Judgment Policies Research Articles

Chapitre 8. Annoncer ou pas la découverte d’anomalies non sollicitées lors d’un test génétique à séquençage haut débit ?

New genome sequencing techniques allow new approaches in medical genetics, in particular by facilitating the diagnosis of genetic diseases. However, their use also leads to unsolicited genetic findings being uncovered. This type of discovery raises ethical, legal and psychological considerations. The objective of this psychological research was to study the different positions of patients, health professionals and general public regarding the acceptability of the announcement of unsolicited findings revealed during a high-throughput sequencing genetic test. the first exploratory study aimed, through non-directive research interviews conducted with 13 patients of a medical genetics service, to understand the psychological repercussions linked to the announcement of a result of a targeted genetic test and to know the patients’ desires regarding the announcement of unsolicited findings if the test had been a high-throughput genetic test. The second study, using a quantitative methodology, aimed to identify the judgment policies of 144 patients, 94 healthcare professionals and 211 people from the general public concerning the acceptability of this type of disclosure. The cluster analyses highlighted six judgment policies as to whether or not to disclose the discovery of unsolicited anomalies: “Tell everything”, “Tell even in part”, “Tell everything unless desperate”, “Undecided”, “Do not tell” and “Do not tell if no prevention”. The participants positioned themselves differently, in particular according to the patient’s consent. This research shows the variability of positioning and the importance of consent in the acceptability of the disclosure of unsolicited findings. However, one of the limitations of the study lies in the fact that in medical clinic, acceptability and acceptance may vary over time. A longitudinal study would undoubtedly afford a better understanding of the psychological progress of patients in this type of care pathway..

Policy Capturing to Support Pilot Decision-Making

Abstract: Single-pilot operations are cognitively challenging for pilots and could benefit from decision-support tools to mitigate risk-prone situations. The Cognitive Shadow is a prototype tool that employs policy capturing, a data-driven technique used to model decisions, to learn users’ judgement policies and alert decision discrepancies from one’s decision pattern. This proof-of-concept study investigates the potential of policy capturing to model pilots’ policies facing unstable approaches. Pilots were presented simulated cases and asked whether to continue descent or to go-around while the policy-capturing tool learned their decision pattern and provided feedback. Individual models reached mean predictive accuracy of ~ 89% while the group model reached 100%. These results speak to the potential of extracting pilots’ knowledge using policy capturing to create decision aids.

Cognitive and Behavioral Impacts of Two Decision-Support Modes for Judgmental Bootstrapping

The Cognitive Shadow is a decision-support system that uses policy capturing to model human operators’ judgment policies and provide online predictions of their decisions. The system can provide support in reaction to a decision mismatch (shadowing mode) or proactively (recommendation mode). The goal of this study was to compare these two modes of operation in their ability to effectively model and support decision-making and to examine impacts on information processing, workload, and trust. Participants took part in an aircraft threat evaluation simulation without decision support or with the Cognitive Shadow (either shadowing or recommendation mode). Dwell time was collected over different areas of the user interface. While the recommendation mode had no advantage over the control group, the shadowing mode resulted in greater human and model accuracy. This mode led to longer dwell time over the parameters zone presenting key information for decision-making. These benefits were maintained even after the tool was removed. Workload was unaffected by the mode, and while trust was initially higher in the recommendation mode, it quickly became equivalent between both modes, overall supporting shadowing as the better configuration for cognitive assistance. Results are discussed in terms of decision processes, operators support, and automation bias.

Beyond Stereotypes: Analyzing Gender and Cultural Differences in Nonverbal Rapport.

The current paper addresses two methodological problems pertinent to the analysis of observer studies in nonverbal rapport and beyond. These problems concern: (1) the production of standardized stimulus materials that allow for unbiased observer ratings and (2) the objective measurement of nonverbal behaviors to identify the dyadic patterns underlying the observer impressions. We suggest motion capture and character animation as possible solutions to these problems and exemplarily apply the novel methodology to the study of gender and cultural differences in nonverbal rapport. We compared a Western, individualistic culture with an egalitarian gender-role conception (Germany) and a collectivistic culture with a more traditional gender role conceptions (Middle East, Gulf States). Motion capture data were collected for five male and five female dyadic interactions in each culture. Character animations based on the motion capture data served as stimuli in the observation study. Female and male observers from both cultures rated the perceived rapport continuously while watching the 1 min sequences and guessed gender and cultural background of the dyads after each clip. Results show that masking of gender and culture in the stimuli was successful, as hit rates for both aspects remained at chance level. Further the results revealed high levels of agreement in the rapport ratings across gender and culture, pointing to universal judgment policies. A 2 × 2 × 2 × 2 ANOVA for gender and culture of stimuli and observers showed that female dyads were rated significantly higher on rapport across the board and that the contrast between female and male dyads was more pronounced in the Arab sample as compared to the German sample. nonverbal parameters extracted from the motion capture protocols were submitted to a series of algorithms to identify dyadic activity levels and coordination patterns relevant to the perception of rapport. The results are critically discussed with regard to the role of nonverbal coordination as a constituent of rapport.

