Major Decisions Research Articles

Identities of Emerging Adult Men in Contemporary Gujarat

Emerging adulthood is considered a phase in which an individual is required to make choices that shape identity. It involves making major life decisions regarding occupation and relationships. This study focuses on understanding the identities of emerging adult men in the domains of career, relationship, and gender roles. Participants included 40 single emerging adult men, 18–29 years, from educated upper middle-class families in Vadodara city in Gujarat. In-depth interviews, including open-ended questions and hypothetical vignettes, were conducted to gather the data. The qualitative data was examined through open and axial coding, followed by identifying the common and salient themes across the identity domains. The results reveal that urban middle-class men are inclined to be gender sensitive and are resistant to stereotypical notions of masculinity. Assertion of individuality is clearly observed among the young men along with concern for family harmony.

Diagnostic Accuracy of Automated Diabetic Retinopathy Image Assessment Software: IDx-DR and RetCAD.

Automated diabetic retinopathy (DR) screening using artificial intelligence has the potential to improve access to eye care by enabling large-scale screening. However, little is known about differences in real-world performance between available algorithms. This study compares the diagnostic accuracy of two AI screening platforms, IDx-DR and RetCAD, for detecting referable diabetic retinopathy (RDR). Retinal images from 758 patients with diabetes were collected during screening from various clinics in Poland. Each patient was graded by three graders with 320 patients graded by Polish and 438 patients graded by Indian graders, with the majority decision serving as the reference standard. The images were evaluated independently by the IDx-DR and RetCAD algorithms. Sensitivity, specificity, positive and negative predictive values, and agreement between algorithms and human graders were calculated and statistically compared. IDx-DR demonstrated higher sensitivity of 99.3% but lower specificity of 68.9% for RDR detection compared to RetCAD which had 89.4% sensitivity and 94.8% specificity. The positive predictive value was higher for RetCAD (96.4% vs 48.1% for IDx-DR) while the negative predictive value was higher for IDx-DR (99.5% vs 83.1% for RetCAD). Both algorithms achieved high sensitivity (> 95%) for sight-threatening diabetic retinopathy detection. In this direct comparison using the same patient cohort, the two algorithms showed differences in their operating parameters for RDR screening. IDx-DR prioritized avoiding false negatives over false positives while RetCAD maintained a more balanced trade-off. These results highlight the variable performance of current artificial intelligence screening solutions and suggest the importance of considering algorithm performance metrics when deploying automated diabetic retinopathy screening programs, based on available healthcare resources.

Knowledge on adolescent and reproductive health among secondary school students in Khulna City, Bangladesh

The main objective of this study was to investigate the depth and breadth of knowledge and ideas about adolescent health among secondary-level students. A concurrent mixed method approach, both quantitative and qualitative methods, was followed to carry out the study. Students enrolled in tenth grade under the Directorate of Secondary and Higher Education (DSHE) in Khulna City, Bangladesh, were chosen as the respondents of the study. Kotwali and Khanjahan Ali Thana of Khulna City were rationally chosen as the areas of the study. A total of 40 schools were randomly chosen, and 400 surveys, 10 surveys from each school, ideally 05 boys and 05 girls, were carried out, including 10 in-depth case studies. Findings indicated that, on average, more than half of the adolescents have knowledge gaps about adolescents and reproductive health, for example, misconceptions about the adolescent period and age range of puberty, vague understanding of the first sign(s) of physical appearances, and face critical emotional and social challenges. Both qualitative and quantitative data further showed that they hardly get sufficient cooperation and support from family and social environments in dealing with their challenges, display risky health behaviour, and make major decisions based on their self-discretionary assumptions to deal with crises. The findings of this study would provide important guidelines to parents and guardians, local and district and regional and national level GOs and NGOs health professionals who work with adolescent and reproductive health services, policymakers, academics, and researchers to create an adolescent-friendly environment.

