Insufficient Adjustment Research Articles

Do Outcomes in Elective Colon and Rectal Cancer Surgery Differ by Weekday? An Observational Study Using Data From the Dutch ColoRectal Audit.

Previous studies showing higher mortality after elective surgery performed on a Friday were based on administrative data, known for insufficient case-mix adjustment. The goal of this study was to investigate the risk of adverse events for patients with colon and rectal cancer by day of elective surgery using clinical data from the Dutch ColoRectal Audit. Prospectively collected data from the 2012-2015 Dutch ColoRectal Audit (n=36,616) were used to examine differences in mortality, severe complications, and failure to rescue by day of elective surgery (Monday through Friday). Monday was used as a reference, analyses were stratified for colon and rectal cancer, and case-mix adjustments were made for previously identified variables. For both colon and rectal cancer, crude mortality, severe complications, and failure-to-rescue rates varied by day of elective surgery. After case-mix adjustment, lower severe complication risk was found for rectal cancer surgery performed on a Friday (odds ratio, 0.84; 95% CI, 0.72-0.97) versus Monday. No significant differences were found for colon cancer surgery performed on different weekdays. No weekday effect was found for elective colon and rectal cancer surgery in the Netherlands. Lower severe complication risk for elective rectal cancer surgery performed on a Friday may be caused by patient selection.

The 'Future Is Now' Bias: Anchoring and (Insufficient) Adjustment When Predicting the Future from the Present

In the present research, we document a novel forecasting bias, which we term the “future is now” (FIN) bias. Specifically, we show that people tend to believe that the future will mirror the present, even when such a belief is unfounded. That is, people overestimate the chances that whatever is happening now, will happen in the future, even when the (known) explicit probabilities of future outcomes contradict such a belief. This appears to be driven by an anchoring and (insufficient) adjustment process, whereby initial beliefs about the future are heavily influenced by the present circumstances, and then subsequent beliefs are not sufficiently adjusted once the probabilities of future outcomes are learned. Across nine studies (employing over 3,800 participants), we demonstrate the FIN bias in a variety of forecasting contexts, show that it manifests in incentive compatible settings, and provide evidence in support of an anchoring and (insufficient) adjustment mechanistic account.

Calculation Method of PFC Assessment Index Based on Time Point Comprehensive Processing

With the increase of DC power supply scale and the increase of new energy output ratio, higher requirements are put forward for the PFC(primary frequency control) performance of thermal power units. Through the introduction of the inherent characteristics of PFC, aimed at the problems of insufficient adjustment range and unable to effectively maintain the adjustment load in the actual modulation process of thermal power units, one calculation method of PFC assessment index based on the comprehensive processing of time points is proposed. This method can calculate the multi-point speed difference rate in accordance with the national standard, improve the effectiveness and accuracy of primary frequency modulation assessment index, ensure that the unit meets the power grid’s demand for the rapidity and stability of PFC action, and ensure the safe and stable operation of the power grid.

Dietary and physical activity patterns related to cardio-metabolic health among Malaysian adolescents: a systematic review

BackgroundA sedentary lifestyle and an unhealthy diet are major factors in the increasing prevalence of obesity among Malaysian adolescents. The purpose of this systematic review is to compile the evidence from observational and intervention studies among Malaysian adolescents to evaluate the associations between diet and physical activity (PA) as determinants of cardio-metabolic risk factors.MethodsA systematic search of Medline via the PubMed, Science Direct, Cochrane Review and Web of Science databases was conducted for studies on the associations between diet and PA factors and cardio-metabolic risk factors among Malaysian adolescents aged 13–18 years that were published until 31 August 2017. The search results were independently screened and extracted by two reviewers.ResultsFrom over 2,410 references retrieved, 20 full texts articles were screened as potentially relevant. Seventeen (16 cross-sectional and one intervention) met the inclusion criteria for data extraction and analysis. All 17 studies were rated as poor quality and the majority had made insufficient adjustment for confounders. As regards the effect of diet and PA on cardio-metabolic health, the intakes of energy (n = 4) and macronutrients (n = 3) and meal frequency (n = 5) were the most commonly studied dietary factors, while the PA score and level were the most commonly studied PA factors. In addition, BMI and body weight were the most common cardio-metabolic health outcomes. The studies showed that obese and overweight adolescents consume significantly more energy and macronutrients. They are also more likely to skip their daily meals compared to their normal weight peers. In most studies, the direction of the PA effect on body weight was unclear. Some studies found that higher PA is associated with a lower risk of overweight and obesity. However, the associations are often small or inconsistent, with few studies controlling for confounding factors.ConclusionsThis review identified a lack of evidence and well-conducted prospective studies on the effect of diet and PA on cardio-metabolic health of Malaysian adolescents.