Should doctors use their judgment? How a system dynamics model elicited knowledge in neonatal care services

Neonatal services, which provide care to babies born with medical complications, are under financial pressures in the United Kingdom (UK). The services are heavily regulated affecting efficiency. One possible solution is to reduce the length of stay (LoS) of babies and allow a degree of doctors’ clinical judgment to make decisions. The aim of this paper is to determine the impact of using clinical judgment on neonatal services performance. To achieve this aim, an system dynamics (SD) model was built and validated in a UK neonatal unit. The model was used initially to evaluate the impact of LoS reduction on performance as clinical judgment policies were rejected by participants. The counterintuitive results led to a behavioural change and participants accepted clinical judgment policies which the results indicated should lead to considerable performance improvement. Results’ implications and SD’s modelling ability to foster learning and alter participants’ perceptions and behaviour are discussed.

Judgment Considerations Policy In Decree Of The Court Criminal Statement Based On Criminal Destination

Crime theft is usually influenced by several factors, such as livelihoods with neatly organized networks or syndicates or some that do so due to economic pressures that force the offender to commit the crime because in his mind there is no longer a way out other than stealing. The formulation of the problem in this research is What is the judge's judgment policy in deciding cases of theft based on criminal destinations in the Draft Law of the Criminal Code, and in Act No. 48 On judicial power ?. The method of approach used is sociological juridical. This type of research is descriptive method. Source of data used from primary and secondary data. In this case the judge in providing a criminal decision must provide the benefit of the convicted person to undergo his conviction and life after leaving the prison to return to the community again. Because the provision of an unfair criminal will affect the survival of the convicted person. The purpose of punishment is as a judge's consideration in deciding the theft of criminal case which is supported by a juridical element in Article 56 of the Criminal Code Bill, and Act No.48 of 2009 On Judicial Power in Article 5 paragraph (1) and Article 8 paragraph (2).Keywords: Judge's Considerations, Theft of Crimes, Criminal Purpose.

A BP-PID controller-based multi-model control system for lateral stability of distributed drive electric vehicle

The lateral stability is the crucial feature in a distributed drive electronic vehicle (DDEV). A high speed DDEV in a sharp turn may lose the lateral stability when it encounters fast varied road adhesion coefficients. To solve this problem, a BP-PID controller-based multi-model control system (MMCS) is designed for DDEV via direct yaw-moment control (DYC) in this paper. Firstly, according to the varied road adhesion coefficients, the working circumstance of DDEV is summarized as seven kinds of typical types. A sub-model set is established to accurately describe the operating mode of the working circumstance. Secondly, based on the sub-model set, a nonlinear sub-controller set is constructed with seven off-line tuning BP-PID controllers and an on-line tuning one. The off-line tuning controller can fast calculate the required direct yaw-moment, and the on-line tuning controller is aimed to achieve a high control accuracy. Thirdly, a controller switching policy is composed of an error judgement policy and a model matching policy. Such switching policy is utilized to precisely identify the working circumstance of DDEV and implement switching control. Finally, simulation experiments prove that the designed MMCS shows a significant control performance and guarantees the lateral stability of DDEV under varied road adhesion coefficients.

Theories of truth and teaching clinical reasoning and problem solving

In this paper, we will first discuss two current meta-theories dealing with different, aspects of “truth”. The first metatheory conceives of truth in terms of coherence (rationality, consistency): a body of knowledge is true when it contains no inconsistencies and has at least some credibility. The second metatheory conceives of truth as correspondence, i.e., empirical accuracy. The two metatheories supplement each other, but are also incommensurable, i.e., they cannot be expressed in each other’s terms, for they employ completely different criteria to establish truth (Englebretsen in Bare facts and naked truths: a new correspondence theory of truth, Routledge, London, 2005). We will discuss both the role of both metatheories in medicine, in particular in medical education in a clinical context. In line with Hammond’s view (Med Decis Mak 16(3):281–287, 1996a; Human judgment and social policy: irreducible uncertainty, inevitable error, unavoidable injustice, Oxford University Press, New York, 1996b), we will extend the two metatheories to two forms of competence: coherence competence and correspondence competence, and demonstrate that distinguishing these two forms of competence increases our insights as to the best way to teach undergraduate students clinical problem solving.