MRI spine request form enhancement and auto protocoling using a secure institutional large language model

BACKGROUND CONTEXTSecure institutional large language models (LLM) could reduce the burden of non-interpretative tasks for radiologists. PURPOSEAssess the utility of a secure institutional LLM for MRI spine request form enhancement and auto-protocoling. STUDY DESIGN/SETTINGRetrospective study conducted from December 2023 to February 2024, including patients with clinical entries accessible on the electronic medical record (EMR). PATIENT SAMPLEOverall, 250 spine MRI request forms were analyzed from 218 patients (mean age = 55.9 years ± 18.9 [SD]; 108 women) across the cervical (n=56/250, 22.4%), thoracic (n=13/250, 5.2%), lumbar (n=166/250, 66.4%), and whole (n=15/250, 6.0%) spine. Of these, 60/250 (24.0%) required contrast and 41/250 (16.4%) had prior spine surgery/instrumentation. OUTCOME MEASURESPrimary–Adequacy of clinical information on clinician and LLM-augmented request forms were rated using a four-point scale. Secondary–Correct MRI protocol suggestion by LLM and first-year board-certified radiologists (Rad4 and Rad5) compared to a consensus reference standard. METHODSA secured institutional LLM (Claude 2.0) used a majority decision prompt (out of six runs) to enhance clinical information on clinician request forms using the EMR, and suggest the appropriate MRI protocol. The adequacy of clinical information on the clinician and LLM-augmented request forms was rated by three musculoskeletal radiologists independently (Rad1:10-years-experience; Rad2:12-years-experience; Rad3:10-years-experience). The same radiologists provided a consensus reference standard for the correct protocol, which was compared to the protocol suggested by the LLM and two first-year board-certified radiologists (Rad4 and Rad5). Overall agreement (Fleiss kappas for inter-rater agreement or % agreement with the reference standard and respective 95%CIs) were provided where appropriate. RESULTSLLM-augmented forms were rated by Rads 1–3 as having adequate clinical information in 93.6-96.0% of cases compared to 46.8-58.8% of the clinician request forms (p<0.01). Substantial interobserver agreement was observed with kappas of 0.71 (95%CI:0.67–0.76) for original forms and 0.66 (95%CI:0.61–0.72) for LLM-enhanced requests. Rads 1–3 showed almost perfect agreement on protocol decisions, with kappas of 0.99 (95%CI:0.94–1.0) for spine region selection, 0.93 (95%CI:0.86–1.0) for contrast necessity, and 0.93 (95%CI:0.86–0.99) for recognition of prior spine surgery. Compared to the consensus reference standard, the LLM suggested the correct protocol in 78.4% (196/250, p<0.01) of cases, albeit inferior to Rad4 (90.0%, p<0.01) and Rad5 (89.2%, p<0.01). The secure LLM did best in identifying spinal instrumentation in 39/41 (95.1%) cases, improved compared to Rad4 (61.0%) and Rad5 (41.5%) (both p<0.01). The secure LLM had high consistency with 227/250 cases (90.8%) having 100% (6/6 runs) agreement. CONCLUSIONSEnhancing spine MRI request forms with a secure institutional LLM improved the adequacy of clinical information. The LLM also accurately suggested the correct protocol in 78.4% of cases which could optimize the MRI workflow.

The Place of Gladue in Constitutional Law

The central aim of this paper is to outline and explain the place of Gladue in constitutional law. I start with a brief treatment of the majority decision in Sharma before moving to the reception of Gladue sentencing in the section 12 context, outlining and contributing to a debate that has circled in this area for years: whether it is acceptable to consider personal characteristics in constructing the reasonable hypothetical offender.

Gender Role of Household Decision Making (A case study Namobudda Kavre)