Individual Differences in Anchoring Effect: Evidence for the Role of Insufficient Adjustment.

Although the anchoring effect is one of the most reliable results of experimental psychology, researchers have only recently begun to examine the role of individual differences in susceptibility to this cognitive bias. Yet, first correlational studies yielded inconsistent results, failing to identify any predictors that have a systematic effect on anchored decisions. The present research seeks to remedy methodological shortcomings of foregoing research by employing modified within-subject anchoring procedure. Results confirmed the robustness of phenomenon in extended paradigm and replicated previous findings on anchor’s direction and distance as significant experimental factors of the anchoring effect size. Obtained measures of individual differences in susceptibility to anchoring were fairly reliable but shared only small portion of variability with intelligence, cognitive reflection, and basic personality traits. However, in a group of more reflective subjects, substantial negative correlation between intelligence and anchoring was detected. This finding indicates that, at least for some subjects, effortful cognitive process of adjustment plays role in the emergence of the anchoring effect, which is in line with expectations of dual-process theories of human reasoning.

The volume-outcome relationship in severely injured patients: A systematic review and meta-analysis.

The volume-outcome relationship in severely injured patients remains under debate and this has consequences for the designation of trauma centers. The aim of this study was to evaluate the relationship between hospital or surgeon volume and health outcomes in severely injured patients. Six electronic databases were searched from 1980 up to January 30, 2018, to identify studies that describe the relationship between hospital or surgeon volume and health outcomes in severely injured patients (preferably Injury Severity Score above 15). Selection of relevant studies, data extraction, and critical appraisal of the methodological quality were performed by two independent reviewers. Pooled adjusted and unadjusted estimates of the effect of volume on in-hospital mortality, only in study populations with Injury Severity Score greater than 15, were calculated with a random-effects meta-analysis. A mixed effects linear regression model was used to assess hospital volume as continuous parameter. Eighteen observational cohort studies were included. The majority (13 [72%] of 18) reported an association between higher hospital or surgeon volume and lower mortality rate. Overall, the quality of the included studies was reasonable, with insufficient adjustment as one of the most common limitations. Eight studies were included in the meta-analysis with a total of 222,418 patients. High hospital volume (>240 admitted severely injured patients per year) was associated with a lower risk of mortality (adjusted odds ratio, 0.85; 95% confidence interval, 0.76-0.94). Four studies were included in the regression model, providing a beta of -0.17 per 10 patients (95% CI, -0.27 to -0.07). There was no clear association between surgeon volume and mortality rates based on three available studies. Our systematic overview of the literature reveals a modest association between high-volume centers and lower mortality in severely injured patients, suggesting that designation of high-volume centers might improve outcomes among severely injured patients. Systematic review and meta-analysis, level III. Systematic review registration number: PROSPERO registration ID CRD42017056729.

Effect of long term aspirin use on the incidence of prostate cancer: A systematic review and meta-analysis.

