Explicit Request Research Articles

Tipping Dilemma in Restaurants’ Age of Automation: Exploring the Role of Social Obligations, Explicit Requests, and Their Timing

ABSTRACT Despite the wide implementation of automated services (e.g. self-service kiosks and mobile checkouts) to optimize service efficiency, restaurant customers’ perceptions related to tipping in this context have received less attention. Two between-subject experiments were conducted among US consumers. The findings reveal that explicit tip requests increase unfairness perceptions when people feel more obliged to tip (Study 1), and for those who feel a higher obligation to tip, the unfairness perceptions are enhanced when the tip is requested before the service delivery (Study 2). This study enhances the existing literature on tipping behavior and service automation, additionally providing valuable insights for restaurant managers by offering guidelines for tip requests aimed at mitigating negative customer reactions such as perceptions of unfairness and decreased trust in the restaurant.

Формирование корпоративной культуры бережливого производства в современных условиях

The current stage of development of the national economy is associated with the formation of technological sovereignty of the country. Harsh sanctions, existing restrictions on access to certain market segments, digitalization and other challenges form an explicit request to Russian business to transform approaches to the organization of production, aimed primarily at increasing labor productivity, which is possible due to several main factors: the development of the production and technical base, maximizing the use of people-human capital and optimization of organizational factors. The first factor is quite costly and time-consuming in terms of implementation. The development of human and organizational factors can be carried out through lean production tools, the main problem of which is the significant resistance of personnel to new introductions. The work of foreign and domestic scientists and practitioners in the field of lean manufacturing and corporate culture has been studied, which allowed to formulate the author's definition of “corporate culture of lean production”, which allowed to develop a model of corporate culture of lean production at three levels of management (TOP, Middle, Down Management). The proposed model of transformation of the existing corporate culture into a corporate culture of lean production is considered in three planes with the designation of the stages of formation of a new corporate culture. It is noted that only voluntary adherence to a new ideology can maximize the effectiveness of innovations.

Examining support marshalling within an asynchronous online peer support forum for individuals affected by dementia.

Online support communities may provide individuals affected by dementia opportunities for reciprocal peer support, however, the support marshalling strategies employed and their success remain unclear. Analysis of 100 randomly selected conversation threads from the Dementia Support Forum indicated that 29% (29/100) of opening posts included a direct support marshalling strategy (i.e. explicit support request) compared with 54% (54/100) labelled as indirect, with the remainder not seeking support. Within the direct marshalling posts, informational support was the most frequently requested (n = 23), followed by network support (n = 7), emotional support (n = 5) and esteem support (n = 1) with analysis of subsequent posts confirming that the types of support requested were present within responses. Regardless of whether a direct or indirect strategy was used, most posts received a response, typically on the same day. Other response facets were comparable, apart from thread duration with conversations elicited through a direct strategy being longer (M = 39.71 vs 14.62 days).

Analogical reasoning during hypothesis generation: the effects of object and domain similarities on access and transfer

In two experiments on analogical hypothesis generation, we factorially manipulated the presence of domain and object similarities between a base situation and a target phenomenon, and assessed their effects on the transfer of the source’s explanatory structure before and after an indication to use the base analog as a source for analogical explanations. The absence of any kind of surface similarity led to very low rates of spontaneous transfer. In both experiments, however, either kind of surface similarity sufficed to enhance the spontaneous transfer of the base explanation during the formulation of plausible hypotheses for the target. The transfer advantage of object and domain similarity cannot be attributed to the effect of these variables on post-access processes, since experimental conditions did not differ with regard to the ability to transfer the base explanation upon explicit request. The effect of domain similarity on spontaneous analogical explanation constitutes a relevant finding, especially given the lack of attention received by this dimension of similarity in behavioural studies and computer simulations of analogical retrieval.