Gender roles in household decision making refer to the traditional division of responsibilities and decision-making power between men and women within a family or household. Historically, many societies have adhered to traditional gender roles, where men are often considered the primary decision-makers, particularly in matters related to finances and major family decisions. Women, on the other hand, have often been assigned the roles of managing the household, taking care of children, and dealing with domestic matters. However, it's important to recognize that gender roles are not fixed and vary significantly across cultures, regions, and individual households. Moreover, over time, many societies have witnessed a shift in traditional gender roles, with more emphasis on gender equality and shared decision making. The main purpose of this research was to understand the perception of people regarding the evolvement of gender roles in any household decision making. A Descriptive Cross Sectional study method was used. Altogether, 40 respondents were selected through purposive sampling method, questionnaires, Face to face interview, Informal focused group discussion; Key informant interview method was used using Structured Questionnaire to collect data from respondents. Data analysis was done through MS Excel. It is revealed from the research Gender roles in household decision making refer to the traditional division of responsibilities and decision-making power between men and women within a family or household. Historically, many societies have adhered to traditional gender roles, where men are often considered the primary decision-makers, particularly in matters related to finances and major family decisions. Women, on the other hand, have often been assigned the roles of managing the household, taking care of children, and dealing with domestic matters. However, it's important to recognize that gender roles are not fixed and vary significantly across cultures, regions, and individual households. Moreover, over time, many societies have witnessed a shift in traditional gender roles, with more emphasis on gender equality and shared decision making

Financial decision dynamics: Environmental, social, and governance factors and managerial choices in emerging markets

This study examines the linkage between the ESG performance of firms and managerial decision-making. It uses 8 years of ESG performance data of 110 Indian firms collected from the Thomson Reuters database. The study finds that high ESG performance mitigates a firm’s cost of debt more than equity cost. Furthermore, increases in ESG performance are associated with higher capital expenditures, lower investment cash flow sensitivity, higher cash holdings, and lesser payout of increased cash flows to shareholders. The findings are in sync with the Slack resources view, suggesting that the requirement of financial Slack for ESG-related innovations and risk-bearing is large and impacts the major managerial decisions of firms. While the effects of environmental and social performance on these decisions are similar to that of the composite ESG performance, governance performance shows an independent impact on the payout decisions of firms. The Granger Causality test reveals a bi-directional association between debt issues and ESG performance. The main results obtained from the multiple panel regressions are robust to additional tests involving lead-lag analysis. The overall findings of this study highlight the importance of ESG performance screening in the managerial decision-making process of investors who would not like to risk growth potential for a short-term increase in dividends.

Availability Problem of Drinking Water in an Urban Area - Effects of Family Size and Monthly Income: An Empirical Study

The availability of water is a major problem faced by the urban masses and policy makers. Bridging the gap between the demand for and supply of water is a major policy decision confronted by the urban authorities. The ever-increasing urban population and shift in occupational structure results in the increased demand which confronts with lagging supply of water which needs immediate policy attention. The present study is based on the survey of households in urban areas who have piped water connections in their homes. 600 households were selected at random from the total connections available. The data is analysed using the x2 test. The present study aims at examining the relation between size of the family and income of the respondents with that of severity of availability problem of water and comes to the conclusion that severity problem is not connected with the size of the family size but it is connected with the family income of the consumers.

Following the leaders: Asymmetric party messaging in the U.S. Congress

AbstractToday, rank‐and‐file members are increasingly removed from the legislative process and often rely on congressional leaders for information to discuss major legislative decisions with constituents. As a result, preparing constituent communication materials has become an institutionalized responsibility for party and committee leaders, leading to a partisan discussion of legislation. Using a mixed‐methods approach of computational text analysis and elite interviews, I demonstrate how members of Congress use leader‐led, partisan messages for constituent communication. Echoing prior work on asymmetric partisanship, I find that Republican leaders are more likely to encourage party‐centric messaging, and rank‐and‐file Republicans, particularly in the House, are more likely to adopt party messaging. The findings illustrate the institutional power of party leaders in a centralized Congress, as well as the role that constituent communication plays in encouraging and maintaining asymmetric polarization.