Previous studies found divergent effects of aspirin use on prostate cancer incidence, potentially due to studies with short durations of aspirin use and insufficient adjustment for screening. A systematic review on the association between aspirin use ≥3 years and incident prostate cancer was performed in accordance with the PRISMA and MOOSE criteria. In the cohort studies, aspirin use for at least 3 years was associated with a lower incidence rate of prostate cancer (Odds ratio (OR) 0.88, 95% CI 0.80-0.97). No protective association was established for the case-control studies (OR 0.92, 95% CI 0.68-1.23). Subgroup analysis of advanced and aggressive cancers showed a protective association (OR 0.82, 95% CI 0.71-0.94 and OR 0.75, 95% CI 0.61-0.97). This synthesis of observational studies suggests a potential protective association between long term aspirin use and incident prostate cancer. The current literature is highly heterogenous and suffers from inconsistent aspirin dose definition and measurement.

Dlaczego kotwica kotwiczy? Przegląd mechanizmów i zasad działania heurystyki zakotwiczenia

Celem niniejszego artykułu jest przegląd wiedzy dotyczącej heurystyki zakotwiczenia. Mimo silnego ugruntowania empirycznego wytłumaczenia efektu zakotwiczenia nie można sprowadzić do działania jednego mechanizmu psychologicznego. W pierwszej części artykułu zostaną omówione klasyczne mechanizmy kotwiczenia – mechanizm niewystarczającego dopasowania i model selektywnej dostępności. Przeanalizowane będą również alternatywne podejścia teoretyczne do wytłumaczenia tego efektu. W drugiej – procedury eksperymentalne wykorzystywane do badania efektu kotwiczenia. Według literatury kluczowe aspekty determinujące skuteczność kotwiczenia to m.in. ilość zasobów uwagowych poświęconych wartości kotwiczącej i spójność kotwicy z celem szacowania. Jednakże zestawienie zasad kotwiczenia z rezultatami eksperymentów wykorzystujących różne procedury wyraźnie pokazuje, że zasady te nie mają charakteru uniwersalnego. Wskazane problemy natury teoretycznej stanowią propozycję kierunku dalszych badań nastawionych na ujęcie efektu zakotwiczenia w ramach jednego mechanizmu psychologicznego.

Surgical treatment of secondary mitral regurgitation: is repair a reasonable option?

The optimal approach for treating secondary mitral regurgitation (MR) is debated. Since annuloplasty alone has resulted in 30% or more recurrent MR in the mid-term, recent studies suggest mitral valve replacement. However, subvalvular repair strategies as an adjunct to annuloplasty in order to prevent recurrent MR due to ongoing left ventricle (LV) remodeling are becoming increasingly popular. In this study we present short term results of patients with secondary MR who underwent mitral repair using a novel subvalvular repair approach and address the questions whether mitral repair is a reasonable option in these patients. Ten patients presenting with functional MR underwent ring annuloplasty and a subvalvular approximation of the papillary muscles using a technique where the distance between both papillary muscles was adjusted with a Polytetrafluoroethylene (PTFE) string during the saline test (Ring-Noose-String technique). Nine of ten patients had none-mild MR while in one patient mild-moderate MR due to ongoing leaflet tethering was diagnosed at discharge. In this patient, insufficient adjustment of the PTFE string is hypothesized as the primary mechanism for suboptimal repair. There were no complications related to the novel surgical technique. No patient died during the follow up period. The Ring-Noose-String technique provides acceptable repair results in the short term. A longer follow-up is needed to proof its long-term efficacy. Subvalvular techniques such as this may allow a durable repair in patients with secondary MR.