How do palliative care doctors recognise imminently dying patients? A judgement analysis

ObjectivesTo identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions.DesignProspective observational study and two cross-sectional online...

Individual Characteristic and Reward System Relate to Nurses’ Performance

Introduction : Nurses are one of the most important profession in health care system. Lack of reward systems and different of individual nurse’s characteristic will be contributed to the quality of nursing service given. This study was aimed to explain the correlation between individual characteristic and nurse reward system with nurse’s performance at RSUD Bontang.Methods : This study used cross-sectional design involved 39 respondents, taken by purposive sampling. The independent variable were individual characteristic and nurse reward system and the dependent variable was nurse’s performance. Data were collected by using questionnaires and analyzed using linier regression with level of significance α≤0,05.Results : Results showed that there were significant correlation between nurse’s performance with individual characteristic and reward system.Conclusion : It can be concluded that individual nurse’s characteristic and nurse reward system had correlation between nurse’s performance nursing care quality. Discussion : Individual characteristic factors (sex, age, education, seniority or work period) and nurse’s reward system must be considered to make judgement policy efficiency by human research. Further research must be done for identification factors who related nurse’s performance.

How to Axe a Double Taxation Avoidance Agreement: Analysing Section 94A of the Indian Income Tax Act

Section 94-A of the Indian Income Tax Act, which allows the Indian government (the executive) to notify any jurisdiction, by having regard to the lack of effective exchange of information with it, as a notified jurisdictional area (NJA) has been a bone of contention in a recent ruling delivered by the Madras High Court in India in T. Rajkumar case where the sole section 94-A notification issued in the year 2013 declaring Cyprus as a NJA was challenged along-with impugning the constitutional validity of section 94-A itself, which arguably may lead to an unilateral treaty override, as in the case of India-Cyprus DTAA. Both the statutory instruments were however upheld by the high court, and important to this judicial determination was the affirmation of adherence of India to the theory of ‘dualism’. In this article the author revisits the said contentious statutory instruments with threadbare-pointed legal analysis of the said judgement and other concomitant law and policy issues, along-with examination of the possible reactionary dispute resolution approaches on the international legal plane for resolving the Double Taxation Avoidance Agreement (DTAA) issues, which are not ordinarily resolvable by the domestic courts.

Judgment Analysis in a Dynamic Multitask Environment: Capturing Nonlinear Policies Using Decision Trees

Policy capturing is a judgment analysis method that typically uses linear statistical modeling to estimate expert judgments. A variant to this technique is to capture decision policies using data-mining algorithms designed to handle nonlinear decision rules, missing attributes, and noisy data. In the current study, we tested the effectiveness of a decision-tree induction algorithm and an instance-based classification method for policy capturing in comparison to the standard linear approach. Decision trees are relevant in naturalistic decision-making contexts since they can be used to represent “fast-and-frugal” judgment heuristics, which are well suited to describe human cognition under time pressure. We examined human classification behavior using a simulated naval air defense task in order to empirically compare the C4.5 decision-tree algorithm, the k-nearest neighbors algorithm, and linear regression on their ability to capture individual decision policies. Results show that C4.5 outperformed the other methods in terms of goodness of fit and cross-validation accuracy. Decision-tree models of individuals’ judgment policies actually classified contacts more accurately than their human counterparts, resulting in a threefold reduction in error rates. We conclude that a decision-tree induction algorithm can yield useful models for training and decision support applications, and we discuss the application of judgmental bootstrapping in real time in dynamic environments.

Capturing judgement strategies in risk assessments with improved quality of clinical information: How nurses’ strategies differ from the ecological model