A taxonomy of demand-driven questions for use by evidence producers, intermediaries and decision-makers: results from a cross-sectional survey

BackgroundGlobally, a growing number of calls to formalize and strengthen evidence-support systems have been released, all of which emphasize the importance of evidence-informed decision making. To achieve this, it is critical that evidence producers and decision-makers interact, and that decision-makers’ evidence needs can be efficiently translated into questions to which evidence producers can respond. This paper aims to create a taxonomy of demand-driven questions for use by evidence producers, intermediaries (i.e., people working in between researchers and decision-makers) and decision-makers.MethodsWe conducted a global cross-sectional survey of units providing some type of evidence support at the explicit request of decision-makers. Unit representatives were invited to answer an online questionnaire where they were asked to provide a list of the questions that they have addressed through their evidence-support mechanism. Descriptive analyses were used to analyze the survey responses, while the questions collected from each unit were iteratively analyzed to create a mutually exclusive and collectively exhaustive list of types of questions that can be answered with some form of evidence.ResultsTwenty-nine individuals completed the questionnaire, and more than 250 submitted questions were analysed to create a taxonomy of 41 different types of demand-driven questions. These 41 questions were organized by the goal to be achieved, and the goals were grouped in the four decision-making stages (i) clarifying a societal problem, its causes and potential impacts; (ii) finding and selecting options to address a problem; (iii) implementing or scaling-up an option; and (iv) monitoring implementation and evaluating impacts.ConclusionThe mutually exclusive and collectively exhaustive list of demand-driven questions will help decision-makers (to ask and prioritize questions), evidence producers (to organize and present their work), and evidence-intermediaries (to connect evidence needs with evidence supply).

Crossing the line? Exploring situated, interactional negotiations of parental involvement in primary homework in England and Italy

AbstractPrimary school homework is a common practice internationally, historically viewed as an independent child activity, but more recently recognised as a family accomplishment. Parental involvement in homework has been principally discussed in relation to general and fixed typologies, with parent behaviours categorised into pre‐defined ‘types’. This paper challenges that framing by theorising homework as an interactional event. It illustrates that parental involvement is not simply determined by parents’ involvement ‘type’; rather, as an interactional exercise, homework is negotiated in‐the‐moment by parent and child, in linguistic, embodied and material ways. Based on a corpus of 74 video‐recorded homework sessions collected in England and Italy, and adopting discourse analysis, the article reveals that parents display their understanding of what counts as ‘appropriate involvement’ and, at the same time, locally negotiate this with their children, often adapting their involvement practices to meet children's explicit or implicit requests. We present this phenomenon as a ‘flexible line of involvement’ which can shift during each interaction, according to local negotiations embedded within the homework encounter. This shapes the unfolding event, as the parent's moment‐by‐moment responses to their child may result in them ‘crossing the line’. By demonstrating the locally negotiated fluidity of parental involvement, this article highlights the complexity of parent–child primary homework, moving beyond common assumptions that homework is either a lone child's activity, a task solely shaped by schools, or the result of fixed types of parental involvement.

Energy Efficiency Enhancement of Next Generation Mobile Systems- An Hybrid Approach

The surge in mobile users and online applications, particularly video streaming, is indeed fueling a significant increase in global data traffic. To accommodate this growth while ensuring fast data rates, it's crucial to optimize data transmission with limited resources. Balancing high data throughput with lower power consumption is essential for network efficiency without compromising Quality of Service (QoS). In our research, we focus on enhancing data transmission efficiency between base stations and multiple users. Our approach revolves around transmitting data only when there's a demand or explicit user request, a strategy aimed at conserving power. By doing so, we achieve substantial energy savings, leading to decreased energy consumption and improved energy efficiency. Central to our methodology is an optimized power control transmission mechanism. This ensures that data rates and QoS requirements are met while maximizing energy efficiency (EE). By dynamically adjusting power levels based on transmission needs, we strike an optimal balance between throughput and power consumption. Our findings underscore the significance of adaptive power control strategies in modern wireless networks. By intelligently managing resources and minimizing unnecessary transmissions, we pave the way for sustainable network growth and enhanced user experiences. DOI: https://doi.org/10.52783/jes.4768

Physicians’ views on the role of relatives in euthanasia and physician-assisted suicide decision-making: a mixed-methods study among physicians in the Netherlands

BackgroundRelatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails.MethodsIn a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were interviewed. The questionnaire included two statements on relatives’ involvement in EAS decision-making. Descriptive statistics were used, and multivariable logistic regression analyses to explore characteristics associated with involving relatives. In subsequent interviews, we explored physicians’ views on involving relatives in EAS decision-making. Interviews were thematically analysed.ResultsThe majority of physicians want to know relatives’ opinions about an EAS request (80%); a smaller group also takes these opinions into account in EAS decision-making (35%). Physicians who had ever received an explicit EAS request were more likely to want to know opinions and clinical specialists and elderly care physicians were more likely to take these opinions into account. In interviews, physicians mentioned several reasons for involving relatives: e.g. to give relatives space and help them in their acceptance, to tailor support, to be able to perform EAS in harmony, and to mediate in case of conflicting views. Furthermore, physicians explained that relatives’ opinions can influence the decision-making process but cannot be a decisive factor. If relatives oppose the EAS request, physicians find the process more difficult and try to mediate between patients and relatives by investigating relatives’ objections and providing appropriate information. Reasons for not taking relatives’ opinions into account include not wanting to undermine patient autonomy and protecting relatives from a potential burdensome decision.ConclusionsAlthough physicians know that relatives have no formal role, involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support. Additionally, physicians want to perform EAS in harmony with everyone involved. However, relatives’ opinions are not decisive.

The Effects of Buddhist Religiosity and Aspects on Prosociality

ABSTRACT Religion prosociality hypothesis, which predicts that religion promotes prosocial behaviors, has been verified by previous empirical research. However, the religion in the previous studies investigating Eastern religions has often been examined as a single and unified concept. In the current study, based on a few studies in the context of Western religions, we considered the religiosity as a complex construct and investigated the influence of Buddhist religiosity and primed Buddhist and Christian aspects on prosociality through two studies. In Study 1, participants’ prosocial tendencies were measured by the Prosocial Tendencies Measure (PTM). In Study 2, we employed a subliminal priming task to investigate the effects of aspects of Buddhist and Christian traditions on prosociality measured by self-reports with explicit requests for donating money amount in nonbelievers. The results of Study 1 revealed that Buddhist believers exhibited more prosocial tendencies than nonbelievers, and female participants exhibited more prosocial tendencies than male participants. Study 2’s results showed that the Buddhist and Christian priming groups exhibited more prosocial intentions than the neutral priming group. Furthermore, for the group primed with the Buddhist words, the aspect of the spiritual activated more prosocial intentions than did the aspect of the agents and institutional. Taken together, these findings suggest that Buddhism, especially the spiritual component of Buddhism, increased prosocial tendencies.

The attitude of Tunisian medicine resident toward euthanasia

IntroductionEuthanasia is the active deliberate ending of life by another person at the explicit request of a patient who is suffering from an incurable condition deemed unbearable by him or her.young doctors in tunisia might be exposed in their daily practice to a request of (E). In some countries the procedure is regulated by law while in others the issue has not been discussed. Before assessing the public opinion the medical core has to be implicated in the debate about the subject.Within the limits of our knowledge this is the first study on the subject in the countries of North AfricaObjectivesTo describe the attitudes of tunisian medicine resident toward euthanasiaMethodsThe validated questionnaire of physicians’ Attitudes and opinions on assisted suicide and euthanasia was distributed via mails addresses to 50 tunisian resident. The participation was entirely voluntary and anonymity was guaranteed.Results Thirty seven medicine resident participate to the study the response rate was 74%. The average age of participants was 28.2years old.The majority;23 were female and 29 had religious beliefs.The most represented speciality was family medicine with 6 participants.Only 2 of doctors were practicing in Europe.About 8 of young doctors were requested for (E).Tunisian medicine residents are generally supportive of the legalization of euthanasia (29), but many have concerns about their own participation in the procedure.ConclusionsEthical and legal complexities surround the topic of euthanasia.It is imperative to deepen our understanding of this practice within the context of the North Africa region,in order to formulate a comprehensive and well-informed policy.Disclosure of InterestNone Declared

Blockchain technology in omnichannel retailing: A novel fuzzy large-scale group-DEMATEL & Ordinal Priority approach

