers. Ten rural paediatricians were interviewed. An individual was found to have key measures of centrality at the core of the entire social network of rural general paediatricians. This included a high degree of 'betweenness' (connections within social networks), and a high broker index (connections between separate areas of a network or between networks) demonstrated by that person combining three disconnected networks into a single coherent network. This central individual was a recently appointed consultant with links to senior paediatricians, peers and junior trainees, and may be instrumental in recruitment and retention in the rural paediatric workforce. Improving understanding of the impact of social networks, and decision-making processes that influence rural career choices, can inform innovative solutions to develop sustainable strategies for recruiting and retaining the rural paediatric workforce. Applying this model on a larger scale may provide more data to support evidence-based programmes that enable this within the Australian context.

Public value judgments about the criteria for reimbursement of medicines in South Korea

ABSTRACT Objectives This study quantified the public value (PV) of the criteria and sub-criteria in the current drug reimbursement systems in South Korea and examined sociodemographic factors that associated with PV. Methods The Analytic Hierarchy Process (AHP) was used to quantify the PVs of criteria and sub-criteria. We developed a questionnaire to generate pairwise comparison matrices among criteria and sub-criteria. From 27 March to 1 April 2023, we recruited 1,000 study participants using a quota sampling method stratified by age, sex, and region based on Korean census data. Results The PVs for the criteria were highest for clinical usefulness (28.5%), followed by cost-effectiveness (27.1%), budget impact (24.3%), and reimbursement in other countries (20.1%). The sociodemographic characteristics of the participants had a significant impact on the PVs of the criteria. Willingness to pay additional premiums for national health insurance was negatively associated with PV for clinical usefulness and cost-effectiveness and positively associated with PV for reimbursement in other countries. Conclusions The public prioritized clinical usefulness and cost-effectiveness as the main criteria. However, the PVs of the criteria were divergent and associated with sociodemographic factors. Divergent public interests require an evidence-informed deliberative process for reimbursement decisions.

Learning obstacle avoidance and predation in complex reef environments with deep reinforcement learning

The reef ecosystem plays a vital role as a habitat for fish species with limited swimming capabilities, serving not only as a sanctuary and food source but also influencing their behavioral tendencies. Understanding the intricate mechanism through which fish adeptly navigate the moving targets within reef environments within complex water flow, all while evading obstacles and maintaining stable postures, has remained a challenging and prominent subject in the realms of fish behavior, ecology, and biomimetics alike. An integrated simulation framework is used to investigate fish predation problems within intricate environments, combining deep reinforcement learning algorithms (DRL) with high-precision fluid-structure interaction numerical methods-immersed boundary lattice Boltzmann method (lB-LBM). The Soft Actor-Critic (SAC) algorithm is used to improve the intelligent fish's capacity for random exploration, tackling the multi-objective sparse reward challenge inherent in real-world scenarios. Additionally, a reward shaping method tailored to its action purposes has been developed, capable of capturing outcomes and trend characteristics effectively. The convergence and robustness advantages of the method elucidated in this paper are showcased through two case studies: one addressing fish capturing randomly moving targets in hydrostatic flow field, and the other focusing on fish counter-current foraging in reef environments to capture drifting food. A comprehensive analysis was conducted of the influence and significance of various reward types on the decision-making processes of intelligent fish within intricate environments.

Leveraging atmospheric moisture recycling in Saudi Arabia and neighboring countries for irrigation and afforestation planning

Effective irrigation planning is crucial for sustainable agricultural development and ecosystem restoration projects in arid regions. With respect to ambitious greening initiatives, Saudi Arabia is establishing a national strategy toward a more sustainable and eco-friendly future not only for itself but also for the broader Middle East region. Thus, comprehensively understanding the water cycle in the region is essential to identify the most suitable target locations for afforestation and reforestation while considering the potential role of irrigation. Herein, in addition to traditional pedoclimatic factors, we introduce a complementary consideration—“irrigation recycling.” Building on the well-established concept of atmospheric moisture recycling and taking advantage from an atmospheric trajectory dataset, we track the path of evaporated water from current or potential irrigated sites to the location where the evaporated water eventually falls as precipitation. Our analysis offers two key benefits. First, it helps pinpoint the regions in which and the periods during which water recycling is maximum within the country, aiding more precise calculations of the investment return value for irrigation infrastructures. Second, it helps identify the land-use change patterns that contribute to international efforts such as drought mitigation in East Africa as an example. We found that one-third of the actual precipitation in the current Saudi irrigated sites originated from evapotranspiration over land, mainly from Saudi Arabia and surrounding countries. Interestingly, most of the evapotranspiration from these irrigated sites will eventually fall somewhere over land (primarily in Iran). Controlling the seasonality and spatial distribution of the future irrigation expansion will allow controlling the atmospheric moisture recirculation in Saudi Arabia and nearby drought-prone regions such as Eastern Africa. The outcomes of this study will be the subject of future integrated assessments to account for the climatic feedbacks of the land-use change scenarios. At present, they provide crucial insights to support the decision-making process surrounding the Saudi and Middle East Green Initiatives. Further, the presented methodology offers a pragmatic framework that can be applied to similar greening projects for other regions, making it a viable and valuable approach for global sustainability programs.