COVID-19 research response to immediate demands: setting priorities with key stakeholders to enable health services research in NSW, Australia

PurposeCOVID-19 has caused unprecedented disruption to health systems. There is much to be gained by capturing what was learned from changes and adaptations made by health services and systems. The Ministry of Health in New South Wales (NSW), Australia, sought to prioritise health services research (HSR) to address critical issues arising from the COVID-19 pandemic. We tested a priority setting methodology to create priorities for a specific funding opportunity and to extract generalisable lessons.Design/methodology/approachA virtual roundtable meeting of key stakeholders was held in June 2020. We used a modified Nominal Group Technique (NGT) for priority setting, with potential items (n = 35) grouped under headings. Data was analysed through a reflective deliberative process.FindingsWe engaged 89 senior policy makers, health service executives, clinicians and researchers in the roundtable. The NGT proved an efficient method with participants reaching consensus on eight priorities. Findings included strong support for learning from the rapid response to COVID-19 and addressing needs of vulnerable populations and the health workforce. Opinions differed about strategic areas investment and where learnings should be via internal evaluation rather than funded research. Three of the eight recommended priorities were included in the funding opportunity.Research limitations/implicationsCoronavirus disease 2019 (COVID-19) required unprecedented change and adaptations within health systems, and rapid, applied health services research can help to create, understand and (where relevant) sustain change beyond the immediate impact of the pandemic. While final decisions may be dependent on a wider range of considerations by government, stakeholder enthusiasm for engagement in priority setting exercises may be dampened if they do not perceive their application in decision-making.Practical implicationsA modified nominal group technique can be used to set research priorities in constrained conditions by engaging large numbers of stakeholders in rankings and then using an online delivery of a roundtable and to reach consensus on priorities in real time. Recommended priorities for health services research can be readily generated through rapid engagement but does not guarantee their application.Social implicationsAustralia’s swift response to COVID-19 pandemic in 2020 was perceived as a relative success due to the rapid public health and policy response and a relatively low number of cases. This response was underpinned by systematic knowledge mobilisation including support for targeted and prioritised health services research to fill knowledge gaps.Originality/valueSetting priority processes can provide rich, engaged input to support government funding decisions about HSR. A wide range of dynamic and iterative processes influence decision-making in a rapidly evolving situation in the health system response to COVID-19. It is crucial to consider how major investment decisions will support a value-based healthcare system.

Keep close tabs on delays due to ‘process board members’

Does your board have one or two people who routinely delay major decisions due to insufficient information, leading to grumbling from the rest of the board, executive leadership and staff? If so, your board chair is failing in their duty to corral these unnecessary impediments and keep things on track, according to Eugene Fram, professor emeritus at Saunders College of Business at the Rochester Institute of Technology.

Dyadic Appraisals of Family Decisions and Health Tasks in Midlife-Older Couples.

Shared appraisals and collaboration within couples play important roles in optimizing health. Less is known about concordance regarding collaboration, factors associated with concordance, and implications for health. Data from 2,761 couples from the Health and Retirement Study (2014/2016 and 2016/2018 waves) were examined to determine within-couple concordance in completion of two tasks (family decisions and medical forms). The majority of couples were concordant regarding who makes family decisions (69.7%) and who completes medical forms (64.4%); 62% agreed they make family decisions collaboratively versus 25.5% completing medical forms collaboratively. Concordance was significantly associated with greater marital support and longer marital duration. Concordance was not significantly associated with depressive symptoms 2 years later, but the link between concordance in making major family decisions and self-rated health differed by age and gender. Future research at the intersection of concordance and collaboration may shed important light on how older couples navigate tasks and decisions.

The Role of Gender in Household Financial Decision-Making: A Survey-Based Analysis in Urban India

This research paper explores the role of gender in household financial decision-making within urban India, focusing on the disparities between male and female respondents in financial literacy, investment behaviors, risk preferences, and decision-making authority. A survey-based methodology was employed, targeting 500 households across five major urban centers in North India. The study found that males generally exhibited higher financial literacy, were more likely to engage in riskier investments such as mutual funds and stocks, and predominantly controlled major financial decisions. In contrast, females preferred safer investments like gold and fixed deposits and were primarily responsible for daily expenses and savings. Education and employment emerged as critical factors influencing financial behaviors, with higher educational attainment and active economic participation correlating with better financial literacy and decision-making capabilities. These findings underscore the need for targeted financial education programs, policies promoting higher education and employment for women, and improved access to professional financial advice. By addressing these disparities, stakeholders can enhance women's financial empowerment and promote gender equality in financial decision-making, contributing to the broader economic development and stability of urban India.