BackgroundNurses’ risk assessments of patients at risk of deterioration are sometimes suboptimal. Advances in clinical simulation mean higher quality information can be used as an alternative to traditional paper-based approaches as a means of improving judgement. This paper tests the hypothesis that nurses’ judgement strategies and policies change as the quality of information used by nurses in simulation changes.MethodsSixty-three student nurses and 34 experienced viewed 25 paper-case based and 25 clinically simulated scenarios, derived from real cases, and judged whether the (simulated) patient was at ‘risk’ of acute deterioration. Criteria of judgement “correctness” came from the same real cases. Information relative weights were calculated to examine judgement policies of individual nurses. Group comparisons of nurses and students under both paper and clinical simulation conditions were undertaken using non parametric statistical tests. Judgment policies were also compared to the ecological statistical model. Cumulative relative weights were calculated to assess how much information nurses used when making judgements. Receiver operating characteristic (ROC) curves were generated to examine predictive accuracy amongst the nurses.ResultsThere were significant variations between nurses’ judgement policies and those optimal policies determined by the ecological model. Nurses significantly underused the cues of consciousness level, respiration rate, and systolic blood pressure than the ecological model requires. However, in clinical simulations, they tended to make appropriate use of heart rate, with non-significant difference in the relative weights of heart rate between clinical simulations and the ecological model. Experienced nurses paid substantially more attention to respiration rate in the simulated setting compared to paper cases, while students maintained a similar attentive level to this cue. This led to a non-significant difference in relative weights of respiration rate between experienced nurses and students.ConclusionsImproving the quality of information by clinical simulations significantly impacted on nurses’ judgement policies of risk assessments. Nurses’ judgement strategies also varied with the increased years of experience. Such variations in processing clinical information may contribute to nurses’ suboptimal judgements in clinical practice. Constructing predictive models of common judgement situations, and increasing nurses’ awareness of information weightings in such models may help improve judgements made by nurses.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0243-1) contains supplementary material, which is available to authorized users.

Justice Judgments: Individual Self-Insight and Between- and Within-Person Consistency

We use the method of policy capturing to address three open-ended questions regarding how people judge the fairness of events. First, do people differ in how they judge whether a situation is fair or unfair; second, are fairness judgments stable within-person; and, third, how much insight do people have into how they make fairness judgments? To investigate these questions, we used the method of policy capturing and a representative design that samples situations as well as participants. Forty-nine employees rated the global fairness of 56 performance appraisals sampled from their own organization (N = 2,744 situations), and regression methods were used to infer their judgment policy from their choices. We found that people differed greatly in how they judged fairness but used quite consistent policies across similar situations. Participants also provided self-reports of their judgment policies, and comparisons of these self-reports with actual policies revealed limited levels of self-insight.

Capturing Non-linear Judgment Policies Using Decision Tree Models of Classification Behavior

Policy capturing is a decision analysis method that typically uses linear statistical modeling to estimate the basis of expert judgments. Using more flexible data mining algorithms may yield more accurate models or instead result in poor functional estimations. The objective of this study is to test the effectiveness of a decision tree induction algorithm for policy capturing in comparison to the standard linear approach. We examined human classification behavior using a simulated naval air-defense task in order to empirically compare the C4.5 decision tree algorithm to linear regression on their ability to capture individual decision policies. The pattern of results shows that C4.5 outperformed linear regression in terms of goodness-of-fit and cross-validation accuracy. Results also show that the decision tree models of individuals’ judgment policies actually classified contacts more accurately than their human counterparts. We conclude that non-linear policy capturing can yield useful models for training and decision support applications.

Steps to Implementing Technology in Inclusive Early Childhood Programs

Twenty-first-century preschool children, with and without disabilities, may be found using technology, including assistive technologies, on a daily basis in their homes, schools, and communities. Early childhood educators are exploring opportunities to integrate technology and interactive media into the present-day curriculum. The authors suggest implementing the following five-step process to support using technology in early childhood inclusive programs: (a) assessing technology knowledge of young children, (b) developing technology rules with young children, (c) applying professional judgment and program policy, (d) implementing technology into the curriculum, and (e) collecting data for decision making. Through this process, early educators may define children's background knowledge and subsequently design a curriculum approach, including instructional methods and strategies, to engage young children while fostering creative learning experiences.

Factors Affecting Antibiotic Prescribing for Acute Respiratory Infection by Emergency Physicians

Background: Antibiotics are frequently prescribed for upper acute respiratory tract infections (ARI) in the emergency department. To reduce inappropriate overprescribing, it is necessary to understand factors influencing physicians’ decisions to prescribe antibiotics. Objective: Analyze the judgment policies of emergency physicians to determine factors predicting antibiotic use. Design: Paper case vignette study. Participants: 104 emergency physicians from Wisconsin. Measurements: We used judgment analysis to derive the policies of 104 emergency physicians from their responses to 20 case vignettes. We designed the cases such that each physician’s use of clinical findings and patient factors could be inferred from the decisions they made about each case. Findings were compared to primary care practitioners (PCPs) in Colorado responding to the same paper cases to examine differences in factors influencing prescribing among the two groups. Results: The emergency physicians said they would prescribe an antibiotic (yes/no) in 51.4% of cases compared with 44.5% in the Colorado study. The majority of emergency physicians gave the greatest weight to duration of illness (51%), followed by temperature (20%) and cough (12%). Conclusions: These emergency physicians prescribed antibiotics more frequently than the Colorado PCPs. There was little difference in how clinical findings were weighted, suggesting this was not the source of the higher prescription rate among the emergency physicians. The considerable emphasis on duration of illness suggests that this would be a productive area for educational efforts to reduce antibiotic prescribing for ARI in the emergency department.