A template and tutorial for preregistering studies using passive smartphone measures.

Passive smartphone measures hold significant potential and are increasingly employed in psychological and biomedical research to capture an individual's behavior. These measures involve the near-continuous and unobtrusive collection of data from smartphones without requiring active input from participants. For example, GPS sensors are used to determine the (social) context of a person, and accelerometers to measure movement. However, utilizing passive smartphone measures presents methodological challenges during data collection and analysis. Researchers must make multiple decisions when working with such measures, which can result in different conclusions. Unfortunately, the transparency of these decision-making processes is often lacking. The implementation of open science practices is only beginning to emerge in digital phenotyping studies and varies widely across studies. Well-intentioned researchers may fail to report on some decisions due to the variety of choices that must be made. To address this issue and enhance reproducibility in digital phenotyping studies, we propose the adoption of preregistration as a way forward. Although there have been some attempts to preregister digital phenotyping studies, a template for registering such studies is currently missing. This could be problematic due to the high level of complexity that requires a well-structured template. Therefore, our objective was to develop a preregistration template that is easy to use and understandable for researchers. Additionally, we explain this template and provide resources to assist researchers in making informed decisions regarding data collection, cleaning, and analysis. Overall, we aim to make researchers' choices explicit, enhance transparency, and elevate the standards for studies utilizing passive smartphone measures.

Careers after COVID: examining the influence of vocational anticipatory socialization on post-pandemic career values and choices of emerging adults in the United States

ABSTRACT The impact of the COVID-19 pandemic on society includes the careers and career decision-making of emerging adults. This impact could influence how emerging adults approach careers and work-life balance. Vocational anticipatory socialisation examines how sources of career information influence the career decision-making process. With the COVID-19 lockdown access to career sources was limited. The current study examines ways in which the career values of this post COVID-19 workforce in the United States have been impacted. An online survey was completed by 349 young/emerging adults. An examination of gender differences found the women to place work–life balance in higher regard than men post-COVID-19. However, male respondents now report interest in examining careers as first responders. Further, this generation reports a lack in socialisation information from the vocational anticipatory socialisation sources of part-time jobs, schools and peers which were unavailable during the pandemic.

Failure risk management: adaptive performance control and mission abort decisions.

The failure behavior of safety-critical systems typically depends on the system performance level, which offers opportunities to control system failure risk through dynamic performance adjustment. Moreover, mission abort serves as an intuitive way to mitigate safety hazards during mission execution. Our study focuses on systems that execute successive missions with random durations. To balance mission completion probability and system failure risk, we examine two decision problems: when to abort missions and how to select the performance level prior to mission abort. Our objective is to maximize the expected revenue through dynamic performance control and mission abort (PCMA) decisions. We consider condition-based PCMA decisions and formulate the joint optimization problem into a Markov decision process. We establish the monotonicity and concavity of the value function. Based on this insight, we show that optimizing the mission abort policy requires a series of control limits. In addition, we provide conditions under which the performance control policies are monotone. For comparative purposes, we analytically evaluate the performances of some heuristic policies. Finally, we present a case study involving unmanned aerial vehicles executing power line inspections. The results indicate the superiority of our proposed risk control policies in enhancing operational performance for safety-critical systems. Dynamic performance adjustment and mission abort decisions provide opportunities to reduce the failure risk and increase operational rewards of safety-criticalsystems.

Selective attention and decision-making have separable neural bases in space and time.