Will recent boom in coal power lead to a bust in China? A micro-economic analysis

In this paper, by adopting the levelized cost of electricity model and the financial appraisal method, we provide an economic interpretation for China's recent coal power bubble under weak demand growth. The study surveys the economics of a typical 600MW newly-built pure condensing coal-fired power plant in six case provinces (Shanxi, Inner Mongolia, Xinjiang, Hebei, Jiangsu and Guangdong), where the profitability margins of coal power are above national average by the end of 2015. Results indicate that the continuous falling in coal prices have lowered the generation costs but there has been insufficient adjustment to the benchmark on-grid tariff, enabling coal power to obtain unprecedented excess profits. Such excess profits have spurred the investment and caused local government to over-rely on coal power under economic downturn. However, in the context of cost escalation by deteriorated operation efficiency, higher environmental and climate change compliance costs and fierce market competition, the profitability of coal power will dissipate soon. Integrated power capacity plan consistent with the new economic normal, stringent control on the scale of new coal power projects and deep power market reform are the key policy implications of our analysis.

Predictive and prognostic factors influencing outcomes of rituximab therapy in systemic lupus erythematosus (SLE): A systematic review.

BackgroundThe clinical outcomes following rituximab (RTX) treatment in patients with systemic lupus erythematosus (SLE) is highly variable. We aimed to identify predictive and prognostic factors associated with RTX therapy outcomes in patients with SLE.MethodsStudies in adults and paediatric patients with SLE were included. We included randomized clinical trials (RCTs) for predictors of differential treatment effect and cohort studies for potential prognostic factors in patients treated with RTX (global clinical, cutaneous and renal either response or relapse, and side effects). Methodological quality was assessed using Cochrane Collaboration Risk of Bias tool and the Quality In Prognosis Studies Tool (QUIPS) for RCTs and cohort studies, respectively. The quality of subgroup analyses testing predictors of differential treatment response was also evaluated. A best evidence synthesis was performed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.ResultsSixteen articles were included (3 from 2 RCTs and 13 from 6 cohort studies). The overall quality of evidence (QoE) was low to very low (GRADE framework). QoE for predictive factors based on RCTs analysing sociodemographic variables, was rated very low due to the lack of interaction tests, limited power of subgroup analyses, study limitations, and imprecisions. Disease-related factors including clinical phenotype and severity, baseline anti-ENA antibodies and anti-Ro antibodies, interleukin (IL) 2/21 single nucleotide polymorphism (SNP), as well as post-RTX complete B-cell depletion and earlier B-cell repopulation showed some evidence for prognostic value, but were rated low to very low QoE because of early phase of investigation (exploratory analysis), insufficient adjustment for confounding in most studies, high risk of bias, inconsistency, and imprecisions.ConclusionsTo date, studies addressing prognostic factors are hypothesis generating and cannot be used to make any specific recommendations for routine clinical practice. A number of potential predictors/prognostic factors were identified, which require to be validated as being specific for response to RTX therapy and to enable more personalised use of this agent.

Male Infertility and Risk of Nonmalignant Chronic Diseases: A Systematic Review of the Epidemiological Evidence.

AbstractThe association between male infertility and increased risk of certain cancers is well studied. Less is known about the long-term risk of nonmalignant diseases in men with decreased fertility. A systemic literature review was performed on the epidemiologic evidence of male infertility as a precursor for increased risk of diabetes, cardiovascular diseases, and all-cause mortality. PubMed and Embase were searched from January 1, 1980, to September 1, 2016, to identify epidemiological studies reporting associations between male infertility and the outcomes of interest. Animal studies, case reports, reviews, studies not providing an accurate reference group, and studies including infertility due to vasectomy or malignancy were excluded. The literature search resulted in 2,485 references among which we identified seven articles fulfilling the eligibility criteria. Of these, four articles were prospective (three on risk of mortality, one on risk of chronic diseases) and three were cross-sectional relating male infertility to the Charlson Comorbidity Index. The current epidemiological evidence is compatible with an association between male infertility and risk of chronic disease and mortality, but the small number of prospective studies and insufficient adjustment of confounders preclude strong statements about male infertility as precursor of these outcomes.

Adaptive Anchoring Model: How Static and Dynamic Presentations of Time Series Influence Judgments and Predictions.