Given the advantages of Omni-Channel Retailing (OCR), such as integrating offline and online channels and offering the convenience of online channels with instant fulfillment of offline channels, this study proposed a new method called ‘Fuzzy Large-Scale Group-DEMATEL& Ordinal Priority Approach’ to detect causal relationships between the studied variables and recognize the causal associations while using Blockchain in OCR. This study assumes that the effect of spreading economic shocks through SCs can be significantly greater than the direct effect of disasters. Of the 25 factors evaluated in this study, disintermediation was identified as the most important one, followed by anonymity and security. Besides, the results obtained by the Fuzzy Ordinal Priority Approach (OPA-F) showed that configuration 4 (CF-4) ranks first in OCR. In this configuration, there are two ways to buy, online and traditional, facilitating a flow of information at all levels. Thus, Internet Protocols must be used to ensure the security of shared information. Accordingly, the way of serving each customer is personalized based on the activities performed in all portals. As a result, not only the explicit requests of the customer are answered, but also their implicit interests and needs are guessed.

Neurophysiological correlates of interpersonal discrepancy and social adjustment in an interactive decision-making task in dyads.

The pursuit of convergence and the social behavioral adjustment of conformity are fundamental cooperative behaviors that help people adjust their mental frameworks to reach a common goal. However, while social psychology has extensively studied conformity by its influence context, there is still plenty to investigate about the neural cognitive mechanisms involved in this behavior. We proposed a paradigm with two phases, a pre-activation phase to enhance cooperative tendencies and, later, a social decision-making phase in which dyads had to make a perceptual estimation in three consecutive trials and could converge in their decisions without an explicit request or reward to do so. In Study 1, 80 participants were divided in two conditions. In one condition participants did the pre-activation phase alone, while in the other condition the two participants did it with their partners and could interact freely. In Study 2, we registered the electroencephalographical (EEG) activity of 36 participants in the social decision-making phase. Study 1 showed behavioral evidence of higher spontaneous convergence in participants who interacted in the pre-activation phase. Event related Potentials (ERP) recorded in Study 2 revealed signal differences in response divergence in different time intervals. Time-frequency analysis showed theta, alpha, and beta evidence related to cognitive control, attention, and reward processing associated with social convergence. Current results support the spontaneous convergence of behavior in dyads, with increased behavioral adjustment in those participants who have previously cooperated. In addition, neurophysiological components were associated with discrepancy levels between participants, and supported the validity of the experimental paradigm to study spontaneous social behavioral adaptation in experimental settings.

Giving oranges and puppies: Children’s production of directional verbs in an emerging sign language from Oaxaca

Children’s acquisition of directional verbs in sign languages has received a lot of attention, but less is known about the sociocultural process of using these verbs, especially in the context of emerging sign languages in diverse language ecologies. Directional verbs are a common grammatical phenomenon of many sign languages in which some verbs such as ‘to give’ and ‘to take’ can move in the direction of one or more of its arguments for indicating grammatical relations between agents and patients or recipients. I discuss the case study of one signing family who uses ‘making hands’, an emic term for the signing practices of deaf Chatino people and their families in the San Juan Quiahije municipality in Oaxaca, Mexico. The family in question consists of a first-generation adult signer and two second-generation child signers, aged 4;6 and 5;3. This article describes their usage of directional verbs for making explicit requests, asking questions, and talking about hypothetical events, including presenting or withholding gifts as part of the cultural understandings and practices of the allocations of goods. Ethnographic data reveals that the children’s production of verbs may be facilitated by directed input in the form of directives from a deaf adult signer, extensive peer play, and visual access to signed adult interactions. This case study offers insight about input and socialization for the children’s usage of directional verbs in an emerging sign language in a local Mesoamerican ecology.

Changes in antimicrobial resistance of Staphylococcus aureus in bovine quarter milk samples from southern Germany between 2012 and 2022