Attention and decision-making processes are fundamental to cognition. However, they are usually experimentally confounded, making it difficult to link neural observations to specific processes. Here we separated the effects of selective attention from the effects of decision-making on brain activity obtained from human participants (both sexes), using a two-stage task where the attended stimulus and decision were orthogonal and separated in time. Multivariate pattern analyses of multimodal neuroimaging data revealed the dynamics of perceptual and decision-related information coding through time (magnetoencephalography (MEG)), space (functional Magnetic Resonance Imaging (fMRI)), and their combination (MEG-fMRI fusion). Our MEG results showed an effect of attention before decision-making could begin, and fMRI results showed an attention effect in early visual and frontoparietal regions. Model-based MEG-fMRI fusion suggested that attention boosted stimulus information in frontoparietal and early visual regions before decision-making was possible. Together, our results suggest that attention affects neural stimulus representations in frontoparietal regions independent of decision-making.Significance statement Attention and decision-making processes are often experimentally confounded in neuroimaging studies, as participants are commonly asked to make categorical decisions about an attended stimulus only. Our study addresses this issue by separating the effects of selective attention from decision-making effects in human observers. We used multivariate pattern analyses to investigate the dynamics of perceptual and decision-related information coding through time (with MEG) and space (with fMRI) and applied a MEG-fMRI fusion analysis to combine data across neuroimaging modalities. Our results show that attention boosts stimulus information in frontoparietal and early visual regions before decision-making was possible. These findings provide an important verification of claims that attention modulates information processing in the brain and highlights the importance of separating these processes.

Quantitative assessment of urban sustainability perceptions in Lurin, Peru

In the current context, urban centres in Latin America are facing fundamental challenges in their endeavour for Sustainable Development. The focus of this study is the meticulous assessment of the perception of urban sustainability within the Lurín District of Peru. It introduces a system based on urban sustainability indicators, derived from social surveys and implements this system through linear regression models to discern their interrelations. The objective of the research is to quantify and evaluate essential elements linked to the management of natural resources, air and water quality, the advancement of sustainable mobility, education and the well-being of urban residents. By delineating these mathematical and statistical correlations amongst variables pertinent to urban sustainability, this study provides a robust framework for quantitative decision-making in the urban sphere. A methodology for the development of univariable and multivariable models has been demonstrated. Amongst the most important findings, it has been discovered that the variable Environmental Education System (SEA) is perceived as the least important and even negligible within the multivariable models. However, we believe this effect occurs because the impacts of education are perceived in the long term. This article contributes significantly to the academic discourse by providing a more nuanced understanding of the social perception of urban sustainability and its influence on policy formulation and decision-making processes in Latin America.

Enhancing procedural decision making with cone beam CT in renal artery embolization

Cone-beam computed tomography (CBCT) has proven to be a safe and effective adjunctive imaging tool for interventional radiology. Nevertheless, limited studies have examined the application of CBCT in renal artery embolization (RAE). The objective of this study is to evaluate the role of CBCT in intra-procedural decision-making for RAE. This multicenter retrospective study included 40 consecutive patients (age: 55.9 ± 16.5 years; male, 55%) who underwent CBCT during RAE from January 2019 to January 2023. The additional information provided by CBCT was classified into Category 1 (no additional information), Category 2 (more information without changing the treatment plan), and Category 3 (valuable information that led to a change in the treatment plan). CBCT did not add unique information for four patients (10%) classified as Category 1. CBCT clarified ambiguous angiographic findings and confirmed the existing treatment plan for 19 patients (47.5%) graded as Category 2; complex vascular anatomy was explained (n = 13), and a correlation between vascular territory and target lesion was established (n = 6). CBCT offered valuable information that was not visible on digital subtraction angiography and changed the treatment plan for 17 patients categorized as Category 3; a mismatch between the vascular territory and the target lesion led to the identification of alternative (n = 3) and additional feeders (n = 8); and the extent of embolization was reduced by using automatic feeder detection software (n = 6). CBCT is an efficient tool that aids in the decision-making process during the embolization procedure by providing supplementary imaging information. This additional information enables the confident identification of target vessels, facilitates superselective embolization, prevents non-target embolization, and helps locate missing feeders.

Role of remediation in cases of serious misconduct before UK healthcare regulators: a qualitative study

BackgroundThe raison d’etre of healthcare profession regulators across the globe is to protect patients and the public from the risk of harm. In cases of serious misconduct, remediation is deemed...

A micro-political exploration of the resignation of Hong Kong experienced kindergarten principals amidst preschool education coordinator turnover

The early childhood education system in Hong Kong operates within a corporate governance framework. However, there is a lack of research on the interaction between principalship and corporate governance in kindergartens and childcare centres. This study aims to address this gap by examining how a preschool education coordinator (PEC), working under corporate governance principles in a non-governmental organization (NGO), influenced the resignation decisions of principals. Using micro-political theory, this study examines power dynamics, conflicts, and decision-making processes that led to principals’ resignations. This phenomenological case study utilized a focus group discussion with three principals who had resigned from the NGO. Through thematic analysis, three key themes emerged from the study: changing governance and accountability, conflicting educational values and beliefs between the preschool education coordinator and the principals, and contrasting leadership behaviours and styles. The findings of this study have significant implications for the local community, as well as offering valuable insights that can inform and benefit international audiences interested in early childhood education leadership development and human resources management. As early childhood education systems worldwide grapple with similar challenges, understanding the relationship between corporate governance and principalship can help devise strategies for enhancing organizational effectiveness and ensuring principal retention.

