Major Decisions Research Articles

Evaluation of RT-QuIC Diagnostic Performance for Chronic Wasting Disease Detection Using Elk (Cervus canadensis) Ear Punches.

Sensitive and specific antemortem diagnostic tests are a prerequisite for effective management of chronic wasting disease (CWD). Paired with readily accessible samples that accurately reflect CWD status, the real-time quaking-induced conversion (RT-QuIC) assay has the potential to enable more effective CWD surveillance and interventions. We evaluated the feasibility of RT-QuIC as a CWD diagnostic test using 6-mm ear tissue biopsies from elk (Cervus canadensis). First, we evaluated the effect of ear spatial location on seeding activity. We observed an effect of ear punch spatial location on the amyloid formation rate (AFR): Samples collected from the periphery of the ear evidenced a statistically significant increase in AFR relative to ear punches from the ventral midline. Gross microdissection of an ear pinna suggested that there was more small nerve innervation around the periphery of the ear. Second, we evaluated the diagnostic sensitivity, specificity, and predictive value of RT-QuIC using ear punches from elk that had been previously diagnosed via ELISA testing. We evaluated the impact of nonstatistical and statistical approaches on diagnostic accuracy. Specificity and positive predictive value were perfect when statistical analyses were used to evaluate the binomial distribution (CWD positive versus CWD negative) of the data. Conversely, sensitivity and negative predictive value were modest, independent of the application of statistical analysis, indicating that RT-QuIC may be susceptible to false-negative data in this context. Taken together, our data support the idea that RT-QuIC, when paired with US Department of Agriculture-approved diagnostic tests, may provide more time to stakeholders for making major management decisions.

Is the interrogating/interviewing of crime perpetrators no longer suspect? A personal commentary on 25 years of progress

This article focuses on some of the main developments regarding the interviewing of suspects during the past 25 years. It contains a personal commentary on: the 25 years ago publication of the 1999 Milne and Bull book; the evolution of the KREATIV approach in Norway; when to disclose information to suspects; a major decision by Wicklander-Zulawski & Associates; the High-Value Detainee Interrogation Group; the Council of Europe's document; the views of jail inmates; the Méndez Principles; the use of cognitive empathy; the American Psychology-Law Society's consultation document.

The Significance of Achieving Carbon Peak and Carbon Neutrality Goals in the Gansu Section of the Yellow River Basin from the Perspective of High-quality Development

The high-quality development of the Yellow River Basin and the strategies of peaking carbon dioxide emissions and achieving carbon neutrality are of great significance to the great rejuvenation of the Chinese nation and the sustainable development, and are major strategic decisions made by the Central Committee of the Communist Party of China after careful consideration. Gansu Province deeply implements Xi Jinping's ecological civilization ideology, adheres to the organic integration of the goals of peaking carbon dioxide emissions and achieving carbon neutrality with the strategy of high-quality development of the Yellow River Basin, in order to ensure that the Gansu section of the Yellow River Basin achieves the "dual carbon" goals as scheduled. Based on data from the "Statistical Yearbook of Gansu Province", this article analyzes the economic development, carbon emissions, and high-quality development of the Yellow River Basin in Gansu Province. It is concluded that from 2009 to 2021, the gross domestic product, total carbon emissions, and per capita carbon emissions in Gansu Province showed an overall fluctuating upward trend, while the carbon emission intensity showed a downward trend year by year. In combination with the actual situation in Gansu Province, achieving the "dual carbon" goals in the Gansu section of the Yellow River Basin will help promote the process of ecological civilization construction, build a clean, low-carbon, safe, and efficient energy system, promote energy consumption revolution, facilitate the upgrading and transformation of traditional industries, drive the construction of beautiful rural areas, and achieve the six aspects of significance for the people to live a better life.

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

Korean Judicial Decisions

Abstract This article reviews four selected major decisions by domestic courts in 2023 by taking a closer look at the changing legal practices and attitudes of the Korean judiciary in applying international law in domestic cases.

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 moderation effect of strategic alignment on the relationship between plant investment decisions and operational performance

PurposeGiven the sudden increase in plant investments across the manufacturing sector due to recent disruptions in the global supply chain caused by the COVID pandemic, the Ukraine/Russian war, ocean piracy incidents, and others, there is a need to strategically align the investments decisions with the overall business strategy. This study aims to establish whether strategic alignment enhances the effect of plant investments on operational performance.Design/methodology/approachUsing the fifth version of the Global Manufacturing Research Group (GMRG V) dataset, we employ a structural equation model (SEM) to establish the moderating role of strategic alignment in plant investments-operational performance relationships.FindingsThe results suggest that strategic alignment enhances the positive effect of plant investments on operational performance, especially in cost, delivery, flexibility, and innovation. However, we found partial support for the moderating role of strategic alignment on quality performance.Research limitations/implicationsAlthough the study was based on the GMRG global dataset and numerous papers have been published using the same dataset, the use of a convenience sample on a select group of companies may limit the generalizability of the results. With the increase in new plant investments in computer chip manufacturing, electronics, and electrical in recent years, the findings could help corporate executives maximize the benefits of their investment decisions. Companies should ensure that their plant investment decisions are strategically aligned with their overall business strategy to achieve optimal outcomes.Practical implicationsWith the increase in new plant investments in computer chip manufacturing, electronics, and electrical in recent years, the findings could help corporate executives maximize the benefits of their investment decisions. Companies should ensure that their plant investment decisions are strategically aligned with their overall business strategy to achieve optimal outcomes.Originality/valueThe study comprehensively demonstrates that the extent of improvement in operational performance depends on how closely plant investment decisions align with the overall company strategy. Manufacturers should align major investment decisions with competitive priorities driven by market requirements to enhance operational performance.

Unilateral decision-making powers in contract to be used by good boys or cognitive misers?

Modern contracts allocate material powers to contractants to take major decisions which affect the interests of counterparties. Empirical evidence, from studies and from litigated cases, tends to show that those responsible for taking decisions using powers granted to them under contracts take those decisions seriously. They give the decision some thought, and they try to be reasonable. The law, however, does not generally insist on high standards of conduct. I explore the law and the social psychology of decision making, System 1 or System 2 as Kahnemann classified it, and how to align them, as well as discuss, from legal theory, how one might define a reasonable decision. Legal argument is underpinned by an analysis which suggests that control of decision-making powers should be a matter of contract construction, the Court's question to be directed at the likely intention of the parties.

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.