The objective of this study was to describe the in vitro resistance of Staphylococcus aureus from bovine quarter milk samples obtained by the udder health laboratory of the Bavarian Animal Health Services between 2012 and 2022. All S. aureus samples were tested for β-lactamase production and only forwarded to further microbroth susceptibility testing either if the β-lactamase result was positive or upon explicit request by the submitter. The growth of most S. aureus isolates was inhibited at the lowest evaluated minimum inhibitory concentration (MIC) of tested antimicrobials, with the MIC50 and MIC90 (the MIC where 50% and 90% of isolates were inhibited by the tested antibiotics, respectively) mostly beneath the respective breakpoint. On average, about one-fourth (24%, n = 5,718) of tested isolates was resistant to erythromycin. However, the prevalence of resistant isolates dropped from 53% (n = 1,018) in 2012 to 8% (n = 113) in 2022. The second highest prevalence of in vitro resistance was to penicillin (17%, of all isolates tested for β-lactamase production, n = 28,069). Less than 14% of isolates were resistant to the remaining assessed antimicrobial agents (cefoperazone, pirlimycin, kanamycin-cefalexin, marbofloxacin, amoxicillin-clavulanate, cefquinome, or cefazolin, respectively). Over the years, 4% (n = 959) of the S. aureus isolates selected for microbroth susceptibility testing (and 0.8% (n = 1,392) of all submitted S. aureus isolates) were methicillin-resistant S. aureus, and 5% (n = 1,162) of S. aureus isolates were multidrug resistant. However, there was an overall trend toward fewer resistant isolates. These findings are consistent with those of several European monitoring programs that reported a slight decrease of antimicrobial resistance (AMR) of bovine S. aureus in countries where antibiotic use in veterinary medicine was reduced. Notably, isolates of clinical mastitis cases were consistently less likely to express in vitro resistance than isolates obtained from milk of healthy cows or subclinical mastitis cases. In conclusion, AMR of S. aureus was decreasing and penicillin should remain the first-choice antimicrobial in the attempt of treating S. aureus intramammary infections in Bavaria.

An On-Demand Partial Charging Algorithm without Explicit Charging Request for WRSNs

Wireless rechargeable sensor networks provide an effective solution to the energy limitation problem in wireless sensor networks by introducing chargers to recharge the nodes. On-demand charging algorithms, which schedule the mobile charger to charge the most energy-scarce node based on the node’s energy status, are one of the main types of charging scheduling algorithms for wireless rechargeable sensor networks. However, most existing on-demand charging algorithms require a predefined charging request threshold to prompt energy-starved nodes with energy levels lower than this threshold to submit an explicit charging request to the base station so that the base station can schedule the mobile charger to charge these nodes. These algorithms ignore the difference in importance of nodes in the network, and charging requests sent by nodes independently can interfere with the mobile charger’s globally optimal scheduling. In addition, forwarding charging requests in the network increases the network burden. In this work, aiming to maximize the network revenue and the charging efficiency, we investigate the problem of scheduling the mobile charger on-demand without depending on explicit charging requests from nodes (SWECR). We propose a novel on-demand partial charging algorithm that does not require explicit charging requests from nodes. Our algorithm accounts for the differences in importance between nodes and leverages the deep reinforcement learning technique to determine the target charging node and each node’s charging time. The simulation results demonstrate that the proposed algorithm significantly improves the charging performance and maximizes the network revenue and the charging efficiency.

No benefit of antidepressants in inpatient treatment of depression. A longitudinal, quasi-experimental field study

RationaleAntidepressants (AD) are mostly considered indispensable for the treatment of major depression. The vast majority of depressive inpatients are treated with AD. However, there is a growing body of studies indicating that the effectiveness of AD is greatly overestimated due to methodological issues with the AD efficacy studies (e.g., publication bias, unintentional unblinding, confusion between withdrawal symptoms and relapse).ObjectivesThe benefit of the additional use of AD in the inpatient treatment of depression with intensive cognitive-behavioral therapy (CBT) has been investigated in a naturalistic design.MethodsDepressiveness was assessed using the Beck Depression Inventory (BDI-II) during a preliminary interview (T0), at admission (T1), at discharge (T2), and at a 6-month follow-up (T3). Two study phases were compared: During Phase A, AD were recommended in accordance with the German guideline. In Phase B, AD were no longer recommended, and they were only prescribed upon explicit request from patients. In phase A (N = 574), 60.3% of all patients were taking AD at discharge. In Phase B (N = 424), 27.9% of patients were on AD at discharge. Apart from the difference in AD usage, the two treatment conditions were similar, and the samples did not significantly differ in terms of age, sex, diagnoses, history of suicide attempts, comorbid anxiety disorders, and unemployment.ResultsIn both study phases, BDI-II scores were strongly decreased at T2 and T3, respectively, compared with T1. The BDI-II scores of the two phases did not differ at any of the measurement time points. Depression changes were similar in both phases. In sequential multiple regression analyses with the total sample, AD were no significant predictors for the reduction of depression at either T2 or T3.ConclusionsThe inpatient CBT was effective in depression. The effectiveness of CBT is not improved by the additional use of AD. The current prescribing practices of AD should be questioned.