When attempting to predict future events, people commonly rely on historical data. One psychological characteristic of judgmental forecasting of time series, established by research, is that when people make forecasts from series, they tend to underestimate future values for upward trends and overestimate them for downward ones, so‐called trend‐damping (modeled by anchoring on, and insufficient adjustment from, the average of recent time series values). Events in a time series can be experienced sequentially (dynamic mode), or they can also be retrospectively viewed simultaneously (static mode), not experienced individually in real time. In one experiment, we studied the influence of presentation mode (dynamic and static) on two sorts of judgment: (a) predictions of the next event (forecast) and (b) estimation of the average value of all the events in the presented series (average estimation). Participants' responses in dynamic mode were anchored on more recent events than in static mode for all types of judgment but with different consequences; hence, dynamic presentation improved prediction accuracy, but not estimation. These results are not anticipated by existing theoretical accounts; we develop and present an agent‐based model—the adaptive anchoring model (ADAM)—to account for the difference between processing sequences of dynamically and statically presented stimuli (visually presented data). ADAM captures how variation in presentation mode produces variation in responses (and the accuracy of these responses) in both forecasting and judgment tasks. ADAM's model predictions for the forecasting and judgment tasks fit better with the response data than a linear‐regression time series model. Moreover, ADAM outperformed autoregressive‐integrated‐moving‐average (ARIMA) and exponential‐smoothing models, while neither of these models accounts for people's responses on the average estimation task.

Sticky Belief Adjustment: A Double Hurdle Model and Experimental Evidence

Given a lack of perfect knowledge about the future, agents need to form expectations about variables affecting their decisions. We present an experiment where subjects sequentially receive signals about the true state of the world and need to form beliefs about which one is true, with payoffs related to reported beliefs. We control for risk aversion using the Offerman et al. (2009) technique. Against the baseline of Bayesian updating, we test for belief adjustment under-reaction and over-reaction and model the decision making process of the agent as a double hurdle model where agents first decide whether to adjust their beliefs and, if so, then decide by how much. We find evidence for sticky belief adjustment. This is due to a combination of: random belief adjustment; state-dependent belief adjustment, with many subjects requiring considerable evidence to change their beliefs; and Quasi-Bayesian belief adjustment, with insufficient belief adjustment when a belief change does occur.

Job Preferences and Expectations of Disabled People and Small and Medium‐Sized Enterprises in Poland: Implications for Disabled People's Professional Development

In spite of general positive attitudes of employers toward disabled people, there are persistently low employment rates for this demographic. One possible explanation is that there has been insufficient adjustment of needs and job preferences to suit disabled people and demands of employers. The objective of the present paper is to present results of empirical research on disabled people's and small and medium‐sized enterprises' preferences, expectations, and needs in relation to employment in small and medium‐sized enterprises (SMEs). We present a multistage study involving quantitative research conducted among 1041 disabled people and 150 SMEs, and qualitative research including case studies conducted in three SMEs that employ disabled people. On this basis, recommendations for the professional development of disabled people are proposed.

Risk aversion and implicit shortage cost explain the Anchoring and Insufficient Adjustment bias in human newsvendors

The Anchoring and Insufficient Adjustment (AIA) bias has been observed in many newsvendor experiments, although a mathematical explanation for this behavior has previously eluded researchers. We show here that risk aversion coupled with an implicit shortage cost, both of which are well-known components of newsvendor decisions, comprehensively explains this behavior. We construct combinations of a risk-averse utility function and a shortage cost that explain the results from previously reported newsvendor experiments.