Why a Little Diversity doesn't Go a Long Way: A Collective Moral Licensing Explanation for Homosocial Reproduction

AbstractDespite significant knowledge on the demographic composition of workgroups, the literature lacks group‐level theory that addresses the tendency of work groups with token levels of diversity to maintain their demographic imbalance over time. We explain this phenomenon by extending moral licensing theory to the group level, arguing that a token level of racial or gender diversity leads to the development of a collective moral credential. This credential provides psychological permission for groups to relax their moral strivings, such that they are less likely to question the influence of bias in group member selection decisions, and thus more likely to make subsequent homogenous group member additions. Additionally, we argue that the diversity climates within which groups are embedded can either magnify (i.e., in fairness‐focused diversity climates) or mitigate (i.e., in synergy‐focused diversity climates) the development of a collective moral credential. Further, we suggest that the effect of token levels of diversity on the development of a collective moral credential can be affected by the prevailing social norms for diversity. Finally, we theorize that the effects of this process can be accentuated by group use of a majority decision rule and attenuated by group use of a unanimous decision rule.

Analisis Dampak Adanya Dissenting Opinion Hakim Terhadap Perkara Perdata

The justice system faces challenges when dealing with different opinions in a case, especially when there is a minority or dissenting opinion. This phenomenon is fascinating in the context of the Denden Verzet case, especially in case No.12/Pdt.Bth/2020/PN.Kla Jo.78/PDT/2020/PT.TJK. Therefore, this research aims to analyze the dissenting opinion in-depth in case No.12/Pdt.Bth/2020/PN.Kla Jo.78/PDT/2020/PT.TJK, to understand the decision in civil case No.12/Pdt.Bth/2020/PN.Kla who has a dissenting opinion and its impact on the legal decision. The type of research used is normative legal research, namely legal research regarding the actual application or implementation of normative provisions in every particular legal event in society. The type of research is descriptive, which is to explain or describe clearly and in detail regarding the clarity and implementation of a regulation. After conducting research, it was found that dissenting opinions can significantly impact civil case decisions. First of all, the existence of a dissenting opinion can raise doubts about the legal strength of the decision. The parties who lose the case can use the dissenting opinion as a basis for filing an appeal or cassation, arguing that the majority decision does not fully comply with applicable legal principles. This can prolong the legal process and increase legal uncertainty for the parties involved. This is evidenced by the change from the decision of the CourtCourt of First Instance to the decision of the Court of Appeal, where the legal considerations at the appellate level are the same as the thoughts of the Dissenting opinion of the judge of the Court of first instance because according to the High Court the Disputants have proven the arguments of their rebuttal in the main case, namely has fulfilled the requirements to be declared a correct Objector so that the objection in the leading case must be granted.

An Investigation of Public Participation on Policy Formulation in Devolved Government in Keiyo South Sub County, Elgeyo Marakwet County, Kenya

Citizens in many county governments are not empowered to understand their role in development issues and feel that policy makers do not put into consideration their contribution in major decision making particularly affecting key development programs. Citizens in many counties feel more often than not that their predicaments have not been addressed effectively by their governments, bring in a lot of conflicts which at times has resulted in public unrest. This study therefore focused on establishing an investigation of public participation on policy formulation in devolved governments in Keiyo South Sub County, Elgeyo Marakwet County, Kenya. The objectives of this study were to: establish the contribution of public participation in policy formulation in devolved government of Keiyo South Sub County, Elgeyo Marakwet County, Kenya and to determine the level of public participation on policy formulation in devolved government of Keiyo South Sub County, Elgeyo Marakwet County, Kenya. The study was based on Participatory Communication Theory and Ladder of Citizen Participation Theory. The study used a mixed-method approach, integrating both qualitative and quantitative research. The study adopted a descriptive survey design. The target population was 115 and the researcher obtained a sample size of 89 respondents using Yamane formulae. The study used stratified random sampling to select the respondents. The study used questionnaires and an interview schedule to collect dataThe statistical package for social sciences (SPSS) version 24 was used to analyze quantitative data from the closed-ended questions. Data was analyzed using descriptive and inferential statistics. Descriptive statistics involved frequencies, percentages, standard deviation, and arithmetic mean. Inferential statistics involved correlation and multiple regression. The analyzed data was presented in the form of charts and tables. Privacy was maintained during the entire research period, and participation was entirely voluntary, free from coercion or inducement. The findings demonstrated that respondents agreed with the statement that member’s ideas and contributions in the public participation are given priorities (Mean=3.70, standard deviation=1.40), further, the findings indicated that that the respondents agreed with the statement that there is a moderate level of public participation on policy formulation (Mean=3.73, standard deviation=1.39). The study concluded that significant number of respondents believed in a high level of grassroots participation and others held contrary views, indicating that there may be disparities in how stakeholders perceive the depth of involvement. The study recommended that policy makers and county authorities should take steps to ensure that public participation processes are equitable and inclusive.