Frequency of euthanasia, factors associated with end-of-life practices, and quality of end-of-life care in patients with amyotrophic lateral sclerosis in the Netherlands: a population-based cohort study

Amyotrophic lateral sclerosis is a progressive and lethal neurodegenerative disease that is at the forefront of debates on regulation of assisted dying. Since 2002, when euthanasia was legally regulated in the Netherlands, the frequency of this end-of-life practice has increased substantially from 1·7% of all deaths in 1990 and 2005 to 4·5% in 2015. We aimed to investigate whether the frequency of euthanasia in patients with amyotrophic lateral sclerosis had similarly increased since 2002, and to assess the factors associated with end-of-life practices and the quality of end-of-life care in patients with this disease. Using data from the Netherlands ALS registry, we did a population-based cohort study of clinicians and informal caregivers of patients with amyotrophic lateral sclerosis to assess factors associated with end-of-life decision making and the quality of end-of-life care. We included individuals who were diagnosed with amyotrophic lateral sclerosis according to the revised El-Escorial criteria, and who died between Jan 1, 2014, and Dec 31, 2016. We calculated the frequency of euthanasia in patients with amyotrophic lateral sclerosis from reports made to euthanasia review committees (ERCs) between 2012 and 2020. Results were compared with clinic-based survey studies conducted in 1994-2005. End-of-life practices were end-of-life decisions by a clinician when hastening of death was considered as the potential, probable, or definite effect comprising euthanasia, physician-assisted suicide, ending of life without explicit request, forgoing life-prolonging treatment, and intensified alleviation of symptoms. Between Jan 1, 2012, and Dec 31, 2020, 4130 reports of death from amyotrophic lateral sclerosis were made to ERCs, of which 1014 were from euthanasia or physician-assisted suicide (mean frequency 25% [SD 3] per year). Sex and gender data were unavailable from the ERC registry. Of 884 patients with amyotrophic lateral sclerosis who died between Jan 1, 2014, and Dec 31, 2016, their treating clinician was identified for 731 and a caregiver was identified for 741, of whom 356 (49%) and 450 (61%), respectively, agreed to participate in the population-based survey study. According to clinicians, end-of-life practices were chosen by 280 (79%) of 356 patients with amyotrophic lateral sclerosis who died. The frequency of euthanasia in patients with amyotrophic lateral sclerosis in 2014-16 (141 [40%] of 356 deaths in patients with amyotrophic lateral sclerosis) was higher than in 1994-98 (35 [17%] of 203) and 2000-05 (33 [16%] of 209). Median survival of patients with amyotrophic lateral sclerosis from diagnosis was 15·9 months (95% CI 12·6-17·6) for those who chose euthanasia and 16·1 months (13·4-19·1) for those who did not choose euthanasia (hazard ratio 1·07, 95% CI 0·85-1·34; p=0·58). According to caregivers, compared with other end-of-life practices, patients with amyotrophic lateral sclerosis choosing euthanasia commonly reported reasons to hasten death as no chance of improvement (53 [56%] of 94 patients who chose euthanasia vs 28 [39%] of 72 patients who chose other end-of-life practices), loss of dignity (47 [50%] vs 15 [21%]), dependency (34 [36%] vs five [7%]), and fatigue or extreme weakness (41 [44%] vs 14 [20%]). According to caregivers, people with amyotrophic lateral sclerosis-whether they chose euthanasia or did not-were satisfied with the general quality (83 [93%] of 89 patients who chose euthanasia vs 73 [86%] of 85 patients who did not) and availability (85 [97%] of 88 vs 81 [91%] of 90) of end-of-life care. The proportion of patients with amyotrophic lateral sclerosis who chose euthanasia in the Netherlands has increased since 2002. The choice of euthanasia was not associated with disease or patient characteristics, depression or hopelessness, or the availability or quality of end-of-life care. The choice of euthanasia had no effect on overall survival. Future studies could focus on the effect of discussing end-of-life options on quality of life as part of multidisciplinary care throughout the course of the disease, to reduce feelings of loss of autonomy and dignity in patients living with amyotrophic lateral sclerosis. Netherlands ALS Foundation.