Metformin and cancer in type 2 diabetes: a systematic review and comprehensive bias evaluation

Background: Existing observational studies provide conflicting evidence for the causal effect of metformin use on cancer risk in patients with type-2 diabetes, and there are concerns about bias affecting a number of studies. Methods: MEDLINE was used to identify observational studies investigating the association between metformin and overall or site-specific cancer in people with type-2 diabetes. A systematic data extraction and bias assessment was conducted, in which risk of eight bias domains (outcome, exposure, control selection, baseline confounding, time-dependent confounding, immortal time, missing data, censoring methods) were assessed against pre-defined criteria, and rated as unlikely, low, medium or high. Results: Of 46 studies identified, 21 assessed the effect of metformin on all cancer. Reported relative risks ranged from 0.23 to 1.22, with 12/21 reporting a statistically significant protective effect and none a harmful effect. The range of estimates was similar for site-specific cancers; 3/46 studies were rated as low or unlikely risk of bias in all domains. Two of these had results consistent with no effect of metformin; one observed a moderate protective effect overall, but presented further analyses that the authors concluded were inconsistent with causality. However, 28/46 studies were at risk from bias through exposure definition, 22 through insufficient baseline adjustment and 35 from possible time-dependent confounding. Conclusions: Observational studies on metformin and cancer varied in design, and the majority were at risk of a range of biases. The studies least likely to be affected by bias did not support a causal effect of metformin on cancer risk.

Experience of negative emotion in nursing students during their CCU internship: a qualitative study

Objective To understand the sources and responses to the negative emotions in nursing students during their CCU internship, in order to improve the nursing clinical teaching. Methods This qualitative study investigated 12 nursing students who practiced in coronary care unit from February to June 2015. The data were collected from the depth interview and concluded to several key themes. Results The experiences of negative emotions were common in nursing students including dysphoria, resistance, depression, fearand tension. The sources could reduce to several themes including: the insufficient psychological adjustment ability, lack of trust, basic nursing workload, high-stress working environments and lack of specialized knowledge. To confront the these kind of negative emotion, most nursing students actively coped with and desired to be concerned at the same time. Conclusions The clinical practice ability should be paid attention to, as well as nursing student′s emotion experience, probing into nursing students′ psychological state and pressure source. The school and departments should provide psychological guide, take corresponding measures to promote physical and mental health, find out new teaching model, in order to improve clinical practice effects. Key words: Student, nursing; Coronary care unit; Emotion; Qualitative study

Explanatory and predictive power of the adaptive learning model: average and heterogeneous behavior in a newsvendor context

The newsvendor problem is an economic decision problem with an interesting degree of complexity while still providing a quite simple and intuitive normative solution. Therefore, one should expect that decision makers find the optimal solution at least when they learn over time and become familiar with the problem. However, this is not the case. On average, decision makers in newsvendor settings tend to order too little when confronted with high-profit goods and too much in the case of low-profit goods. This inefficiency is well documented through a variety of laboratory experiments assuming symmetric demand functions and is known as pull-to-mean effect. We analyze data from an experiment that is based on an asymmetric demand function and are able to discriminate among the possible focal points, namely, mean demand, median demand, and the middle of possible demand. Interestingly, the result is not a pure pull-to-mean effect. We show that the adaptive learning model is able to better explain the ordering behavior than the models of anchoring and insufficient adjustment, demand chasing, the regretting newsvendor, reference dependence, or bounded rationality not only on the aggregate but also on the individual level. In particular, we find out that the top ranking of the adaptive learning model is not the result of mixing individual behavior according to the explanatory models with less parameters. Furthermore, we are able to improve the explanatory and predictive power of the adaptive learning model by modifying the demand indicator that is used.

Heurystyka zakotwiczenia z wykorzystaniem bodźców fizycznych – czy cięższe jest warte więcej?

The anchoring heuristic does not have to rely on numerical anchors – this effect also occurs when physical stimuli serve as anchors. In this article, we investigated the influence of subjectively perceived weight on the numerical estimations regarding weight and value. Experiment 1 determined the relation between subjectively perceived weight and numerical estimations of weight and value of the object. Experiments 2 and 3 combined the physical anchors of different weights with the numerical information about the weight and value. The results suggest that the subjective perception of weight does not influence estimations regarding value. The anchoring effect was observed in amounts compatible to the information provided with the anchor. The results are discussed in the context of mechanisms of insufficient adjustment and the model of selective accessibility.