Multi-fidelity design framework integrating compositional kernels to facilitate early-stage design exploration of complex systems

Abstract Early-stage design of complex systems is considered by many to be one of the most critical design phases because that is where many of the major decisions are made. The design process typically starts with low-fidelity tools, such as simplified models and reference data, but these prove insufficient for novel designs, necessitating the introduction of high-fidelity tools. This challenge can be tackled through the incorporation of multi-fidelity models. The application of MF models in the context of design optimization problems represents a developing area of research. This study proposes incorporating compositional kernels into the autoregressive scheme (AR1) of Multi-Fidelity Gaussian Processes, aiming to enhance the predictive accuracy and reduce uncertainty in design space estimation. The effectiveness of this method is assessed by applying it to 5 benchmark problems and a simplified design scenario of a cantilever beam. The results demonstrate significant improvement in the prediction accuracy and a reduction in the prediction uncertainty. Additionally, the paper offers a critical reflection on scaling up the method and its applicability in early-stage design of complex engineering systems, providing valuable insights into its practical implementation and potential benefits.

대학생의 전공선택 탐색 및 새로운 학사제도에 대한 인식

[Objective] This study aims to determine whether the motivation for choosing a major affects the satisfaction with major decisions after entering university. Additionally, it seeks to understand perceptions of new academic systems designed to increase satisfaction. [Contents] This study analyzed whether the motivation for selecting a major before enrollment influences the desired major decision. In addition, it is intended to analyze the factors affecting the satisfaction of major decision after admission, and to suggest the direction of education policy after understanding the recognition of the introduction of a new academic system to operate it effectively. [Conclusions] The conclusion of this study is as follows. First, the intrinsic factors (aptitude and interest, dream realization) of major selection before entering college were higher than the extrinsic factors (employment outlook, grades). Second, it was confirmed that the satisfaction with major decision after entering college affects the satisfaction with major decision in the order of the connection between college major and employment, the relationship between college major and career, high school career education, and university field. Finally, it was said that ‘support for opportunities to experience various studies’ is the most necessary for matters to be considered at the university level in relation to the operation of the new school system, and as a problem, there are concerns about ‘the phenomenon of concentration on popular departments’ and ‘difficulty in managing students related to major decision’. Based on these results, implications and suggestions for follow-up research were presented in relation to college student’s major decision and career education.

베이커리 전공선택동기가 전공만족도 및 진로결정에 미치는 영향 관계에서 전공만족도 매개효과

The purpose of this study is to study the mediating effect of major satisfaction in the relationship between major selection motivation of college students majoring in bakery and career decision, and the results of the study that analyzed the data collected for college students majoring in bakery in Seoul and the metropolitan area are as follows. First, it was found that personal motivation and social motivation had a positive (+) effect on major satisfaction and career decision among major selection motivation, and it can be seen that personal motivation has a greater impact on major satisfaction and career decision than social motivation. Second, major satisfaction has a positive (+) effect on career decision-making, Third, as a result of analyzing the mediating effect of major satisfaction in the relationship between major selection motivation and career decision-making, the regression coefficient of individual motivation, an independent variable, decreased from stage 2, and major satisfaction, a parameter, satisfaction has a partial mediating condition in the relationship between personal motivation and career decision.

Review of 2023 Major Medical Decisions

Review of 2023 Major Medical Decisions