P453 RECURRENT SYNCOPAL EPISODES IN A YOUNG PATIENT: TO IMPLANT THE PM OR NOT TO IMPLANT THE PM, ALWAYS A DIFFICULT DECISION!

Abstract Introduction Syncope represents one of the main causes of access to the Emergency Department and outpatient visits, accounting for up to 13% of hospital admissions. Although usually benign, syncopal episodes are a source of considerable distress for the patient and family members, particularly when dealing with otherwise healthy young patients. We report the case of a young patient who presented with recurrent syncopal episodes with important psychological and professional implications. Case Report A 33–year–old man comes to our Syncope Unit with a long history of repeated syncopal episodes preceded by fleeting warning signs, sometimes with minor trauma, occurring during daily activities, in conjunction with minor injuries or post–voiding but never during exertion. The patient began to limit his activities for fear of syncope and was inhibited from driving work vehicles and performing tasks at height. The various cardiological examinations performed over the years were normal. The study of syncope evoked a syncope with a 13 sec pause on carotid sinus massage while the Head–up Tilt Test was negative. A Loop Recorder (ILR) was then implanted to correlate the syncopal episodes with any slowing or pathological pauses in the heart rhythm. At remote monitoring of the ILR, an asystole of about 16 seconds symptomatic for syncope was documented. In relation to the recurring syncopal episodes, the important professional limitations imposed on the patient, as well as at the explicit request of the patient himself, despite the lacking scientific evidences availables, we proceeded to implant a dual–chamber pacemaker with a frequency response algorithm. In the 4 years after the implant there were no syncopal recurrences and the patient resumed his normal daily and professional activities with a marked improvement also in his psychological setting. After 2.5 years, however, the ventricular lead broke and required its extraction and reimplantation. Conclusions The decision to implant the device was not easy, precisely in relation to the possible complications over the years, but this allowed the patient to resume a normal private and professional life. However, an accurate risk–benefit assessment is required, sharing the "weight" of the decision with the patient and his family.

How People Use Web-Based Parenting Information to Support Others in Their Social Circle: Qualitative Descriptive Study

Almost two-thirds of the North American population have searched for health information on the web, and the majority report searching on behalf of someone else in their social circle, a phenomenon referred to as proxy seeking. Little is known about how proxy seekers use web-based health information and the outcomes they experience. The main aim of this study was to explore why proxy seekers used a parenting website on behalf of parents in their social circle and the outcomes they reported. A qualitative descriptive study was conducted in the context of a partnership with a web-based parenting resource to explore the contexts and motivations for proxy web-based health information seeking, use of information, and subsequent outcomes. A total of 14 participants who self-identified as family members, friends of parents of young children, or professionals who worked with young children were interviewed, and a thematic analysis was conducted. The following 4 reasons for proxy seeking were uncovered: for reassurance, out of personal curiosity, as part of a professional role, or following an explicit request from the parents. Information was used to provide informational support for parents or material support for a child. Positive outcomes of using the information and some of the resulting interpersonal tensions were described. This study provides an in-depth look at proxy seeking behavior and outcomes among users of a web-based parenting resource.

What Happens When Employers Can No Longer Discriminate in Job Ads?

When employers' explicit gender requests were unexpectedly removed from a Chinese job board overnight, pools of successful applicants became more integrated: women's (men's) share of callbacks to jobs that had requested men (women) rose by 61 (146) percent. The removal “worked” in this sense because it generated a large increase in gender-mismatched applications, and because those applications were treated surprisingly well by employers, suggesting that employers' gender requests often represented relatively weak preferences or outdated stereotypes. The job titles that were integrated by the ban, however, were not the most gendered ones, and were disproportionately lower-wage jobs. (JEL J16, J23, J41, J63, J71, M51, P31)