Independent-channels models of temporal-order judgment revisited: A model comparison.

The perception of temporal order or simultaneity of stimuli is almost always explained in terms of independent-channels models, such as perceptual-moment, triggered-moment, and attention-switching models. Independent-channels models generally posit that stimuli are processed in separate peripheral channels and that their arrival-time difference at a central location is translated into an internal state of order (simultaneity) if it reaches (misses) a certain threshold. Non-monotonic and non-parallel psychometric functions in a ternary-response task provided critical evidence against a wide range of independent-channels models. However, two independent-channels models have been introduced in the last decades that can account for such shapes by considering misreports of internal states (response-error model) or by assuming that simultaneity and order judgments rely on distinct sensory and decisional processes (two-stage model). Based on previous ideas, we also consider a two-threshold model, according to which the same arrival-time difference may need to reach a higher threshold for order detection than for successiveness detection. All three models were fitted to various data sets collected over a period of more than a century. The two-threshold model provided the best balance between goodness of fit and parsimony. This preference for the two-threshold model over the two-stage model and the response-error model aligns well with several lines of evidence from cognitive modeling, psychophysics, mental chronometry, and psychophysiology. We conclude that the seemingly deviant shapes of psychometric functions can be explained within the framework of independent-channels models in a simpler way than previously assumed.

A Relative Projection-Based Multiattribute Group Decision-Making Model With Noncooperative Behavior Management and Application to NEV Supplier Selection.

This article reports a novel consensus model where a group of internal and external experts evaluate alternatives under multiple attributes and provide mutual evaluations. First, different from previous studies, the cognitive and interest conflicts of internal and external experts are considered simultaneously. But interest conflict is emphasized for internal experts, and cognitive conflict is mainly considered for external experts. Second, we explore the categorization and management methods of noncooperative behaviors (NCBs) of experts. The relative projection-based indexes are proposed for the first time to measure the degrees of cognitive and interest conflicts by using multiattribute preference matrices (MAPMs) and the weight vectors of attributes. A group of experts are divided into three categories and the corresponding management strategies are developed. Third, we investigate the consensus mechanism among experts with cognitive and interest conflicts. For reaching an acceptable consensus level, an adjustment process is proposed to revise some local entries in MAPMs and mutual evaluation matrix (MEM). A penalty mechanism is further established to dynamically update the weights of experts. An algorithm is designed to capture the consensus reaching process in multiattribute group decision making, where internal and external experts are distinguished by proposing a parameter. Finally, the high-performance battery supplier selection of new energy vehicle is studied to illustrate the proposed model. The results reveal that the efficiency of reaching consensus can be enhanced by using the developed model with effective management of NCBs.

Identifying locations for electric vehicle charging stations in urban areas through the application of multicriteria techniques

The incorporation of electric vehicles (EVs) into urban mobility is increasing daily, driving the need to incorporate urban charging stations (EVCSs) additionally. This study proposes a methodology for identifying adequate EVCS locations within an urban area. This methodology is based on the joint application of multicriteria decision-making methods (MCDMs) to solve urban planning problems related to the placement of EVCSs. As a starting point, the locations of the existing fossil fuel supply stations in each city are used as alternatives. The city of Cuenca, Ecuador, is used as a case study. Criteria and subcriteria have also been determined based on the available information and are used to propose three scenarios based on their value variation, which is established as preponderance weights. Among the results obtained, three alternatives scored better than the rest in most of the evaluations. As there was no conclusive result, a statistical analysis was conducted to strengthen the decision-making process and determine the most favourable potential locations.

The Impacts on Interorganizational Project Coordination: A Multiple Case Study on Large Railway Projects

Interorganizational transportation projects are increasingly difficult to manage because of a need to coordinate complex interdependencies pertaining to railway organizations with increasing levels of connectedness. In this article, the perceived dynamics of coordination mechanisms in the decision-making processes of interorganizational projects of the Dutch railway system are investigated. The results of this study suggest that the perceived effectiveness of interorganizational decision-making can be positively impacted during the pre-project phase, by emphasizing relational coordination. A reinforcing relationship between trust and mutual understanding among stakeholders by means of relational coordination mechanisms is one explored explanation.