Physicians' tacit and stated policies for determining patient benefit and referral to cardiac rehabilitation.

The benefits of prescribing cardiac rehabilitation (CR) for patients following heart surgery is well documented; however, physicians continue to underuse CR programs, and disparities in the referral of women are common. Previous research into the causes of these problems has relied on self-report methods, which presume that physicians have insight into their referral behavior and can describe it accurately. In contrast, the research presented here used clinical judgment analysis (CJA) to discover the tacit judgment and referral policies of individual physicians. The specific aims were to determine 1) what these policies were, 2) the degree of self-insight that individual physicians had into their own policies, 3) the amount of agreement among physicians, and 4) the extent to which judgments were related to attitudes toward CR. Thirty-six Canadian physicians made judgments and decisions regarding 32 hypothetical cardiac patients, each described on 5 characteristics (gender, age, type of cardiovascular procedure, presence/absence of musculoskeletal pain, and degree of motivation) and then completed the 19 items of the Attitude towards Cardiac Rehabilitation Referral scale. Consistent with previous studies, there was wide variation among physicians in their tacit and stated judgment policies, and self-insight was modest. On the whole, physicians showed evidence of systematic gender bias as they judged women as less likely than men to benefit from CR. Insight data suggest that 1 in 3 physicians were unaware of their own bias. There was greater agreement among physicians in how they described their judgments (stated policies) than in how they actually made them (tacit policies). Correlations between attitude statements and CJA measures were modest. These findings offer some explanation for the slow progress of efforts to improve CR referrals and for gender disparities in referral rates.

Relative importance of attributes of drug benefit plans: Thai civil servants' perspective

The drug benefit plan of Thailand's Civil Servant Medical Benefit Scheme (CSMBS) must be amended to control increasing costs; to that end, it is important to gather the views of beneficiaries before making changes to the benefit plan. To examine the relative importance of attributes of drug benefit plans from the perspective of CSMBS beneficiaries. Attributes and levels adopted from focus group discussions and a preliminary survey were used to develop a questionnaire concerning hypothetical drug benefit plans. A convenience sample of 650 CSMBS beneficiaries in Songkhla province was asked to rate the drug benefit plans. To determine the beneficiaries' decision models, judgment analysis was used. Policy-capturing analysis was used to examine the beneficiaries' preferences, and cluster analysis was conducted to explore the variability among judgment plans. Judgment policy insight was also examined. The results of the study showed that the beneficiaries weighed on cost-sharing as their most important attribute. The results remained unchanged, although only data from the beneficiaries who used the compensatory model were analyzed. The results of the cluster analysis showed that the largest cluster of beneficiaries weighed mostly on the cost-sharing attribute. The judgment policy insight results not only supported the finding that most beneficiaries focused on the cost-sharing attribute but also revealed that they might have the least understanding of how the formulary attribute affected beneficiaries' decision making. Cost-sharing was the most important attribute for the CSMBS beneficiaries. This study indicated that a possible preferred drug benefit plan should have no cost-sharing, permit access only to drugs listed in a closed formulary, allow beneficiaries to obtain 3 months of drugs, and allow them to obtain drugs from either a community pharmacy or a government hospital.

Teaching young dogs new tricks: improving occupational therapists' referral prioritization capacity with a web-based decision-training aid

Objective: A web-based clinical decision aid was designed to improve novices' capacity to prioritize occupational therapy referrals in community mental health teams. The aim of this research was to test the effectiveness of the decision aid. Design: A trial was conducted using a consensus expert policy as the educational intervention; a one-group pre-test, post-test design was chosen to measure any effect of training. Participants: A total of 100 pre-registration occupational therapy students accessed the decision aid; they prioritized a set of referrals before and after being trained with graphical and descriptive representations of the expert policy. Setting: Data were collected online via the World Wide Web from students at 12 UK universities. Results: The effect of training was demonstrated through more accurate prioritization ratings when matched with expert ratings on the same referrals and more accurate judgement policies when matched with the consensus standard judgement policy. Conclusion: The tool was found to be effective as it improved referral prioritization capacity.